Monday, April 27, 2015

Conference on Countertransference and Ethics

An erotic transference can stir up anxiety in the analyst. I recently had opportunity to view a teaching film in which a male analyst is asked by a female client whether or not he is attracted to her. 

She begins the session modeling her new dress. The analyst says she must be going somewhere [after]. She sits and looks glum. The analyst asks her ‘what’s the matter?’ She says she had felt so foolish because she had gotten “no response” from him upon revealing in their previous session that she had a “crush” on the analyst. He disagrees that she should feel foolish [attacking her point of view/ the validity of her experience] and she reiterates that she indeed felt foolish. Again he disagrees and tells her that her revelation took courage. The client again complains that the analyst had said nothing about how he felt about her. The analyst gives an explanation about the asymmetry of the therapeutic relationship.The client persists in saying she felt stupid because the analyst did not speak to his feelings about her. He empathizes with her difficulty [saying nothing about his own]. He does state a dilemma: if he tells her he is not attracted to her she will be devastated and feel more like the fool; If he says he is attracted to her, the atmosphere will shift and she will feel less safe to say what she feels [He apparently does not consider the possibility that his honesty might model and engender further honesty from her]. The client stated again [third or fourth time, by now] that she still wanted to know if he finds her attractive.The analyst complains that what he is saying is being ignored. The client persists, “Am I attractive?” and the analyst complains he is being steamrolled in the way that her previous boyfriends have complained she tried to control them and dismissed their POV.  The client persists, wanting an answer to the question asked at the beginning of the session. The analyst [in an attempt to force mentalization, I think] accuses the client of not caring what he feels. The client says the analyst is being “stubborn” by not answering “a simple question.” The analyst says the client does not want him to be her therapist. She denies this and becomes tearful as she complains that he will not do what she wants. The analyst seizes this opportunity to tell her she wants to control men. The client acquiesces [or has insight?] and says she does not know why [controlling men] is so important to her.  The analyst tells her that she fantasizes if she can control men then they won’t leave her. Hanging her head, moving her tongue side to side pressing the insides of her cheeks, she says she can see that. The analyst adds that her father, asserting his independence, left her and her mom, so the client repeats the same thing over and over not getting the outcome she wants [you know, the definition of stupidity]. The client says she sees, but does not like it.

If an analyst’s anxiety can be measured by how much he/she talks and/or intellectualizes, the audience was certainly privy to the anxiety of this analyst in the video who talked significantly more than his patient did and who intellectualized with her instead of speaking to the affective relationship in the room. The audience was divided in their response, some seeing the analyst as deflecting, using ‘neutrality’ and abstinence and accusation [interpretation] as a shield; some seeing the analyst as handling the transference perfectly appropriately and using interpretation to impart insight. In this situation, I, too, have been made anxious. It is difficult for the analyst to stay empathically immersed (as Geist was able to in his 2009 paper on mutually constructed boundaries) when faced with confusion about the best way to proceed. How do we validate the client’s POV and still have a differing one conveyed? How do we speak to the emotions in the room present in both therapist and client and still keep open the potential space [instead of foreclosing space by reifying through action]?  Certainly I have failed multiple times in this regard. What is missing in the therapeutic relationship in the consulting room that the client, or analyst, is willing to throw it over in favor of something else? How do client and therapist alike speak to and mourn what cannot be, and still remain in relationship? Analysis, in addition to everything else it is, after all, is also simply 'two people in a relationship.'

Sunday, April 19, 2015

Frankenstein's Monster

Alternately titled Modern Prometheus, we are led to think that Dr. Frankenstein wished to rival the gods (or women) by creating life. For a woman in 1817 to write a masterpiece was not simply unusual, it was considered, like Prometheus' stealing of fire, an act of hubris. But more than hubris, Frankenstein is a story about attachment and the longing for restoration of lost relationship.

Mary Wollstonecraft Shelley, the author of Frankenstein (1818, 1831), lost her own mother at only eleven days old from complications (infection) of childbirth. Her parents had hoped for a boy. Childbirth was perilous in Shelly's day. Shelley herself, as a teen, lost her first child within days of her daughter's premature birth. Her second, named after her father, and third child, also died very young. Shelley experienced multiple miscarriages and only one son lived to adulthood. Shelley was a widow by age 25.

Did Mary grow up believing she had killed her mother? That her mother had abandoned her because Mary was an unlovable monster just as Dr. Frankenstein abandoned his creation at its birth? It is immensely plausible to speculate that a small child would wish for restoration of the lost mother. Not only had Shelley lost her mother, so does Victor Frankenstein, and his bride, as did Shelley's husband Percy, upon whom Victor was partially modeled. Shelley, who dedicated the book to her father, might have wished as well for reparation with him for he had cut off all ties with her when she ran way with the already married Percy. 


Victor, unseen or misrecognized by his parents, misrecognizes his creation. Dr. Frankenstein's monster becomes the Brombergian 'not-me': the loss, the envy, the rage of the abandoned child, and it vengefully and relentlessly pursues its creator-mother just as Mary, as a child, spent countless hours at her mother's grave (and it was there that she and Percy fell in love). 

A child learns to see itself first in its mothers face, her gaze, her mind, and learns to regulate its emotions from its mother's lending of soothing and containment of distressing emotions and sensations. 

Frankenstein's creation had none of these advantages, a monstrous child, indeed, left to long ragefully for connection. 

Film with Boris Karloff shown today at 200pm.

Sunday, February 15, 2015

Boyhood













If The Grand Budapest Hotel created a magical like wonderland for the viewer, Boyhood, written and directed by Richard Linklater, makes magic out of the everyday, much like Turner taught us to see fog or Hockney the light on the surface of a swimming pool. Peter Travers of Rolling Stone called it “an unassuming masterpiece.”

Boyhood is another coming of age film, but it is unique in using the same actors over twelve years of intermittent filming  (Ellar Coltrane as Mason, Patricia Arquette as his mother, Ethan Hawke as his father, Lorelei Linklater as his sister) so that we see their real aging and changing, which gives the viewer a sense of ...  inclusion, peace, authenticity. We are caught up in the change, compelled by time slipping by so fast, this knowledge so poignant in our own lives. This use of real time creates a kind of transcendence that has, for me, an ineffable quality.

Patricia Arquette (on 2-9-15 on The Daily Show) said  of director Linklater that he “believed what is beautiful is life. Normal life. Love. Mistakes. That we are here on Earth, a real celebration of just human beings.”

Linklater himself recounted how, in his own childhood with divorced parents, a father who lived over an hour away, he spent, with his dad, that three hour round trip trying to forge a connection. Hawke tries to do the same with the Coltrane and Linklater characters, striving to know one another as best as they can. I think it is a marvel to behold. Nominated for six Oscars, it has already won the Golden Globe and the British Academy Film Award for Best Picture, Best Director, and Best Supporting Actor (Arquette). 

Tuesday, February 10, 2015

The Grand Budapest Hotel

Perhaps quirkiest of all of this year’s nominees is The Grand Budapest Hotel directed by the quirky Wes Anderson (Moonrise Kingdom, Rushmore) and starring Ralph Fiennes (Harry Potter, The English Patient) as concierge extraordinaire Gustave H. who seeks to provide, on the brink of WWII, unparalleled service to the guests of this magnificent hotel. 

In his nightly ‘sermon’ to the hotel staff, Gustave H. instructs his staff on how to deal with rude guests [reminiscent of the therapist’s understanding of hostile patients]: Rudeness is fear, proclaims Gustave, fear that one will not get what one wants. Thus, he explains, the staff must provide what is missing in order to disabuse the rude guests of their expectation of going unsatisfied. And Gustave H. always satisfies, both male and especially older, lonely female guests. One such guest, Tilda Swinton, bequeaths him a priceless painting which her family, of course, contests. Gustave H. steals the painting and a series of comic, and then not so comic, mishaps ensue. 

The banter in this film is unexpected and, sometimes,twitterpating, delivered so dryly at times that my brain needed a moment to register the laughter. One of the most amusing scenes to me is the enduring politeness and hospitality of the imprisoned Gustave H. as he graciously offers mush to the other prisoners, treating them as if they were his honored hotel guests. 

The sets are as delicious as the pastries and confections from Mendl’s Bakehop used to influence (maybe even bribe) prisoners and guards alike. As Nazis emerge on the horizon, Gustave H. clings to the belief that etiquette and elegance, masking his own occasional crudeness, might maintain a vanishing civilization. His sidekick, the lobby boy Zero Moustafa (Tony Revolori; later F. Murray Abraham), says of Gustave H. many years later, “He certainly maintained the illusion with remarkable grace.”

The Grand Budapest Hotel touts an extraordinary cast as well, with Adrien Brody, Willem Dafoe, Jeff Goldblum, Harvey Keitel, Jude Law, Bill Murray, Edward Norton, Tom Wilkerson and Owen Wilson, to name a few.

Friday, February 6, 2015

Oscar Nominations:Birdman (the unexpected virtue of ignorance)

Many of the films nominated this year for Best Picture are unusual in their quirkiness and singularity of subject. One such quirky film is Birdman, directed and co-written by Alejandro Gonzalez Inarritu [Babel and Biutiful] and starring Michael Keaton as Riggan Thomson. Birdman is a film about painful transformation and the search for meaning.  Thomson, a once Hollywood blockbuster superhero (Birdman), is trying his hand at Broadway and at a comeback by writing, directing and starring in a play which is an homage to author-poet Raymond Carver’s short story “What We Talk About When We Talk About Love.” This short story, now play, features two couples, Mel (Keaton) and Terri (Naomi Watts) and Nick (Edward Norton) and Laura (Andra Riseborough), who sit drinking around a kitchen table discussing what is real love. [I, among others, believe that only through love is transformation possible.Only through communion is meaning created and do we come to know we matter.] Later, Thomson asks the existential question, “Do I matter?”

Thomson searches for an “honest performance” and finds it in Mike Shiner (Norton) who otherwise, and ironically, lives inauthentically, even stealing Thomson’s back story for his own to use in a New York Times interview; and Shiner can only achieve an erection when on stage. Thomson hopes to find relevance, but theatre critic Tabitha Dickenson (Lindsay Duncan) has promised to destroy his play because, she claims,  celebrities of “cartoons and porn” aren’t legitimate actors, to which Thomson retorts with indignation that critics, unlike actors, “don’t risk anything!”

Thomson is divorced, but seems to regret it, and is attempting to reconnect with his drug-rehab’ed daughter Sam (Emma Stone). He is followed about by his alter ego Birdman who both torments [People “love action, not talking, depressing, philosophical shit”] and encourages Thomson. Birdman also allows Thomson the power of telekinesis and, at his lowest points of suicidal thoughts, lets him fly above everyone else. The final lines of the play-within-the-film, reminiscent of those which may be oft spoke by certain of our own patients, and, if we are honest, ourselves, occur just after Thomson in the play playing Mel discovers his wife Terri in bed with another man (Nick played by Shiner) and just before Mel shoots himself:  “What’s the matter with me? Why do I always have to end up begging someone to love me… I don’t exist.”

On opening night, Thomson exchanges the prop for a real gun, causing the critic Dickenson to glowingly opine that “blood spilled literally and figuratively” had been “long missing from the veins of theater,” and calling it “SuperRealism.” As Thomson recovers in the hospital, his bandaged face, reminiscent of Birdman’s mask, he and his daughter finally connect. Thomson struggles with suicidal thoughts and he experiences transformation through flying as Birdman. But we know from psychoanalyst Philip Bromberg’s work that death of our previous selves accompanies transformation. Sam, who looks out the open hospital window, and up, sees her father fly and this could as easily be metaphorical.

Some of the amusing tidbits include, Mike Shiner getting a shiner; Thomson ‘going viral’ [by living the common anxiety dream of everyone at work seeing you in your underwear] despite eschewing social media; a reference to Ryan Gosling’s failed directorial debut; and imagining Emma Stone could ever be invisible. The biggest laugh for me came when a man on the street was shouting about the “sound and the fury, signifying nothing.”  Schizophrenia? No. An aspiring actor, auditioning,  And there is a luminosity [literally] in a liquor store where the hot pepper shaped, copiously strung lights look like a festive Christmas or the stained glass of a church. But the heart of the film is about meaning, meaning co-created within an authentic relationship. Sam says the hardest thing to bear from her father is that he is always trying to make up for not having been in her life by “constantly trying to convince me I [am] special.” Thomson admits he “wasn’t present at his own life.” How fortuitous then that the stage manager calls out over the loudspeaker, “Last chance for places.”


Sunday, January 25, 2015

Film today: The Sixth Sense

The 2014-2015 Film Series of The Tampa Bay Institute for Psychoanalytic Studies, Inc (T-BIPS) and The Tampa Bay Psychoanalytic Society presents today the M. Night Shyamalan film, The Sixth Sense, starring Bruce Willis as a child psychologist Dr. Crow and Haley Joel Osment as his disturbed patient, Cole. And what ails Cole the most? Like so many gifted children in a disturbed world of family ghosts, he sees what no one else can bear to see.

That parents in many families unwittingly reveal their torments –having dissociated or repressed their own past traumas of chronic misrecognition; attacks on their reality; or physical, emotional, and sexual abuse— inadvertently leads to terrifying consequences for their children and themselves. It is not only the ghosts of Shyamalan’s film who are lost souls, but all of us who cannot face our own trauma, including our inevitable finitude. Our wish not to see what Cole sees, along with our collective denial of death, allows the audience to believe that Dr. Crow must be alive after having been shot a year earlier. This despite that crows, of course, were well known to have been long associated with death, or its harbinger. The crow has also been attributed powers as a spirit guide, with the powers of sight and transformation.

It is Dr. Crow who must lead lost souls, both living and dead, to some form of grace. The ghosts are tormented by their self deception— they do not know they are dead. Cole, like the gifted child in a family haunted by the ghosts of past trauma, struggles valiantly to face that which he also wishes to avoid (seeing the torment of others). Ironically, perhaps inevitably, it is the healer himself who cannot face his own truth—for we are all wounded healers—and Cole can only be helped to face, to listen to, the ghosts as he helps Dr. Cole face his own plight.  The wisdom in Cole is his gentleness in revealing what he intuitively understands is too painful for Dr. Cole to see.

[Is it an ethical dilemma for the therapist to be blind about one’s self (and only on the road to healing) while simultaneously attempting to heal patients? Is it incumbent upon the therapist to be set free by one’s own truth before ever attempting to help others? Perhaps Cole and Crow were both lucky to have encountered one another, despite the pain engendered on their way to a second chance.] 

Friday, January 16, 2015

Depression is Us

Bromberg, who has written cogently on the patient’s need to stay the same (not give up a part of himself or lose a sense of who he is) while changing, cautions the analyst against attempts to alleviate a patient’s depression without first respecting that depression is not merely an affective state but is also who the patient is: “For many people [depression] is a self-state with its own narrative, its own memory configuration, its own perceptual reality, and its own style of relatedness to others.” Because the patient has a need to preserve the self and self meaning, he cannot easily allow the analyst to destroy a part of his personal reality as if it is meaningless.

By giving in to a patient’s demands in an effort to relieve him of his depression the analyst attacks the patient’s self and speaks to the analyst’s incapacity to bear with him his suffering. Gratification of patient’s needs (in attempts, for example, to relieve depression) can become “a form of misrecognition, …evidence to the patient that the analyst is unable or unwilling to authentically ‘live with’ the patient’s state of mind.” While “patients in general need soul-searching emotional openness from their analysts” the analyst’s inauthenticity makes it difficult for her to give the patient what is actually needed—genuine mutuality— and so the patient understandably responds by pushing the analyst “to the edge” in the hope of helping her change into someone more capable of genuine mutuality.


Tuesday, January 6, 2015

Body sensations as the precursor to thought

Patients with psychosomatic disorders have been variously conceived as lacking in symbolization, being alexithymic (without words for emotions), and having deficits in mentalization. Lombardi’s paper is reminiscent of our discussions in the Repetitive Painful States course about symbolic origins, or lack thereof, and the development of (bodily) experience into “the differentiating force of thought.” According to Lombardi, the body is the starting point for mental activity, and upon it psychic reality is based. “[T]he body furnishes the constitutive elements from which are derived both the precursors of the emotions and the perceptual structure out of which the ego develops.” Without an internal construct, internalization is meaningless.

Furthermore, “[T]he sensory level imposes itself as the sole condition for gaining access to existence.” Through bodily sensations (such as the smell of an unwashed body) Ogden’s autistic-contiguous position posits experience of the feeling that one exists, for “the body [is] the first and founding entity upon which the subject’s identity is based.” The body is used in an attempt to repair and heal the internal void. In attempts to feel real or alive one may attack the body (e.g. self mutilation). Conversely, bodily sensations may be marginalized or corporeity rejected altogether (such as in Lombardi's clinical case of the man with anorexia nervosa; or in the extreme case of psychotic depersonalization). Therapists, then, may find verbal communication obfuscated by the predominance or exclusion, respectively, of the sensory-emotional dimension.

Relying on the work of Ferrari, Lombardi writes that “the continuous flow of sensations from the body” and “the intersection of sensations and thoughts” allow the “potential for expressing current emotions” such as ‘I am afraid’; I don’t feel well; I feel lost; you are beautiful; I love you; I hate you.’ “[T]hinking is deemed to be at all times connected with feeling.”

Delusions, obsessions, phobias, may be primitive sensory expressions, a necessary resort until more favorable conditions for mentalization present themselves “such as an encounter with an analytic reverie, which afford[s] an opportunity for…language proper and hence thought…[and for] the construction of a language to enable corporeity to speak.” Just as the mother’s reverie quells tensions allowing for mental space to process (‘receive and recognize’) the infant’s bodily sensations, providing an “area of transition from the concreteness of sensation to the first forms of abstraction and representability,” psychotherapy gingerly develops language to allow for symbolic expression and for the re-integration of the false duality between mind and body. Aptly put, Lombardi notes, “The function of analysis is to lead the analysand back to a real lived dimension so as to generate fragments of authentic experience.”


Lombardi, R. (2002). Primitive Mental States and the B... Ferrari's Concrete Original Object. Int. J. Psycho-Anal., 83:363-381.


Saturday, January 3, 2015

Attachment and Separateness

Both separateness and attachment develop our self identity. Mahlerian separation theories did not distinguish the development of the individual from development and maintenance of relationships, where, through internalization [a specious distinction between inside and outside], object constancy is eventually established allowing for more comfortable separateness. In contrast, attachment theories see the development of the individual as inherently interactive, with the self made up of past and present internal relationships. Relatedness, instead of the individual, is emphasized. Blass and Blatt speak of  the dialectic between separation (development of ‘self’) and attachment (the development of ‘self with other’), reminding us that it is not a linear process, but two distinct lines of development, whose progress in one line is essential to the other, each being continually renegotiated and reintegrated throughout the life cycle. The two primary developmental tasks, then, are the establishment of a consolidated, positive sense of self and the capacity to maintain mutually satisfying relationships. Within these interpersonal relationships, one learns to accept the limitations of the other, accept separateness and ambivalence.

Osofsky, likewise, sees the self as developing, and existing, within relationships. She notes that internalization of relationship experiences (of self as good and competent, or, conversely, self as bad and incompetent) become the internal representations, Bowlby’s internal working models—based on real life events – [and, perhaps, Stern’s RIGS, representations of interactions that have been generalized]. Early affect sharing and communication in the developing relationship between mother and infant contribute to the infant’s differentiation of self from other, that is, the self develops within the caregiver system [Winnicott’s no such thing as a baby]. The quality of this affect sharing and mutual regulation, affecting the quality of attachment, influence the child’s developing sense of self and of others. An infant can only “be competent to the extent that there is a caregiving environment that is alert and responsive to the infant’s ‘signals’.”  Meaning develops according to what the child means to the parent, and implicit rules of relating become the basis of the sense of self and the self with others. Later, “the analysand forms a relationship with the analyst that recreates and [hopefully] reworks old ‘working models’ of attachment figures.”

The self comes into being through interaction with important caregivers and through experiences of the self as separate. Blass and Blatt take Kohut’s ideas about the self as primarily a separate, self-contained  entity, and grapple with the paradox of self as continually embedded in relationship with others, that is, as also attached in loving relationship to others. They note that Kohut failed to emphasize that object ties (attachment) “can be based on other motives in addition to narcissistic ones.” They also point out how empathy as an expression of attachment can conflict with the self’s need to experience oneself as differentiated within a relationship, the “wish to be incomprehensible, obscure, [Winnicott’s private self] and thus separate.” Kohut struggled with whether to consider the selfobject experience as intrapsychic or interpersonal. Loewald put it in neither realm, but ‘in an intermediate region.’ Kohut spoke to relationships in regard to their contribution to self cohesion (that is, the other as selfobject), and distinguished object love and narcissism on degree of: differentiation between self and other; drive satisfaction; and contribution to self cohesion. Paradoxically, object love is attachment with increased differentiation, whereas the narcissistic aim is separateness (and intimates self interest) despite decreased differentiation (experiencing other as part of self, perhaps through projective identification).  In fact, write Blass and Blatt, “ongoing existence of others is experienced as an inherent and integral component of the individual’s cohesive sense of self separate and autonomous.” This paradox speaks to the speciousness of dichotomizing differentiation (separateness) and attachment for, as Blass and Blatt note, they are dialectically intertwined. Likewise, there is conflict and tension between the aims of attachment and autonomy. Thus, negotiation between autonomy (separateness) and relatedness (attachment), between self-sufficiency and dependency, is a universal human dilemma.

Blass, R.B., Blatt, S.J. (1992). Attachment and Separateness—A Theoretical Context for Integration of Object Relations Theory with Self Psychology.  Psychoanal. St. Child, 47:189-203.

Osofsky, J.D. (1995). Perspectives on Attachment and Psychoanalysis. Psychoanal. Psychol., 12:347-362.

Wednesday, December 17, 2014

novel Blindness; blind to recognition, containment, acceptance?

In Blindness— the 1995 novel by the Portuguese (1998) Nobel laureate for literature Jose Saramago— an epidemic of “white blindness” mysteriously renders all people, save one, blind, and chaos and cruelty ensue. Written without much punctuation the reader must, much like a therapist trying to make sense of the patient’s narrative, discern who is speaking to whom and about what. Blindness teems with allusions to our metaphorical blindness, such as people “behave as if they were afraid of getting to know each other.”  Saramago speaks to the sanctity of reciprocity: “I have no right to look if the others cannot see me,” and to the wrath – “some will hate you for seeing” –  of being the one who sees what all others are blind to (or disavow, like a parent who attacks the seeing child’s reality). There are moments of tenderness, such as when two blind lovers reunite: “how did they recognize each other…love, which people say is blind, also has a voice of its own,” and moments of despair when one’s true self goes unrecognized: “what good would it do her beautiful bright eyes…if there is no one to see them.”

Because all, save one, are blind, there can be no witness, yet some manage to find affective sharing when the blight can “convert strangers into companions in misfortune.” Despair overtakes many in this dark novel for “what meaning do tears have when the world has lost all meaning.” Even the one who is spared this affliction is incredulous to what becomes of those around her: “what shocked her was her disappointment, she had unwittingly believed that…her neighbors would be blind in their eyes, but not in their understanding.”

If blindness is, in part, the blindness to the need of the other, then I am reminded of Stuart Pizer’s 2014 paper The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness” which eloquently joins with and departs from Emmanuel Levinas’ idea of putting the suffering other above oneself. If one is to lean towards another’s need, one must first see (recognize) the need. Pizer takes Sullivan’s concept of the ‘tension of tenderness’: “the analyst’s recognition of a need or an affect state in the patient evokes an internal tug constituting the analyst’s need to provide for what has been recognized.” He writes, “An instinctual tug toward tenderness, or a spirit of generosity, in response to a recognized state of need in the Other is an inherent feature of our functioning attachment system.”

But how does a blind person see the Levinasian strange, transcendent, unfathomable ‘face’ of the other? Pizer sees generosity as instinctual, but expects Levinas to “reject instinct in favor of a subjectivity open to interruption, surrender, and awakening by an encounter with the Other.” Pizer continues, [we are] “wired to seek community, relational embeddedness, or ‘we-ness.’” Generosity sometimes requires of the analyst, per Corpt, an “unsettling re-evaluation and openness to amending any and all aspects of analytic practice in light of the patient’s forward edge strivings.” Pizer learned from his grandfather the healing power of the affectively resonant, witnessing presence of someone who recognized his need, and accepted him just as he was. Saramago notes its opposite, “Blindness is also this, to live in a world where all hope is gone.” That is, no hope of being seen, recognized, contained and accepted.


Pizer, S. (2014). The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness”. Psychoanal. Dial., 24:1-13.