Friday, September 28, 2012

Poem: A Therapist's Morning

The young man grows up
With a father, chronically disparaging, disappointed
In his son.
The father, a ne’er do well.
‘Who is he to criticize me?’
The boy wonders.
The boy learns to hide himself:
“We don’t have to tell your father’
‘No need to stir things up’
Says his mother.
At school he invents a life,
Invents pot, invents sex
To be cool, to be accepted.
No one sees him.
Like Eleanor Rigby
He puts on face
He keeps in a jar by the door.
No one sees him. Who is he?

Do we seek recognition here?
Will I be seen?
Will someone like me?

A young woman grows up
One of far too many siblings.
‘Suck it up!’ says her father.
‘Pray’ says her mother.
Over the years their lack
Of inclination
To see her
Begins to wear her away.
Their insistence on boxing
Her into their religion or
You are no longer our daughter
Pulverizes her
Dust now.
Only exhaustion remains
The stone of resentment
Long placed atop her
Disappointed longings.

Do we seek recognition here?
Will I be seen?
Will someone like me?

Monday, September 24, 2012

uncertainty, compassion, chaos: early morning ramblings

The Self Psychology Study Group of the Tampa Bay Institute for Psychoanalytic Studies, Inc recently read C.B. Levin’s 2006 paper “That's Not Analytic”: Theory Pressure and ‘Chaotic Possibilities’ in Psychoanalytic Training. It saddened me that she endured from her supervisors “the constricting pressure to conform” from their authoritarian, dismissive comments about her creative and spontaneous work, but also inspired me that she wrote such an illuminating and interesting paper about her experience. If American ego psychology privileges as psychoanalytic free association and interpretations of conflict, resistance and transference, and eschews as unanalytic, and merely supportive, the participation in co-creating and negotiating the analytic process, then the possibility for change by analysand and analyst alike is greatly constrained.

It is hard to be on “the edge of chaos” as a patient, a therapist, a person trying to make her or his way in the world. As therapists we try to open our hearts to the unknowable, the uncertain, the unpredictable. For some, the need to be certain, to stand on unshifting conviction about what is right or true becomes a life or death struggle, whether to prevent annihilation of the self, the soul, or one’s physical existence.

Sometimes, the more one’s certainty is attacked the more one might dig one’s heels into the presumed safety of the rigidity of certainty of creed, dogma, or ideological beliefs. White Jim Crow southerners feared the loss of the self (defined by their straw man superiority over ‘coloreds’); fanatical Muslims, also often poor and uneducated, take to the streets on the edge of a deadly chaos in protest against the ill-conceived, so-called film The Innocence of Muslims, and people are killed.

In the U.S. we ask ourselves: Where does freedom of expression cross the line to become intent to incite violence? When does free speech become agitprop? How do we reconcile poor taste and ill humor with freedom of expression? Certainly Terry Jones, the Florida preacher, voiced intent to provoke fanatical Muslims in hopes to reveal Muslims as gone astray from the nonviolence of Mohammed, just as Jim Crow southerners went astray from the teachings of Jesus. The dangers of dogma in the consulting room are less drastic, while perhaps more insidious.

In the psychoanalytic world, being rule-bound allows little room for possibilities foreign to one’s circumscribed world, a world made impermeable by the rigidity of dogma, seemingly protecting one from uncertainty, but also from the chaotic possibility of making something new and changing the self and other in the process. A patient accuses me of never being able understanding her trauma, tortured in a war ravaged country experiencing ethnic cleansing, atrocities I can barely imagine much less bare to listen to. I cling to a belief that, in being a witness, in feeling compassion, in listening attentively, I diminish her isolation and honor her suffering. But what if my belief keeps her pain from truly penetrating my weltanschauung? This work is rife with uncertainty, as it must be. I liked Levin’s modus operandi of “opening up a space for honest inquiry” and revealing as “unanalytic certainty of knowing a priori what is analytic.” And so we press on.

Levin, C.B. (2006). “That's Not Analytic”: Theory Pressure and “Chaotic Possibilities’... Psychoanal. Inq., 26:767-783.

Thursday, September 20, 2012

Shame, Aloneness, and Winnicott

More than theory or technique here at the Tampa Bay Institute for Psychoanalytic Studies (T-BIPS), we again and again emphasize the analytic attitude. Of great importance to this attitude is the avoidance of shaming our patients. Because disappointed longings often induce shame in the one who is disappointed (I am too greedy, I am too needy, It must be that I am so unlovable/so unworthy that I do not deserve what I long for) it becomes incumbent upon the analyst to strive toward being ever mindful of the reaction of our patients to any of our communications.

A very interesting discussion about Winnicott ensued last evening in the second year course Development of Shame taught here at TBIPS. We were reading about Being and so read Winnicott’s Capacity to be Alone and Playing: Creative activity and the search for the self. Candidates and students claimed to enjoy the discussion so much and to find it so illuminating that we toyed with the idea of writing a handbook, a kind of Winnicott for Dummies. We were especially taken with delineating the capacity to be alone with the capacity to be alone-in-the-presence-of-the-other.

The capacity to be alone results from the infant’s repeated experience with having its needs met in a timely fashion. Consequently, the infant has the expectation that what is needed will be forthcoming. Hunger and loneliness, then, are bearable because of the infant’s faith that these will eventually be resolved. An infant without this faith will be overwhelmed by the expectation of unrelenting hunger (or pain or loneliness). An adult without this capacity may strive to avoid unbearable feelings of want (overeat, become addicted to behaviors or substances, incessantly need to be in the company of others).

The capacity to be alone-in-the-presence-of-the-other is an even more sophisticated developmental achievement, also wrought from experience with caregivers. Does the caregiver allow the toddler to explore the world without undue intrusion and impingement? The capacity to be alone-in-the-presence-of-the-other is also linked to creativity and spontaneity, to very aliveness, if you will. Creativity in early childhood is fostered when the caregiver provides objects for exploration (pots, pans, blocks, etc) but does not insist on how these objects be explored (as opposed to uwanted intrusions like No, don’t line the blocks up like that, stack them like this). The caregiver, in the background, enjoys, sometimes even participates in, the child’s play. The child is given psychological space to enjoy the world and her/himself in the world but is not abandoned to the world. The caregiver in the background is ready to step in when needed.

Ideally, both adults in a partnership have developed the capacity be alone-in-the-presence-of-the-other, and then come together for mutual enjoyment, sharing, recognition, comfort and reciprocity. Adults who have not developed the capacity be alone-in-the-presence-of-the-other may constantly demand attention from the other, be jealous and resentful of time the other devotes to hobbies, work and friends, may feel chronically dissatisfied, and devitalized, may distort themselves to garner attention from others.

Most clinically apropos: how does the therapist give the patient enough space to allow for exploration, creativity and play in the therapeutic situation and still be in the background awaiting use should s/he be needed? This tricky tightrope is a huge challenge for the analyst. Winnicott intended to provide enough space for Ms X to allow her to spontaneously develop her own way in the world, but, as a few in the class noticed through Ms X’s repeated complaints, Winnicott failed to be sufficiently at the ready for joining with Ms X when she needed him to be more present. How does a therapist know when to give space and when to join in? It is not easy, but I think our patients tell us, by their words, tone, breathing, posture, facial expressions, etc, moment by moment, where we need to be if we can pay attention and learn to walk a very thin line, juggling on a tightrope.