Pathological Accommodation

Last month at our Tampa Bay Psychoanalytic Society, Inc meeting, I found myself literally jolted by a concept. Many of our speakers have left indelible ideas and memories within me, but this notion explored on a November Saturday morning struck me as profound and clear and pervasive. Dr. Shelley Doctors elucidated the psychological process called "pathological accommodation," in which a person, likely from infancy onward, learns essentially to erase him- or herself in order to have a relationship with an important other. In other words, a child grows up knowing that in order to maintain a relationship with a caregiver, he or she must deny longings, feelings, and opinions that reside authentically within: "I will accommodate to you, my mother, so that I can have a relationship with you and thereby survive, but I do so at the cost of my very self and its development. I will do this because to be rejected by you, I fear, will be the very end of me. So, this is my choice, the lesser of two evils, between having no self and having nothing at all."


The Impact of Pathological Accommodation

It was not the idea of pathological accommodation per se that rocked me, but rather, the developmental course that this may take in one's life. Authors Brandchaft, Doctors, and Sorter1 describe these possible trajectories:

The child may attempt to preserve and protect this core of individualized vitality at the expense of object ties by determined non-conformism or rebellion. That is a path of isolation and ultimate estrangement. Alternatively, the child may abandon or fatally compromise his central strivings in order to maintain indispensable ties. That is the path of submission. Or the child may oscillate
between these two . . . Depression becomes the dominant affect in a person whom such a conflict has become chronic and internalized. It signals the loss of hope where no synthesis can be found between intimate connectedness with important others and the pursuit of a program of individualized selfhood. (p. 56)

It is deep within this quandary where I see many precious people. Those who disconnect relationally may do so because they have come to the conclusion that the price tag surrounding personal connections, especially intimate ones, is simply too high: it requires a submission of self-ness, authentic personhood. Those who remain in unhappy intimate situations may do so because they have concluded that it is better to have a relationship that is smothering and controlling (or abusive), than to disconnect from it and risk alienation or worse. And the third group: those who cannot be at peace in isolation or stultifying relationship. These try one approach until the pain of their current dynamic overwhelms them and then they flee---either into nonconformity in a brave attempt to find and hold onto their own voice, or into a painful intimacy in an attempt to feel less alien, less disconnected from.

Perhaps as you read about this process, you might identify with it, if only to some degree; perhaps you have noticed themes in your life not altogether different than the process of pathological accommodation. Coming to a point in life where you dare to believe that you can indeed have relationships that are mutual and reciprocal, that do not require a forfeiture of self, is not only a life-changing moment, but a life-giving one.

Steve Graham, PhD

1. Brandchaft, B., Doctors, S., & Sorter, D. (2010), Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision. London: Routledge.

Birthday: RFK

Had he lived, Robert Francis Kennedy would be 86 years old today. Perhaps like his brother before him, would also have been a U.S. President and an Elusive Hero. Robert Kennedy, on April 4,1968 in Indianapolis on the campaign trail, upon learning of the assassination of Martin Luther King, Jr, spoke to the crowd gathered before him, and, like a good enough therapist or parent, put himself in the shoes of an other when he said, “For those of you who are black and are tempted to be filled with hatred and distrust at the injustice of such an act, against all white people, I can only say that I feel in my own heart the same kind of feeling.”

As many that night had shown up with intent to avenge the murder of their beloved spokesperson, it was this empathic attunement which, I believe, circumvented in Indianapolis the violence that erupted in other U.S. cities. By acknowledging, understanding, and accepting such a feeling for himself, noting that he, too, had had a family member killed, the crowd knew that it had been heard and so action as attempt to be understood was not necessary. More than mere empathy, Kennedy, offering himself in communion with their sorrow, offered an alternative that might be shared by all “people who love peace all over the world.” That alternative was “love and wisdom, and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or they be black,” claiming that “the vast majority of white people and the vast majority of black people in this country want to live together, want to improve the quality of our life, and want justice for all human beings who abide in our land.”

In this same address, Robert Kennedy said,
“My favorite poet was Aeschylus. He wrote:

‘In our sleep, pain which cannot forget falls drop by drop upon the heart until, in our own despair, against our will, comes wisdom through the awful grace of God.’ ”

Sometimes I find the work that we do is also through awful grace.

Shaddock Shares Systems Theory Approach to Couples

The Tampa Bay Institute for Psychoanalytic Studies, Inc (TBIPS) was delighted to have as guest lecturer on October 19, 2011 David Shaddock, author of Contexts and Connections: an interubjective systems approach to couples therapy, apply systems theory to his work with couples. Intersubjective Systems theory recognizes that people are inherently connected. Moment to moment an individual’s psychological life is embedded in relational context. One advantage of a Systems approach is that everything is inherently contextual, everything potentially important. Likewise, the therapist does not have to be the one who knows (everything), as the goal instead is to bring about a shift in the dynamic system. The therapist asks herself in the moment ‘What triggered this shift?’

Shaddock says that a Systems approach, with its tenet that the whole is more than the sum of its parts, is optimistic, for systems can rearrange unpredictably after perturbation. Phase shifts are always possible. Perturb the system and the chance that it will reorganize itself in a new way becomes possible. Systems theory recognizes that the self is organized and reorganized spontaneously, not predictably predetermined. The therapist ‘catches’ these phase shifts. The couples therapist can, by making explicit a shift in the system, empower a couple with the experience that it does not take much to induce change. For example, when an angry couple suddenly softens because of something implicit, Shaddock will, to bring it under conscious control of the couple, point out the shift (e.g. ‘What just happened here? Your face just softened with concern and then your wife became calmer.’)

The therapist may view the couple through the frames of the repetitive selfobject dimension (ala Stolorow ), and the self/interactive regulation of affect dimension (ala infant research). In the former, one member of the couple may, in the therapy situation, have her/his worst fears confirmed. Couples therapist Carla Leone will watch the faces of each member of the couple to discern any hint of this retraumatization. The therapist can then intervene to shift from the repetitive pole to the more hopeful, regulatory one.

Recognizing two important ways to organize the world: defensively, and engaged toward relatedness, the therapist focuses on ‘toward relatedness.’ Couples therapists want both members of the couple to feel understood. (This decreases defensiveness, engenders hope, and increases the chance that each feels safer to state which needs each would like met.) A history, taken in front of the other partner, helps both the therapist to elucidate for herself a partner’s repetitive pole, and invites a new relational dynamic between the couple (by allowing the other partner to witness that it is historical factors, not the witnessing partner, which trigger fearful responses) and this may lead to a reparation of empathy.

In the affect regulatory dimension, each partner sometimes needs attunement from the other (interactive regulation) and sometimes needs time apart or alone for self regulation. Problems arise when there is a mismatch between how much a partner prefers one type of regulation. Because how we regulate and organize ourselves becomes who we are, the mismatch can suddenly shift to a ‘do or die’ level when denial of a preference threatens the self and feels like annihilation. Shaddock will make the shift explicit (e.g. Five seconds ago you were just talking about who does the dishes and now we are talking about divorce. How do we understand such a shift?).

Shaddock’s presentation was so illuminating that we look eagerly forward to his return to TBIPS in January 2012 to lecture again in our Couples Treatment course.

Rimbaud: “Je est un autre” the constructed self

Parents who fear for the future of their rebellious teens might take heart from the life of Arthur Rimbaud who, born in Charleville on this date in 1854, wrote his renowned and iconoclastic poetry before the age of majority and lived, a runaway, his wild, debauched, drugging (to derange his senses) days in Paris, London, and Brussels while still a teen. Rimbaud then put poetry and rebellion behind him to become, for the remainder of his short life (he died in 1891 at the age of thirty-seven), a lucrative coffee and guns trader in colonial East Africa for a French trading company. Not unlike teenagers today, Jean-Nicolas-Arthur Rimbaud, before running off to Paris, scrawled graffiti (“Shit on God”) on town walls, smoked, grew his hair long, and mocked a town priest with an homage to his holy bowel movements (the poem “Squattings”).

Teens have been discovering and held anthem the revolutionary works of precocious, adolescent Rimbaud ever since. Marcel Proust, Jim Morrison, Bob Dylan (who refers in one of his songs to Rimbaud’s tumultuous experiment with homosexuality and Verlaine); singer-songwriter Patti Smith (who wrote Rimbaud’s Illuminations “became the Bible of my life.”) have all, in some way, cited Rimbaud’s influence. Even the film Eddie and the Cruisers (with its nod to the poetic lyrics of Bruce Springsteen) referenced Rimbaud, with Eddie’s lost album entitled Seasons in Hell.

Rimbaud wrote to his friend and former teacher Georges Izambard: “I'm working to turn myself into a seer: … It has to do with making your way toward the unknown by a derangement of all the senses.” And “It's wrong to say I think: one should say I am thought.” and “I is someone else”. Rimbaud was perhaps the most avant garde in this statement “JE est un autre” ( I am an other) intimating, like Hegel before him, that the subjective self, the “I”, is constructed, the other, constitutive. A useful construct, yes, but within it are multiple components, opposing sameness, what today we call multiple selves.

And with nothing merely as its constructed façade, Rimbaud saw the value of writing not only of internal things but also of ordinary things as experienced through the unique subjective self. This required a new way of constructing poetry, including synesthesia (as Baudelaire had done), such that chaos was captured in correct form (Oh, that my keel might rend and give me to the sea!). Soon after, he contacted the Symbolist poet Verlaine.

Mothers of prodigal sons might also appreciate that Rimbaud returned again and again, after many escapes, to the home of his own stern mother, his father having abandoned them when he was five. At fifteen, Rimbaud sought his fortune in Paris, for the Franco-Prussian war had led to closure of his school and he was too young to be allowed to be a soldier. This runaway, homeless in Paris, arrested, destitute, was, most likely, also raped. His suffering and early losses are reflected in his poetry. (See, e.g., The Drunken Boat below.)

In Enid Starkie's biography, she writes that Rimbaud gave up poetry when he realized it would not bring enlightenment. His mother’s influence, when she wrote to encourage the suicidal Verlaine: “..each of us has a wound in his heart, more or less deep...true happiness consists solely in fulfilling of one's duty, however painful it may be. …you'll see that misfortune will grow weary of pursuing you, and you'll become happy once more”, may be evident in Rimbaud’s choice to become an industrious trader of goods. In a twist of fate, his capitalististic endings perhaps mock his earlier work, just as his poems had earlier mocked French conventional verse, liberating it from its 19th century themes and form.

Rimmbaud's suffering is evident in this excerpt from Oliver Bernard’s translation of The Drunken Boat

But, truly, I have wept too much! The Dawns are heartbreaking.
Every moon is atrocious and every sun bitter:
Sharp love has swollen me up with heady langours.
O let my keel split! O let me sink to the bottom!
If there is one water in Europe I want, it is the
Black cold pool where into the scented twilight
A child squatting full of sadness, launches
A boat as fragile as a butterfly in May.

Sunday Morning Musings

This morning I had the unexpected pleasure of hearing a hospital chaplain friend of mine give a sermon at his church. He shared with us his personal story of loss and darkness woven masterfully with the readings of the day from Exodus 33:17 (where God says to Moses “…I know thee by name”) and from Revelations 2:17 (where the those who “overcome”—did my friend know that the Martin Luther King, Jr Memorial was dedicated today?—will be given “a white stone, and in the stone a new name written”) and with the birth and naming of his first son. He thought perhaps the name at time’s end written for him in the white stone might be ‘the carrier of sorrows’ but should one turn over the stone, one might find also the name of joyousness.

After service, my friend reminded me of the psychiatrist (Peter Wilkins, see blog post of 9-9-11) who was asked how he could bear listening all day to the sorrows of others. Then I thought of my answer to the many times I have been asked such a question: I do not bear others’ sorrows as some burden, but rather I embrace them, with joy of communion, and with the recognition of the privilege that is bestowed when others share them with me. Then I thought of a person I see, a Buddhist who lessened her burden, not by bearing her sadness, but by giving it a name, by making it a companion always beside her, recognized and acknowledged, both sides of a coin, or of a stone.

Ethics and Outrage

A few weeks ago at brunch at the home of friends we were expressing our disappointment with the US President. We agreed that Obama seemed to lack outrage, a righteous indignation, at what is happening all around us. It seems Obama has not expressed outrage since the unfortunate arrest of Harvard professor Henry Louis Gates, Jr in Cambridge, MA in July 2009.

So I was very happy to come across the interview with Stephane Hessel two evenings ago on the PBS Newshour. Hessel, a German born Jew raised in Paris, a member of the French Resistance, and a concentration camp survivor, was cogently speaking about his book Time for Outrage--Indignez-Vous! In Time for Outrage, published in October 2010, Hessel asked people to get angry and indignant when their government is not doing what is necessary to preserve the dignity of people.

The subsequent Arab Spring and, later, Occupy Wall Street, hearten him, and he encourages younger people -- now 94 years old, he quips that almost everyone is younger than he—to engage in a cause with outrage, not by violence, but by a determined will. He believes that international law, encouraged by Franklin Roosevelt and the UN charter, the ideals for which WWII was fought, are the values now threatened by failing financial fidelity and corruption around the world. He also sees as unacceptable the treatment of Palestinians by Israel, treatment of the world’s immigrants, that social security does not cover requirements of living, and the organization of lobbyists to oppress our governments.

Just yesterday, in TBIPS’ Practical Analytic Subjectivity course, the class was discussing Claire Allphin’s An Ethical Attitude in the Analytic Relationship (Journal Analytical Psychology, 50:451-468) in which she reminds us that “the source of ethical capacity is the ability to accommodate conflicting needs…” a plea for intersubjectivity if I ever heard one. She cites John Beebe’s obligation of the ethical attitude to protect (the patient’s) self esteem, or, as Hessel might say, each person’s dignity. I was reminded of a 20th century Christian hymn which sang “guard each [one’s] dignity and save each [one’s] pride” as the class, later, discussed interpretation and the exhortation to avoid shaming a patient by the meaning we may bring to their narrative or behavior.

Nobel Laureate

It is hard to be an instructor in psychoanalysis. It is a struggle to hold lightly to our theories while attempting to impart key psychoanalytic concepts, and while simultaneously hoping to co-create an open inquiry in the classroom in order to both model open inquiry and to facilitate the procedural learning of it. The comments this week of Isreali born scientist Dan Schechtman may have helped.

Dan Schechtman, in 1982, described a new chemical structure “quasicrystals” which then defied the expectation that crystals are to be regular and repeating, and for this he lost his place on a US research team. In 1982 his idea was too unorthodox to be credible. Almost thirty years later, quasicrystals are being studied as a way to convert heat into electricity. Schechtman is not only vindicated, but honored when this week he was awarded the Nobel Prize in Chemistry.

Schechtman, now 70 years old, said about his work, “A good scientist is a humble and a listening scientist, and not one who is sure 100% in what he reads in the textbooks; and this is a lesson also to students to be open.”

Self and Relational Psychologies Face-off

Soon after Labor Day each year, The Tampa Bay Institute for Psychoanalytic Studies, Inc (T-BIPS) recommences its two (Self and Relational) Study Groups. On Friday, September 16, the TBIPS Self Psychology Study Group read the 2005 paper by Israeli analyst David G. Kitron The Unacknowledged Knowledge and the Need for a Sanity-Confirming Selfobject. It made for a lively discussion about whether or not an analyst could actually “temporarily” or “partially” “suspend his or her own subjective experience.” Self psychologists and the Stolorow et al Intersubjectivists tend to intimate that we can. Relational Intersubjectivists claim this is not possible.

No doubt that our profession aims at being helpful to our patients, which means being toward a focus, even with our own subjective experience, on the patient’s experience. Kitron aptly commends Ghent’s (1990) surrender over submission. He also reminds us that survivors of childhood trauma have had their reality-testing attacked, what he calls a failure of a sanity confirming self object. I applaud when he writes, “It is the therapist’s duty…to search for any mistake he might have made.” Not to do so would attack again the patient’s reality-testing (gas lighting) and re-traumatize. The analyst’s mistake, if denied by the analyst, becomes part of the “unacknowledged knowledge.”

Where Kitron and Relational thinkers may diverge is when does the therapist deem that “a side-by-side coexistence of two subjectivities is gradually made possible.” Kitron says “the therapist has to ‘step aside’ and suspend his subjectivity temporarily” until the patient has developed the capacity for intersubjectivity [mentalization, Fonagy would contend, is a component of this capacity]. I tend from the very beginning to lean toward the “hold in tension” philosophy. What I mean is that I do not want to obfuscate the part of the patient that is inevitably aware of my subjectivity [as even psychotic patients are] even while, because the patient has had the repeated experience of attack on her/his reality testing, the patient finds any other’s subjectivity unwelcome, even noxious or traumatic. To “suspend” my subjectivity might then be a mere reversal of where one “dominates and paralyzes the other.” I try, then, to hold my subjectivity in tension with the need of the patient to have her/his subjectivity exalted.

Poetry

Reflective, pensive, sad in the week preceding this tenth anniversary, my words seem inadequate. Instead I will post those of Ben Feldman, a colleague, a poet, and a student at TBIPS.


On Compassion

Compassion salvages the heart,
Wounded.
But revenge, vindictive,
Tears and tastes the meat
Like lions.

Practice
If compassion is to create
an antitoxin in the soul
then it must be played and practiced
like a cello in love
under stars with kin in soul
and harmonies woven in heart.

--Ben Feldman

"Super Vision" by Peter Wilkins (Blog)

A provocative account of an imaginary supervision session invites therapists, both novice and seasoned, to examine the rich complexity of our feelings towards our patients.

"Super Vision"

Several people have alluded to the emotional costs of being a therapist. ‘How do you cope,’ they have asked, ‘having to face other people’s distress day after day?’ It is a very pertinent question. How do we, as therapists, manage to survive our own feelings generated by our encounter with the other? (cont.)

Read the rest of the post at http://bit.ly/qrpwyA

Post from "Peter Wilkins Blog"

The Monkey and the Fish

As the Tampa Bay Institute for Psychoanalytic Studies, Inc, a contemporary training program, gears up for classes to begin September 21, 2011, I often muse about how to convey to candidates and students an open attitude toward patients, an attitude which often includes ‘letting go’ of the bastion of [pejorative, accusatory] interpretation in its attempt to rid patients of “defenses” as if we are the authority on what is best for a patient.

My colleague, Horacio Arias, and I have, more than once, discussed the idea, captured beautifully in his pithy statement ‘there is no such thing as pathology,’ that patients have established their ways of being in the world (whether nuanced and called symptoms, defenses, transference, organizing principles, RIGS, relational paradigms, etc) for very good reason, and, as such, we therapists best be respectful of the necessary purposes these serve to maintain the psyche’s functioning, however precarious or constraining that functioning may be (or seem to us). Rushing in to interpret may not be at all fortuitous, and may create a less safe –and inadvertently humiliating-- psychoanalytic space, or even result in bringing down a house of cards.

To bulwark my patience, I remind myself of a little story told on Mt. Gorongosa in central Mozambique about white colonists and modern philanthropists who thought they knew what is best for the local African people. It is the story of The Monkey and the Fish and it goes like this:

A monkey was walking beside a river one day and notices a fish in the water. The monkey thinks to itself, “Oh, no! That poor animal will drown! I must do something.” The monkey scoops up the fish and the fish begins flailing in the monkey’s hands. The monkey says to itself, “Look how happy I have made it. It leaps for joy.” The fish dies, and the monkey thinks, “If only I had gotten here sooner, I might have saved its life.”

I try to remember to not be the monkey in this story when I am tempted to think I know what is best for my patients to do, like when I think they should give up drug use, leave a battering spouse, or stop being so stubborn.

Martin Luther King, Jr Memorial and the Arab Spring

The Martin Luther King, Jr National Memorial, conceived in 1984 by King’s college fraternity and signed into legislation in 1996 by President Clinton, was to be dedicated today, but its dedication was postponed by the vast width of the rains of Hurricane Irene. It stands at 1964 Independence Ave, adjacent to the tidal basin and situated between the Lincoln and Jefferson Memorials. (1964 is the year President Johnson signed, with King at his side, Civil Rights legislation.) Forty-eight years ago, on the steps of the Lincoln Memorial, King gave his “I Have A Dream” speech.

Two huge, granite stones, like a mountain, flank the Memorial’s entrance, symbolic of King’s words: “hew out of the mountain of despair a stone of hope,” and a thirty foot sculpture of King is carved in this ‘stone of hope.’ A 450 foot wall boasts fourteen quotes, no less relevant today, from King. At its ground breaking in 2006, President Clinton said of the monument to be built there, “The monument … will be but a physical manifestation of the monument already constructed in the lives and hearts of millions of Americans who are more just … because he lived.”

Johnetta Cole, Director of the Smithsonian National Museum of African Art, said of the monument that it conveys the “power and possibility of change.” She sees as apropos that “Dr. King rises out of a rock … solid and unshakeable.” “To honor and celebrate him,’ she adds, is done “not by our words but by our actions.” Rev. Jesse Jackson, activist and personal friend of King’s, intimates that this memorial compells Americans to “unfinished business” to “fight poverty, illiteracy, disease…”

Sculptor Lei Yixin of China, hoped to convey in King’s serious expression King’s “passion…for hope for the future.” But I think King would have smiled to have his memorial completed and unveiled in the year of the Arab Spring. Despite the violence in Libya, this popular uprising of the Arab world, especially in North Africa, is a bid for justice and liberty, a bid King knew much about.

Perspectival Realism and Rape

Whose reality is it? Whose truth? As is often the case with sexual assault (a crime which usually occurs with few witnesses) it comes down to a battle of credibility, seeming, then, to put the complaining victim, not the defendant, on trial. Yesterday, August 23, 2011, after three months of investigation, the sexual assault charges against former IMF President and likely French presidential hopeful Dominique Strauss- Kahn were dropped. His accuser Nifassatou Diallo, an immigrant from Guinea, Africa was the hotel maid where Strauss-Kahn was staying. The NY prosecutors, perhaps having rushed to charge a man who was getting on a plane to France (a country without an extradition agreement with the USA), yesterday sounded angry at the accuser for the changes, for which she was discredited, in her story.

Certainly defendants can be falsely accused. With changes in the justice system over the decades, the victim is no longer accused of dressing provocatively or 'asking for' the sexual encounter. But questions will always remain in the case of Strauss-Kahn about what happened in that ten minutes. So many questions! Is Diallo a person who could seize the opportunity of a powerful man's sexual activity for her own financial gain? Can't liars and druggies be raped? And while it is said that there are men who would pursue a sexual encounter with anyone at any time, I ask myself: why would such a powerful and wealthy man be so indiscriminate, so pressing with motivation at that moment?

At the time of her report to coworkers, boss, and police, Diallo appeared credible and credibly shaken and injured. "Beyond a reasonable doubt" favors the defense, as is should. But therapists know that trauma causes disorientation and dissociation, making memory patchy. I can therefore understand Diallo moving to clean the next hotel room or returning to clean the room where the alleged attack occurred. I know that people are known to be motivated to please authority, whether the police or the prosecutor (or the rapist) by telling them what they want to hear. Many people can possibly understand lying to gain asylum as Diallo did to stay in the United States. I ask myself: Will this case set back courage to report crimes such as rape or crimes perpetrated against immigrants?

Let Freedom Ring: Psychoanalysis and Politics

While USA unveiled its Martin Luther King, Jr monument yesterday August 22, 2011, Libyan rebels, after six months of fighting, captured the capital of Tripoli. Of this victory US President Barack Obama said, "The pursuit of human dignity is stronger than any dictator." The PBS Newshour aired last night at least ten minutes of footage of Libyan men rejoicing in the streets, on rooftops, and in cars. In the footage of these hundreds of men I noted, maybe, a half dozen women and wondered to myself if women of Libya, 42 years under dictator Momar Gadhafi, will have a voice as Libya reinvents itself in its striving toward democracy. UK Prime Minister David Cameron intimated as much in his support of a "free, democratic, inclusive Libya." UN Secretary General Ban Ki-moon called this a "hopeful moment."

In the consulting room, freedom is described more personally, whether freedom from unconscious conflict, or freedom to embrace our multiple selves, or even freedom from the tyranny of the procrustean bed of analysts who hold too tightly to their theories. Individuals require what countries transforming themselves require: access to frozen assets, building of infrastructure, secure enough borders, and (an international) community. Therapists help patients develop their voices. In this moment of hope, my hope for Libya is that the international community aids Libya in including female voices for a truly inclusive endeavor.

Poet Laureate Philip Levine

Yesterday the former Detroit factory worker, 83 year-old, Phillip Levine was named the 18th Poet Laureate of the United States and will begin his one year term in October. The PBS Newshour last evening replayed its interview, from last year, on Levine. In that profile, Levine credited his shift from the metal press to the pen, as “pure luck,” pure luck to have met his wife on his 26th birthday, who worked to support him while he wrote, and perhaps more importantly, Levine noted, “She honors what I’m doing. And I think that is the most crucial thing-- to be honored as a poet, not by a nation, because a nation is an abstraction, but just to be honored by this person or that person…”

His words “to be honored” struck a deep chord with me as an analyst because, for me,an analytic attitude includes, not interpretation as accusation but, love and acceptance, an honoring of all the patient has been through, utilizes in present day to cope, and will one day be. Levine asked incredulously about his wife of, then, 55 years, “How many women would stay with a guy who has no prospects and wants to write poetry…?” I was reminded of a fine marriage of analyst and analysand, sticking with one another through the rough and ready years, honoring each other and the work as best and as tenaciously as each can in minutes of uncertainty and pain, with the hope that something is in the process, like a poem, of becoming.

Here is an excerpt from Any Night

…I will have to learn
to sing in the voices of pure joy
and pure pain. I will have to forget
my name, my childhood, the years
under the cold dominion of the clock
so that this voice, torn and cracked,
can reach the low hills that shielded
the orange trees once. I will stand
on the back porch as the cold
drifts in, and sing, not for joy,
not for love, not even to be heard.
I will sing so that the darkness
can take hold and whatever
is left, the fallen fruit, the last
leaf, the puzzled squirrel, the child
far from home, lost, will believe
this could be any night. That boy,
walking alone, thinking of nothing
or reciting his favorite names
to the moon and stars, let him
find the home he left this morning,
let him hear a prayer out
of the raging mouth of the wind.
Let him repeat that prayer,
the prayer that night follows day,
that life follows death, that in time
we find our lives. Don't let him see
all that has gone. Let him love
the darkness. Look, he's running
and singing too. He could be happy.

Create Date: Monday, January 13, 2003
by Philip Levine

Film: Tree of Life

No film has ever been so evocative of a childhood: walking on cans tied with thick string; torturing small amphibia and reptiles with cherry bombs and firecrackers; running chest forward, arms outstretched, into mosquito-killing DDT clouds. These were the long, languorous days of southern summers before play dates and gated communities and the expectation of kidnappers and child molesters around every corner. Without standard plot or dialogue, the observer, like the analyst, is drawn into memory with Jack (Sean Penn), invited to lean in toward his experience of sprinkler drops on the skin, ligustrum hedge tops on the fingertips, or the jarring, contemptuous shouting of a father at a mother. One immerses oneself, the visual and auditory so penetrating as to be tactile. It is dream-like, hallucinogenic, poetical.

A nipple. An eye socket. A crater on the moon. Mud pots and phosphorescent pools. Molten lava and microbials. A nipple. The protruding umbilicus of a pregnant woman. Jupiter’s moon. What do we make of creation? Of the tree of life? This film intimates the interconnectedness of all creation. But the thread of loss and trauma flies in the face of connectedness, aggravated when one suffers in isolation, disconnecting us from the fabric of life.

Jack as a middle edged man remains connected to his childhood in the drops of water and the drops of sunlight of his glass-and-steel grownup world. His luminous mother (Jessica Chastain) had urged him to “love everything.”

The Tree of Life, written and directed by Terrence Malick (Badlands, Days of Heaven, and The Thin Red Line) is a wonder, visually, and its soundtrack magnificent. That Malick was a philosophy major and a Rhodes scholar is no surprise. But Malick must be a connoisseur of great music as well, with soundtrack by Alexandre Desplat, connecting Mahler, Bach, Smetena’s Die Moldau, Holst’s The Planets, Berlioz’ Requiem, Bach, and Brahms. The mystical ‘Tree of Life’ in religion, philosophy, mythology, connects all things in spirit and evolution. It brings eternal life. Malick ambitiously illustrates this conceptual interconnectedness of the ‘Tree of Life’ in his film thusly named, juxtaposing it with a singular, 1950s, Texas family, the O’Briens. Its eldest son Jack (Hunter McCracken) questions, in whispered voiceover, God or the universe and the meaning of existence. How Malick coaxed such a veridical performance from McCracken and Laramie Eppler as R.L. is a marvel,and the cinematography by Emmanuel Lubezki, exquisite. This is the best picture of 2011, or, perhaps,ever.

Michael Poff comments on Hiroshima, Mon Amour

It was not oedipal conflicts that I believed remained unsuccessfully resolved. My observation was that although there were triangular features to the relationship in Hiroshima Mon Amour (see April 4, 2011) that might typically suggest Oedipal-level repetitions (i.e., references to cheated-upon third party/spouse/dead lover; Lui’s thrill at being special to Ella compared to all her past lovers; the recurring subject of lying; the central theme of sleeping with the forbidden/the enemy), much more obvious, in this case, were the effects of the later trauma in early adulthood (the pervasive dissociative affect, the intensity to the repetition compulsion, an inexpressible humiliation and rage isolated behind the glassy “reasonable” defense). In fact, in the absence of other history, it was only the massive quality of that trauma that made more understandable the pervasive regressive and pre-oedipal emotional atmosphere of the affair (i.e., repetitive fantasies of annihilation by being consumed/devoured; borderline psychotic-like confusion of past/present, loss of self/other boundaries, etc.). Elle’s early refrain, “Without a record, there’s only reconstruction”, highlighted for me the parallel between her ‘remembering’, first in action then in words, with Lui and reconstruction in analysis. I see no inherent problem calling this a co-construction (But I was using Elle’s words.) so long as some conceptual principle for the asymmetrical relationship and the ideal of (relative) neutrality on the part of the analyst is preserved for the protection of the patient. It was Lui’s reference to what he will remember of Elle when he is compelled by habit into future affairs, and Elle’s staying ‘reasonable’ for the remainder of their relationship after he slaps her just as she risked expressing her anger, that signaled the unresolved quality of the problems each was attempting some mastery over with the affair. I agree wholeheartedly with you that there was much caring in the ‘play’ and healing (for Elle, most obviously, given her resolution in the end to return home to Nevere) that came of the encounter between the two lovers. Michael Poff MA, MSW

Psychoanalysis and Compassion: the Death Penalty

With the two recent posts on this blog, one by Tim LaDuca on May 31, 2011 (about the compassion of psychoanalysis), and one by Loren Buckner on June 2, 2011, (describing --regarding the Anthony case-- how even good parents can sometimes harbor hateful, even murderous thoughts, toward their children), I was reminded of an article I had read.

Appearing in the May 9, 2011 issue of The New Yorker, the article The Mitigator by Jeffrey Toobin reported on the decline of the use of the death penalty, particularly in Texas, where defense attorneys have, in the last decade, finally begun to utilize the opportunity to present mitigating evidence to the prosecutor before the charging decision is made. In addition to medical history, MRIs, and character witnesses, an extensive life history is conducted and used to help explain how “'a beloved brother and husband and father and son can also commit a terrible act.’” This enables the jury to have mercy, both on the defendant and the defendant’s family members.


Scharlette Holdman, an anthropologist and “a pioneer in the field” of providing into evidence a mitigation narrative (e.g. for Ted Kaczynski the Unabomber) said, “'That narrative is not there for the asking…It requires not just knowledge and skill but experience in how you search for, identify, locate, recognize, and preserve the information.’” Having read this article, my first thought as an analyst was: who is better to help identify, recognize, and construct a compassionate life story than a psychoanalyst? Forensic work is not my favorite, but it seems to me that the mitigation narrative screams out for the skill of the psychoanalyst, especially one with experience in childhood traumas, who is an expert in co-constructing a compelling story of a person’s life and is able “to create a complex portrait of a haunted and troubled defendant.”

The article featured Danalynn Recer, a Texas attorney and defense strategist for capital cases, who is quoted as saying, “'I don’t apologize for saying I love my clients in all their complexity. We insist on seeing their humanity despite what they’ve done.'” Now couldn’t that also be said by analysts about their clients/patients?

ParentWise by Loren Buckner

Tampa psychotherapy colleague Loren Buckner, MSW, is author of ParentWise: The Emotional Challenges of Family Life and How to Deal With Them. ParentWise is a most unusual parenting book in that it does not tell people how to parent but instead explores what it feels like to be a parent. Writing on May 31, 2011 for the Orlando Sentinel as a guest columnist, Buckner shares some thoughts from ParentWise in the article entitled “Lessons from the Anthony trial: Inner reflection can help conflicted parents:

“…There's a risk, though, to pointing our fingers at other so-called "bad" parents. Focusing on their problems can lead to minimizing our own. Most of us admit to a certain amount of everyday anger. But we avoid confronting the deeper feelings, the ones that keep us up at night.

The Anthony case, and others that periodically dominate the news, center on parents who have lost their way. After every tragedy, we wonder: How could something like this possibly happen? This response is problematic, too, because as long as the question remains unfathomable, we can avoid thinking about it seriously.
The truth is we hear about families and children in crisis practically every day. We read about parents who hurt their children and about kids who are violent. To help them deal with their emotions, doctors prescribe antidepressants to kids and parents who are overwhelmed by how they feel and at a loss as to what do about it. Over-eating, under-eating and addictions of varying kinds have become common but unhealthy ways to cope.

This tragic case presents an opportunity to bring to light a painful truth that is hard to admit even in the privacy of our own thoughts, never mind say out loud. Normal, everyday kinds of parents sometimes hate their children.

Hatred feels awful. It fills parents with such unspeakable guilt and shame that hiding this excruciating feeling seems like the only respectable thing to do.

The word "hate," usually believed to be a horrid, immoral emotion, is difficult to use without cringing. Admitting that there are times when we do, in fact, hate being parents or hate our children may seem appalling. However, there's a type of hate that's different from the evil kind.

Like other strong feelings, hate is as much a part of life as any other emotion. Not only is hate a normal feeling, hate and love aren't mutually exclusive. We feel happy and sad, relieved and disappointed, and we feel love and hate, too. Most people have mixed feelings about all sorts of things. Parenthood is no exception. Containing the hate and anger we feel toward the people we love the most — our own children — is one of the most gut-wrenching parts of parenting, making it vital to understand.

Feelings, even disagreeable ones, do not determine our character. How we react and how we interact with others, especially when we're upset, is what's telling. We know in our hearts when something is wrong inside. We need to listen to these feelings instead of drowning them out. Pretending that everything is fine when we're confused and unhappy can lead to serious consequences.

People tend to think they wouldn't feel bad inside if they had stayed married, had a more traditional family, or had more money. Parents believe that somewhere out there are moms and dads who don't suffer with bouts of anger, guilt or self-doubt.

In reality, we all have to learn to manage painful feelings. Individual circumstances vary, but disturbing emotions are an integral part of a family's journey. Feelings, even negative ones, are not character flaws or signs of weakness; they are signs of life.

As parents, we have a responsibility to look into our own personal stories. We need to understand and learn how to cope with the complicated and conflicting feelings we have. Our kids deserve this degree of dedication.

And even if we haven't been committed to a self-reflective parenting style, we can certainly honor Caylee Anthony's memory by developing one now.”

I am grateful to Loren Buckner for sharing her much needed ideas in such an accessible manner for all to read and to the Orlando Sentinel for publishing her work.

Psychoanalysis - On the Front Lines of the Experience of Reality

It has been my experience and observation that personal pain, unexpressed and unshared, is a root cause of much malaise and suffering in the world. To the extent this can be remedied on a personal level, people can experience more freedom and become more empathic, kind and caring individuals.

To the extent that analysands can explore there own misery and suffering, share and express their pain, psychoanalysis is a tool to provide more freedom, empathy and kindness in the world.

I believe the potential collective amount of suffering in the world is boundless. It can be limitless. It is relative and thus can always improve or decline.

Thus I see psychoanalysts on the frontlines of pushing the collective experience of life in one direction or another. It's the only school of therapy I've surveyed that gives people a chance to explore deep misery and pain.

Throughout history, we have observed enormous human tragedy inflicted on humanity by it's own participants. Hitler, for example, was a person who had intense pain buried within, unshared and unaddressed (Dorpat, 2007). We all know the incredible misery he inflicted upon mankind.

Humans alone among all species (Becker, 1971) must confront their own mortality. This painful truth had led many to run from reality and lead quiet lives of misery. Projected fear of mortality has lead to all manner of collective abuse, collective denial and maladaptive behavior on a societal level.

Just as the personal experience of reality can be profoundly changed by confronting one's own deepest fears and pain, so too can the collective experience of reality be profoundly changed.

Psychoanalysis has incredible potential for humankind. Suffering is here to stay for homo sapiens. How we express it, constructively or destructively, is entirely our collective choice. As a tool for meaningful social change, psychoanalysis is the most promising frontier for mankind. Analysts and analysands alike stand at the frontlines of our collective pain and suffering.

As a tool for fighting poverty, I think psychoanalysis may be a potent tool. As a tool for alleviating social stratification and collective alienation, psychoanalysis may be the best we can offer ourselves.

All this assumes that psychoanalysis is performed with patience, respect and kindness. No school of thought has a monopoly on these traits. It also assumes that psychoanalysis can become less of a tool of, by and for those of great means, insomuch as it is just that.

Finally, I do believe psychoanalysis has an unparalleled modern voice of kindness and reason, a light that points it in the right direction. I humbly suggest this voice is that of the late Dr. Theo L. Dorpat. It is my hope that I can send as many clinicians and patients alike straight to his works. I firmly believe Dr. Dorpat shows us all the way forward to 'a more peaceful, just, and verdant society.'

-- Tim LaDuca

Correction

Please note that the final line by Tim LaDuca in yesterday's post "In Your Eyes..." should read: Some of us are searching more badly than others, because that maternal gaze was not so forthcoming, the universe not so friendly.

Please go to that post to see it in its entirety.

"In your eyes", infatuation, or the spark of maternal love?

"Love...
I get so lost sometimes
Days pass
And this emptiness fills my heart
When I want to run away
I drive off in my car
But whichever way I go
I come back to the place you are
All my instincts
They return
The grand façade
So soon will burn
Without a noise
Without my pride
I reach out from the inside
In your eyes
The light, the heat
In your eyes
I am complete
In your eyes
I see the doorway
To a thousand churches
In your eyes
The resolution
In your eyes
Of all the fruitless searches
Oh, I see the light and the heat
In your eyes
Oh, I want to be that complete
I want to touch the light
The heat I see in your eyes"
-- Peter Gabriel, "In Your Eyes"

Is this song not just infatuation run amok? Seeing everything we've ever wanted to see in another woman's eyes? Don't we someday realize these are the eyes of a fallible human? What woman could possibly live up to such a standard?

But let's think about this from a more primal point of view:
Does not the infant get so excited to see the "light and the heat" in his mother's eyes? Is this not what he seeks? The attention he adores, the loving gaze of his mother’s eyes? Does he not often go hungry wondering if the universe will ever answer his calls? To the infant, the mother is the universe, the mother is his universe. And what could be more amazing than to gaze into the eyes of that universe staring right back at you? Especially after a long night of hunger you have no way of knowing will ever end?

As adults, I think many of us go out in the world looking for this gaze, as it was lost or withheld from us somewhere along the way. We seek the magical maternal gaze in the eyes of a significant other. The gaze that meant all was good; hunger would end; warmth would come. The adult seeks the infant’s "catch" of what for it is permanent bliss. Some of us are searching more badly than others, because that maternal gaze was not so forthcoming, the universe not so friendly.

By Tim LaDuca




Lycia Alexander-Guerra adds:

This post is very timely for the TBIPS Relational Study Group which this week reads: You Are Requested to Close the Eyes (2004) Psa Dial, 14:349-371, in which Bruce Reis critiques the Freudian, Lacanian, and Kohutian concepts of mirroring as unidirectional and failing to take into account the intersubjective experience in which “to see is to see oneself being seen by an other.” Reis contrasts these to Winnicott’s concept of mirroring which moves beyond subject-object complementarity to “communion with otherness,” ‘a two-way process in which self-enrichment alternates with the discovery of meaning in the world of seen things.’

Freud saw the visual as psychopathology (e.g. scopophilia, exhibitionism, the over excitation of the child who views the primal scene, even the blind Oedipus). Freud’s own discomfort in being looked at may have contributed to advocating the anonymous, blank screen (opaque mirror) in addition to use of the couch. Lacan proposed that the infant was alienated from its self when first recognizing itself in totality in a mirror, and doomed to “confuse the external image of herself with the images of other subjects” (Reis). Antipodal to Lacan, is Kohut’s theory that through the visual, mirroring by the mother for an infant “seeking witness for its experienced grandeur and perfection” (Reis), the infant develops its cohesive, nuclear self. Still, the mother is experienced as an object, need fulfilling though she may be.

Reis addresses “the difference between object and other,” a salient component of relational psychoanalysis. As Benjamin notes, development is facilitated by the inclusion of the not-me inherent in intersubjectivity. Reis writes of “a relationally embedded self that recognizes itself as another for another and is obliged to acknowledge that there are other perspectives.”

From infant research, Reis tells us that interpersonal matching parses (quoting Meltzoff and Moore) ‘interactions in terms of relationships rather than particular behaviors.’ Mirror neurons not only help with imitation of actions, but understanding of them. Infant research (Stern; Beebe) also reveals “that split-second responsivity occurs in facial-visual interactions between mothers and infants. Each partner influences the other moment to moment…” and, also, “there remains an irreducible otherness to the other, a strangeness that is there from the first look….” For Winnicott and Reis, this difference in the form of the other contributes to and is constitutive of selfhood. “Seeing and being seen are inextricably bound together because, for an infant to see, it must be visible for an other.”

Finding our analytic way

As TBIPS concludes its academic year, candidates continue to grapple with what are the therapeutic aims of treatment and what brings about change. This grappling is a never ending negotiation between therapist and patient, and therapist with her/his own professional identity.

Sandy Shapiro [see Sept 12, 2010 post]said that patients will let us know what they need. Sometimes people come with unspoken but profoundly human motivations communicated in the action of relationship. Therapists, relying both on the unique patient’s needs, and a background of understanding of human needs in general, are able to provide experiences which have been heretofore lacking [deficit model] for the patient. E.g., if a patient grew up discounted and ignored, the analytic situation offers an opportunity for a different experience and a reconfiguring of the way a patient sees her/himself in the world.

The biological striving to pass on genetic material for the survival of the species is accompanied by many postulated psychological motivations. Freud’s theory of motivation postulated the discharge of the accumulated energy from instinctual drives. Winnicott saw creativity and play as essential aspects of the true self. Kohut advocated the development and maintenance of a cohesive self. Bach saw as important the integration of a “sense of wholeness and aliveness” which included developing one’s own awareness and subjectivity, as well as learning to see oneself as one among many, with a place in the world. Maroda notes that people, to develop a full interpersonal repertoire as both subject and object, need to have their affective communications responded to, held, and returned in modified form [ala Bion]. Spezzano writes that human beings are motivated to share their conscious selves, regardless of other unconscious motivations, and that we can only know ourselves in light of how others know us.

If people require a sense of agency, including capacity for self and mutual regulation of affective states, and a sense of the subjective self in the context of relatedness and recognition by (and identification with) others as subjects in their own right, then isn’t it helpful to patients for therapists to include in their analytic attitudes the capacity to sometimes regulate dysregulated affect, the articulation of being affected by the subject of the patient, as well as the capacity to play, and an open-hearted acceptance of a patient as s/he is now while also holding in mind the future, changed patient? If a patient was made to feel helpless and hopeless about affecting others, the analytic relationship is a place where the analyst, when moved, does not necessarily keep a blank face or remain silent. If a patient endured trauma in isolation, s/he now has a companion who knows her/his suffering. Each candidate strives to hone her/his personal identity and style while trying to meet each patient’s unique needs. It is a formidable task, and a joyful one.

Projective Identification

Recently, at TBIPS’ Relational Study Group, a paper we were discussing brought up projective identification, a concept that has baffled clinicians for decades. I would like to share my thoughts on projective identification. When Melanie Klein coined the term, it was to describe an intrapsychic phenomenon: how the unwanted parts of the self (often aggression or helplessness) were projected into the other, and were then seen as under the control of the self, and, consequently, so too was the other seen as under the control of the self. Note that s/he who did the projecting was also doing the identifying with the unwanted part.

Projective identification became redefined as a phenomenon between two people: what was projected by the self was identified with by the other such that the other began to behave commensurate with the projection. E.g. a patient projects sadistic impulses into the therapist and the therapist inadvertently becomes sadistic, or feels sadistic. The self could behave in such a way as to make the other feel what it felt like to be the one doing the projecting. Projective identification, then, began to include the countertransferential use of the projection giving the therapist information about the patient’s experience.

Even when projective identification is seen as emanating from the paranoid position, it nonetheless is an attempt to communicate how one is feeling, as well as a wish to be understood. Because patients are sometimes bereft that the therapist will ever know what it feels like for the patient to experience such rage or helplessness or envy or despair, they are nonetheless sometimes fortunate enough to utilize projective identification to help move the therapist’s understanding along. Otherwise, patients might feel untenably isolated and unconnected to us. Despite how uncomfortable (causing the therapist to disparage the defense and pathologize the projecting patient) it may be to be in the throws of the experience, if not bound by the projection, the therapist might sometimes have the wherewithal to inquire whether the patient has somehow managed to come upon a way to aid the therapist to better know what the patient’s experience felt like by inadvertently helping the therapist to feel that way too.

Since its original definition was conceived within a one-person psychology, contemporary Relational theorists, if they use the term at all, have further redefined projective identification. Relational theory questions the unidirectionality of projective identification. It does not conceive the projection to originate entirely from the patient’s psyche but instead recognizes how unlikely the therapist would be to ‘identify’ with a ‘projection’ were it not to resonate with something already within the experience of the therapist. The therapist, too, contributes to what is projected in addition to resonating with the projection.

I like to say that it is one thing to wear the attributions of a patient and explore what, for both the patient and oneself, it would be like to do so, but it is something else to be what the patient attributes to us. I suggest to less experienced colleagues that we be brave about discussing patients’ (e.g. aggressive) feelings toward us. When patients have ‘split’ us into the bad or hateful object, it sometimes helps restore personal equanimity to consider how and why it became necessary for the patient to operate, at this moment, from the paranoid position. Harder is to consider how we might have inadvertently contributed to this shift.

Frame

In the Fall of 2011 TBIPS will offer to both first year and third year classes a practical course on helping the analyst negotiate with patients the analytic frame. We will ask what distinguishes psychoanalysis and psychoanalytic psychotherapy from what a good friend or a loving family member can provide. What makes psychoanalysis and psychoanalytically oriented psychotherapy so special a relationship? Does the psychoanalytic attitude [see Jan 3, 2011 post] really allow the patient a freedom of self unlike any other relationship? Can the relationship really allow for the safe exploration of automatic ways of being with another in the world?

Analyst and patient together negotiate the frame or rules on which the two will come to rely. The analyst is punctual [lest the patient unnecessarily be made to feel like ‘chopped liver’] and alert [lest the patient unnecessarily be made to feel unable to garner the attention of important others], ready to be interested and self-reflective. And when the analyst is not punctual or interested and alert, the analyst must open her/his failings to the patient for exploration. The frame will describe when and how often the sessions will occur, the analyst’s availability between sessions, the fees, times, etc. including how many weeks or months the analyst is out of the office (conferences, vacation, etc). The frame includes the psychoanalytic attitude with its asymmetrical focus on what is in the best interest of the patient and with the safety of the patient’s psyche foremost. Safety is fostered when analysts do not judge, when we do not question with implicit incredulity or veiled contempt [both which can inadvertently humiliate a patient]; when we are attentive to changes in the patient’s (and our) self states, tone or prosody of speech, autonomic responses, or other indications that we may need to ‘slow down’.

Safety is also facilitated by our reliability, punctuality, earnestness in the experience, by our listening, processing, and considering what we have seen, heard, felt, and experienced. Maintaining the frame will, at times, help communicate safety. At other times, the frame must be flexible enough to allow for negotiation, and for enactments [sometimes patients seek to break the frame, not as resistance but as an attempt to reach us]. Because psychoanalysis (or psychoanalytic psychotherapy) is a dialogue within a frame, and with a reciprocity of sorts, and because it includes the multiple unconsciouses of both participants, both patient and analyst will emerge changed in some way.

Happy Birthday, Horacio Arias

Yesterday was the 87th birthday of Tampa Bay Institute for Psychoanalytic Studies, Inc faculty and Board member Horacio Arias, M.D. and there are two valuable lessons he indefatigably, though quietly, articulates which I wish to share.

One is his reminder about the tendency to have the paranoid schizoid position come to the fore with its penchant for part object relating, along with its corollary, which he encourages, to see others as the whole person. Having trained in South America, in Colombia, Dr. Arias is immensely familiar with Kleinian theory, and steadfastly supports the person cast as the part object villain. When local psychoanalytic politics cast one another as the bad object, Arias not only points out the paranoid dynamic afoot, but continues to see each colleague in full light. I have found his words enormously helpful as I struggle in my role as a leader in various local psychoanalytic forums to maintain connection with the varying splintering factions that plague us.

A second phrase, enormously avant garde in my opinion, often heard from Arias is, “There is no such thing as pathology.” Does Arias mean that people do not suffer with paralyzingly constrained repertoires? I don’t think so. Instead, this is an analytic attitude of his which constrains the harsh judgment therapists inadvertently have for choices made by patients. (Often condemned are drug use, staying with an abusive partner, self injury, and so on.) Arias recognizes that people, all of us, are doing the best we can, that we choose less than optimal behaviors because it is the only viable solution we can conceive at the time. For me, Arias is saying that only in a safe and welcoming environment do people dare to change. It is the therapist’s responsibility to create such an environment, which includes holding both the welcoming acceptance of who the patient is at this moment (all painful choices included) alongside the hope that one day the patient will have a greater repertoire of meaningful, enriching choices.

Orange on Levinas

Donna Orange, in her visit on April 9, 2011 to the Tampa Bay Psychoanalytic Society, spent most of the day discussing her take on the philosophy of Emanuelis Levinas (a student of the Talmud and a contemporary constructivist and phenomenologist , he believed in a hermeneutics of lived experience) who wrote about the "wisdom of love" (as opposed to the ‘love of wisdom’). Levinas believed that ethical responsibility is integral to the encounter with the Other, [and consequently, to intersubjectivity], a responsibility that is constitutive to our own being and interiority, that is, that subjectivity is formed, in part, through the encounter with the other. In this privileged encounter with the other, one feels both the relatedness with and the alterity of the other. Unlike what Self Psychology would purport about the confrontation with otherness, Levinas wrote: "The Other precisely reveals himself in his alterity not in a shock negating the I, but as the primordial phenomenon of gentleness."

In discussing Levinasian ethics, in particular Levinas’ idea of transcendence and the belief that one instantly recognizes the transcendence of the Other, Orange emphasized putting the other above oneself. As Orange’s form of intersubjectivity, like that of Stolorow’s/Atwood’s, with its influence from Self Psychology wherein the focus on the analyst's subjectivity is as a source of understanding, and where the need of the patient for the analyst as a selfobject is paramount, it came as no surprise that Orange would be enamored of this facet of Levinasian ethics. In fact, for me, her heavy emphasis was seen as a justification for empathic immersion and for the analyst to function predominantly as a selfobject experience for the patient.

While I agree that placing the suffering other above oneself (who would not open the door for someone struggling with crutches to get through it?) is, for those not so preoccupied with themselves as to be aware of their surroundings, a natural response, I think it is a hard philosophy to adopt when the other is not a suffering other. Orange, taking from Levinas his holding the other above self, even being responsible for the sins of others [here I am reminded both of Christ dying for the sinners’ sins and of the self blame of victims; Levinas, as a Lithuanian Jew, had survived the Holocaust but his family, sadly, did not] advocates a philosophy beyond ‘love thy neighbor as thy self’ to “love thy neighbor more than thy self.”

More than one audience member asked: how does one avoid masochism in this philosophy? Her advice to read Emmanuel Ghent’s 1990 paper on Masochism, Submission, Surrender did not suffice to further the dialogue (though his brilliant paper does). Had Orange made explicit the inference to the clinical applicability of Levinasian ethics, given that the patient is seen as the suffering other, then the attendees might have better embraced the philosophy Orange touted. Had clinical examples been supplied to illustrate the practical application of such ethics, then the audience would have been won over by her scholarly explication of Levinas’ ideas of transcendence.

Ghent, E. (1990). Masochism, Submission, Surrender—Masochism as a Perversion of Surrender. Contemp. Psychoanal., 26:108-136.

Motivation and Development

Mental health includes a sense of agency and of the subjective self in the context of relatedness and recognition by, and identification with, a subject (m)other/therapist who is a subject in her own right. Spezzano writes that human beings are motivated to share their conscious selves, regardless of other unconscious motivations, and that we can only know ourselves in light of how others know us.

Alongside the biological imperative to pass on genetic material for the survival of the species are many postulated psychological motivations. Freud’s theory of motivation was discharge of instinctual drives. Winnicott saw creativity and play as essential aspects of the true self. Bowlby and subsequent attachment theorists write about the need for safety and security. Ghent might have added “surrender.” Bach sees it as important to integrate a “sense of wholeness and aliveness” which included developing one’s own awareness and subjectivity, and learning to see oneself as one among many, with a place in the world. Maroda notes that people, to develop a full interpersonal repertoire as both subject and object, need to have their affective communications responded to, held, and returned in modified form (ala Bion).

Understanding of development is an important backdrop for the therapist when listening to and experiencing our patients. Therapy contributes to enhanced development, perhaps by recommencement of truncated development through a safe, empathic, good enough environment which facilitates reorganization of patterns of experience, as well as that co-constructing shared meaning can enhance self regulation.

More about Listening

How we organize what we hear and observe is influenced by our own subjectivity, our experiences, and our theories. Because no theory holds the ‘truth,’ we must hold our theories lightly, recognizing that each person’s reality is perspectival, and recognizing that the meaning of the material need not be fit into the procrustean bed of a theory. As I listen and muse on what is going on in the therapeutic dyad, I often think I am like a juggler, with many plates in the air at once. I must simultaneously consider whether or not I hear at this moment a familiar sigh or theme from the patient; whether or not the present narrative or relational paradigm harkens back to the patient’s childhood events; what, if any, are the transference counter-transference implications; what happened in this past moment or last session or over the months or years of analysis that contributed to this coming up or happening now; and so on; all the while being open to the unknown and to surprise in a free floating reverie with evenly hovering attention!

Listening is dialectical (you can never stand in the same river twice), which means patient and therapist influence each other and neither is ever the same again. Listening is intersubjective, containing within it both the listening and the being listened to. Listening allows space for creativity (Winnicott) and for the, as yet, unformulated and unspoken. It is a gift we give our patients, interested in every word and gesture. It is a gift our patients give us, along with the privilege of their trust. When we listen, we do not seek to confront or contradict the patient, though we may sparingly ask for clarification. Many people have never experienced such genuine attentiveness from another.

As communication is both explicit (with words and common gestures) and implicit (perhaps what Freud referred to as unconscious to unconscious communication) we must listen as well with our perceptions and unconscious perceptions. We attend to the texture of feeling and gestural communication and not just to words or content or to conscious understanding and insight. We become comfortable, not impatient, with silences when the patient may need to be with some caring other without the pressure to produce or perform. Each therapist will have a unique interest in this or that part of a story, evoking a resonance with something in the therapist’s personal history. Each therapist must find her/his own way of expressing, in a way contributory towards patient growth, what has meaningfully affected us.

Is Mutual Recognition a Foil to Empathy?

I have long struggled with attempts to integrate theories from Self Psychology with those of the varying ideas about Intersubjectivity. Self Psychology emphasizes the receiving of empathy (by patient from analyst, or, developmentally, by child from caregiver) and not the development, as Klein noted and Winnicott elaborated, of the capacity for concern, or empathy, for the other. Benjamin writes about intersubjectivity (in part, the capacity to relate subject to subject) as a developmental achievement. She also notes that it is the “mother’s recognition [that] is the basis for the baby’s sense of agency.”

Orange expands on the idea of recognition: “What we acknowledge, in relation to the other, is not primarily the other’s identity or status, but rather our own intersubjective vulnerability.” Using language (semantics) and taking literally the etymological roots of re-cognition (‘to know again’), Orange refers to Benjamin’s use of Hegel’s anerkennung, which Orange says lacks the ‘again’ and, therefore, refers to acknowledgement or appreciation and acceptance. While Benjamin emphasizes the joy of mutual recognition, Orange, expanding again, quotes the philosopher Hans-Georg Gadamer “The joy of recognition is rather the joy of knowing more than is already familiar.” Since recognition is “profoundly lopsided for a long time” Orange advocates that we do not “underestimate…trauma” [the noting by Orange of Winnicott’s being-with the patient in the co-created space (a transitional, or third, space) reminds me of the emphasis placed by relational theorist Bruce Reis on being with a patient whose traumatic experiences might be without words] of our patients, and that we not impose our own “agenda” (to be recognized as subjects) on patients. Orange “place[s] the primary responsibility for attunement and responsiveness on the analyst”.

Orange writes, “Perhaps we should give up the search for the Hegelian self-conscious subject, with the implied demand for the other to re-cognize and create it.” Orange intimates that other (not Self psychology) theorists expect the patient to meet equally the needs of the therapist. This mischaracterizes, I think, relational intersubjective emphasis. Orange is coming to Tampa Bay tomorrow (April 9) and I am eager to hear more about her foils (other theories of intersubjectivity) and how one might enter into dialogue with them.

Benjamin, J. (1990). An Outline of Intersubjectivity: The Development of Recognition. Psychoanal. Psychol., 7S:33-46.

Orange, D. (2008). Recognition As: Intersubjective Vulnerability in the Psychoanalytic Dialogue. Inter.J.of Psychoanal.Self Psychol., 3: 178-194.

Hiroshima, Mon Amour

The beautifully rendered Hiroshima, Mon Amour, directed by Alain Resnais, screenplay by Marguerite Duras, is a 1959 French film which, along with Truffaut’s 400 Blows and Godard’s Breathless ushered in French New Wave film. It is dreamily (without sequential time or cause and effect) shot and its script is poetical with its repetition of phrases. Beautiful and moving to any viewer, it may be especially so for the contemporary psychoanalyst in the way it speaks to the power of the witnessing of trauma.

We never know from the film, nor hear, the names of the two protagonists. Elle (Emmanuele Riva), a French actress (in Hiroshima to shoot a film about peace), suffered the loss of her wartime, German lover, then was ostracized by the residents of her hometown Nevers for this love; and Lui (Eiji Okuda), a Japanese architect, lost his entire family of origin and his hometown on August 6, 1945. Their personal traumas have for their backdrop the trauma of nations.

Opening the film, the two lovers entwined, the ashes of nuclear devastation on their skin transforming into perspiration, Lui responds to Elle’s narrative, telling her: you “remember nothing.” (For how could she possibly remember Hiroshima?) Later in the film, Lui says to Elle, “Tell me more.” And he is jubilant [reminiscent of the therapist’s privilege] that he is the only one who has ever heard her story. Elle’s later, second narrative includes, “One day, I’ll remember nothing,” [i.e. will be haunted no longer]. Only then does she consider returning to Nevers [facing the unknowable]. The peace march of the film within the film foreshadows Elle’s leaning toward healing. She finds Lui (He tells her that she gives him “a tremendous desire to love”) and re-finds “impossible love”. This time she does not have to bear it alone. Therapy, likewise, is not so much the ‘impossible profession’ as an ‘impossible love.’

Hiroshima, Mon Amour, shown April 3, 2001, was the ultimate film in the 2010-11 Film Series Developing Passions, cosponsored by the Tampa Bay Psychoanalytic Society, Inc and the Humanities Institute at the University of South Florida. The discussants were USF Humanities Associate Professor, Amy Rust, and local Freudian analyst, Michael Poff. Rust, in elaborating French New Wave films, also explicated components of contemporary psychoanalysis: The story [content] is subordinate to style [way of relating]; There is no omniscient viewer; Ambiguity is embraced; Subjective reality is privileged and the social history of the bombing of Hiroshima turns into the personal history of Elle and of Lui, and each’s interpretation of the world is negotiated alongside historic events.

Poff, too, saw the healing themes both between two persons (Elle and Lui) and two peoples (social historical context), but interpreted the film as “a failed attempt to resolve old trauma” referring to the Oedipus complex (both Elle and Lui deceive their respective spouses with this brief affair) and to transference, Elle’s putting of the past relationship (with the German soldier) onto the present one (with Lui), and to reconstruction (Freud)of the past. [Instead, I delighted in Lui’s capacity to ‘play’ (ala Winnicott) in the space between himself and Elle, wearing the attributions of her dead lover as part of the witnessing, and healing in relationship, which Elle requires. I found it a beautiful example, not of reconstruction, but of co-construction.]

Richard Geist replies to comments...to March 13, 2011 post

I agree with Richard that it is imperative we recognize the patient's healthy tendrils that are often embedded in their pathology because this is really the only thing we have to work with and build upon. Focusing on pathology often feels humiliating to the patient and provides little more than intellectual insight. The issue of empathizing with oneself is also crucial, but unfortunately not written about in the literature and a therapeutic goal. Carolyn and Amy, what can I say except thank you for your kind words! And being medium is pretty good for patients. Jessica, I agree completely; working from a connectedness perspective comes with its own complications and risks and requires more of the therapist/analyst than using a "technique" that keeps us somewhat distant, but safer. But, as you say, it also requires that we are very careful that what we are doing is in the service of the patient's needs not ours. Kristine, you're probably right there will be some criticism and you're right that I was enamored with my patient, but I think in the way that parents tend to over value their kids--and feeling slightly over valued as a patient is not such a bad thing. Barbara, I hadn't thought about it that way, but of course you're right that sharing the information with her was in itself an action, in this case I think in the service of welcoming what I perceived as an emerging twinship selfobject need. But again it is important as you point out to make sure we at least think we are acting in the service of the patient's needs. Steve, those patients who resist closeness require the same empathic understanding of their overwhelming fear of being close (and often the emotional traumas that have resulted from it). If we can allow them to remain distant while understanding the necessity for it, I have found eventually they will allow themselves to come a bit more connected. Christine, I think you're right (as was Pam); there were sexual undertones, but I didn't feel they were the central theme in terms of her sense of self. If they had been, I would have responded more directly to them. Ernesto, I think you're right; affect is central to connectedness and empathy as well as selfobject function. Perhaps I took this too much for granted rather than spelling it out.

Richard Geist, Ed.D.

'Listening'

Living an examined life (Socrates) requires a penchant for a balancing act. In the treatment process, there is always the need to balance orders of experience: the intrapsychic with the interpersonal; the analyst’s subjectivity and experience with the patient’s; the past, present and future; moving toward or away from a closer approximation of the ‘truth’; and so on. Tension needs to be held between dichotomies with an attitude of not ‘either-or’ but ‘both’. While psychoanalysis has traditionally long privileged left brain (explicit, verbal), growing evidence seats the unconscious in the right brain which is emotional-affective, bodily based, relational, and implicit. So another balancing act includes ‘listening’ not only to patients’ words, but to implicit communication.

Right brain information processing is so rapid as to be is non-conscious. It is ultra-rapidly integrative of emotion, affect, facial expression, auditory prosodic, gestural, and other relational data. The right brain is the seat of implicit memory, but interfaces with the left hemisphere, where explicit, verbal communication originates. The brain develops in a way such that self and mutual regulation go on at the non-conscious, implicit level. Schore states that 60% of communication is non-verbal (facial expression, gesture, tone, prosody, pitch, inflection, etc) and recommends that analysis consider affect-laden experience, even dissociated affects. This requires not only understanding language, but understanding implicit process as well.

Freud advocated for the fullest possible acquaintance with the unconscious mind through free association, which presupposes psychic determinism and contiguity, by the patient, and through careful and trained listening by the therapist. Attentive listening is paradoxically balanced with evenly hovering attention and reverie (Ogden), a listening with the third ear. During the evaluative process we let the patient talk freely without too much interruption or direction, but probably ask lots of questions at that time. Subsequent sessions can afford the patient a more direct role in the process while the therapist listens for not merely content but for shifts in the content and affect of the patient; waxing and waning attunement on our own part; shifts in the patient’s and our own self states; initial comments of the hour; developmental issues; character style; relational patterns; transference references; fantasies; etc. Standing in the spaces between so many avenues of inquiry and interest can seem daunting, or meditative, depending on our comfort with uncertainty.

Obama and Contemporary Therapy

Many times since his inauguration, President Barack Obama's approach and/or language has uncannily called to mind the philosophical leanings of contemporary psychoanalysis. He has talked about rupture and repair, and has held in tension disparate opinions (causing some early on to accuse him of being indecisive). Last night (March 28, 2011), ten days into the Libyan conflict, from National Defense University in Washington, D.C., President Obama addressed the nation about U.S. action in Libya. In his usual circumspection, he spoke both to those who want no U.S. action there and those who want action increased to the point of removing Moammar Gadhafi.

He explained clear goals and expectations (opposing violence against one's own people; advocating freedom to choose one's own government; a government responsive to the aspirations of its people) and extolled negotiation with other heads of state (the United Nations coalition) saying, "We should not be afraid to act, but the burden of action should not be America's alone." This comment of Obama's called to mind for me the psychoanalytic situation, where participation, the burden of knowing and uncertainty, the courage and the hope, belong neither to the analyst nor the patient alone. These are negotiated, apportioned according to the moment, and shared between two people who have no way to foresee the outcome.

As therapists, we welcome into our offices the longings of our patients, constructing together an increased breadth of possibility or freedom. So just as in the quote above I might have substituted 'the therapist's' for "America's", so in this later quote from Obama's address, I might substitute again 'the therapist' for "the United States": "Wherever people long to be free, they will find a friend in the United States." Always proud to be a U.S. citizen, Obama makes it easier. Likewise, I have also been always proud to be a psychoanalyst.

The Person of the Patient

Patients come to us for many reasons, often associated with symptoms such as anger problems, loneliness, insomnia, lack of interest in sex, depressed or anxious mood, repetition of unpleasant situations, or general unhappiness. Some come hopeful, some without hope. Some are motivated to decrease psychological suffering; some seek increased self awareness. Some are coerced by others to show up; some are desperate for any relief we might offer. Some may ask for advice, yet might benefit more from figuring out what has prevented them from taking advice they have already heard. It is the therapist’s job to ‘feel’ our way into their moccasins. By doing so, and by listening openly, if nothing else we decrease their isolation by sharing in their experience. To this we might add engendering hope.

When patients seem to us to ‘fail’ to make an effort, to change, to accept responsibility, or to let us ‘fix' them, we may feel angry, helpless, incompetent. There will be things about patients that will challenge our capacity to engage them whole-heartedly. They may smell, be combative and oppositional, or they may be supercilious and insulting. They may scare us or make us feel incompetent or helpless with their self injurious behavior or their threats, or with their too slow progress. They may whine or chronically come late or not show up at all. They may be too clingy, call us too frequently between sessions, or behave as if what we say and do has no effect at all on them. They may delay or withhold payment. We do neither patients nor ourselves any favor by pretending that patients don’t get under our skin.

It is also the job of the therapist to collaborate with patients to understand the perfect sense that their constraining, obnoxious, or even harmful behaviors make in light of their histories. These behaviors were the best possible solution at the time, usually in childhood, of their inception. A child is without experience, perspective, cognitive maturity, or, sometimes, without any aid or advocate. And because these behaviors may hold a fragile self together, patients and their behaviors are to be respected, and to be changed only with great caution.

An Introduction to "Prisoners of Childhood" by Alice Miller (1981)

Prisoners of Childhood, published by Basic Books,(republished under it's German name Drama of the Gifted Child in 1997) is ironically a basic, but essential book that focuses on the the loss of the self (and its origins) and on the traumatic consequences of this loss. Prisoners of Childhood is divided into three short chapters rich in psychoanalytic insights (especially in the first two chapters).

First, a little bit about the two editions of the book. The original edition centered around the psychoanalytic concept of narcissism. In the ensuing years, Miller had a complete falling out with the psychoanalytic community and even turned away from the concept of psychoanalysis itself, which is a bit confounding given what a gifted psychoanalyst she was. Thus in the 2nd edition she stripped the work of any and all psychoanalytic "jargon". I believe something was lost in the process, so I have chosen to review the original.

Like my review (March 17, 2011) of Gaslighting... (Dorpat), I will quote this book extensively for it is rich in deep insights spoken so eloquently they hardly need explanation.

In the foreword Miller focuses on the ways many children are taught to behave at a very early age. With this focus on behavior, the child, who cannot risk losing his parents' love, complies, behaving before he can possibly understand what the behavior means. Miller than goes on to show how this leads to the development of a "false self" in gifted children (by "gifted" Miller is referring to those children that are very good at modifying their behavior to secure the parents' love, i.e. surviving).

On the lack of "respect for others" found in the narcissist, Miller has this to say:

If a mother respects both herself and her child from the first day onward, she will never need to teach him respect for others. (viii)

How lost this is on so many parents! I see it all around me, the commandment "Thou shall Honor thy mother and thy father" is drilled into a child's head on the one hand, but that honor is never practiced in the parent-child relationship. Children learn through observation and experience, what better way to teach a child respect than to respect yourself as well as the child? This commandment ought to be "Honor thyself and thy child". The original is a poisonous commandment that has misguided countless parents and poisoned society.

Miller continues:

... a mother who [was not respected as a child] will crave this respect from her child as a substitute; and she will try to get it by training him to give it to her. The tragic fate of such training and such "respect" is described in this book, (viii)

Miller makes some poignant observations about this early focus on behavior:

[it is inconceivable to love others] ...if one cannot love oneself as one really is. And how could a person do that if, from the very beginning, he has had no chance to experience his true feelings and to learn to know himself? For the majority of sensitive people, the true self remains deeply and thoroughly hidden. (viii-ix)

Miller's point is that the 'gifted' child, the child who most successfully conforms to her parents' wishes of behaving a certain way (and thus being something the child is not) most thoroughly loses any notion of love and respect for who she really is.

Miller poignantly concludes:

Such people are enamored of an idealized, conforming, false self. They will shun their hidden and lost true self, unless depression makes them aware of its loss or psychoses confronts them harshly with that true self... (ix)

On page ix we get the origin of the books title, where Miller speaks of the "true self's 'solitary confinement' within the prison of the false self." (ix) For Miller then, the ultimate goal of therapy is to help the patient experience his true feelings which will allow him to face repressed instinctual conflicts, which he will experience intensely. (x)

I could justifiably end this review with the opening sentence, one which could not be more insightful or informative to the therapist and patient:

Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and the unique history of our childhood. (3)

but continuing,

for many people the truth is so essential that they must pay dearly for its loss with grave illness. (4)

I have born deeply personal witness to the veracity of this statement! "The truth hurts, but lies kill" I often say.
Miller goes on to say

Sometimes I ask myself whether it will ever be possible for us to grasp the extent of the loneliness and desertion to which we were exposed as children and hence intrapsychically are exposed as adults." (5)

by Tim LaDuca

(To be continued...)

"Who's Afraid of Virginia Woolf?"

Edward Albee, born March 12, 1928 and adopted by wealthy rightwing Republicans, claims relief to discover he did not belong to such a family. Leftist political views, being gay, and artistic talent sufficed him as a young man to leave his adoptive family and live in poverty. [We might surmise that Albee received little mirroring (Kohut) or approbation as a child.]

Albee later says "All plays, if they're any good, are constructed as correctives. That's the job of the writer. Holding that mirror up to people. We're not merely decorative, pleasant and safe."Perhaps his view might coincide with that of the traditional psychoanalyst who holds up the mirror to the patient as a ‘corrective’ with the self satisfied knowledge that s/he knows exactly what is correct. A more contemporary analyst might allow for more uncertainty and take some responsibility for what is seen.

Albee’s play Who’s Afraid of Virginia Woolf?, denied the Pulitzer prize in 1962, [Albee subsequently received Pulitzers for A Delicate Balance, Seascape, and Three Tall Women] is now playing at the American Stage Theatre in St. Petersburg, FL. It is said that Martha’s and George’s [yes, named after the Washingtons; Nick after Nikita Khrushchev] dialogue resembles Albee’s relationship (1952-59) with composer William Flanagan. Like another of his plays [The American Dream (1961)] Virginia Woolf? mocks the American family and dream.

Virginia Woolf? might epitomize what English theatre director Peter Hall said about Albee: "Edward is a very daunting personality. He makes a religion of putting people off. He loves destabilising people" and, when drunk, Albee could be cruel. He once wrote an apology to a host: "By nature, I am a gentle, responsible, useful person, with a few special insights and gifts. With liquor, I am insane."

Liquid courage, it is true, emboldens us to blame others for our flaws [nostalgically called projection]. Neither Martha nor George, nor, I imagine, Albee could, it seems, sustain the felt presence of another in their corner. This chronic failure of recognition and attunement embitters the soul no matter how desperately one clings to maintaining connection to the depriving other.