Sunday, February 9, 2014


In April 2008 at the American Psychological Association, Division 39 (psychoanalytic division) meeting I first heard Lauren Levine, PhD, who was a candidate at the time, present a paper weaving her experience as a mom with that of her analysand’s. There was something so moving and so singular about her presentation that I immediately invited her to Tampa to speak to our local psychoanalytic society. And in 2010 she presented two papers in Tampa, both papers subsequently published. She is guest faculty at the Tampa Bay Institute for Psychoanalytic Studies, Inc and when I found out she had written another paper, I asked her to share it with us. On February 8, 2014 she presented her latest works to the Tampa Bay Psychoanalytic Society, Inc.

I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory.  In a feat of lived, not theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.  In her mindful disclosures to her patients, she reflects to them, in her eyes, themselves, deepening connection and expanding the space for creativity, for herself and her patient, and opens the possibility for desire and greater aliveness. There is reparation and resilience, and transformation ensues. In "A mutual survival of destructiveness and its creative potential for agency and desire," Levine demonstrates how destruction became an agent of change.

I have often stated to supervisees that I feel myself with certain patients holding on to the rim of the abyss, dangling there by one hand, holding the patient, whose weight threatens to pull me down, with the other. I am torn to breaking. I know I must join the patient in the abyss and I know to do so will be the end of us both. Levine, too, describes standing on the edge, trying to pull the patient out of the abyss, feeling too frightened to join him there. There is great shame for us, the therapist, to have doubts about our competency so triggered. It collides with our past vulnerabilities of childhood helplessness and ineffectualness. But, as Levine notes, no matter how difficult it is to find a shared humanity we reach out nonetheless to the disparaging other, knowing that it is in the fidelity to the shared process that hope lies.  


Unknown said...

In What Spirit Do We Do Our Work?

When Lauren Levine said on Saturday that when she is working with a patient she is not thinking about theory, I thought with enthusiasm one more time “What manner of a psychoanalyst are you!?”

She had been answering my question, however, since the first informal morning meeting, and for some of you since dinner Friday night. And she continue to answer it until the moment we parted. For among so much else, her presentations were reminders for me that inextricable, reciprocal, and more-or-less corresponding personal and psychoanalytic values, dispositions, and attitudes toward work and toward the other, adopted a fundamental working attitude, constitute our interpretive mind-set.

No, I said to myself, Levine is not thinking about theory, she is living it! And if it is in her bones, theory need not be an impediment in her heart and in her thoughts. Part of the theory she is living is what Aristotle called phronesis or practical wisdom in contrast to techne or technical know-how, and in so doing, Levine was telling us in a most compelling way that psychoanalysis is a form of practice, not a technique.

Levine’s interpretive stance is one of trust : she practices recognizing in the other person another sufferer both like and unlike herself (partior , the Latin word for patient means to suffer), and may respond by wondering what the other needs in this moment to feel included inhumanity, held and healed; on this relational foundation of trust, together with her patient Levine remains attentive for what remains unsaid, disguised, enacted, and the like; she practices caring for emotional fragility; Levine trusts that the patient is trying to communicate her truth to her, by whatever she says or does, and that it is up to Levine to try to understand; she sustains a basic faith, even in very dark moments, that the patient’s suffering has meaning and that together they can gather up the fragments of a shattered life.

To my mind, she conducts a minimally theoretical psychoanalysis, seeking together with her patient to make sense of the emotional catastrophes in the patient’s life, rather than trying to find confirmation of a theoretical construct. In this shared healing process, both patient and analyst are transformed. From time to time throughout the day, the luminescence in Lauren Levine’s face told that tale. How fortunate we were on Saturday!

Ernesto Vasquez, MD
February 9, 2014.

Unknown said...

Emotional Understanding

“The person with understanding does not know and judge as one who stands apart and unaffected; but rather, as one united by a specific bond with the other, he thinks with the other and undergoes the situation with him.”
Hans-Georg Gadamer, Truth and Method.

I believe emotional understanding is the golden thread running through the two accounts of her work with patients with which Lauren Levine honored us on February 8, 2014 – remember she wrote the afternoon paper specifically to present it to us. I offer here brief reflections on understanding, psychoanalytic and otherwise, prompted by her presentations.
Plato defined thinking as a conversation “that the mind carries on with itself about any subject it is considering.” In ordinary discourse we distinguish subjective understanding from knowing-about. Knowing-about is external and observational. Understanding is knowledge by participation, in the Platonic sense, knowledge from within.
Using one of the four principal definitions of intersubjectivity in psychoanalysis today, I would like to offer a view of the notion of “within.” Psychoanalytic understanding is knowledge gained from within the intersubjective system formed by the interplay of the differently organized worlds of subjective emotional experiencing of patient and analyst. Our individual world of experience is a non-linear or complex system whose nature is “messy, fluid, and context-sensitive.” Our relatedness forms a supra-system of the same nature.
I mentioned in my previous comment that psychoanalysis can be thought of as conversation, as making sense together. Levine demonstrated that in psychoanalysis, where the subject matter of the conversation is the patient’s emotional life, understanding that heals requires a mutually experienced emotional connection between patient and analyst. We understand psychoanalytically by attempting to participate in the emotional experience, in the being, of the other.
This view of psychoanalytic understanding raises important questions. We must ask what conditions and attitudes support good-enough emotional understanding.
One requirement is the emotional availability of a particular analyst for a healing connection with the particular patient that come for analysis or therapy. Emotional availability is the combination of willingness and capability of the therapist to provide for that person a developmental second chance at a rich and integrated emotional life. Only when emotional availability is present, as Levine showed us in her two amazing case studies, can patient and analyst make sense of what seems senseless.
Another condition is that analyst and patient embrace an enriched conception of memory that includes tacit and somatic forms as well as verbal expressions, that is, memory as a knowing-beyond-words. In her work Levine amply evidences the two conditions above, as well as the one I described in my previous comment: an interpretive mind-set of trust.
I believe Lauren Levine is Hans-Georg Gadamer’s “person with understanding,” able and willing to enter the patient’s suffering and share the painful history, willing and able to “undergo the situation”with the other.

Ernesto Vasquez, M.D.