Sunday, March 13, 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


Richard Nikla said...

It is true that we have feelings for clients during the session. It is also good to examine them in construct to why we are having them and in what light. We are not robots. If we criticize the therapeutic process then we have to ask ourselves for what purpose and who benefits. For me the important parts of his presentation reflected around the therapist support psychotherapy and not pathologies and the therapist helping the client to empathize with themselves. Would like to read more on that. It is too easy to label a client because of not understanding their fear and frustration. Finding fault and not addressing the feelings does a disservice to the therapist and the client.

Carolyn Smith said...

He was awesome! I think I am going to try to read everything he has ever written. He seemed so smart, kind and honest. He seems like the type of person who should be a therapist. I was glad that Laura has such a caring therapist and that he was willing to share the story. If there was a Geist fan club I would become an active member. He was just amazing.

Amy Biegel, PhD said...

An association…When I was pregnant with my son I came across a simple piece of advice in some parenting book or article. It said: 1) Don't act big. 2) Don't act small. 3) Be medium. I wrote it down right away thinking that this is just what I hope to instill in my child (and self). Richard Geist is a beautifully medium. To me, when a person is that brilliant and simultaneously gracious, doesn't get better than that. It was an inspiring day.

Jessica Rausch-Medina, MD said...

I really enjoyed him. He was quite fascinating. I love how willing he was to be open and candid about his work, it was very helpful, he really dissected the process. But at the same time I realize that this business of being very present and real with the patient can be dangerous if not done responsibly and with care. He put a great deal of thought and care into it, I don’t know how to emphasize enough that it is something done with the patient in mind, not mindlessly.

Kristine Butler, LCSW said...

I enjoyed listening to Geist and agree with his views on the relationship. I admired his ability to respond to his client in such a caring manner. I did walk away thinking he was enamored with his client and was probably going to take strong criticism on his paper. It is good he has clear boundaries!

Barbara Casasa-Cohen, PhD said...

Geist was refreshing, raw, real...honest, almost disarmingly so. I think that is the beauty of his work. Powerful stuff, especially in the hands of the seasoned clinician-- a bit trickier for training purposes. When he referred to fantasies that were "un-actionable" (i.e, sharing with patient that he too had fantasy of her driving him to airport) some would argue that choosing to share that information with her is itself an action. Then one ponders to what end? to preserve the integrity and authenticity of the relationship...yes. But at what potential cost, whose needs are at the forefront? As opposed to say exploring what that fantasy represented for her. Anyway, I so admire his honesty and bravery in deftly handling the delicate moments we encounter.
Barbara Casasa-Cohen, PhD

Steve Graham, PhD said...

I thought Geist modeled and presented a wonderful way of being both authentic and empathic. I recognize that speakers (and writers) tend to showcase examples that wonderfully illustrate their theory, while not accounting for those that don't so much. I wanted ask him about those patients who tend to resist closeness -- those more on the schizoid end of the spectrum. This was the second of two case studies presented by Geist showcasing erotic transferences -- and wanted to ask about that, too.

Christine Hardway, LCSW said...

I enjoyed the conference. I thought
Geist was insightful and interesting. He was honest regarding some of his fantasies and feelings about the client. I enjoyed listening to
Dr.Pam Epp's comments about how she was sensing some sexual undertones present in the session with the particular client.

Ernesto Vasquez, MD said...

The lively discussion [March 12, 2011] had such great energy and I enjoyed that part of it. Over the years the Psychology of the Self has been of limited theoretical interest to me. I did not utilize it in my clinical work.

Although affect seemed implied in much of what Geist talked about, he did not offer an explicit elaboration of its importance in his theorizing.

I tried to raise the issue albeit poorly a number of times and got one word responses. I was glad to hear you [Dr. Alexander] use the words 'emotional engagement' or the 'implicit' because that is what I was trying to get us to talk more about. It seems to me that affectivity is central to the notion of connectedness as well as to the concept of empathy.

Anonymous said...

I am a patient of Richard Geist. I have to say that his openness and the vulnerability he exudes is amazing. NO ONE would take the chances that he took with me, being a borderline patient. Sandy