Saturday, June 24, 2017

Bullies and Bystanders

Tomorrow June 25, St.Petersburg, FL celebrates diversity with its Gay Pride Parade. I am reminded of two old movies, Tea and Sympathy and Rebel Without A Cause, from a time in which diversity was not so celebrated.

Tea and Sympathy (1956)(directed by Vincente Minnelli, based on Robert Anderson’s 1953 play of the same name) is oppressive to watch when viewed from the 21st Century.  Difference is taunted and ostracized. A prep school senior, Tom Lee (John Kerr) is called “sister boy” [for what could be worse from the hypermasculine POV than being compared to a woman/girl] because he prefers music, theater and poetry to baseball and mountain climbing. He is bullied to suicidal thoughts. The coach and house headmaster’s wife Mrs. Reynolds (Deborah Kerr) takes Tom’s part. Defending Tom to her husband (Leif Erickson) and chastising him for being a bystander, she says “‘He’s not like me, therefore he’s capable of all possible crimes.’ ... [T]he tribe has to find a scapegoat to reaffirm your shaky position... If he could be manly, then you had to question your own definition of manliness.” Eschewing the false dichotomy, she rails against her husband’s black and white thinking. [Twemlow and Sacco write about bullying in their ebook Preventing Bullying and School Violence].  But should one mistake Tom for a homosexual, as his classmates do, one only need note the foreshadowing in Tom’s reading of Candida to confirm his love for Mrs. Reynolds. [Wikipedia’s author writes it is Voltaire’s Candide, but I think this is a mistake, for it is in GB Shaw’s play that a young man falls for, and seemingly desperately needs, the older, married woman. Candida chooses the man who needs her more, her husband, who must so desperately dissociate his need for her. Mrs. Reynolds, however, a modern woman, I suppose-- or perhaps riddled with the shame and guilt her constraining contemporary society demands -- chooses neither man.]

Also painful to watch is how women are treated in this film. Mrs. Reynolds, her opinions interrupted and disregarded and spoken to by her husband as if she were a child, is relegated to the keeper of men’s emotions and the one who attempts to smooth over painful feelings in her husband and Tom. The local soda shop’s server Ellie Martin, a former ‘a-dime-a-dance gal, is unrelentingly sexually harassed by the “regular guys” from the local prep school.


Rebel Without A Cause (1955) (directed by Nicholas Ray) also portrays the bullying of boys who are Other or different. In the 1950’s, a gay theme could appear only as subtext, but the bullying of Plato (Sal Mineo) was undoubtedly, in part, about his homosexuality (noted by the photo of Alan Ladd in his locker, and by his crush on Jim Stark (James Dean)). His torment ends with possible suicide by cop. Mineo, hailed today by the LGBT community as one of their own, was nominated for Best Supporting Actor for this role and, at that time, was the youngest actor (16 years old) ever to be nominated for an Oscar. James Dean, himself posthumously nominated for this role (and for Giant), was purported to have ‘experimented’ with homosexual liaisons, as well as to have been sexually abused when younger by a pastor. Dean, also an auto racer, died prematurely in a car accident at age twenty-four.

Here's hoping for better days, days when bystanders stand up to bullies and difference is celebrated.

Thursday, June 15, 2017

Fargo

    My favorite TV show (on Fx), inspired by the Coen brothers’ film of the same name, set in Minnesota, always features a laudable female, police chief. Gloria Burgle (Carrie Coon) is that policewoman, only In this its third season, she is demoted from chief, has been left by her husband for a man, has a teenager who prefers the mall to her, and feels she does not exist. Confirmation of her non-existence comes from the sensors on automatic door openers,  soap dispensers, and faucets, none of which ever sense her presence, so do not open, dispense soap, nor turn the water on.
    It is only in the penultimate episode of the season, when Gloria has a listening ear in Winnie Lopez (Olivia Sandoval), a neighboring town’s police officer, that things change for her. Like Horatio to Hamlet, WInnie hears, really hears, and what she hears is Gloria’s fears about not existing. Subsequently, Gloria is able to engage with soap dispenser and faucet sensors. This reminds me, of course, of how infants (and adults) need to be seen and held in the mind of the other to feel one’s existence in the world, to feel part of something bigger than oneself. Good-enough caregivers provide this, as do good-enough therapists, by seeing and holding the experience of the other in mind.
    I was also reminded of Hegel’s understanding that a subject cannot be fully a subject until recognized by another equal subject [within independence is this dependence, that is, there is interdependence]; and of the title of a Dean Martin song, ‘You’re nobody ‘til somebody loves you;’ Here love is embodied in the seeing, accepting,and welcoming in of the other, all the parts of the whole other, without having to give up the self (that is, done whether we agree with the other or not). Yesterday, was a sad day in northern Virginia, when baseball practice became tragedy. Perhaps the good coming from it will be a bit more understanding of the other [side of the Congressional aisle].

Monday, June 12, 2017

New Cycle of Courses begins Sept 20, 2017

The Tampa Bay Institute for Psychoanalytic Studies (TBIPS) is pleased to announce a new cycle of its four year curriculum starting Sept 20, 2017. You can start at the beginning with 'Introduction to Psychoanalytic Concepts.' As you know,  theories and methodology in psychoanalysis have changed tremendously over the decades, thanks to contributions from caregiver-infant and attachment research, and from neuroscience.  While relationship and the 'unconscious' (or 'non-counscious') remain paramount, gone are the days of authoritarian and distant analysts who knew the secrets of the individual's mind. Instead, analysis is a collaborative effort of building safe and supportive relationships where  new ways of being in the world and healing  can take place. At TBIPS we emphasize an open and welcoming attitude, both for students and patients, and focus on development, attachment, and making whole the fragmentation caused by trauma.

Please know that TBIPS is happy to accept long distance candidates (courses, personal therapy, supervision0 for training and students for course work. We would be delighted to have you join us in the Fall. Further information can be found at tampapsychoanalytic.com.

Monday, June 5, 2017

Response to Co-creation of Dreams, posted May 22

One can imagine that the fences in the patient’s dream are less about “unspoken boundaries” between the patient and his father and more about those that stand between the patient and the therapist. One can imagine the patient feeling the intimate confines of the consulting office and a desire for therapeutic boundaries to vanish leaving him and the therapist free to explore the vast horizons beyond.

In my mind, the two benevolent white-haired men could symbolize wisdom and morality. They have perhaps ascended from above to give the patient an understanding of both the permeability of the boundaries that he and the therapist have co-created and his understanding their moral necessity. 

The therapist, too, in her dream, is reaching out past the boundaries and, like her patient, understands the need to maintain them and consequently turns away.

Interestingly, by disclosing her dream to the patient, she is in fact reaching past the boundaries and thereby simultaneously expanding them and reaffirming that they are there. Her disclosure reveals her trust that he understands the limits of the therapeutic relationship and the necessity of those limits. Her sadness demonstrates that, despite the application of clinical terminology like “transference,” “counter transference,” and “therapeutic alliance,” underneath are real people with real emotions, which are sometimes intense and sometimes bump up against the therapeutic boundaries. This is, as the patient says, romantic, at least in the sense that true love involves walking the boundary between the selfish desire to possess and the selfless sacrifice of putting the other’s happiness above that selfish desire.

Therapeutic relationships sometimes walk this line, but a patient whose relationship with his father was distant probably benefits more from experiencing the reality beneath the “therapeutic alliance” than he does from any clinical assessment of his psychological history. I suspect that while he most likely grieves the lack of a relationship with his father, what he desires now is real connectedness. The lack of a relationship with his father may explain his desires for connectedness, but it doesn't satisfy it. The emotional reality behind the therapeutic alliance demonstrates that such connectedness is possible, that he is a person who is worth investing in emotionally, and that limits around the connectedness do not diminish its worth. 

The emotions “stirred up” (dare I say ignited) in the therapeutic relationship are indeed the mutual property of the therapist and the patient, but I wonder if Dr. Alexander-Guerra understands her role in the co-creation process (for it is an evolving process). Does she understand that by making the therapist’s session with the patient blog-worthy, she has added a layer of legitimacy to the emotions? I wonder if as a result, the therapist feels more secure in her relationship with the patient and if the patient reciprocally feels more secure. I wonder if Dr. Alexander-Guerra understands if she is now part of the co-creation between the therapist and the patient. I wonder if the patient has read this and feels a mutuality with Dr. Alexander-Guerra. I would if I were the patient.

         submitted anonymously

Friday, June 2, 2017

Graduation

 On the TV show Major Crimes (Season 1: Episode 4,  aired 9/3/2012), a foster child, dealing with always having to leave and start over someplace new, that is, with always being a stranger, and, also, dealing with always expecting to be repeatedly sent away to a new place, requests, from his latest foster mother, thirty days notice before he is sent away again. She reassures him: “Whatever happens here, you will one day go off and be the new kid again. But no matter where you go, no matter when, you’ll never be a stranger to me. I will always know you.”  



That brief interchange resonated with me as a psychotherapist because for a short while we ‘foster’ the growth and development of our patients, temporarily providing safety and succor, while growing ourselves. The world is a better place for both of us. But despite this fostering of a most emotionally intimate of relationships, our patients, like our children grown, must leave us; and we are left to mourn. We take solace in the recognition that they will never be strangers, joy in that we have known and, in some ways, will always know them. We send them off and into the world with great pride, matched with loss.

Monday, May 29, 2017

The 100th Birthday of John F. Kennedy falls today on Memorial Day

This year’s Memorial Day also happens to be the 100th Birthday of John F. Kennedy. Born May 29, 1917, he was the 35th president of the United States, and himself a WWII veteran of the Navy. A quick study, having learning from the Bay of Pigs debacle and negotiations with the then Soviet Union to get missiles out of Cuba, under pressure from Freedom Riders, Martin Luther King, Jr, and many others, Kennedy turned his attention to Civil Rights. It was only after his assassination in November 1963 that his successor Lyndon B. Johnson was able to get passed through Congress the Civil Rights Act of 1964 which outlawed discrimination based on race, color, religion, sex, or national origin. [We might remember today just what types of discrimination were outlawed.]

Memorial Day is a time to pause and remember those who died as soldiers, Marines, Airmen and women, sailors, Coast and National Guard persons. We thank them. Today might also, perhaps, be a time to recommit ourselves to giving back for their service by offering an hour a week pro bono psychotherapy to the family members, or veterans who remain, through, for example, Tampa Bay Institute for Psychoanalytic Studies’ Veterans Family Initiative.  Many clinicians in the Tampa Bay area have generously given of their time and expertise to help families and wounded warriors afford much needed mental health services. We thank them as well.

Friday, May 26, 2017

From Fantasy to Imagination

Bromberg tells us that “the negotiation of selfhood and otherness...has a lot to do with imagination and creativity.” and that “The relative presence of “imagination” in human discourse overlaps to no small degree with the relative capacity for intersubjectivity that exists in any relationship.” [Being able to let in another’s experience allows for a “shared intersubjective space.”] Bromberg expands the shared space to include shared imagination, “loosen[ing] the rigidity” of one’s singular believes about the self [and other] to allow for a “relational unconscious.” I take this to mean if one is stuck in solipsistic fantasy, there is little to no room for interrelating with others much less comprehending that there exists another’s mind, one with separate contents from one’s own. He writes:
The cocreation of a lived, relational unconscious more and more nourishes the willingness of each person to participate in a growing sense of “We” that includes “Me” and “You” as part of their individually expanded self-experiences. By living together in the enacted shadow of what is visible but not perceived, an opportunity is afforded to encounter what has been hidden in plain sight. … This allows their relationship greater interpersonal spontaneity and creative self-expression that is carried by an expanded sense of selfhood into the world “out there.”

Relying on Winnicott’s 1971 paper on “Dreaming, Fantasying, and Living,” Bromberg elaborates that fantasy is a dissociated (‘Not me’) state while imagination embraces the ‘Me’. A colleague of mine noted that fantasy is somehow without hope [a remedy to hopelessness], while imagination includes hope about the future.  Winnicott put it, in his enigmatically paradoxical way, like this: ”In fantasying, what happens, happens immediately, except that it does not happen at all.”

Bromberg explains:
For a person who is “imagining,” the state of affairs is different; the person is experiencing the self as it now exists, projected into the future. Because the self  being imagined is the same self that is doing the imagining, the person as he is now has the capacity to act into a future that is real to him because the future that is imagined in the here-and-now is itself real. When the capacity to transform fantasy into imagination starts to increase, self-state transitions do not disrupt self-continuity, which in turn allows the present and the future to be bridged and thus to coexist. The person does not have to remain stuck in fantasy. What is imagined is not impossible for the self in the present; it just hasn't happened yet. [Einsteinian]

When the therapist can imagine, much like the mother for the infant, the patient’s expanding future on the horizon, then the patient, too, can consider such a future. The mother develops the mind of the infant by holding the infant in mind. The therapist develops the imagination of the patient by imagining.



Monday, May 22, 2017

Co-creation of Dreams

A therapist discloses to a patient the dream she had about him the night of their previous session:
I was sitting next to you on the couch in my office. You were sitting in the middle of the couch and I was to your left. We were facing each other. I reached over and touched your face. Your skin was soft. You then reached over to me and I felt guilt and sadness. So I turned away crying, feeling that loss. I wondered if you felt I was rejecting of you. I turned back to you and you said, “I love your father.”
The therapist recognized the resurgence of familiar feelings: her love for her patient, the patient’s love for her, and how it could not be; also familiar feelings with the therapist’s father. The therapist knew she also loved her father, and he, her, and it could not be. So, said the therapist, I am in touch with my sadness.
  
The patient shares his dream:
I was in the backyard. There was a helicopter overhead. It started coming down, through the trees. I could see the pilot, we made eye contact, and waved, two men with white hair. Then the fence disappeared. Then it changed to the backyard of my childhood home and there were fields with no end.
The patient quipped [associated], Why can’t I dream about sex instead of about benevolent old men with white hair?


The therapist mused aloud, Maybe this is about your father, the unspoken lifelong wish that there were no longer barriers between the two of you, instead of your usual, professed indifference toward a preoccupied, distant and disdainful father.


The patient and therapist had long since past been in the throes of an erotic transference- countertransference. The patient, old enough to be the father of the female therapist, had, before therapy, used extra marital affairs to help him feel desired and competent. The female therapist had lost her own father when she but was a toddler. Now there was more honest, intimate relating between therapist and patient, able now to uphold boundaries without the presence of fences between them, and without the fear that boundary violations would occur. The patient, now able to talk about sexual desires without the urge to have to act on them. He no longer could accept hurting his wife with his infidelities.


Bromberg writes that the feelings stirred up in the therapist about the patient are not the personal property of the therapist, but belong to both.


The therapist, having understood about co-creation, no longer felt ashamed about her dream. She was able to feel the mutuality of her own father’s love. The patient said, “There is something  so romantic about recognizing feelings that one can’t act on.” The therapist felt  sadness, not romance.

Wednesday, May 3, 2017

Envy and Failed Mutual Regulation

The final semester at TBIPS for fourth year candidates and students includes an Electives course in which each candidate has the opportunity to teach the rest of the class about an area of interest chosen by the candidate. We are presently learning about the relationship between mothers and daughters and how not ‘good enough’ mothers can affect their daughters, daughters who later come to us for treatment. Those in the class with a Kleinian bent emphasize envy. We were discussing today Charles’ (2001) paper “Stealing Beauty” about how narcissistic mothers envy their children and cannot help them succeed, nor bear to see their children as separate subjects. Sometimes their envy is transformed into self sacrifice (a reaction formation).

I have my personal doubts about whether envy is innate and, instead, see it as a problem arising from failed early relationships. An interesting, more specific thought came up in class today when Bharat Bharat, an aspiring psychology student auditing the class, asked about whether envy is genetic and whether it is somehow linked to children in those delayed gratification studies (don’t eat the marshmallow now and get an extra one later) who may later grow up to want (enviously) what they do not have (and cannot manage to get due to problems with delayed gratification).  Because I see children with poor impulse control as having a problem with self regulation, and problems with self regulation as a product of failed mutual regulation in early attachment relationships, I then wondered whether envy, if a problem with self regulation, stems from failure of early mutual regulation. Is failed mutual regulation (and, thus, insecure attachment) a mechanism for the development of envy?

If the caregiver, -- due to a history of trauma which now leads the caregiver to be preoccupied, dissociated, and unable to be with the child and with the child’s mind-- is unable to help the child feel attuned to and seen (unable to feel important enough), a child might feel deficient and defective, setting up a vulnerability for envy. This mechanism does not require envy of a good breast (but may include it), and, moreover, does not require gymnastic feats of imagination to explain envy, at least, to my mind.

Thursday, March 30, 2017

Dissociation as the hallmark of trauma

Because Adrienne Harris so eloquently discussed intergenerational transmission of trauma on March 18, 2017 at the Tampa Bay Psychoanalytic Society [see 3-21-2017 post], I thought I might share a bit of what Bruce Bradfield’s wrote on the subject:

“[P]sychic trauma...attempts to make meaning out of a phenomenon that resists knowing. … [D]issociation [i]s a primarily relational process, which keeps traumatic experience
unformulated and ambiguously signified in both the mother and her child. … [It is] a defense against intolerably painful affective states,which manifests in the mother’s intrapsychic experience, and in the relationship between mother and child…[T]rauma [is]...an experience that overwhelms the individual with inassimilable affects.

“[E]lements of parental traumatic experience are passed on to their children …and… subsequent generations. …[D]issociation is a consequence of a disruption of the parent’s caregiving capacity. [The parent’s] disrupted capacity to be emotionally attuned to the child ...[and] may impact on the child’s expectations[.]... [W]hat may be dissociated are not only the emotions associated with the parent’s trauma, but also the child’s need for relationship with the parent. …[T]rauma [is] communicated through patterns of relationship. … [C]hildhood interpersonal trauma has implications for the development of a particular disruption in lived experience [going on being], affecting attachment relationships directly. [There is] a relation between attachment style and posttraumatic responses.

“[A]ttunement within the relationship between mother and child facilitates the development of a capacity to integrate and contain painful emotions. … [D]issociation [is] an experience of disruption of the... capacity to integrate painful affective experiences. [D]issociation [is] manifest in future interpersonal relationships. …[and] reflects the incommunicability of traumatic histories, with trauma being held in familial and individual narratives as something unformulated and nameless.”