Sunday, November 8, 2015


Actor George Takei, best known for his character Sulu in the original Star Trek,  makes his Broadway debut at the Longacre Theater in Allegiance, which opens tonight. Allegiance is a musical about the internment of Japanese Americans during World War II and is partly based on Takei's own experience. When Takei was five years old his family was sent to an internment camp for almost four years. His childhood imprisonment taught him about gaman which means “to carry on.” Takei says of resilience that it includes “the ability to find joy — even under those harsh circumstances— and love.”

Takei recalls having chastised his own father with “you led us like sheep to slaughter.” His father agreed. Takei felt so guilty that he never apologized to his father. But now he says he can apologize nightly through his participation in this musical, the humanization of those injured by this protracted injustice in America’s history.

Sunday, October 4, 2015

Rudnytsky and Milton’s “Paradise Lost”

The Tampa Bay Psychoanalytic Society, Inc hosted an unusual speaker last weekend at its monthly speaker program meeting. Peter Rudnytsky, UF professor, Shakespeare and Freud scholar, long time honorary American Psychoanalytic Association member, and long time, former editor of American Imago, explicated in his paper “Freud as Milton’s God…” the long running critical debate over an inherent contradiction in Milton’s Paradise Lost. The contradiction concerns whether humankind had free will to choose to disobey God or whether the Fall was predetermined, even put into motion by God’s actions, God in Milton’s poem failing intersubjectively to take responsibility for situating himself*  in the outcome. Quoting Rumrich’s take on the epic poem – “negotiations between narcissistic longings for perfect recognition and the recalcitrance of an unresponsive reality” – Rudnytsky adds that God is portrayed as a controlling and narcissistic parent, demanding obedience, which if not freely given will be exacted through punishment.

We now know that it is failure to provide sufficient response to longings for recognition which sets up narcissistic longings for perfection. The narcissistic parent has been unable to accept the imperfect child as good enough, and the child, humiliatingly aware of its deficiencies, grows up seeking to overcome or to hide what its parents made glaringly shameful, often requiring, as Milton’s God seems to, “an insatiable need for praise.” [But what if the injured God was also seeking healing or, naively, reconciliation?]

Rudnytsky notes that Freud, too, exacted loyalty, or else followers were extruded from his inner circle.Freud, in anointing Jung the ‘crown prince’ both elevated Jung above all his other followers and, at the same time, made Jung subordinate to himself. In subordinating another, rebellion is engendered, as is the Oedipal struggle and sibling rivalry.  God, too, in Milton’s poem, by anointing Christ, created Satan from a passed over Lucifer.

*While for Milton, and for many, God is the Father, an interesting discussion ensued about womb envy and the need for men to erect a male Creator in compensation for the fact that it is from women’s bodies that we come into this world; An interesting reversal of this fact is Eve springing from Adam’s rib; or Athena from Zeus’ head.

Sunday, September 27, 2015

Film: Away From Her

The Tampa Bay Institute for Psychoanalytic Studies, Inc and the Tampa Bay Psychoanalytic Society, Inc kicked off their co-sponsored 2015-16 Film Series “On Aging” with writer/director Sarah Polley’s 2006 Away From Her based on a short story (The Bear Came Over the Mountain) by Alice Monro. Film critic Roger Ebert described it as “the story of a marriage that drifts out of the memory of the wife [Fiona Anderson played by Julie Christie], and of the husband’s [Gordon Pinsent as Grant] efforts to deal with that fact.”  Of Polley he wrote that she, unlike Bergman’s merciless ‘winter light,’ “bathes the film in the mercy of simple truth.”

Discussant USF Film Professor Scott Ferguson, PhD called Away From Her a tour de force by Polley who made this beautiful film more “capacious, ambiguous, and interesting” then its contemporary Still Alice (which is based on a true story and which more narrowly focuses on the disease process of Alzheimer’s and how to combat its loss of identity). Away From Her is about being and time and difference, and about the “deliciousness of oblivion” in all its “passions, horrors, surprises, melancholy, and potential.”

The clinical discussant Kathryn Lamson, LMHC reminded us that “as we age, we move toward resolution, separating the essential from the non essential.” Grant suffer the inescapable loss of his wife and of her as co-witness to their shared lives.

Erickson (1950) extended Freud’s developmental stages beyond young adulthood to include love, care (generativity v. stagnation), and, over 65, wisdom (ego integration v. despair). Hildebrand (1987) noted “the creative power of continually changing relationships.” Aging can bring increased acceptance of the self (Wild Strawberries on Nov 22nd), new discoveries, time for latent talents and for luxuriating in new found pleasures and for creative, social and spiritual endeavors (Quartet on May 17th, 2016). Enthusiasm and curiosity can keep us young (Cherry Blossoms on Feb 28th). The risk for despair comes, too, with age.  Loss of family (Amour on Mar 27th, and, of course, Away  From Her) and friends (through death and empty nest), decline in sexual function, possible physical and mental infirmity (as in Away  From Her), isolation, childhood fears of abandonment, and proximity to our own death. Economic security may improve for some, but decline for others (Grey Gardens on Jan 24th, 2016). It takes courage, and adaptability to face losses (Trip to Bountiful on Oct 18th) and accept changes in function and the narcissistic injuries that ensue. Hopefully, we will be in good company as we age.

The sensitive and moving topic of aging will be discussed next on October 18th at 2:00pm in Trip to Bountiful (written by Horton Foote) by USF Professor Adriana Novoa, PhD and clinician Linda Berkowitz, LMHC. Hope you join in.

Saturday, September 5, 2015

Who is responsible?

A precocious ten year old asked me yesterday what I plan to do to help the Syrian refugee children. An only child, she wishes to “adopt” at least one child. Her question shook me deeply. As Hungary struggles with an overwhelming influx of refugees fleeing the war in Syria-- many who will never reach the Euro Zone but instead die at the hands of ruthless traffickers by suffocation in vans, or drowning, as 3 year old Ilan Kurdi did, as they attempt to make their way from Turkey to Greece-- one German reporter characterized Hungary’s change of heart to bus refugees to the Austrian border as “not finding a clear line” and ”a confused policy” to explain the doubt of frightened refugees for Hungarian authorities’ intentions. Volunteers along the lengthy march through Hungary to Austria hand out food and water and offer a place to sleep.

Pundits are asked “Who is responsible?” and I am reminded that ‘Few are guilty, all are responsible’ [Heschel]. Yes, the world-- not solely the USA, who did create a power vacuum for so called ISIS in Iraq-- has insufficiently turned its attention to the tragedy that is destroying Syria.  My ten year old patient said to me hopefully, “When I adopt a child, you can talk to her like you talk to me.” 

Monday, August 10, 2015

FIlm "Inside Out"

Today I went to see a movie "Inside Out," a Disney animation on emotion, and how emotions interact. 
I think Disney depicted the emotions pretty well, still keeping the information understandable.  I would recommend that anyone interested in affect and neuroscience  see this movie.  The movie gives a brief but accurate account of how emotions interact to cause our behavior.  The movie also goes into long and short term memory and lost or forgotten memories and images.  

One thing that the movie depicts is that we are not completely in charge of all our emotions but that emotions are based on circumstances as well as on past memories and experiences.  The movie also pointed out that emotions are also based on future expectations, which in turn involve past and current experiences.  

The characters of happiness and sadness  are initially working separately, each thinking their  ideas are the only important thoughts, and then unite to  create a thought process that is more beneficial. The unity of the characters of happiness and sadness united the other emotions, joy, disgust, fear, anger which  also  evolved.  Disney depicted  the presence of happiness as the most important emotion but the other emotions, once united, as a very necessary contributor to a person's well being.

Sometimes I think that there are those who feel that we have control of our behavior by just understanding what is going on and what may be the correct way of doing things.  In this schema it is hard to  accept that our behavior and actions are controlled by electrical and chemical interactions that form an action potential to initiate stimulation and our actions, which is based on storage of past experiences and other past stimulation.  [But] there is the expression "that which fires together wires together."

by Richard Nikla, LMHC

Thursday, July 23, 2015

Making Meaning Dyadically

Edward Tronick in his talk “The Dyadic Expansion of Consciousness Model of Psychoanalytic Change” noted that there are many “something more”(s) going on between two people in a dyad and that the state between the two contains more information than either has for one’s self. This information can be apprehended by either and used to make meaning. Tronick further noted that one needs to feel secure [At the body level this refers to wholeness, safety,  boundedness] if one is to be flexible, creative, and able to engage in relationship with others.  Conversely, insecurity impairs meaning making, self regulation, and can lead to rigidity, dissociation, defensiveness, etc. as the patient holds on to the organizing patterns he already has.

Information may come at the bodily level, for example, through synchrony of respiratory sinus rhythms by parasympathetic regulation, particularly when each has protracted experience of the other, through ‘matching’ of tone, prosody, etc, as well as emotional matching and shared meaning at the symbolic (linguistic) level. Meaning making occurs bodily, emotionally, and symbolically and one system can bring to light (and help regulate)another.

His comments reminded me of a patient who complained that his “true self” was being “crushed” by the phoniness displayed by friends and family members and induced in him a likewise inauthenticity. I inquired where he felt this sensation of ‘being crushed’ in his body for as he reiterated his complaint I had the image of a baby’s face smashed into its mother’s breast while nursing. He replied that it was his face, like a mask smothering him. When I shared my image aloud, he though it “weird” but was willing, when invited, to consider (or play) with the image I introduced. He came up with a heretofore unrecalled memory of his father musing aloud when the patient cried that “Indians” blew into the face of their crying infants to get them to stop crying, by way of “suffocating” them. [The patient had oft complained of not being able to breathe, not catch his breath fully, since childhood, and of having no one, not even the family doctor, understand his complaint.]

This vignette came to mind as Tronick spoke because it illustrated to me to one particular moment where my patient and I had access to information between us that neither of us might have had access to alone. It was in exploration of the bodily component that the memory was activated and put into words. 

Tuesday, June 23, 2015

A Tiny Note on 2 Moliere plays

Never more clearly than in two French satirical plays by Moliere, Tartuffe and The Misanthrope, do we find the longing to know and be known. Humans are born with the hard wiring to read the intentions of others but many of us have that capacity thwarted during childrearing when caregivers contradict the reality of children with reprimands such as ‘You don’t want that’; or ‘Yes, you are cold’; or ‘You don’t mean that’; the worst case scenario might well be denial of sexual abuse when adults pretend with children that it is not happening. Thus we learn to doubt what we know to be so.  Because children’s survival depends on attachment, children acquiesce their own reality to that of their caregivers.

Tartuffe, a con artist who dupes Orgon of all his property by posing as a Holy Man and turning Orgon against his own family, is seen by all except Orgon and his mother Madam Pernelle for the imposter he is. How did Orgon become so unseeing? Part of the answer surely lies with transgenerational transmission of attacks on the reality of others. Mme Pernelle accuses her grandchildren of not listening to her but it is she who prattles on, insulting her grandchildren and her daughter-in-law Elmire.  She also contradicts them about Tartuffe’s character insisting “all of you Must love him” and “Rubbish!” (Act One,  Scene I). Orgon has learned from his mother that relationship can have only one subject, not accommodating the other’s reality, and so inflicts the same on his daughter Marianne. Wishing to force her to marry Tartuffe, he tells her “Because I am resolved it shall be true. That it’s my wish should be enough for you.” (Act Two, Scene 1)

While Tratuffe is sometimes also named The Hypocrite, we also find great hypocrisy in The Misanthrope, a later play in which Moliere made more subtle his spoofing so as not to so plainly offend the Church and the Aristocracy. Our misanthrope Alceste claims to dislike all the courtly flatterers who, behind the backs of others, gossip and malign. He speaks his opinion, mostly tactlessly, and pleads for authenticity from others. Meanwhile, Alceste loves a young widow Celimene who herself embodies all the disingenuousness against which Alceste rails, an illustration of how we are multiple selves, at times heroically going against the politesse, at times foolishly expecting the ideal to be concretized. Alceste might seek out Celimene perhaps because offstage (behind closed doors) Celimene and Alceste share their ‘true’ selves with one another. Alceste says to her, “Let’s speak with open hearts, then and begin…”  (last line, Act Two, Scene 1)

Tuesday, June 2, 2015

Having Fallen into the Abyss Myself...

A supervisee, praised in her respective psychoanalytic training program for her “calmness and stability,” asked me recently how she could keep herself stable when faced with her very unstable patient whose instability, lamented the supervisee, she could feel inside herself as if her patient were “pushing” her. The therapist complained that she could feel herself “influenced” by her patient’s self states. Her patient was continually running away from the chaos of her own world and now the therapist-supervisee wanted to run away from this patient. A professional therapist, the supervisee claimed, can keep herself stable, work deeply and slowly, and could “stay there” in the room with her patient.

I was pleased to know that the therapist I supervised had the capacity to be influenced by her patient. Now we had to find a safe and comfortable enough way for the therapist to share with her patient that her patient was no longer alone in the chaos. And what a good job the patient was doing communicating her own internal states. [Is this what projective identification is?] If the therapist, too, could feel the chaos, and if the therapist could both survive the chaos and not be shamed by her lack of stability, what might these mean for the patient? That the patient was no longer alone? That it is okay to make mistakes? The supervisee further lamented that when she managed to feel calm and stable with this challenging patient, it was at the cost of feeling “dead” inside, feeling “serious: and unable to “interact” with her patient. The therapist found that paying attention to her own body sensations relieved her some of the deadness. The supervisee asked how she could be both alive and stable with this patient.

That is the big question, isn’t it? Bromberg, in On Knowing One’s Patient Inside Out (1991), wrote about how very difficult it is to be both participant and observer [Sullivan]. I have often wondered how one can hold the patient’s hand and jump into the abyss with the patient, and still hang on to the rim. It must take Herculean strength, and personal mettle. I know I failed gravely at least one patient.

Is the deadness the therapist feels inside not also, at least partially, a joining with a self state of the patient’s? Could the patient’s chaos be a way to protect herself from such deadness? Had the therapist stumbled upon something that the patient had dissociated in attempt for the patient to save herself from deadness? The supervisee asked why I, the supervisor, in multiple venues we had shared, was always so alive. That got me to thinking about from what deadness inside myself did I wish to run? Was avoidance of such deadness what made it impossible for me to truly leap into the abyss with my patient(s) and could it have simultaneously caused me to let go of my observer stance? The supervisee worried that, were she to enter the self states of her patients, they would either not make progress in therapy or they would leave treatment altogether for they would lose hope. I surmise that, should we make friends with our dissociated self states, neither destroyed not shamed, that might open a path for hope.

Sunday, May 17, 2015

Film: The Innocents, Henry James' The Turn of the Screw

The paternal grandfather of Henry James, an Irish immigrant who became quite wealthy, had little time for James’  father Henry James, Sr.  James, Sr. himself was injured in a fire as an adolescent and lost his leg. He remained bedridden for a few years which finally garnered the attention of his parents. He too was a writer (newspapers), dabbled in theology, but was disinherited by his own father after a few years as a wayward youth. Having felt unloved by his father, James, Sr. was determined to shower his first born son William (the American physician, philosopher-- and psychologist who met Freud) with attention. Tragically, his controlling ‘love’ of William, and of his second born son Henry, left both sons feeling oppressed by their father’s attention, something from which both struggled to free themselves, but not without life-long battles with depression. It is thought the suicidal William was bipolar as well. Their younger siblings, Wilkerson, Robertson, and Alice (the recipient of inappropriate courting from William) all suffered mental illness as well, e.g. Bob with alcoholism, Alice with ‘hysteria’.

Henry James never married, but he wrote about some of the ‘ghosts in the nursery’ [what therapists know as fear, helplessness, rage]. These ghosts are intergenerationally transmitted, speak to the pain of multiple losses [such as loss of recognition, attunement, love, and actual caregivers]. In The Turn of the Screw, Miles and Flora have lost first their parents, then grandparents, then their beloved governess.  The governess narrator arrives and devotes herself to her wards, reminiscent of Henry James, Sr.’s crippling devotion to his two elder sons. Only after the two children are separated from one another, the governess – unable to bear the sadness of her wards’ many previous losses [much like the hapless therapist]— in the last straw, the turn of the screw, in ‘saving’ Miles from his demons,  contributes to his fatal injury. The governess has failed to hold Miles in mind, having deprived him of healing through relationship. Much like Henry, Sr., she has blurred the distinction between her own needs and those of her charge.

That which is disavowed can return with a vengeance. James deftly leaves us to consider whether the ghosts here are from within or from without, or both.

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.'