Tuesday, December 12, 2017

Film: Three Billboards Outside Ebbing, Missouri

With Renee Fleming’s homage to Angela on the soundtrack, the opening of the film is of tattered billboards on a road that seems to lead to nowhere; One is of a baby like an unfinished jigsaw puzzle. This immensely entertaining film directed by Martin McDonagh [In Bruges] is written for our times, an allegory of the road America is on, and like the billboards, on a road “nobody ever goes down… unless [they are] lost or retards.”  And ‘retard’ is not the only politically incorrect utterance in this film. From “midget” to “Mexican,” Three Billboards conjures them all [emboldened much like our country has been by its current president].

Three Billboards has the ability to surprise, followed 
immediately by the satisfying feeling of  ‘of course!’  Frances McDormand as Mildred Hayes, is, as always, a woman of 
substance; Hayes lives out loud in her courageous determi-
nation to light a fire [literally, it turns out] under the law to [let’s say] ‘encourage’ Chief Willoughby (Woody Harrelson) to solvethe rape and murder of her daughter Angela. In her grief and anger Hayes poses a solution: “pull blood from every man in 
town over eight,” every male child born, for a database of 
DNA, and, if it matches the crime, “kill him.” [Whether assaultson journalists, actors, Air Force Academy cadets, or a teen-
age girl walking home because her mother wouldn’t lend her 
the car, this solution is an understandable, though untenable, 
fantasy of survivors and their families.] [Hayes rebukes the 
Church, as well, for its sexual assaults against boys.] The Me,Too movement, and perhaps all women, will feel a bit of 
impolitic vindication, evident in something as simple as the 
change in singer of Buckskin Stallion Blues from male
(Townes Van Zandt) early in the film to female (Amy Annelle) much later, or the he-said, she-said of the dentist and Hayes. The idyllic mountain lake scene of two female children on a 
blanket with fishing poles can not obliterate the uneasiness 
about what can happen to girls.

Every detail of this film is redolent: the name Angela; the later burned out building bringing to mind Angela Hayes’ earlier 
charred body; Red Welby reading Flannery O’Connor; Officer Dixon (Sam Rockwell) may not be wearing mirrored sunglas-
ses but his persona is every bit as ominous as the officer in 
Psycho -- but he reads comic books [Dixon lives with his momjust as the police who beat and sodomized Abner Louima -- inreal life -- did]; and especially Carter Burwell’s exquisite 
soundtrack. Wistful, melancholic, original music accompanies Willoughby [bearing no resemblance to Sense & Sensibility’s Willoughby] and we soon discover why -- It is not just 
because he is singled out by Hayes to solve this cold case. 
Renee Fleming sings Thomas Moore’s poem The Last Rose 
of Summer [for Angela]; the Four Tops’ Walk Away Renee 
begins “When I see the sign[s]” [for the billboards? I have to 

I have not yet seen the other films nominated for Golden 
Globe’s Best Drama, but watching Three Billboards, I had the same thrilling sensation as I did watching American Beauty, 
Crash, and No Country for Old Men, all Best Picture Oscar 
winners. As in the 2005 Crash, characters inThree Billboards are made up of multiple selves; villains can also be heroes. 
Willoughby guides the heretofore abhorrent Dixon in that 
direction via a posthumous letter when he writes: “What you 
need to become a detective is love” because love leads to 
calm and calm, to thought [reminding me a little of the psycho-
therapist’s mission, with her welcoming attitude and the regu-
lation of right brain affects allowing in left brain thinking]. The 
final scene -- a road trip with two who have reached across anhorrendous rupture, about life and life’s choices, “I guess we 
can decide on the way” -- my companion thought a too abrupt ending, but I thought it left open the possibility of a return to 
sanity, rationality and redemption.

Friday, December 1, 2017

Baldwin and Race Relations in America

The American writer, poet  and civil rights activist James Baldwin (Go Tell It on the Mountain, Giovanni’s Room} died thirty years ago today, and what he said about race relations in the USA is, hauntingly, still true today. In the PBS Newshour replay (on Feb 2, 2017) of a 1963 interview with him, Baldwin notes “I’m terrified at the moral apathy ---of the death of the heart--- which is happening in my country. These [white] people have deluded themselves for so long, they really don’t think I’m human.” 
Dissociated from our ‘not-me’ parts, projecting unwanted parts onto the Other, we view the Other as less than human (e.g. the historical, economic motivation to hold black slaves and to count black men as 3/5ths of a person; women were not counted). I imagine that these parts of self that later must be disavowed were originally unwelcomed by caregivers, such that we became ashamed. Treated by parental figures as less than fully human subjects with agency seems more likely to cause us to dehumanize others in turn. Baldwin had eight younger half-siblings and was treated harshly by his stepfather, and outside his impoverished home, he felt the crush of a racist society.

In the documentary “I Am Not Your Negro” -- directed by Raoul Peck about Baldwin, based on his writings, Baldwin notes  “What white people have to do is try to find out in their own hearts why it was necessary to have a nigger in the first place. ‘Cause I am not a nigger. I am a man.”

Sunday, November 26, 2017

"Delicate' Cutting

On November 18, 2017, the Tampa Bay Psychoanalytic Society, Inc hosted Shelly Doctors, PhD  who read a paper titled Advances in Understanding and Treating Self-Cutting in Adolescence. Doctors sees “delicate” (careful, superficial) cutting as a strategy for coping with overwhelming affects. With the lack of a reliable partner in mutual regulation, a child with insecure attachments learns from experience that others cannot be counted on to soothe and regulate painful feelings, so the child relies instead on strategies of self soothing.

Cutting can serve to both down regulate and up regulate extreme ends of arousal of the autonomic nervous system. This is how I understand it: The hyperarousal of the sympathetic (fight/flight) nervous system is calmed by the release, upon cutting, of endogenous opioids. The parasympathetic (freeze) nervous system’s numbing and deadness are up-regulated when it is likewise dampened by the brain’s opioid release.

Doctors notes that this kind of self “management” does not necessarily include suicidal ideation. What others see as problematic, the cutter sees as problem solving, a way of attending to an unbearable affect state or self state which, Doctors says, heralds self loss. This fragmentation of the sense of self is frightening, experienced as an assault on the self, and cutting, paradoxically, restores the self [by regulating overwhelming, that is, fragmenting, affect]. Cutting may be a response to separation, rejection, or loss, when the patient feels utterly alone, tense, or angry. Self-cutting increases when other means of self-regulation are blocked (for example, in prison, when drunk, etc).

Monday, November 20, 2017

Relational but not intersubjective?

Shelly Doctors, PhD, promoter of Self Psychology and of one of its daughters, Intersubjective Systems Theory, wrote a brief paper on Self Psychology’s “Earning a Seat at the Table (Again),”  which reminds us how Kohut’s paradigm shift from intrapsychic conflict to the importance of environmental surround was rejected by mainstream psychoanalysis of its day. Now Doctors notes a second struggle for Self Psychology: being accepted at the relational table. [She does not mention how earlier relational theorists, such as Ferenczi or Bowlby -- with his ideas on attachment and the importance of the environmental surround-- were also denied for decades ‘a seat at the table.’  Winnicott, also an early relational theorist, is likewise not mentioned (perhaps following in Kohut’s footsteps of not mentioning earlier theorists upon whom Kohut may have built his ideas), though Winnicott, wisely using classical language for his revolutionary ideas, was more palatable to his traditional peers.] Doctors also notes the irony of Self Psychology, having once been too relational, is now seemingly not relational enough.

Championing Kohut’s ‘selfobject’ as a unique contribution to psychoanalytic thought and as evidence of Self Psychology’s relationality, Doctors does not go further to discuss how ‘selfobject’ is not intersubjective. The selfobject experience is to the subject any person, thing, or idea which leads to an increased sense of self as cohesive, coherent,and continuous. The trouble is that it sees the other as a function and not as a subject in her or his own right. So while Self Psychology is relational in that it recognizes the importance of the human surround, it is not necessarily intersubjective when it emphasizes one of its greatest achievements to be the ‘selfobject’ concept.

Benjamin, on the other hand, sees intersubjectivity as a goal, if you will, or outcome of the psychoanalytic process, the precariously held capacity to both be a subject oneself and recognize the subjectivity of the other. Not only is this tension of subject-to-subject relating hard to sustain for any length of time, but may only be achieved in a particular self state and not other self states (or affective states), and only by that self state in a particular moment. Go figure.

Thursday, November 16, 2017


Happy Birthday, G!

From PBS NewsHour’s ‘Brief But Spectacular Series’ aired on August 10, 2017
G Yamazawa, Poet & Rapper, and teacher, said of the following piece, “I wanted to acknowledge this place in my life that i felt Iike I was proud of myself and all the things I’ve done up to this point”:

I think I’m starting
To rhyme more
‘Cause I want my life
To start connecting
‘Cause, see, I’ve learned
How to learn, so
Now I’m learning
How to teach
‘Cause I done learn how
To practice
Whatever I preach
Boy, I grew from a grain
Into a beach
And I knew
For the game
I’m playing for keeps
So whatever I say I say
What I mean
So whatever I speak
I’m able to reach
A place that bleeds
And a place that burns
And a place that knows
I got a lot
More to learn.

G Yamazawa

Shouts to Durham

Sunday, November 12, 2017


Marking the 50th anniversary of the 1967 Supreme Court landmark civil rights decision in Loving v. Virginia -- which struck down the 1660s  (300 years old!) anti-miscegenation law (prohibition against interracial marriage) in Virginia -- PBS NewsHour interviewed, on June 15, 2017, Sheryll Cashin, Georgetown University Law Professor and the author of Loving: Interracial Intimacy in America and the Threat to White Supremacy. The case was brought to the Supreme Court by the  Virginia couple, married in 1958, Richard and Mildred Loving, about whom the 2016 movie, Loving, was made. 
Cashin said some things in that interview that I thought very apropos of our work. For example, she defined “Cultural dexterity as “the ability to enter a situation where you are outnumbered by a different group and experience that with comfort, even wonder. An enhanced capacity for dealing with people of a different group. It is the opposite of colorblindness, it is the ability to see and understand difference and accept it rather than demanding that someone else assimilate to your cultural norm.” 

Isn’t this also demanded of us therapists, that we see, with wonder, and accept difference, and not expect patients to acquiesce to our agendas?
Cashin hopes that a critical mass, of particularly white people, will accept the loss of centrality of whiteness and join with growing populations of people of color to fight together for the common good. Cashin believes racists today are a minority and that there is a growing population of people who embrace diversity.

Monday, November 6, 2017

Listening Stance

Analysts listen. But in what ways?

Fosshage delineates, adding jargon to the lexicon, two modes: an empathic mode of perception which he calls “the subject-centered listening perspective;” and one from the vantage point of the other who listens, and who also experiences the patient as the other, called “the other-centered listening perspective.” What is required of the analyst by the patient is an ongoing (repetitive) experience of the analyst as empathically attuned. The analyst’s empathic listening implicitly affirms her/his interest in the patient; lends validation to the patient’s experience; regulates affects, thus creating a safe attachment and space; and conveys understanding of the patient’s experiences.

Fosshage, J.L. (1997). Chapter 4 Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness. Progress in Self Psychology, 13:33-55.

One problem with jargon is its inherent ‘narrowing-by-naming.’ For example, in ‘subject-centered’ listening, Fosshage means the patient as the ‘subject,’ as if this subject can be delineated from the relationship between the patient and analyst, and, moreover, from the co-created third, the shared unconscious that emerges as something bigger than either of the two separately. Of course, the patient is separate from the analyst, but the process is separate from neither.

Attunement and empathy, listening and perception, bring me to the major paradigm shifts in psychoanalysis from left brain (cognition, interpretation, insight) to right brain (affect and its regulation); from content to context; and from ‘how to’ (technique) to a way of being in relationship. More than Freud’s one-person “evenly hovering attention” to the patient’s narrative content is a shared affective state, shared dissociation and enactment in which attunement now speaks to a “contextualized perceptual experience.” (Bromberg) We 'listen' with more than our ears. We are hard-wired with the added capacity to perceive meaning in micro-expressions, in tone and prosody, and more.

Bromberg, P (2011) The Shadow of the Tsunami. Ch.6. Routledge, New York.

Listening, it turns out, includes who we are--- and who we are emerges uniquely with each unique patient.


Friday, October 27, 2017

Meadow's "Treatment Beginnings"

An elegant, little paper from 1990 by Phyllis W Meadow, simply titled “Treatment Beginnings,” shows the author’s perspicacity about contemporary psychoanalytic ideas. She encourages the therapist to consider “[w]hat quantity of stimulation will help the patient to be in the room with me and to talk.” [‘Quantity of stimulation’ is what is noted in infant research re: regulation: up or down, to engage or sooth, respectively, the  infant.] She writes, “the initial phase of treatment is… creating an environment in which the patient can give up his resistances to talking in the presence of the analyst.” Contemporary analysts might substitute for “give up his resistances...” the words ‘feel safe and participate in building a relationship,’  but the author’s meaning is clear: “Creating the relationship that will be therapeutic is the primary task of the analyst…”  It is the analyst who bears the lionshare to create the safe space and to keep the process alive. (Winnicott described the good-enough mother who adapts the environment to the infant’s needs.) Meadow’s ideas about awareness of the patient’s “patterns for making contact” speak to a utilization by the analyst of relational paradigms. In fact, she states explicitly, “change takes place within the doctor-patient relationship.”

I am particularly fond of her stating that “The projector does not need a contradictory perception…” because I think it speaks to the idea that the patient first needs us to join with him, to welcome his perspective [and only later, when intersubjectivity is accessible to the patient, introduce our otherness.]  Recently a patient accused me of being “vindictive and treacherous” which I could not initially wrap my head around until the patient added that she believed I was plotting with another patient to kill her. Owning that all of us have murderous impulses, I then could understand my treachery. Wearing her attributions, instead of contradicting them [Note: if I had contradicted them even silently, with right-brain to right-brain knowing she would have felt my opposition] had the effect of calming her fright. She was calmed somewhat perhaps because I was not contradicting her, not challenging her beliefs, not murdering her agency, if you will. Later, much later, in moments of mentalization (a necessary component of intersubjectivity), we were able to consider her ‘assumptions’ as thoughts, without a psychic equivalence.

Another lovely pearl was Meadow’s “Even the simplest mode of interpretation, confrontation, pointing out a patient’s behavior or explaining its effects, even this leaves the patient feeling criticized or attacked…” [and shamed, like a specimen under a microscope, less than fully human;
All interpretations in the classical sense, ‘you did this ---  because of that ---’ may serve to humiliate and criticize.] Meadow notes that such confrontations “may intensify self-doubts.” Don’t many of our patients already come to us with a history of having their hard-wired capacity for reading the intentions of others vitiated by parents who scolded, ‘You don’t mean that!’ or ‘You don’t feel that way.’? When analysts want patients to question assumptions and erroneous beliefs, we hope to find a way for the exploration to be a collaborated effort which includes the patient’s curiosity and not just our own ambitions. Meadow wrote, "More important than progress is the ability to resonate with a patient..."

Meadow, PW (1990)Treatment Beginnings. Mod. Psa. 15: 3-10.

Monday, October 23, 2017

Group Process

On Oct 21, 2017 Jeffrey Roth provided to the Tampa Bay Psychoanalytic Society an organizational group process consultation [akin to Tavistock groups]. Here were some of the things to be gleaned:

Groups are fertile ground for primary process. [By this, Roth meant sexuality and aggression, seeming less interested in attachment and affiliation.] Just as in individual treatment, there is the stated task and the “covert task” [explicit and implicit]. All that transpires is “data” [fair game, in this case]. There are no ‘as-ifs’--psychic reality is the reality of the group. Differing narratives are not destructive, but combined toward greater understanding. Individual members are ‘elected’ by the group to hold certain characteristics and affects [projections; projective identification] such as the inept one, the angry one, etc. This leaves the one doing the projecting bereft of being able to utilize that characteristic or feeling. What one member says about another is a disguise for what the speaker feels about her/himself. One question is to reflect on whether a projection serves to make the group more or less functional. Ideally, a well-functioning group is one which works to own its projected parts.

References by the leader to any individual is really a reference to the role that individual is playing on the group’s behalf. Issues of boundaries and autonomy come up. The leader speaks to the process of the group, removing the target off any one member. By questioning a member’s complaints of, for example, not having a voice or not wanting to be unkind, the leader challenges the abdication of agency by the complaining member. [Tavistock groups can serve to train leaders, facilitating recognition of what one is ‘made of’ and examining impediments to agency.] “False stupidity” [disavowal] or false muteness may serve an individual by hiding competitive strivings, avoiding risk of rejection, avoiding shame for competitive strivings or from rejection. The leader would amplify the implicit voice, eg. complaining someone was ‘long-winded’ might be interpreted as meaning a “wind-bag” and wanting to say, “Shut the F--- Up!” The leader added that, by the way, a windbag can fill the sails of another(‘s sadness, e.g.).

The group leader seeks “authorization” from the group or a member to make an interpretation about what is going on in the group. Roth would often say “pause” to stop the group and invite it to reflect. If leader does not stop to point out what is happening, then the leader is colluding. The leader does not assume to understand what any member or the group but instead offers hypotheses. He encourages each member to check out their hypotheses with other members. A leader who criticizes is not functioning well in the leader role. When asking questions, the leader reiterates that one is free to answer or not answer. “Experiments” are proposed, e.g. asking one member to speak in the voice of another member’s voice or role. The leader encourages the group to celebrate when an individual is willing to share her/his pain in service of the work of the group.

Friday, October 20, 2017


Bromberg writes that dissociation is both a structure and a process; it can be pathological--in its extreme, DID: Dissociative Identity Disorder, formerly known as Multiple Personality Disorder-- defensive, or normative, the latter occurring ubiquitously and a part of everyday life, such as putting aside our maternal selves while performing open-heart surgery or when we drive home with no memory of how we got from point A to point B.

When we think of dissociation as sequelae to attachment (relational) trauma, or to traumatic events, we consider overwhelming affect-- unmitigated, unshared, unsoothed-- that threatens to disrupt one’s sense of ‘going on being’ or continuity of self. Bromberg writes:

In order to preserve the attachment connection and protect mental stability, the mind triggers a survival solution, dissociation, that allows the person to bypass the mentally disorganizing struggle to self-reflect without hope of relieving the pain and fear caused by destabilization of selfhood.

Often patients have complained that they would feel ‘weak’ or ‘too dependent’ if they expressed their need for comfort (for shared affect) from an important other. Bromberg reminds of us the double shame inherent in the psychoanalytic process: the shame that comes from both seeking solace and from the belief that their needs are illegitimate, unreal to the other, and thus that the patients themselves are unreal and risk losing the attachment bond. He reminds us that, if the analyst does not recognize the patient’s desire to communicate to us the dissociated parts of the patient’s self, then the patient will continue to feel her needs are illegitimate and undeserving of solace.

Bromberg, P (2011) The Shadow of the Tsunami. Ch. 2. Routledge, New York & London.