'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.

Review of "Gaslighting, the Double Whammy, Interrogation, and other Methods of Covert Control in Psychotherapy and Analysis" by Theo Dorpat (1996).

As a layperson I found Gaslighting... by Theo L. Dorpat a true gift. Through it I learned that the psychoanalytic process could be a useful and trustworthy tool in the treatment of mental illness. Before I read Gaslighting..., I harbored a great distrust for psychoanalysis and psychotherapy in general. Gaslighting... taught me it is not these great institutions that matter, but the individual persons who populate them and their kindness*.

It is hard to get across the impact this book has had without quoting it extensively, which I shall do. It has a very high signal-to-noise ratio. By that I mean it is jam packed with facts and truths, and I would recommend it for that alone.

Gaslighting... is a book about "covert methods of interpersonal control" both inside and outside of the therapeutic framework. It's not just about covert abuse in psychoanalysis but the role of covert abuse in the genesis of mental illness. This dual framework is what makes the book so amazing. Hopefully the first three sentences will peak the readers interest:

It has been said that fish don't know they swim in water until they are out of the water. Similarly, most people do not know about the subtle and covert types of interpersonal control, domination, and abuse they are exposed to all of their lives in their families, at their schools, or in their workplace. Not until they have experienced relationships that are more caring, respectful, and nonmanipulative are they able to recognize how much they have been covertly manipulated, controlled, and abused by others. (1)

Aptly covered is the concept of "projective identification", Dorpat's definition:

In projective identification, the subject first unconsciously projects unwanted aspects of themselves onto another person and pressures the object to contain, as it were, the subject's disavowed affects and contents. (6)

This is a primary form of gaslighting, which I assert, is unfortunately used quite commonly on children unwittingly by their parents becoming the source of many, in Dorpat's words, "pathogenic beliefs" often seen by clinicians.

Dorpat covers many covert methods of interpersonal control in the therapeutic situation including the aforementioned projective identification, a form of gaslighting which "...is an attempt to impair or destroy an individual's confidence in his or her psychic abilities". (7) Also covered are questioning, "defense interpretation", confrontations, interrupting or overlapping communication, and abrupt change of topic all which can lead to a "fragmenting [of] the patient's experience" (11).

I want to emphasize that although this book emphasizes the therapeutic framework, it also recognizes the covert methods that are endemic in society.

Dorpat wastes no time with a brief, simple but scathing critique of behavioral therapy and it's use of rewards and punishment, noting that "Humans have used rewards and punishment as effective means of training and attaining social control over others... for millions of years" (22), concluding that behavioral therapy is merely a means of getting patients to "act normal"(23). [In the interest of revealing my own bias, I would add that CBT is even more insidious with the "C" merely a proxy for brainwashing.]

Dorpat includes numerous, rich case studies to explore the dynamics of psychoanalysis. By studying where psychoanalysis goes wrong he manages to show its immense worth by saving the baby from the bathwater. He discusses a patient's reaction to attacks on the patient's judgements and perceptions noting the patient's "self-esteem fell as his confidence in his reality-testing and mental functions was markedly lowered." (36)

Dorpat skillfully portrays the use of questioning (quite simply, asking questions) as a method of control. In a vignette he reaches a beautiful conclusion of what a patient tries to communicate about the author's use of questioning: "Don't worry about not immediately knowing something about me. Your questions are pushing me away!" (54) Dorpat takes a very hard line on questioning, stating that it is only useful "in situations where the therapist is uncertain about the meaning of something said by the patient...". (71)

Gaslighting... shows some ways psychoanalysis can be counter-productive and the meat of this book illustrates in great detail, through vignettes, the disastrous results of covert interpersonal control in therapy. I fast-forward to the beautiful conclusions of this book. Extensively paraphrasing Wiess et al. (1986) Dorpat agrees:

Psychopathology stems from unconscious pathogenic beliefs of dangers if the patient were to pursue certain important goals. Unconscious pathogenic beliefs are irrational and they involve feelings of guilt, shame and anxiety. These are mainly formed in childhood out of traumatic relationships with parents and others... Patients are powerfully motivated to disconfirm these beliefs because they are maladaptive and grim, and they produce much mental pain. (238)

This is pure gold. Other conclusions are: to avoid the use of stereotyped psychoanalytic approaches (226); to recognize the importance of the nature of the analyst's interaction with the patient (231); and the importance of evaluating patient's responses to interventions by the analyst (247).

Much of my admiration for this book is due to the fact that it is very extensively sourced (a quality with which it shares in common the Pulitzer Prize winning "Denial of Death", Becker (1972)), drawing on works from A-Z including Hienz Kohut, Robert Langs, Joe Weiss, DW Winnicott, Eric Fromm, Bob Stolorow, and more than 100 others.


Gaslighting... is a great starting point for anyone interested in covert abuse, mental illness, psychoanalysis, and how power is unconsciously communicated in American society. I'll end with the books cogent epigraph:

For those who stubbornly seek freedom, there can be no more urgent task than to come to understand the mechanisms and practices of indoctrination. These are easy to perceive in the totalitarian ocieties, much less so in the system of "brainwashing under freedom" to which we are subjected and which we all too often serve as willing or unwitting instruments. Noam Chomsky, 1987


* Dorpat's kindness and caring is unconsciously woven though every page of the book.


Tim LaDuca
Wednesday, March 16, 2011

Richard Geist delineates Self from Ego Psychology

One of the most celebrated authors read at the Tampa Bay Institute for Psychoanalytic Studies, Inc.’s Self Psychology Study Group, Richard A. Geist, Ed.D., may also possibly become one of the most celebrated speakers at the Tampa Bay Psychoanalytic Society where, on March 12, 2011, he read two of his papers. The seamless way Geist was able to weave audience questions and comments throughout the presentation of his elegant clinical papers provided implicit knowing about the way he works. As such, at almost no time in the presentation did we feel read to [for some, being read to in a professional forum may call to mind the classical approach of the analyst as ‘the one who knows’, imparting knowledge to the analysand, the experience as wooden as the blank and ‘neutral’ analyst]. Instead, his presentation was immensely collaborative, much as contemporary clinical work aspires to be.

Geist said that an analysis which is mutually empathic will more easily evoke healthy transferences (consequently, allow more easily for a patient to feel understood), and it is through the analyst’s willingness to allow her/his boundaries to become permeable, facilitating the felt presence of each in the other’s life with interpenetrating subjectivities, that mutual empathy is fostered. The analyst’s responsiveness, with its components of empathy [I noted how Geist’s child training at Boston Children’s Hospital, where in Behavioral Pediatrics one learns to stay close to the experience of the child, fits well with Self Psychology’s staying empathically close to the patients’ experience], selfobject transference, and subjectivity contributing to connectedness, are all experienced by the patient as part of self.

Elaborating on the analytic attitude, which is accepting, understanding, and responsive emotionally, Geist noted that the analytic attitude is always in service of maintaining a cohesive sense of self and toward connectedness. An analytic attitude is also protective of the patient. Geist, in utilizing the concept of protection (much like many of us might refer to safety) expanded our understanding of how the protecting selfobject transference safeguards the ‘tendril’ of growth (Tolpin’s ‘leading edge’) and protects from affect overload. The creating of a sense of safety and trust is aided by permeable boundaries and empathic immersion. Drawing from Kohut, Geist offered that we think of ourselves not as the object of a patient’s anger, but instead as the subject of the patient’s feelings, remaining empathically immersed and asking ourselves what it must be like for the patient to feel a particular way in the therapy.

Delineating Ego psychology from Self, Geist noted that Ego psychology is designed to dissect the self, while Self psychology is designed to put the self back together. The Self psychologist responds to the whole self in its contextual ambience, and, unlike the Ego psychologist, does not focus on a particular defense or a particular affect found at any given moment. Self psychology sees transference as always in the direction of health, not as a distortion (as per Ego psychologists), and, as such, do not conceptualize in terms of ‘negative transference.’ Self psychology heeds research that shows a child develops optimally in an environment of responsiveness, and is therefore, unlike Ego psychology, not built on a frustration model. Interpretations were perhaps one of the most delineating concepts of the day: Interpretations, though but one aspect of what helps patients get better, are designed to welcome the patient’s fantasies as attempts at healing, and they emerge from connectedness within the clinical situation, not from theory. Interpretation is always in service of what the patient needs in order to maintain sense of self and always in the service of expanding permeable boundaries for interpenetrating subjectivities.

If there could be a disappointment to his visit, it would be the ‘bait and switch’ of the advertised paper to be presented (Geist, R.A. (2009). Empathy, Connectedness, and the Evolution of Boundaries in Self Psychological Treatment. Int. J. Psychoanal. Self Psychol., 4:165-180) [and the most provocative of any I have ever read], but this was aptly relieved by the reading instead of his soon to be published paper: Our Private Theory of Change_Connectedness and the Analyst's Attitude. I also highly recommend his paper: Geist, R.A. (2008). Connectedness, Permeable Boundaries, and the Development of the Self: Therapeutic Implications. Int. J. Psychoanal. Self Psychol., 3:129-152.

by Lycia Alexander-Guerra, MD

photo provided by John Lambert, LCSW

Safety and a Flexible Frame

Early in my medical training I recognized that a large majority of patients sought medical help for behavioral (overeating, excess alcohol, lack of exercise) and other psychological (anxiety, depression, psychosomatic illness) problems. I gave up Family Practice in favor of Psychiatry, but early in psychiatric residency training I entertained the notion that accurate diagnosis and appropriate medication-- while perhaps dampening psychosis, vegetative symptoms, and autonomic responses-- may not fix a bad marriage, undo past trauma, or feed the soul. The rare psychoanalytic supervisor seemed to have a deeper grasp on the exigencies of being human. But what is so special about the psychoanalytically oriented psychotherapeutic relationship? why psychotherapy; why psychoanalytic training; what distinguishes therapy from a good friend or a loving family member?

In addition to an analytic attitude (Jan 3, 2011), psychoanalysis (and psychoanalytically oriented psychotherapy) allows the patient a freedom of self unlike any other relationship. It allows for the safe exploration of automatic ways of being with another. Together therapist and patient negotiate the frame, or rules, on which the two will come to rely, such as punctuality, alertness, and a readiness to be interested and self-reflective. When we as therapists fail to be punctual or alert or ready, we must open our failings to the patient for exploration. 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 we do not judge or incredulously question in a way that humiliates; 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’.

Likewise our reliability, punctuality, earnestness in the experience, our listening, processing, and considering what we have seen, heard, felt, and experienced also facilitate safety. Maintaining the frame will, at times, help communicate safety. Sometimes the patient seeks to break the frame, not as resistance but as an attempt to reach us, particularly if we hide behind a role. At other times, the frame must be flexible enough to allow for negotiation, and for reenactments. Because psychoanalytic psychotherapy is a dialogue within a frame-- with a reciprocity of sorts-- and because it includes the multiple unconsciouses of both participants, both patient and therapist will emerge changed in some way.

Aviva, my Love

The penultimate film in this year’s Film Series: Developing Passions, co-sponsored by the Tampa Bay Psychoanalytic Society, Inc , and The Humanities Institute at USF, was Aviva, My Love (screenplay and direction by Shemi Zarhin) a poignant, often humorous, Israeli film about family in which an aspiring writer struggles to manage all the competing demands in her life: her unemployed husband, her three, sullen children, her eccentric mother, her infertile sister and brother-in-law, and the bills. Men in the audience felt sad for Aviva. Women in the audience saw Aviva as doing what women have always done to keep a family together.

The film opens where an aging and corpulent dentist tells Aviva (Asi Levi) that her daughter’s dental bills will be forgotten if Aviva will take off her shirt. [I found it disconcerting that the audience laughed here.] This scene foreshadows a more significant form of prostitution [and sets the emotional tone for the women of the audience]. Aviva refuses the dentist, but not Oded (Sason Gabai), a writing professor who, ten years previously, had written a best seller.

Aviva, never having attended college herself, is a writer, writing in her head as she prepares food at the hotel restaurant where she is employed as a chef, writing in her notebooks as her children at home argue, TV blaring. Aviva is uncertain of her talent. Though never published, her husband Moni (Dror Keren) and her sister Anita (Rotem Abuhav) refer to her, encouragingly, as the “famous writer.” Younger, envious Anita types Aviva’s scribbled stories.

Throughout history, women with mouths to feed have been forced to sell their bodies or their souls. Aviva stumbles, then, recovers herself, to find her voice, and, at the end of the film, she writes now in first person.

Aviva, My Love was discussed by clinician Sheldon Wykell, LCSW and USF professor Rina Donchin. The last film in the series, Hiroshima Mon Amour, will be viewed on Sunday, April 3, 2011 at 2pm in room MDA 1097 at the USF medical school.

Subjectivity, self-disclosure, and an ideal

It is now well articulated that our own subjectivity greatly influences, both explicitly and implicitly, the work co-created by us and our patients. Whereas Freud thought abstinence, neutrality, and anonymity were part of the ideal stance, contemporary thinkers know these to be not only impossible but sometimes unhelpful, even detrimental, to the therapeutic process. Aron (1991), and Hoffman(1983) write that the patient's experience of the analyst's subjectivity needs to be made conscious, that is, it is sometimes okay to ask patients what they notice about us and our reactions, perhaps particularly when we have feelings we hope we have kept hidden from the patient. Patient reaction to our subjectivity is only one aspect of the transference, but was, traditionally, a neglected area of exploration. (Remember that what patients notice about us may also be defended against by patients.) Just as patients can not entirely know themselves, neither are we the authority on the accuracy of our patients' perceptions of us. Patients learn about themselves from us, so we, too, learn, often uncomfortably, about ourselves from patients. Bion thought that the more real the analyst, the more the analyst can be in tune with the patient’s reality.

Still we strive to be careful not to impinge on the psychoanalytic process by excessive self-revelation. I like to think that self disclosure pertains to allowing into the process what is going on with me in the therapeutic relationship, not about what goes on with me in my private life. Semrad quipped that psychotherapy is a mess trying to help a bigger mess, his way, I think, of saying that you do not have to be a perfect person to be a good therapist. Because self-revelation by the therapist is ongoing and inevitable, we (through our deportment, dress, attitude, etc) cannot help but to reveal our imperfections. They may impinge upon the patient less when we find in our personal lives gratification in love, work, and play, separate from what gratification we un/consciously hope for from patients.

When considering our own subjectivity (point of view, beliefs, opinions, goals, desires, etc.), we might examine our own motivations for having chosen the mental health profession as well as our fantasies about how we might help others, and ourselves, by having so chosen. Philosophically, do we have hope for ourselves (and do we hope to facilitate hope in others) for a life experienced with fullness and passion, for both joys and sorrows, and to experience life, not in isolation, but in authentic connection with others? Is ardor for life a personal value? An ideal stance then might better be suited by being open and curious, and brave toward newness, uncertainty, and psychological intimacy.


Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1:29-51
Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.