It's Not Incompatible After All!
Using Theoretical Differences

A Commentary on Susan Sands' article, "Self Psychology and Projective Identification - Whither Shall They Meet?"

By Jacqueline Roller, PsyD


Susan Sands identified herself as a relational clinician whose work is grounded in self psychology. I was impressed with her ability to examine how self psychology may fall short of understanding some patients. I had been drawn to self psychology because it purports an empathic immersion with the patient. I previously understood this empathic stance as one of the most mutative elements of analysis. Her article made a sound argument that the empathic immersion is with the patient’s ego (concordant identification). Sands cautioned that self psychology is at risk of missing an important aspect of the patient’s internal world, namely the internalized objects (complementary identification). This article challenged me to re-examine my previous theoretical stance in order to more fully understand the patient.

Sands argued that the analyst may miss the countertransference in the empathic immersion. The analyst may be blinded from recognizing when the identification is with the patient’s internal objects (complementary identification) rather than the patient’s ego (concordant identification). The article emphasized that patients have a desire to be fully understood; including their disavowed affective experiences. Sands contends that empathic immersion promotes understanding only one aspect of the identification.

After consideration of the article, I continue to believe empathic immersion is a helpful tool for concordant identification with the patient. With this immersion I can gain greater understanding of the patient’s ego. However, I am left without an understanding of the patient’s internalized objects, namely complementary identification. This article challenges me to receive the patient’s experience of disavowed affect in order for complementary identification to occur. I believe projective identification is a useful tool for receiving the experience. The transformative element will occur when I can receive the projection, contain the experience, survive it, and then offer something different to the patient. The article builds a strong case for using the empathic immersion of self psychology while maintaining an open container for receiving the projection. If I offer a space that allows for both concordant and complementary identification there is a greater chance that the treatment will be mutative.

References
Sands, S.H. (1997). Self Psychology and Projective Identification—Whither Shall They Meet? A Reply to the Editors (1995). Psychoanal. Dial., 7:651-668


Jacqueline Roller, PsyD attends the New Directions program in psychoanalytic writing at the Washington Center for Psychoanalysis in Washington D.C. and is in private practice in Sarasota, Florida.

Christopher Bollas in Tampa



on Free Association and the Logic of Sequence



If the measure of our interpretations is the subsequent enhancement of facilitating the patient's narrative, free associations, and new material, then Christopher Bollas, hosted today in Tampa by the Contemporary Institute (Sarasota, FL), can not be found wanting. His presentation today generated "redolent" discussion on breaks, at lunch, even in the car pool home. Bollas declared himself a Freudian, noting that there are many Sigmund Freuds, depending on whom one asks. His model is pluralism and what comes to mind is based on the clinical material at hand [conflated inevitably with what the analyst has learned from theory]. Bollas is a Freudian in the classical sense of following Freud's privileging of analytic tasks of surrendering one's self to one's own unconscious in evenly suspended attention, not trying to fix in memory anything the analyst has heard, but rather in attempt to catch the patient's unconscious with the analyst's own unconscious. This is different from, what Bollas says is, the ego psychologist's having even temperament and being attentive. Bollas does not believe that what passes for classical analysis (the neutral blank screen who says little) is really what Freud meant, that is, is not really classical.



Bollas is especially laudatory about The Interpretation of Dreams because, in it, Freud recognizes that dreaming is another form of thinking, and that in Freud's having asked his patient to give their thoughts about specific dream elements, Freud discovered the value of the technique of free association. Bollas thought dreaming might actually be the most sophisticated and significant form of thinking that humans possess, for in dreaming, we can condense a multiplicity of ideas into a single image and express a simultaneity of a plenitude of thoughts. This remarkable ability of the mind is what inspires art, music, poetry. To interpret in the here-and-now is impossible because there are too many simultaneous levels happening in any given moment.



Freud understood that if one listened long enough to the patient's free associations, a pattern would emerge, a pattern that linked seemingly unlinkable thoughts. This is the logic of sequence [juxtaposition, contiguity]. (If content A is followed by content B, then this is read as AB.) And the unconscious mind functions with this logic! But, the patient needed to be instructed to be completely honest and not hold back even seemingly nonsensical, unimportant, or irrelevant thoughts.



Bollas added that Americans, as a culture, do not know how to free associate, whereas Europeans do. Americans communicate in and accept phatic [meaningless, insignificant, importless] language, only sharing a social reality but not really communicating. Therefore, analysands need to be instructed how to produce their narrative in a more meaningful way. [I had a difficult time reconciling this idea with evenly suspended attention and the faith in my unconscious being able to communicate with my patient's unconscious, but I invite explanations, please.] Later, he said all people free associate, that the unconscious poses questions, then comes to insights on its own, if we don't impede their free association with our comments. [I am aware of neuropsych research that shows the mind, particularly in dreams, does just that, organizing and problem solving.] It was noted that free association, in allowing the patient liberty to let the unconscious do its thing (as well as patient having become an attentive and dispassionate observer, too), is curative in itself, that is, comes to its own insights.



So when does the analyst make a comment? When the free associations indicate that the analyst's conclusion are evident. When the material at hand indicates and when the analyst is following the line of thought of the analysand. The purpose of listening (and interpretting), Bollas says, is to gain greater access to unconscious processes.



In a most illustrative way, Bollas gave a verbatim session of a supervised case. (He asked the attendees to free associate to the material [with which we complied so well, acting as patients, that we ignored the point of the lecture: finding the unconscious processes in the sequence of the material, or acting like analysts]. ) He then discerned aloud what the unconscious connections were thought to be, relying on the patient's associations, and the logic of sequence, as the evidence. It deserves reiteration: the analyst's conclusions are based on evidence from the patient's associations. This is why we must avoid interfering with the patient's associations.



These are just some of the thoughts after this stimulating and generative day. Let's hear from some of the other attendees. There was so much going on at one time, one can not possibly associate to every element in today's exciting workshop.

THE OSCARS ARE COMING

Juno

Here's another surprise (or, sleeper) of a delightful little comedy that garnered four Oscar nominations : best picture, director-Jason Reitman ("Thank You for Smoking"), actress- Ellen Page ("Hard Candy"), and original screenplay--Diablo Cody).

Juno is courageously idiosyncratic. Neither I nor my friends in high school could boast the kind of poise, level of quips and sarcasm, or the equanimity that Juno can. But we had heard of birth control. This is an entertaining film for adults but most of the struggle of a teen in this situation was far too subtle and adumbrated by the glib humor. I would definitely heed the PG-13 warning and not allow pre-teens to see this movie. Even with older teens, I would then discuss the content.

For all the luminosity of Ellen Page, I found myself most enamored of her down to earth, HONEST-with-themselves parents. The most poignant moment was when Juno, in contrast to the teens who know-it-all, admits, "I don't really know what kind of girl I am." Some thought Jennifer Garner as the perspective adoptive mother Vanessa was moving as she talked to the fetus through Juno's abdominal wall. I was more impressed with her more realistic portrayal of a first time mother, painfully awkward and unsure of her self. I might have been reluctant to choose an adoptive mom who was so rigid and seemingly up-tight and proper. Perhaps Juno thought Vanessa a welcome contrast to her own biologic mother, who seemed a bit eccentric and clueless, sending cactus as a gift year after year.

I liked the honest portrayal of girls, too, being interested and curious about sex, no Persephone having to be kidnapped to be sexual. I just don't understand why the movie did not allow for better understanding of the motives behind two smart teens, who know where babies come from, doing something so cavalierly. The matter of fact way they handled the outcome was a bit eerie. But I guess any difficult situation is fair game for humor. And I laughed a lot at this movie. I was just surprised about all the nominations.

THE OSCARS ARE COMING

Michael Clayton

Kudos to Michael Clayton for showing in an accurate light the symptoms of a person who suffers with bipolar affective disorder. But was the change of heart and integrity of Arthur Edens (Tom Wilkinson) only the result of going off medication? The protagonist, same name as the movie's title, certainly was more anguished in his choice to do the right thing. That Michael Clayton has been nominated for an Oscar for best picture makes this movie, to me, a sleeper (in fact, I dozed off in parts), the fine Tom Wilkinson and marvelous Tilda Swinton performances not with standing. One colleague thought it made the list because it speaks about the corruption, even willingness to kill, of contemporary corporate America, in particular, the Bush administration. I don't know.

Written ("Bourne" trilogy) and directed (first time) by Tony Gilroy, it is in the genre of John Grisholm and intelligently suspenseful. It is a story about one man's (Clayton's, played by George Clooney) redemption. But unlike "Atonement," this main character is so covered in figurative mud it is easy to believe he had to be pushed into doing the right thing. Clayton says of himself, when a client hopes he can get off scott-free after a hit-and-run , "I'm not a miracle worker, I'm a janitor." Clayton cleans up the messes of his law firm's senior partners and of their clients. In this case, Edens, defending an agri-giant with a poisonous product in a $3 billion law suit, has decided to go over to the righteous plantiffs' side and to reveal documents which seal his client's culpability. Unethical for a lawyer, perhaps Edens invokes a higher judge. "I have blood on my hands!" and "I am an accomplice!" Edens tells Clayton. Edens was inspired by one plaintiff, Anna: "She's a miracle, a perfect little creature," whose parents are dead and whose brother is dying (think Erin Brockovitz and Changing Lanes).

But the movie isn't about Edens (or Eden). It's about the lengths people wil go to to protect their own (greedy) interests and about Clayton's change of heart. It was difficult, though I am in that business, to understand how Clayton is finally led to change. Perhaps it was his tenuous, though valued, relationship with his son, just as Edens may have seen his daughter in Anna, that helped both men strive to make the world a safer place, or, at least, to hold accountable those who poison the world. Perhaps it was the loss of a valued friend and mentor that was the last straw for Clayton. The other characters showed no shortage of a deficiency in putting themselves in another's shoes. But that is a hard thing for all of us.

Protecting one's interests reminds me of Jessica Benjamin's work (see "It Takes Two..." posted on this Blog on February 6, 2008.) How very difficult it is to put oneself in the other person's shoes, that is to say how easy it is to dehumanize, if only momentarily, another person to that of an object for one's own devices. (Anton Chigurh "No Country for Old Men" was on such an inhuman mission, and was unrelenting. Daniel Plainview "There Will Be Blood" sometimes connected with his adopted son and had to struggle to stay disconnected from his past and from his longing for family).

Change of heart? Isn't that a welcome by-product of psychoanalytic psychotherapy? New York Times writer Manohla Dargis said of Clayton's legal morass "an abyss, largely of our own making." Don't our patients, with us, sometimes discover that they have more freedom than here-to-fore realized to make changes which invite more joy and peace into their lives?

Let us know what you thought of Michael Clayton.

Poverty poisons brain development in early childhood

The Financial Times of London, reporting on the recent Boston meeting of the American Association for the Advancement of Science (AAAS), cites recent studies from several American universities that show that neural development is interfered with in children growing up in conditions of poverty. This effect is thought to be due to unhealthy levels of stress hormones, and is above and beyond any damage caused by poor nutrition and/or exposure to toxins. These studies were done at the University of Pennsylvania and Harvard, and show the pervasive harm is greatest during brain development between the ages of six months and three years. The director of Harvard's center on the developing child, Prof. Jack Shonkoff, said "the foundation of all social problems later in life takes place in the early years." Excessive levels of these stress hormones disrupt the formation of synaptic connections in the developing brain, and "literally disrupt the brain architecture." The scientists think that this neurocognitive damage is why programs such as Head Start have produced only modest results.



The full article can be found at: http://www.ft.com/cms/s/0/62c45126-dc1f-11dc-bc82-0000779fd2ac.html



Paul Krugman, writing in the New York Times on February 18, has a poignant column titled "Poverty is Poison" and cites that 17.4 percent of children in America lived below the poverty line in 2006. He faults the governmental shift to the right, since LBJ's "War on Poverty" with its de-emphasis on combatting poverty, for the worsening problem. His very touching article can be found at:



http://www.nytimes.com/2008/02/18/opinion/18krugman.html?_r=1&hp&oref=slogin



These are important considerations to bear in mind in working with patients and clients who may have grown up in conditions of poverty - as well as in our social and political thinking. The societal consequences are broad and deep and long-lasting.



Key words: Poverty; Neurocognitive impairment; Brain development; Social conditions; Public policy

Posted by Edward H. Stein, M.D.

An Interview with Owen Renik, MD

by Randall C. Wyatt, PhD and Victor Yalom, PhD on Psychotherapy.net

"The concept of resistance presupposes that the therapist has a superior knowledge of what is going to be good for the patient, that trumps the patient—which is disastrous—rather than constantly negotiated for the best in a dialogue between patient and therapist."

Click here to read full interview

About Owen Renik, MD

Owen Renik, MD, is currently a Training and Supervising Analyst at the San Francisco Psychoanalytic Society. He was Editor in Chief of the Psychoanalytic Quarterly for ten years, Program Chair of the American Psychoanalytic Association for two terms, and served as Director of Training and Associate Chief of the Department of Psychiatry at Mount Zion Hospital, San Francisco. He maintains a private practice in San Francisco.
Source: Psychotherapy.net

THE OSCARS ARE COMING

Atonement

This cinemagraphic pleasure is nominated for seven Oscars including best picture, best supporting actress (13 year-old Saoirse Ronan, who plays young Briony), best cinematography, and best adapted (from Ian McEvan's novel) screenplay. Directed by Joe Wright, it won the Golden Globe 2007 for best picture, and Kiera Knightly garnered the Globe for best actress. Freudians won't be able to avoid conflating Briony's girlhood crush on Robbie (James McAvoy), the housekeeper's son, and her witness of her older sister Cecilia's (Kiera Knightley) sexual relationship with him, with an oedipal triangle.

Briony, as a much older woman (Vanessa Redgrave), has written her last novel: about those long ago, family events, but conceived with a happier ending in order to give back, in fiction, what she had stolen from the lovers in real life. This happier, fictional spin is how many patients arrive in our offices, and the therapeutic work becomes its antithesis. Therapeutic work is not to justify some truth to childhood unhappiness, but rather to bring to light the fiction (erroneous beliefs) that is a child's explanation of events (written with a child's limited experience, cognitive maturity, and perspective) which amplify unhappy experience. It is to rework the narrative into a more realistic, more forgiving one. The grown up Briony entitles her novel "Atonement" precisely because she feels guilty. While she may, as a child, have known Robbie was no rapist, or may have conflated the coitus in the library with the rape on the grounds, she comes to realize her mistake. What may have been harder for her to forgive in herself was that her crush on Robbie motivated her vengeance. It doesn't take Freud to figure out that Briony (and Cecilia) devote themselves as nurses to wounded soldiers, both to be closer to Robbie away in the war, and also, for Briony, to assauge her guilt.

Where A.O. Smith of the New York Times writes of "the film's failure to find a strong connection between the fates of the characters and the ideas and historical events that swirl around them," I see this "failure" as an accurate depiction of how historical events, for most of us, are overshadowed by the emotional primacy, particular to our personal relationships, which lives in the human psyche. This film is worth seeing for it's richness in scenes and psyche, but it is not my pick for best pic.

VALENTINE'S DAY, CELEBRATING EROS



Love
What Jessica Benjamin writes in her first book The Bonds of Love (1988) Chapter 1 "The First Bond" about love is appropos to quote on Valentine's Day, when Cupid, or Eros, is celebrated at the fore front:

the sensation of love: relaxing the boundaries of the self in communion with others

requires an awareness of one's own internal experience, a recognition that others have it too, and the possibility of sharing these. The attunement of two separate subjects who can momentarily share the same feeling brings joy, increased by the simultaneity of connection and separateness.

Perhaps the greatest struggle in a relationship is the one which strives to balance the tension between two, separate subjects, each with her/his own desire and agency. The human desire to assert one's self, one's autonomy, will, agency, subjectivity is at odds with the desire for recognition, connection, communion, attachment. This tension is so precarious that some find themselves believing that to love is to submit one's will to the other, or have the other submit her/his will.

As in therapy, where one can be oneself, be authentic, and accepted for whom one is, warts and all, many long for love which includes security, safety, feeling important and special to the other, as well as the newness and unpredictability that comes only with another subject, not from a love object,

Eroticism
and, (Benjamin) in erotic life:

"when we experience together the gulf that separates us, we recognize our mutual condition...[thereby] creating sexual excitement."

In erotic union we hope for transcendence, a connection to the outside world. We hope for completeness of our inner world, a "true self" [Winnicott] experience. The other can become for us a "transformational object" [Bollas], helping to regulate the discomfort generated by the everyday activities which may be dissonant with our authentic feelings. We, as well, can participate in an act of creativity, affecting the other and creating a new space for relationship.

In Like Subjects, Love Objects Benjamin writes, "One must recognize another other as another subject to fully experience the self in the other's presence."

Benjamin writes that pornography uses both the intrapsychic fantasy of relationship with an (idealized or denigrated) object as well as an intersubjective acknowledgement of an other, and the erotic transference must look to both the intrapsychic forces as well as the intersubjective.

History (in case you were wondering)
There are numerous legends about St. Valentine, who may or may not have been more than one person, but, in general, Claudius II Emperor of Rome was the Scrooge of love: He forbade marriages and engagements because they interfered with military recruitment. So, the Bishop Valentine married young couples in secret. For this, or perhaps for refusing to denounce Christianity, he was martyred in about 269 AD. While awaiting execution in jail, he befriended, or fell in love with, the jailor's daughter Asterius. Allegedly he performed the miracle of restoring her sight (helpful if one is to be sainted later), but, at any rate, signed a farewell love note to her: "Your Valentine." Voila! Now we all can send valentines to our friends and loved ones. (Thank you, Hallmark.) By the way, the relics of St. Valentine can be found buried at the Whitefriar Street Carmelite Church in Dublin, moved there in 1836 courtesy of Pope Gregory XVI.

Valentine's Day falls, as every school kid knows, on February 14th. This was another conflation of celebration by the (Catholic) Church, this time with the Roman pagan Feast of Lupercalia which fell on February 15th and followed Juno Februa (Juno the purifier, the queen of the Roman pantheon) which fell on February 14th. In the 4th century, young Roman men and women celebrated with a lottery where couples were paired off as a rite of passage. Pope Gelasius frowned on this encouragement of carnality and so in 496 AD replaced the diety Lupercus with St. Valentine. Young Roman men, having given up the Lupercan, and adopting St. Valentine's name, now courted young women with their handwritten declarations of love.

This exhibition of love from antiquity was revived in the Middle Ages, compounded with the, then, belief that birds chose their mates in mid-February, and promulgated by the likes of Chaucer (1382). Even Ophelia remarks on St. Valentine's Day (Lucky Tampa, discussing Hamlet on March 15). In fact, many poets, Dayton, Donne, Wadsworth wrote of birds and Valentine's Day. The printing press allowed for anonymous, and, therefore, risque, declarations (which would later scandalize Victorians) and, by the 16th Century, Cupid the son of Venus the Roman goddess of Love adorned valentine cards along with the heart shape we know today. (Freud preferred the Greek Eros, son of Aphrodite. For an interesting take off from Eros and Psyche, read C.S. Lewis' novella Till We Have Faces.)

Clinical Questions (ala J. Benjamin):

1. How does one recognize the other as an equivalent center of experience?

2. In any relationship, how does one contain, rather than resolve, contradictions?

3. How do we recognize the other with her/his differences without assimilating or repudiating the other, without turning the other subject into an object? [Identification preserves difference by allowing for different "self-positions" even while relating to the other as an object. It also helps with empathy and acceptance of difference.]

4. How to we accept the unknowability of the other?

5. How does one balance the desire to be connected with the wish to be independent and separate?

6. How do we help our patients "acknowledge the value of what has been banished?"

7. Does the inability of our patients to allow for love and nurturance from others reflect a defensive clinging to an [American, and some psychoanalytic] ideal of self-sufficiency and omni-competence?

8. How do we recognize the mutuality of influence between patient and therapist even while acknowledging the assymetry of our roles?

The OSCARS ARE COMING

There Will Be Blood

Starting as early as the title, chosen by writer/director Paul Thomas Anderson, this film's events reek of Biblical metaphor of Flannery O'Connor proportion. But this film is about more than a mere battle between greed and god. It depicts, however subtley, one man's struggle to maintain, perhaps to create, a sense of self. Garnering an identical eight nominations from the Academy, "There will Be Blood" is, in my opinion, only a close second to "No Country for Old Men."

I agree with Roger Ebert that Daniel Day-Lewis as Daniel Plainview gives an Oscar-worthy performance, but disagree with 's Ebert's view of Plainview as a man who regrets nothing and misses nothing. Other reviewers have described Plainview as the devil, evil incarnate, and a consummate antisocial, but Plainview managed to sustain a loyal employee, Fletcher (Ciaran Hinds), and I saw Plainview as genuinely connected to his son H.W. (Dillon Freasier). (Does the H. stand for some family attachment from the past, such as father, or brother Henry he longed to know, but never knew?) While it is true, Plainview uses his son as a "prop" to pose as a family business in order to acquire more wealth, the denouement with his son, now grown, shows that Plainview had every hope that it be, in fact, a family business. When Plainview repeats, "I am a family man," it is not so much a lie as, like a child, a wish that it be true.

Plainview, at first, only takes the toddler silently on his lap, but with affectinate touches. As H.W. grows, Plainview has learned to share verbally with the boy his knowledge, plans, etc., and continues affectionate touch and play. Even when sending the boy away to a special school, Plainview does, though crudely and without the contemporary understanding of the meaning of attachment (ala John Bowlby), what he thinks is best to help his son, and he does so with evident pain and guilt. (Any of us in the 1920's might have done the same to help our child accomplish as much as possible given H.W.'s acquired deafness.) When Daniel must, for land and oil, humiliate himself before a congregation which he finds false and superstitious, I couldn't help thinking of Jerry Maquire shouting 'Show me the money!' ---except this is more dramatic, and is another hint of Plainview's sincere guilt about his son. Only a man, consumed by the bitterness that can compound the loss of early attachments, and brain damaged by years of alcohol consumption, could disown his son with such viciousness, the penultimate pummeling, this time verbal, of the film. When Plainview shouts at his son, "You've been building your hate for me piece by piece. I don't know who you are!," we recognize that Plainview, without awareness, is describing himself. (I liked the movie enough to forgive the medical error of having the grown son speak as if he had been born deaf instead of had acquired deafness.)

It is interesting that the two murders Plainview perpetrates are both against men who falsely claim to be his brothers/brethren, thereby stirring up an anguish deeply imbedded in Plainview's psyche. These imposters remind him of what he has longed for and lost, perhaps never had: a past which held filial and familial attachments. The narcissistic rage with which he kills his second victim at first is comic, particularly the victim's behavior, as if in Mel Brooks' "High Anxiety," but we are left unsettled by Plainview's utter despair in this most desperate attempt to restore himself by annihilating the other. (Think E. Wolfe, Chapter 6, "Narcissistic Rage," p. 79, in the text, The Psychology of the Self: ..."when the self feels absolutely helpless, vexed, and mortified, that is, paralyzed while agitated to the extreme and in deathly danger of losing its integrity...the offending selfobject...must be made to disappear, violently if necessary, even if the whole world will go up in flames." )

At the start of the movie (with its soundtrack, a nod to "2001, A Space Odyssey"), as I watched Plainview fall down a mining shaft, break his leg, pull himself out and go about his business as usual, I was reminded of Anton Chigurh ("No Country for Old Men") who binds his broken arm, bone protruding and bloody, in a sling made from a boy's shirt, picks himself up and walks down the sidewalk, business as usual. I wondered, was Plainview going to turn out to be a ruthless automaton like Chigurh? He would not. Psychoanalytic training allows for a fuller picture of a man (and I say "man" because women are all but absent in this film), his greed and his goodness, his loss and his longing. I applaud Peter Travers (Rolling Stone) for having the courage to write we "see ourselves in Plainview." (Ironically, this double entendre is seldom true, for most of us do not see ourselves in plain view).

What are the curative factors in recovery from mental illness?

Link to a very interesting article in the Washington Post on Feb. 10, by Charles Barber, a mental health worker at Yale:

http://www.washingtonpost.com/wp-dyn/content/article/2008/02/08/AR2008020803272.html?hpid=opinionsbox1

Barber describes his own journey to recovery from an incapacitating mental condition, and draws some observations from his own experience and from research into the conditions that facilitate recovery. He speaks against the "medical model" of attempting to alleviate symptoms through the use of drugs, and instead focuses on the healing effects of "social context." He notes that outcomes from even such severe mental illnesses as schizophrenia are better in developing countries, where "patients get more support from family and society." His is an argument against pharmacotherapy and "therapist as expert," and instead, an argument for immersion in a supportive social mileau.

Barber does not use the language of self psychology or relational analytic theory but, using these schools of thought as lenses, what he says becomes readily explainable. A self psychologist would recognize all of the curative factors Barber lists as sustaining selfobject relationships that lead to restoration of cohesion to the disequilibrated self. What Barber describes as curative is the restoration of the "selfobject mileau."

Near the end of his article, Barber states that "Listening to patients [the curative factor] cuts against the establishment grain." Here, he speaks of what Kohut and others have termed "empathic immersion" in the patient's experiential world. (Cf. also Donna Orange et al.)

How would other schools of psychoanalytic thought explain what Barber describes in his article? Post your thoughts, reactions, and other musings on how best to explain the important observations about what constitute the curative factors that Barber describes.

Note that Barber has a newly-published book in which he elaborates on these ideas.

Tampa Bay Psychoanalytic Society Scientific Meeting 2-9-08 "Expanding the Domain: Privacy, Secrecy, and Confidentiality"

by Jack and Kerry Kelly Novick

Jack and Kerry Novick, Ph.D.s and both Child, Adolescent, and Adult Analysts, on faculty at the Michigan Psychoanalytic Institute (Ann Arbor), the NY Freudian Society, and the Tampa Bay Institute for Psychoanalytic Studies, gave a most helpful clinical paper. They discussed the increasing acceptance of the practice of seeing both child and parents, whether this is done concurrently, and how frequently, as well as what is disclosed to each. They note that D.W. Winnicott said there was no such thing as a baby, only a mother and a baby.

In working with children and adolescents, they advocated discussing early in treatment, with both patient and parents, the distinction between privacy and secrecy. Privacy is the right of every person to keep her or his inner world of thoughts and feelings to her/himself, or just between patient and analyst, and to choose when and with whom to share what is in her/his mind. Secrecy is motivated by the wish to withhold and thereby feel powerful in relation to an excluded other. Privacy is not secrecy. And any secret can be the object of analytic scrutiny. The analyst supports the privacy of thoughts and feelings while simultaneously examining, in their respective therapeutic arenas, the actions of both child and parents. As adolescents learn in therapy to better distinguish between privacy and secrecy, they discover an increased freedom to share only what is helpful with their parents and learn they need not divulge everything about their private life.

Parents, like analysts, are interested in the forward developmental movement of their child. The analyst forms an additional alliance with them by discussing the dual goals in therapy of 1) restoration of the child to a progressive developmental path, and 2) restoration of the child-parent relationship so that each may be a life-long resource for the other. The Novicks discuss parental concerns openly with the parents, e.g. the fear of losing the child. One hope of treatment is to facillitate communication between parent and child. Inclusion of parents in treatment increases the chance of both retaining the patient and the success of the treatment.

A clinical example illustrated the harmful impact on a child of a heretofore undiscussed family secret. When brought into the open during a session with the parents, the parents were then able to acquire the tools, and courage, to discuss it with their child. This greatly relieved the self-denigration which had resulted from the imagined explanation by the child of family events, and it improved the marital relationship.

When parents feel helpless, they often expect the analyst to act in their stead to police the child. The Novicks call this an externalization (of superego, a defense just as likely applied by the child). The analyst, however, promotes the parents as central in the child's life and development, as well as primary in being responsible for the child. Therapy simulataneously promotes the child's capacity to self-regulate. Dr. Novick will ask if the patient is being a good parent to her/himself. (If not, this may indicate the child's modeling of parents in their lack of parenting.) The analyst does not turn a blind eye to lack of appropriate behavior and supervision on the part of the parents. Parents need to support appropriate controls which aid in the child's development. They need to see both a child of growing strengths and competence and the need for provision of continuing parental supervision.

So how is confidentiality managed? Confidentiality is seen as a basic component of any treatment, but it is placed within a hierarchy of other values. The analyst emphasizes that therapy is a safe and private place in which to explore one's most private regions of self, and which allows for and respects competence, creativity, and love. The analyst emphasizes the difference between private thoughts/feelings and actions, which are public. Both privacy and safety are maintained. The latter includes letting the parents know of dangerous actions to aid the safety and comfort of all family member in the therapeutic situation. The Novicks enumerated some of the behaviors which arise in adolescence: drug use, unprotected sex, eating disorders, gang activity, suicide and murder, delinquency.

The Novicks redefined separation and separateness. Physical separation does not equate with psychological separateness. [I would insert here, as the Novicks intimated, that a goal of development includes both a sense of self as separate, balanced with a capacity to, not only see the other as separate but, maintain a connection between separate selves, that is, to develop both autonomy and attachment or relatedness.] When the analyst colludes with an adolescent to withhold information about the patient's dangerous activities, this secrecy impedes development by creating an illusion of separateness. The clinical example of a suicidal young man, about to embark for college, was discussed. Dr. Jack Novick had asked the youth if his parents knew of his intention to shoot himself with his father's accessible gun, encouraged the youth to tell his parents, then arranged an emergency session with parents and youth to arrange how to keep the young man safe.

The Erotic

"In Treatment," HBO touts therapy

There is a man in my life. I hang on his every word. I observe his every gesture. When he lifts an eyebrow. When his breathing hastens. When his eyes smile. I want to know everything about him, who he is, where he came from, what his family is like. And I remember everything he tells me.

Is this not love? Would not this devotion engender love? (Remember that he is my
analysand.)

Not just because February is the month for Valentine's Day that I wanted to make a few remarks about the erotic transference that appears on Monday nights in this 9 week HBO series. When the male therapist is asked by his female patient (2-4-08 show) whether he thinks about her sexually, he hesitates, then lies, and says, 'No.'

The exploration of the transference, of the patient's fantasies about the therapist's thoughts, controversies over self-disclosure, etc. notwithstanding, when do we ever want to lie to a patient? Don't we want to do two important things in the therapeutic relationship:

*be part of an authentic, though mindful, relationship, and

*not repeat for a patient the experience of not being able to trust her own perceptions

Analytic therapy is a gift of listening, listening with an ear to understand, without judging. But what about the gift of relationship where we admit, at least to ourselves, our contribution to the experience. Isn't this relationship, despite any ideas on transference, also a unique relationship created by patient and analyst? Isn't the space between us, between just us as well? A space where play, in the Winnicottian sense, or hope ala Frank Summers, can happen? Do we really want to lie and inauthentically model to the patient that she has no effect on the world and on us?

I have heard many a colleague speak of love for a patient. Not so many like to acknowledge sexual feelings for a patient. (Of course, one is never to act on these feelings. ) I have also heard many a colleague talk about their anger, even momentary hatred, vis a vis a patient. Why the reluctance to admit to the erotic? This failure of bringing into the light this part of ourselves reminds me of parents who allow their children to watch movies/TV with violent, but not sexual, content.

Yes, the erotic feelings our patients have for us is transference and defense and the expression of gratitude and dependency and..., but is it not also engendered by and from us?

I would love to hear your comments.

Currently, HBO is offering free viewing of full episodes online at http://www.hbo.com/intreatment/

WELCOME!

Welcome to "Contemporary Psychoanalytic Musings," the blog of the Tampa Bay Institute for Psychoanalytic Studies or, as it is conveniently known, T-BIPS.

We invite you to post your comments on psychoanalysis and books, film, conferences, the media, art, theory, clinical situations, current controversies, social issues, and anything else as seen through a psychoanalytic lens.

We look forward to a spirited dialogue with you.

Gabcast! Welcome! #3

It Takes Two, Baby, Me and You

It Takes Two, Baby, Me and You

(Intersubjectivity)

Having read 3 books by Jessica Benjamin (The Bonds of Love, 1988; Like Subjects, Love Objects, 1995; and Shadow of the Other, 1998), I wanted to discuss with colleagues philosophical and clinical thoughts gleaned from and engendered by them.

* Humans are in a constant dialectic with self-assertion and recognition.
That is, there is a struggle to sustain the tension of one’s own subjectivity with that of the other’s subjectivity; we keep wanting the other subject to be an object who fulfills our desires as if the other had no independent desires. What’s more, to balance one’s own subjectivity with the other’s is a Herculean task, and doomed to fail. The good news is we can continually renew the task.

Hegel writes that each strives to be recognized as an independent self while, paradoxically, requiring (depending on) an other for recognition.

Benjamin writes that mutual recognition is necessary to fulfill the potential of both our autonomy and our relatedness. This desire for recognition as a separate self , including to have an effect on the world, fuels the therapeutic relationship.
Intersubjectivity posits a place, a third, between two subjects, where there exists the possibility of the sharing of a like experience by two different minds. This moment of recognition that two different minds are sharing the same experience brings joy to mother and toddler, to erotic union, and to the clinical experience. It is where empathy lives.

* The capacity to recognize the other as an independent subject is a developmental achievement. Winnicott writes that a child’s self-assertion includes negation of the (m)other, a destruction (in inner life) that she must survive (in external reality) to aid a child in its ability to differentiate inside and outside, fantasy and reality, self and other.
To live in the dialectic, one must keep negation alive alongside recognition.

For therapists, this can mean recognizing and tolerating the negative views of us by the patient, as well as exploring the therapist's real relationship contribution to these negative views.

* The different other is a threat to self because we are reminded we can’t be everything nor can we have everything. This has an impact on gender development, on the oedipal resolution, and on the grieving process inherent in the clinical situation.

An Afternoon At The Theatre

"To be, or not to be,

-that is the question-"

Join us for an afternoon at the theatre
followed by dinner and lively discussion

HAMLET

Saturday, March 15, 2008 3:00 pm matinee
American Stage
211 Third Street South, St. Petersburg, FL

Featured Discussant:

Shakespearean Scholar
Peter Rudnytsky, Ph.D.

Professor of English, University of Florida; Editor, American Imago

Reserved seats, $24.00, available on a limited basis through TBIPS
Cost of dinner is additional

RSVP to TampaBayPsa@aol.com or 813-908-5080

THE OSCARS ARE COMING

No Country For Old Men

Not since Carl Franklin's "One False Move" has tension been so quiet and so excrucuating. This is no country for the faint of heart. This eight times Oscar nominated film (including for Best Cinematography, Director, and Picture), produced and directed by the Coen brothers (of "Fargo" fame) has already won two Golden Globes (Best Supporting Actor-Bardem; and Best Screenplay -adapted from Cormac McCarthy's 2005 crime novel), and has won two Screen Actors Guild awards (Best Cast and Best Supporting Actor-again, Bardem). A.O.Scott of the New York Times called it a "ruthless application of craft."

What motivates Llewelyn Moss (Josh Brolin) to take two million dollars found in the Texas desert at a "goat fuck" of dead men and dogs, and, more bewildering, to take water back there to a dying man starts a chain of relentless slaughter by Anton Chigurh (Javier Bardem) who, as a grim reaper-like "psychopathic killer" is compared to the bubonic plague, and wastes anyone, unless spared by the toss of a coin, in his path who is seen as an obstacle or an annoyance.

I am reminded of another, tamer, allegory for therapy, the children's book Where the Wild Things Are, and how we clinicians are willing to go to the inner world of patients, their violent fantasies, their search for omnipotent control, their setbacks and acceptance. Analytic therapy is no place for the faint of heart. We therapists must contain the onslaught of hostility directed, sometimes misdirected, at us which rages inside our patients and not only hold it, even digest and re-present it, but hold it alongside their elegance, humor, and grace.

Unlike the violence-wearied Sheriff Bell (Tommy Lee Jones), perhaps so named to sound the death knoll, we choose not to retire from the never-ending task of looking at the heretofore unspeakable acts of the unconscious. Like the characters throughout this movie we follow unflinchingly the trails of blood. We also bear with our patients the unpleasant truth that the world is sometimes indifferent to us, and that terrible things can happen. Llewelyn's hubris that he can take on professional killers has dire consequences; Therapeutic outcomes, perhaps because narcissism becomes more adaptively configured or because most of us are only killers in fantasy, are usually of a happier nature.

My vote for the Best Picture Oscar is No Country for Old Men. Let us know what you think about this and other films.

Click here to visit the official movie site for No Country for Old Men