Long before any theoretical contributions from various schools of psychoanalysis are introduced to first year candidates at the Tampa Bay Institute for Psychoanalytic Studies, the majority of the first year course, Introduction to Psychoanalytic Concepts I, discusses with candidates how to be with patients. How fortuitous that I have recently come across the immensely readable (and highly autobiographical) primer by Louis Breger, Psychotherapy Lives Intersecting (2012; Transaction Publishers, New Brunswick, NJ) which adds the perspective of former patients, what they found helpful and unhelpful in their treatments, to the pearls gleaned from his vast experience as a psychoanalyst. Breger aims his book at people considering therapy, but therapists, too, will greatly benefit from this jargon free exposition. What is unique about this book is that the many clinical vignettes are enriched by reflections from patients about their own psychoanalytic journeys, something the reader may find courageous.
Elizabeth (pp. ix) writes, 'Throughout the therapy experience with you, I always felt like a person in a relationship, rather than a person to be understood by you, and then explained back to me…you communicated an utter lack of judgment, an acceptance of the aspects of my life about which I was most embarrassed, and modeled that Not Knowing was okay'. Another patient, Bernie, (pp. 29) “singles out catharsis, having a safe person to talk with, and insights-in that order-as the helpful factors of his therapy.” Breger says of his own analysis, “…it was the relationship itself—being accepted, listened to in a noncritical manner, understood, appreciated, even liked—after revealing what I felt were my most shameful and guilt-ridden secrets—that was most helpful." Breger listened closely, was not dogmatic, and did not dictate rules.
Just as research shows that the person of the analyst is more important than her/his theoretical orientation, Breger recognizes that relationship is as important, maybe more so, as interpretation and insight. Breger also sees the benefit of ‘fit’ between analyst and analysand, including whether the therapist likes and identifies with the patient. Instead of illustrating how to behave as an analyst, Breger writes about an analytic attitude. Breger muses on anonymity, authenticity (about being human), self disclosure (must [also] be for the benefit of the patient), and analyzability. But Psychotherapy Lives Intersecting is as much about Breger’s personal journey as an analyst as it is about how his patients viewed their treatment. The neophyte will benefit greatly from this disclosure. His “straightforward approach” to writing and to his patients is refreshing. As a traditionally trained analyst who also found a relational home in contemporary theories, I found it wonderful to immerse myself in a book where I found like mindedness.
Wednesday, May 30, 2012
Posted by Lycia Alexander-Guerra, M.D. at 7:24 AM
Monday, May 14, 2012
While I advocate in analytic treatments for openness and authenticity, I was surprised that Henry A Crumpton, whose book The Art of Intelligence: Lessons from a Life in the CIA's Clandestine Service which came out today, stated some things that good spies have in common with therapists, namely "an intense intellectual curiosity; willingness to deal with ambivalent situations [by which I took he meant ambiguity]; and a certain degree of creativity." Part of me shudders. Still, I like to see our work as therapists as one of collaboration, where both parties strive, by the very nature of their relationship, toward a common purpose, not enemies except in moments of rupture, not out to deceive the other except in protection of the sense of self coupled with a longing to be known and understood. Therapy is a tricky business, no precious metals to be acquired, no missile heads to be dismantled, no foreign dignitaries to be protected, but sometimes a sense of life or death for a particular self state or relationship, an urgency to find one another in the tumult of the outside world, and a hope that we each will sleep more peacefully tonight.
Posted by Lycia Alexander-Guerra, M.D. at 8:12 PM
Sunday, May 13, 2012
Winnicott said that the good enough mother never asks the infant to answer of itself the question about the transitional object ‘did I find it or did I create it?’ I also think the good enough mother welcomes and enjoys her infant, sharing the joy of its developing experiences, accepting and loving it, most times, just for its being born, and making quick repair when she doesn’t. But the greatest gift a mother gives her child is her own genuine happiness, a consequence of her own subjectivity and interests, her own feeling of being loved and accepted in the world. This gift gives children the license to be happy themselves, permission for their own subjectivity, hope for the future (of aging), as well as infuses them with the belief that they are enjoyed, welcomed, and contribute to parental happiness. Jessica Benjamin noted that the subjectivity of the analyst also relieves the patient of having to feel responsible for the analyst’s ‘happiness.’ A Happy Mother’s Day to all the moms out there.
Posted by Lycia Alexander-Guerra, M.D. at 3:12 PM
Tuesday, May 8, 2012
Posted by Lycia Alexander-Guerra, M.D. at 1:20 PM