I am always delighted when I read how contemporary relational thinkers reconfigure century old tenets in psychoanalysis. Adrienne Harris does just that with conflict in her 2005 paper Conflict in Relational Treatments (PsaQ 74:267-293). Though finding her paper somewhat confounding, the TBIPS Relational Study Group delightedly discussed the elaborations of conflicts in human experience which Harris considers. She elaborates on conflicts between the needs of self and others (interpersonal conflicts), between two unconsciouses (intersubjective conflicts), and conflicts between self states, in addition to the traditionally understood conflicts between wishes and between wishes and their prohibitions. Along with conflicts between ego-id-superego, additional intrapsychic conflicts exist between the multiple selves of one person and the multiple unconsciouses found within these multiple selves. Disavowed or dissociated parts of self may then never come into the treatment with the selves states of a particular analyst. Conflicts for the analyst, too, include the conflict between sticking to the rules of training and being spontaneous; the conflict of desiring the imposition on the patient of the normative and the hope for the patient to have freedom from these constraints. Speech, too, provides for conflict, for example, between what is said and how it is said, between content and tone/prosody, or content and intention. For both participants there is the pull between the wish to change and the wish to stay the same. There are the interpersonal and intersubjective conflicts between analyst’s and analysand’s agendas, both overt and covert, and also those between the unconscious(es) of the analysand and the analyst. Consider then the multiplicity of the analyst’s selves and those of the analysand in their innumerable combinations! I often think that the analyst must juggle a huge number of balls in the air-- while walking a tightrope. Harris made me consider adding to that number.
Sunday, April 29, 2012
Friday, April 20, 2012
In the Development course of First Year at the Tampa Bay Institute for Psychoanalytic Studies, the paper Aggression and Sexuality in Relation to Toddler Attachment: Implications for the Caregiving System by Alicia F. Lieberman (1996, Infant Mental Health Journal, 17(3) 276-292) was recently discussed. I recommend this paper for its elegant vignettes which readily illustrate how parents might enhance a child’s sense of self and self worth by their responses to a toddler’s aggressive or sexual strivings. But it is its applicability to the psychoanalytic situation that cause me to quote from what Lieberman describes as the outcome of well or poorly handled responses.
She writes that when negative feelings are generated in the attachment relationship around sexuality or aggression, there occurs
a constriction in the areas of experience where the child can rely
trustingly on the attachment figure’s emotional availability …
Attachment loses some of its richness and range because certain
domains of experience must be kept secret from the parent for the sake of not risking rebuke and disapproval.
And its corollary:
When aggression and sexuality are appropriately accepted, modulated, and socialized by the attachment figures, in contrast, there is an expansion in the range of affect that becomes permissible to experience and to share. Toddlers acquire a visceral [procedural] sense of pleasure in who they are and how they are made when their parents cherish and celebrate their body and its accomplishments…when appropriate limits are being set that allow the child to learn what is permissible and what is not in a clear and nonpunitive manner.
Certainly, the analyst hopes to invite in to the consulting room the broadest range of affective experience and to eschew rebuke and disapproval for what a patient brings. We want our patients to cherish and celebrate a broad range of self experience. Likewise in the psychoanalytic situation it is incumbent upon the therapist to remain emotionally available to analysands even when they bring potentially unwelcome strivings, to remain emotionally available by empathizing with and remaining sensitive to the patient’s strivings, keeping open the elaboration of wishes and desires without unduly frightening a patient and without foreclosing the transitional space for play by reifying or concretizing patient’s wishes through action. Keeping the elaboration of desire alive while holding sensitively to the limits of its permissibility is a very difficult balance, reminding me of what a medical school, surgery mentor used to say when things got unpredictable and potentially dangerous on the operating table, “We’re in tiger country now.”
Monday, April 16, 2012
I recently began musing on happiness when invited by David Burton, a local, independent, documentary filmmaker to be interviewed on this very subject for his present film project. I thought about how the human brain is wired for moments of happiness; it releases happiness chemicals during certain experiences such as love or orgasm or a runner’s high. The more experiences our brains have with happiness, the greater our faith that we can expect future happiness to be forthcoming. As such, I recommend we practice some joyfulness every day.
Because as infants and toddlers we require attachment for our very survival, each of us as children constructs what we believe will maintain that attachment bond. As such, children will comply with parental demands to themselves be the parent to the parent, or to be the container of all bad feelings or behaviors, to achieve in sports or academia, and so on. Even with good enough parenting, eventually well-fed and well-loved infants who have delighted in playful interchanges with caregivers learn as toddlers that their caregivers are no longer under the child’s omnipotent control, a loss compensated, ala Benjamin, by the joy of two separate minds coming together, because they choose to, to share one thing, e.g. the child’s wonder at a dandelion. Later when we are aware that we are finite, mortal, and alone in the universe, this meeting of the minds bridges the gulf of existential isolation, and momentarily we are joyful.
Happiness, or at least contentment, comes with satisfaction of certain innate strivings of human beings, five that Lichtenberg beautifully delineated: physical needs (food, safety, shelter); needs for creativity, exploration, and play; for sensual and sexual pleasures; for attachment and affiliation; need to defend against or escape adversity as well as to assert ourselves. Happiness is co-created in the context of relationships. When we have had the experience of being welcomed and enjoyed, then our parents’ joy infuses us. We learn joy and to enjoy ourselves, as well as others. Happiness comes more easily to those who have been welcomed and enjoyed. And when we despair, it is easier to keep the faith that happiness will eventually be coming around again.
I remembered a psychiatry resident from a few years ago whom I was to supervise. She came to me, terrified about the prospect of doing psychotherapy without sufficient training, and I asked her what she thought most people want. After a few moments she answered, profound in its simplicity, "love and acceptance." That is, then, I told her, exactly what we must learn as psychotherapists to weave into the treatment relationship.
I advocate, then, for love and acceptance in the psychoanalytic situation, welcoming and enjoying our patients, even their darkest self states, such as anger, despair, envy, and murderous rage, self states of which they are ashamed and may disavow, but being welcomed into the treatment room can find voice, and, ideally, can find dialogue with one another. The psychoanalytic experience of love and acceptance coaxes forth shamed and disavowed self states, invites in play and creativity, and a communion between self states, mine and the other’s, in a panoply of possibility. When I experience myself with another, intimately, fully, authentically, there is happiness.
Posted by Lycia Alexander-Guerra, M.D. at 5:47 PM
Wednesday, April 11, 2012
The Tampa Bay Institute for Psychoanalytic Studies, Inc's first year class has been reading Freud’s ideas on female sexual development in the Development course. Because in each class we try to offer a dialogue between antipodal points of view, as a preview to the readings in today’s class I thought I might comment on Jessica Benjamin’s 1991 paper Father and Daughter: Identification with Difference — A Contribution to Gender Heterodoxy.
It seems Freud could not conceive that small children wanted it all, to be and to have all, but instead thought both male and female children only wanted the penis. Likewise, Freud did not conceive that 'normal' children might have homoerotic longings but instead only heterosexual ones: when little boys longed for attention, affection, love from their fathers, they must be feminized (the negative oedipal complex) and likewise little girls attached in an active way to their mothers must be like little men, be little men, just like little boys who want their mothers in a heterosexual way. While Freud postulated that the fear of losing his penis catapulted the little boy out of the oedipal phase, he posited that little girls enter the oedipal stage from their castrated state, turning to the father in search of a penis (or its psychic equivalent, a baby).
Benjamin revisits and reconfigures penis envy of little girls and places it not at the cusp of the oedipal configuration but instead squarely in the pre-oedipal period, noting that pre-oedipal girls turn to the rapprochement father, not yet an object of erotic love, but instead as an object of identification. The father, the penis, the phallus all stand for independent agency, subjectivity. Little girls, as do little boys, use the glamorous, exciting out-in-the-world-father as an idealization of subjectivity, a role model, a subject with agency, will, and desire. It is identification with this father as subject, separate from and independent of mother, that allows for children of both sexes to individuate from mother. Benjamin further expects that the latency age girl who wishes to be buddy to her father seeks to consolidate her identification with an independent subject. Rather than seeing this behavior as a masculine protest (Freud), Benjamin notes that it further consolidates a feminine identity.
Benjamin proposes that thwarted identificatory love may also explain girls’ fantasies in Freud’s A Child is Being Beaten. Thwarted identificatory love may lead a woman to privilege desire of a man over her own desire, whereas welcomed identificatory love, Benjamin writes, may sow the seeds for later erotic, mutual heterosexual love rather than being complicated by submissive, even masochistic, behavior towards men.
Posted by Lycia Alexander-Guerra, M.D. at 6:36 AM
Sunday, April 8, 2012
For Christians, Easter Sunday is the holiest and most joyous holiday, the day they believe that Jesus Christ rose from the dead. While their believe insubstantiates the triumph over death, psychoanalysts engage instead in the metaphorical (re)vitalization of their analytic partners who often come to analysis with the complaint of feeling empty, dead inside. In feeling their suffering I sometimes wonder to myself, ‘where was the parent with the gleam in her/his eye to enjoy this self as baby, infusing the self with joy and enlivening it via connection with a mutually attuned other?’ Is analysis some kind of ‘corrective emotional experience’ in which there is a way that together we can find a moment of connection that enlivens us both? Before we were isolated, separate, and hopeless, and then, in an unexpected and miraculous moment we meet, are fleetingly connected. Is this connection (perhaps more protracted for the faithful) not what a god promises its supplicant?
Because we can never know the suffering of others, I am reminded of Roger Rosenblatt in Kayak Morning quoting Philo’s admonition “Be kind for everyone you meet is carrying a great burden.” This resonates for analysts who recognize that all of us, like Christians who walk in Jerusalem the Via Dolorosa (translated as the way or road of suffering) to commemorate Jesus’ carrying the cross to his death , walk through the world in suffering, suffering both made worse and caused by isolation from others.
Posted by Lycia Alexander-Guerra, M.D. at 10:14 AM