Wednesday, September 20, 2017

When transference stinks

What we learn first stays with us the longest. 

In beginning a new cycle of first year courses this semester, TBIPS, in its Intro to Psa Concepts I, starts with a contemporary point of view. Asking candidates and students to think about what are some possible components of a psychoanalytic process, someone includes ‘transference.’ We have read for today’s class a paper by Lew Aron and one by Irwin Hoffman.


A psychoanalytic candidate expresses scepticism about the relational concept of mutual influence in the transference: ‘Doesn’t the patient bring things in her head that have been there before she ever met you?’ Of course the patient brings things that had nothing to do with the therapist, but what emerges with the therapist is constitutive of being with the therapist. The candidate gives an example: ‘I open the door to a first time patient and she says, “your building smells.” How could that not have come from her alone?’ I am curious. The candidate says this particular patient had had a traumatic past and had been physically disfigured-- her face, her gait-- in a fire. I inquire: what was his experience at the moment he opened the door to this patient whose face had been thus scarred. The candidate said that the film The Exorcist had come to his mind, her face horrifying, terrible.


Since microexpressions can be non-consciously communicated, right brain to right brain, and since horror can look like disgust, and disgust akin to bad smells, was it possible that this new patient recognized her new therapist’s look of disgust and her right brain registered it as ‘something stinks around here’? Maybe. The patient did not return after the initial consultation. What might have happened had the therapist spoken aloud to the trauma this patient endured as evident from her facial scars and, more important, had inquired about what it was like to see the initial shock of them on his face?


The class is inordinately grateful for this candidate’s example which helped us illustrate a more contemporary view-- that of mutual influence-- of transference. His example speaks to the readings:


From Aron:
The analytic situation is constituted by the mutual regulation of communication between patient and analyst in which both patient and analyst affect and are affected by each other. The relationship is mutual but asymmetrical.”
“the patient’s experience of the analyst’s subjectivity needs to be made conscious”
It is often useful to ask patients directly what they have noticed about the analyst, what they think the analyst is feeling or doing, what they think is going on in the analyst, or with what conflict they feel the analyst is struggling.”       
The exploration of the patient's experience of the analyst’s subjectivity represents only one aspect of the analysis of transference.”  


From Hoffman:
“For Langs what is wrong with the classical position is that it overestimates the prevalence of relatively pure, uncontaminated transference.”
“the implications of the patient's ability to interpret the analyst's manifest behavior as betraying latent countertransference.”


Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1(1):29-51.


Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.

Thursday, August 17, 2017

Requesting more Swift progress


I may not be very familiar with the music of Taylor Swift but I have, of course, heard of her stature in the music industry when she stood up for music artists’ income by pulling her music off Spotify (a streaming music service) in 2014. Now, in a victory that affects many more women and men, she is standing up “for...anyone who feels silenced by sexual assault.” On Monday (8-14-17), Swift won a victory [She was awarded what she asked for, a symbolic $1.] against a former DJ who blamed Swift for his firing when she accused him of groping her at a pre-concert photo shoot.


Our profession knows only too well the devastating effects on sexual assault survivors. Now, if only the U.S. President would stand up against bigotry and hatred. Many of us were more than chagrined at his waffling about such hatred evidenced last week in Charlottesville,VA with the death of Heather Heyer and injury to others. I do know one lyric attributed to Swift, “Haters gonna hate.” Unfortunately, many cannot “shake it off” and the consequences of hate also need to be given a voice. A voice is another important, empowering benefit of therapy.

Saturday, August 12, 2017

More about narrative, or narrating one’s story

American writer Richard Ford, who has recently written Between Them -- the memoir of his parents’ (Parker and Edna) life and love-- shared with PBS Newshour’s IMHO (In My Humble Opinion) on May 19, 2017 some of the reasons one writes a memoir:


“To render testimony
To bear witness
To make sense of a recollected life...
Substantiate ourselves to ourselves…
To utter what must not be erased…”
and because “I missed them” and some longings are “acted upon even long after it might be
supposed that enough time has passed for longing to subside.”


Furthermore, “Age is a winnowing process and sometimes what gets sifted out as we seek to know the important consequence of lives are the actual lives themselves.”  About his parents’ lives, he recognized that though “as most parents are, [they were] all but unnoticeable in the world’s disinterested eye,” they were of importance to him because of the love and relationship they shared with him. [I am reminded of the iconic play “Our Town” (1938) by Thornton Wilder where the ordinary town of Grover’s Corners and the ordinary lives of its citizens are made extraordinary by the relationships people share.] He said of them: “Being their son seemed a privilege, and almost mysteriously, they opened for me a world of immense possibility.”


Perhaps in response to the current political climate, he added, “In a world cloaked in supposition and opinion and misdirection and often in outright untruth, things do actually happen. My parents’ lives did take place.”

Some of Ford's reasons for writing this memoir speak to our work (witnessing, remembering and making sense, even instantiating authentic beings through actual experience). When we listen with reverence and love to the stories of the lives of our patients, we validate the importance of their memories, their feelings and their lives. For as Ford noted from Saint Augustine ‘Memory is a faculty of the soul.’

Wednesday, August 9, 2017

More on storytelling narrative, and on how to do so, literally, or literary

A lot has been written in contemporary psychoanalysis about the need to free ourselves from strict theory and technique in favor of the process of the moment to moment experience of two people intimately engaged in the collaborative construction of relationship and of meaning, primarily for the patient’s benefit. I was pleasantly struck to find the same ideas about uncertainty, spontaneity, surprise, and surrender in the process of one author’s writing.

Listen to what George Saunders, author of the critically acclaimed and New York Times best-selling novel Lincoln in the Bardo (2017), tells Jeffrey Brown on the Newshour Bookshelf (March 28, 2017) about the process of writing: “The holiest state is to be a little confused by what you are doing and you are guided by the energy that the story is actually giving you as it is revised. That’s kind of tricky because it means you have to abandon your ideas about organization or thematics and really submit [surrender] to the story… and hopefully it will result in some new mode of beauty.”

I thought it aptly put. (He is a wordsmith after all.)

By the way, Saunders additionally said in the same interview that he was inspired by Lincoln who had somehow been able to “transform... sorrow into a kind of expanding empathy for everybody” and whose “response to fear or hardship was expansiveness instead of shrinkage.” Were that we all were so heroic.

Sunday, August 6, 2017

The search for happiness, I mean, meaning.

Emily Esfahani Smith, author of “The Power of Meaning” reported in a PBS Newshour IMHO (In my humble opinion) segment on Mar 10, 2017 that psychologists have counterintuitively concluded that the chasing after happiness can leave people unhappy and lonely. It is instead the search for meaning and trying to figure out how to make our lives count which bring happiness. She cites the epic of Gilgamesh, one of the oldest known literary works (Mesopotamian, ~ 2500 BC), and sees in it the hero’s search for how to live knowing that he will die. Smith says his quest remains urgent.


Social scientists say meaning is found when we connect and contribute to something beyond ourselves, such as to family, work, nature, or god. Smith cites three conditions found in people who say they have meaningful lives: 1) They believe their lives matter; 2) They have a sense of purpose;  and 3) They think their lives are coherent and make sense. Storytelling itself gives meaning, she says, and offers clarity.


I am reminded of the work we psychoanalysts do, a connection which brings personal meaning to our lives, but also affords to our clients both a search for meaning and an attempt at a coherent story.  We know that a coherent narrative in Mary Main’s Adult Attachment Interview predicts secure attachment.  We know, too, that an important job in parenting is to convey to a child that she or he matters, has a right to exist, and is connected to something bigger (the family). Tomorrow, were he alive today, would be my father’s 96th birthday. I wanted to give a grateful shout out to my father for having always conveyed meaning to our lives by his love and dedication to his family (he was a great listener and storyteller himself) and to his work (he was a writer who showed joy and meaning could exist in one’s professional life), and by seeing his joy burgeon as he aged (through his interaction with his grandchildren).


Meaning through connection and narrative? Our profession was made for it.

Sunday, July 30, 2017

Container Function

Bion conceived of the analyst as a ‘container’ of projected parts of the other-- as mother is for infant-- particularly of intense, negative affects. The extruded parts and affects of the other are what is ‘contained.’ Analyst (as with mother) is not merely a receptive container, but a welcoming and validating one, and, moreover, accepts and modifies them (a part of the alpha function), but does not necessarily interpret them. The ‘container’ ideally dampens these overwhelming affects so that they are eventually amenable to regulation and self-reflection.


Thus, through projective identification (projection and response to what is projected) the analyst has come to know unwanted affects and painful relational patterns, and furthermore attempts to ‘digest’ them and re-present them in a more ‘palatable’ form. We might note the similarity to making use, after the fact, of enactments which bring to light nonconsciously encoded patterns of ‘how to be” in relationship-- except that enactments are made use of by both analyst and patient who intersubjectively process shared experience and co-create any meaning making. An example might be mutual recognition containing aggression because complementarity is no longer at work.

Spezzano adds a felicitous element to Bion’s ambiguous term ‘container’ when he intimates it is: to be held in the mind and meaning system of the other as a protection against psychic homelessness, meaninglessness and chaos. Putting parts of the self in the other may then be an attempt to create holding of the self in the analyst’s mind. In the analyst’s mind, there can be an increased opportunity to co-create context for them, and an increased capacity to safely play with these projected parts, as was the case with a young man-- an avid user of ‘spice’ or K2, but no longer a user of heroin -- who let me feel all the sadness, himself long indifferent (numb) to the pain experienced by the little boy whose mother had left him and his father when he was but six years old (he never saw her again). Tears could stream down his face when I described the plight of an abandoned six year old, but that boy’s sadness was not his own. Through approaching the loss and confusion of a child through the little boy I held in mind, my patient could begin to approach what might have been his own experience.

Wednesday, July 19, 2017

Lullaby

    Clinicians just starting out often worry about saying the ‘right’ thing to a patient. I often tell supervisees that people come to us not for answers, and not necessarily for words, but for “something more,” such as a longing to be recognized, to have someone take an interest in their inner lives. As humans, we usually have an interest in others, and as therapists, a deep interest in others and in their inner lives. We have a desire to know more, and we make an effort not to impinge with our curiosity, to have a benevolent curiosity if you will. So far so good.
     People also come to us needing to be held in mind. Just as caregivers grow the brains of their infants by gazing at them, by enjoying them, by remembering and imagining what it was like to be such a baby with an inner life and with experiences, so the holding a patient in mind (even outside of the session) comes to us as we reflect on and imagine the past, present, and future experiences of our patients. The caregivers’ interest grows the baby’s inner life: the baby experiences itself as ‘I am interesting. I am important. I have a right to be here. I exist.’ 
Sometimes our patients need such things from us: to be held in mind, to be enjoyed, to hold our interest, to have their feelings “marked” (in the same direction of the affect, without being identical). These experiences are part of “implicit relational knowing” and do not require words to effect reconfigurations in brain anatomy and brain chemistry. 
Sometimes our most sorrowful of patients have missed out on some necessary pre-verbal experiences: of being gazed at, nursed, rocked, sung to, of being held in the caregiver’s arms, and being held in mind. Ogden called this very important fundamental stage of sensory experience the autistic-contiguous position. It is the foundation or sensory ‘floor’ upon which subsequent experience is integrated and organized.  
    I recall a 15 year old boy with a horrible history of abandonment, neglect and physical and sexual abuse, often in foster care, who was court ordered to see me after punching his father. (His father had called the police.)  The boy arrived for the first appointment very angry. He crossed his arms, declared emphatically that he was not going to talk to me, and promptly fell asleep on the couch for the entire session. 
Perhaps I had the autistic-contiguous position in mind. Perhaps I was thinking about this boy’s childhood (some of it previously revealed to me by his father when the father had made the appointment) and thus was imagining that this boy had probably never been held in the mind of a caregiver, never been held in a caregiver’s arms and been rocked and sung to, never had consistent opportunities for mutual regulation of distressing affects. But, whatever the 'reason,' I began to sing him a lullaby as he slept there immobile. When the session was over, he lept off the couch. He returned the following week and each week thereafter, and talked and told me his sorrows. (He even hoped to continue long past the six months ordered by the court.)

Ogden, TH. (1989) The Primitive Edge of Experience. Northvale, NJ: Jason Aronson.

Thursday, July 13, 2017

Intersubjectivity and China

In psychoanalysis we talk a lot about intersubjectivity, seeing the other, the different other, as “an equivalent center of being” (Benjamin), the recognizing of difference. In the USA, with travel bans and threats to build walls between countries, we lament the negation of the other, the falling to one side of a polarity, failing to sustain the tension between differing subjectivities.

In 2010 I congratulated the talented Chinese therapist I supervised, for the Nobel Peace Prize had been bestowed on her fellow countryman Liu Xiaobo. She had not heard. 

Censorship was only one area against which human rights activist Liu struggled. He authored books on democracy and human rights.  Liu, imprisoned after co-authoring in 2008 ‘Charter 08’ -- a petition-manifesto signed by hundreds which criticized Chinese government and called for political reform -- was not allowed to receive the Prize in person. He died today, disallowed from receiving treatment outside of China for liver cancer. He is the first Nobel laureate to die in detention in almost eighty years. Liu had been previously imprisoned for over a decade after taking part in the 1989 Tiananmen Square protest, where students faced down tanks. He had been an activist for human rights in China since then.

Sunday, July 9, 2017

Black Girl Interrupted, Black Girls’ Internalization

Internalization alludes to aspects of the other, including those projected, which can become part of the self, encoded experientially and procedurally in the brain, as do interactions or way of interacting with the other. What the other feels about the self, what is implicitly communicated, also becomes part of the sense of self, whether positive or negative feelings. It is the feeling (affect) more than the action that is encoded. Whether the self can come to expect soothing or neglect is also internalized. This procedural knowledge is carried forth into later life.

Black girls age 5-9 years are seen as older than their years, called ‘adultification,’ according to a recently published study by Jamilia J Blake, PhD, Associate Professor of Educational Psychology at Texas A&M University and Rebecca Epstein, Executive Director of Georgetown Law’s Center on Poverty and Inequality. Blake and Epstein found that black girls are seen by the school and juvenile justice systems as more adult and less innocent than their white peers. They are perceived as needing less protection and less comfort and nurturing, and were found to be punished more harshly than white peers, e.g. five times more likely than white girls and twice as likely as white boys to be suspended from school. Teachers were more likely to call the police on black girls and prosecutors less likely to drop cases against them than white girls. While a previous study by a separate research team [Perry] had shown a similar ‘adultification’ of black boys from about age ten years, black girls showed a higher disportionate rate of disciplinary action than even black boys, thought due to ‘gender transgressions’ (violating norms of femininity).

What adults project onto children affects the way children see themselves. So, what happens when children are seen as less innocent and more adult like (whether ‘adultified’ or parentified)? are punished more harshly? and given less nurturing? Do they grow up perceiving themselves to be ‘bad’ and unworthy of their longings for [inter]dependency, comfort, and help? Do they feel undeserving of tender caring and instead are the caregivers, or, worse, so bereft of receiving care that their subsequent and understandable resentment and anger lead to lashing out, even becoming the delinquents others expected all along?

Saturday, July 1, 2017

Recognition

Recognition is the ability to take in the other person’s perspective, finding sameness and difference in the other’s mind and accepting it; to see the other as a separate self and the needs and desires of the other as equally valid (intersubjectivity). Recognition may be the deepest longing in a human being; and it is incumbent upon the analyst to provide it.


USA Washington Journalisten im Wei├čen Haus (Getty Images/M. Wilson)

Last month I was felt both ‘recognized’ and embarrassed when on June 19 Germany’s international news organization DW (Deutsche Welle)’s Freedom of Speech Award went to a U.S. recipient: the White House Correspondents’ Association. 

[This award honors a journalist who toils under great oppression yet continues to stand for freedom of expression and human rights despite consequences, sometimes fatal ones. In 2015,  the Saudi blogger Badawi (imprisoned) was so honored; and, in 2016, it went to the Turkish editor Ergin who dared oppose Pres. Erdogan.] 

Journalists continue to hold governments accountable even when told, as currently in the U.S., that they are liars who disseminate  “fake news.” I felt ‘seen’ that, even across the ocean, a prestigious news organization recognizes our plight and sympathizes and encourages us. I felt embarrassed because I had complacently thought that the USA would/could never allow such an attack on a fundamental freedom. Freedom of the press is the mainstay of democracy, a necessary watchdog on government and private industry alike. Hopefully, we recognize this.

Saturday, June 24, 2017

Bullies and Bystanders

Tomorrow June 25, St.Petersburg, FL celebrates diversity with its Gay Pride Parade. I am reminded of two old movies, Tea and Sympathy and Rebel Without A Cause, from a time in which diversity was not so celebrated.

Tea and Sympathy (1956)(directed by Vincente Minnelli, based on Robert Anderson’s 1953 play of the same name) is oppressive to watch when viewed from the 21st Century.  Difference is taunted and ostracized. A prep school senior, Tom Lee (John Kerr) is called “sister boy” [for what could be worse from the hypermasculine POV than being compared to a woman/girl] because he prefers music, theater and poetry to baseball and mountain climbing. He is bullied to suicidal thoughts. The coach and house headmaster’s wife Mrs. Reynolds (Deborah Kerr) takes Tom’s part. Defending Tom to her husband (Leif Erickson) and chastising him for being a bystander, she says “‘He’s not like me, therefore he’s capable of all possible crimes.’ ... [T]he tribe has to find a scapegoat to reaffirm your shaky position... If he could be manly, then you had to question your own definition of manliness.” Eschewing the false dichotomy, she rails against her husband’s black and white thinking. [Twemlow and Sacco write about bullying in their ebook Preventing Bullying and School Violence].  But should one mistake Tom for a homosexual, as his classmates do, one only need note the foreshadowing in Tom’s reading of Candida to confirm his love for Mrs. Reynolds. [Wikipedia’s author writes it is Voltaire’s Candide, but I think this is a mistake, for it is in GB Shaw’s play that a young man falls for, and seemingly desperately needs, the older, married woman. Candida chooses the man who needs her more, her husband, who must so desperately dissociate his need for her. Mrs. Reynolds, however, a modern woman, I suppose-- or perhaps riddled with the shame and guilt her constraining contemporary society demands -- chooses neither man.]

Also painful to watch is how women are treated in this film. Mrs. Reynolds, her opinions interrupted and disregarded and spoken to by her husband as if she were a child, is relegated to the keeper of men’s emotions and the one who attempts to smooth over painful feelings in her husband and Tom. The local soda shop’s server Ellie Martin, a former ‘a-dime-a-dance gal, is unrelentingly sexually harassed by the “regular guys” from the local prep school.


Rebel Without A Cause (1955) (directed by Nicholas Ray) also portrays the bullying of boys who are Other or different. In the 1950’s, a gay theme could appear only as subtext, but the bullying of Plato (Sal Mineo) was undoubtedly, in part, about his homosexuality (noted by the photo of Alan Ladd in his locker, and by his crush on Jim Stark (James Dean)). His torment ends with possible suicide by cop. Mineo, hailed today by the LGBT community as one of their own, was nominated for Best Supporting Actor for this role and, at that time, was the youngest actor (16 years old) ever to be nominated for an Oscar. James Dean, himself posthumously nominated for this role (and for Giant), was purported to have ‘experimented’ with homosexual liaisons, as well as to have been sexually abused when younger by a pastor. Dean, also an auto racer, died prematurely in a car accident at age twenty-four.

Here's hoping for better days, days when bystanders stand up to bullies and difference is celebrated.

Thursday, June 15, 2017

Fargo

    My favorite TV show (on Fx), inspired by the Coen brothers’ film of the same name, set in Minnesota, always features a laudable female, police chief. Gloria Burgle (Carrie Coon) is that policewoman, only In this its third season, she is demoted from chief, has been left by her husband for a man, has a teenager who prefers the mall to her, and feels she does not exist. Confirmation of her non-existence comes from the sensors on automatic door openers,  soap dispensers, and faucets, none of which ever sense her presence, so do not open, dispense soap, nor turn the water on.
    It is only in the penultimate episode of the season, when Gloria has a listening ear in Winnie Lopez (Olivia Sandoval), a neighboring town’s police officer, that things change for her. Like Horatio to Hamlet, WInnie hears, really hears, and what she hears is Gloria’s fears about not existing. Subsequently, Gloria is able to engage with soap dispenser and faucet sensors. This reminds me, of course, of how infants (and adults) need to be seen and held in the mind of the other to feel one’s existence in the world, to feel part of something bigger than oneself. Good-enough caregivers provide this, as do good-enough therapists, by seeing and holding the experience of the other in mind.
    I was also reminded of Hegel’s understanding that a subject cannot be fully a subject until recognized by another equal subject [within independence is this dependence, that is, there is interdependence]; and of the title of a Dean Martin song, ‘You’re nobody ‘til somebody loves you;’ Here love is embodied in the seeing, accepting,and welcoming in of the other, all the parts of the whole other, without having to give up the self (that is, done whether we agree with the other or not). Yesterday, was a sad day in northern Virginia, when baseball practice became tragedy. Perhaps the good coming from it will be a bit more understanding of the other [side of the Congressional aisle].

Monday, June 12, 2017

New Cycle of Courses begins Sept 20, 2017

The Tampa Bay Institute for Psychoanalytic Studies (TBIPS) is pleased to announce a new cycle of its four year curriculum starting Sept 20, 2017. You can start at the beginning with 'Introduction to Psychoanalytic Concepts.' As you know,  theories and methodology in psychoanalysis have changed tremendously over the decades, thanks to contributions from caregiver-infant and attachment research, and from neuroscience.  While relationship and the 'unconscious' (or 'non-counscious') remain paramount, gone are the days of authoritarian and distant analysts who knew the secrets of the individual's mind. Instead, analysis is a collaborative effort of building safe and supportive relationships where  new ways of being in the world and healing  can take place. At TBIPS we emphasize an open and welcoming attitude, both for students and patients, and focus on development, attachment, and making whole the fragmentation caused by trauma.

Please know that TBIPS is happy to accept long distance candidates (courses, personal therapy, supervision0 for training and students for course work. We would be delighted to have you join us in the Fall. Further information can be found at tampapsychoanalytic.com.

Monday, June 5, 2017

Response to Co-creation of Dreams, posted May 22

One can imagine that the fences in the patient’s dream are less about “unspoken boundaries” between the patient and his father and more about those that stand between the patient and the therapist. One can imagine the patient feeling the intimate confines of the consulting office and a desire for therapeutic boundaries to vanish leaving him and the therapist free to explore the vast horizons beyond.

In my mind, the two benevolent white-haired men could symbolize wisdom and morality. They have perhaps ascended from above to give the patient an understanding of both the permeability of the boundaries that he and the therapist have co-created and his understanding their moral necessity. 

The therapist, too, in her dream, is reaching out past the boundaries and, like her patient, understands the need to maintain them and consequently turns away.

Interestingly, by disclosing her dream to the patient, she is in fact reaching past the boundaries and thereby simultaneously expanding them and reaffirming that they are there. Her disclosure reveals her trust that he understands the limits of the therapeutic relationship and the necessity of those limits. Her sadness demonstrates that, despite the application of clinical terminology like “transference,” “counter transference,” and “therapeutic alliance,” underneath are real people with real emotions, which are sometimes intense and sometimes bump up against the therapeutic boundaries. This is, as the patient says, romantic, at least in the sense that true love involves walking the boundary between the selfish desire to possess and the selfless sacrifice of putting the other’s happiness above that selfish desire.

Therapeutic relationships sometimes walk this line, but a patient whose relationship with his father was distant probably benefits more from experiencing the reality beneath the “therapeutic alliance” than he does from any clinical assessment of his psychological history. I suspect that while he most likely grieves the lack of a relationship with his father, what he desires now is real connectedness. The lack of a relationship with his father may explain his desires for connectedness, but it doesn't satisfy it. The emotional reality behind the therapeutic alliance demonstrates that such connectedness is possible, that he is a person who is worth investing in emotionally, and that limits around the connectedness do not diminish its worth. 

The emotions “stirred up” (dare I say ignited) in the therapeutic relationship are indeed the mutual property of the therapist and the patient, but I wonder if Dr. Alexander-Guerra understands her role in the co-creation process (for it is an evolving process). Does she understand that by making the therapist’s session with the patient blog-worthy, she has added a layer of legitimacy to the emotions? I wonder if as a result, the therapist feels more secure in her relationship with the patient and if the patient reciprocally feels more secure. I wonder if Dr. Alexander-Guerra understands if she is now part of the co-creation between the therapist and the patient. I wonder if the patient has read this and feels a mutuality with Dr. Alexander-Guerra. I would if I were the patient.

         submitted anonymously

Friday, June 2, 2017

Graduation

 On the TV show Major Crimes (Season 1: Episode 4,  aired 9/3/2012), a foster child, dealing with always having to leave and start over someplace new, that is, with always being a stranger, and, also, dealing with always expecting to be repeatedly sent away to a new place, requests, from his latest foster mother, thirty days notice before he is sent away again. She reassures him: “Whatever happens here, you will one day go off and be the new kid again. But no matter where you go, no matter when, you’ll never be a stranger to me. I will always know you.”  



That brief interchange resonated with me as a psychotherapist because for a short while we ‘foster’ the growth and development of our patients, temporarily providing safety and succor, while growing ourselves. The world is a better place for both of us. But despite this fostering of a most emotionally intimate of relationships, our patients, like our children grown, must leave us; and we are left to mourn. We take solace in the recognition that they will never be strangers, joy in that we have known and, in some ways, will always know them. We send them off and into the world with great pride, matched with loss.

Monday, May 29, 2017

The 100th Birthday of John F. Kennedy falls today on Memorial Day

This year’s Memorial Day also happens to be the 100th Birthday of John F. Kennedy. Born May 29, 1917, he was the 35th president of the United States, and himself a WWII veteran of the Navy. A quick study, having learning from the Bay of Pigs debacle and negotiations with the then Soviet Union to get missiles out of Cuba, under pressure from Freedom Riders, Martin Luther King, Jr, and many others, Kennedy turned his attention to Civil Rights. It was only after his assassination in November 1963 that his successor Lyndon B. Johnson was able to get passed through Congress the Civil Rights Act of 1964 which outlawed discrimination based on race, color, religion, sex, or national origin. [We might remember today just what types of discrimination were outlawed.]

Memorial Day is a time to pause and remember those who died as soldiers, Marines, Airmen and women, sailors, Coast and National Guard persons. We thank them. Today might also, perhaps, be a time to recommit ourselves to giving back for their service by offering an hour a week pro bono psychotherapy to the family members, or veterans who remain, through, for example, Tampa Bay Institute for Psychoanalytic Studies’ Veterans Family Initiative.  Many clinicians in the Tampa Bay area have generously given of their time and expertise to help families and wounded warriors afford much needed mental health services. We thank them as well.

Friday, May 26, 2017

From Fantasy to Imagination

Bromberg tells us that “the negotiation of selfhood and otherness...has a lot to do with imagination and creativity.” and that “The relative presence of “imagination” in human discourse overlaps to no small degree with the relative capacity for intersubjectivity that exists in any relationship.” [Being able to let in another’s experience allows for a “shared intersubjective space.”] Bromberg expands the shared space to include shared imagination, “loosen[ing] the rigidity” of one’s singular believes about the self [and other] to allow for a “relational unconscious.” I take this to mean if one is stuck in solipsistic fantasy, there is little to no room for interrelating with others much less comprehending that there exists another’s mind, one with separate contents from one’s own. He writes:
The cocreation of a lived, relational unconscious more and more nourishes the willingness of each person to participate in a growing sense of “We” that includes “Me” and “You” as part of their individually expanded self-experiences. By living together in the enacted shadow of what is visible but not perceived, an opportunity is afforded to encounter what has been hidden in plain sight. … This allows their relationship greater interpersonal spontaneity and creative self-expression that is carried by an expanded sense of selfhood into the world “out there.”

Relying on Winnicott’s 1971 paper on “Dreaming, Fantasying, and Living,” Bromberg elaborates that fantasy is a dissociated (‘Not me’) state while imagination embraces the ‘Me’. A colleague of mine noted that fantasy is somehow without hope [a remedy to hopelessness], while imagination includes hope about the future.  Winnicott put it, in his enigmatically paradoxical way, like this: ”In fantasying, what happens, happens immediately, except that it does not happen at all.”

Bromberg explains:
For a person who is “imagining,” the state of affairs is different; the person is experiencing the self as it now exists, projected into the future. Because the self  being imagined is the same self that is doing the imagining, the person as he is now has the capacity to act into a future that is real to him because the future that is imagined in the here-and-now is itself real. When the capacity to transform fantasy into imagination starts to increase, self-state transitions do not disrupt self-continuity, which in turn allows the present and the future to be bridged and thus to coexist. The person does not have to remain stuck in fantasy. What is imagined is not impossible for the self in the present; it just hasn't happened yet. [Einsteinian]

When the therapist can imagine, much like the mother for the infant, the patient’s expanding future on the horizon, then the patient, too, can consider such a future. The mother develops the mind of the infant by holding the infant in mind. The therapist develops the imagination of the patient by imagining.



Monday, May 22, 2017

Co-creation of Dreams

A therapist discloses to a patient the dream she had about him the night of their previous session:
I was sitting next to you on the couch in my office. You were sitting in the middle of the couch and I was to your left. We were facing each other. I reached over and touched your face. Your skin was soft. You then reached over to me and I felt guilt and sadness. So I turned away crying, feeling that loss. I wondered if you felt I was rejecting of you. I turned back to you and you said, “I love your father.”
The therapist recognized the resurgence of familiar feelings: her love for her patient, the patient’s love for her, and how it could not be; also familiar feelings with the therapist’s father. The therapist knew she also loved her father, and he, her, and it could not be. So, said the therapist, I am in touch with my sadness.
  
The patient shares his dream:
I was in the backyard. There was a helicopter overhead. It started coming down, through the trees. I could see the pilot, we made eye contact, and waved, two men with white hair. Then the fence disappeared. Then it changed to the backyard of my childhood home and there were fields with no end.
The patient quipped [associated], Why can’t I dream about sex instead of about benevolent old men with white hair?


The therapist mused aloud, Maybe this is about your father, the unspoken lifelong wish that there were no longer barriers between the two of you, instead of your usual, professed indifference toward a preoccupied, distant and disdainful father.


The patient and therapist had long since past been in the throes of an erotic transference- countertransference. The patient, old enough to be the father of the female therapist, had, before therapy, used extra marital affairs to help him feel desired and competent. The female therapist had lost her own father when she but was a toddler. Now there was more honest, intimate relating between therapist and patient, able now to uphold boundaries without the presence of fences between them, and without the fear that boundary violations would occur. The patient, now able to talk about sexual desires without the urge to have to act on them. He no longer could accept hurting his wife with his infidelities.


Bromberg writes that the feelings stirred up in the therapist about the patient are not the personal property of the therapist, but belong to both.


The therapist, having understood about co-creation, no longer felt ashamed about her dream. She was able to feel the mutuality of her own father’s love. The patient said, “There is something  so romantic about recognizing feelings that one can’t act on.” The therapist felt  sadness, not romance.

Wednesday, May 3, 2017

Envy and Failed Mutual Regulation

The final semester at TBIPS for fourth year candidates and students includes an Electives course in which each candidate has the opportunity to teach the rest of the class about an area of interest chosen by the candidate. We are presently learning about the relationship between mothers and daughters and how not ‘good enough’ mothers can affect their daughters, daughters who later come to us for treatment. Those in the class with a Kleinian bent emphasize envy. We were discussing today Charles’ (2001) paper “Stealing Beauty” about how narcissistic mothers envy their children and cannot help them succeed, nor bear to see their children as separate subjects. Sometimes their envy is transformed into self sacrifice (a reaction formation).

I have my personal doubts about whether envy is innate and, instead, see it as a problem arising from failed early relationships. An interesting, more specific thought came up in class today when Bharat Bharat, an aspiring psychology student auditing the class, asked about whether envy is genetic and whether it is somehow linked to children in those delayed gratification studies (don’t eat the marshmallow now and get an extra one later) who may later grow up to want (enviously) what they do not have (and cannot manage to get due to problems with delayed gratification).  Because I see children with poor impulse control as having a problem with self regulation, and problems with self regulation as a product of failed mutual regulation in early attachment relationships, I then wondered whether envy, if a problem with self regulation, stems from failure of early mutual regulation. Is failed mutual regulation (and, thus, insecure attachment) a mechanism for the development of envy?

If the caregiver, -- due to a history of trauma which now leads the caregiver to be preoccupied, dissociated, and unable to be with the child and with the child’s mind-- is unable to help the child feel attuned to and seen (unable to feel important enough), a child might feel deficient and defective, setting up a vulnerability for envy. This mechanism does not require envy of a good breast (but may include it), and, moreover, does not require gymnastic feats of imagination to explain envy, at least, to my mind.

Thursday, March 30, 2017

Dissociation as the hallmark of trauma

Because Adrienne Harris so eloquently discussed intergenerational transmission of trauma on March 18, 2017 at the Tampa Bay Psychoanalytic Society [see 3-21-2017 post], I thought I might share a bit of what Bruce Bradfield’s wrote on the subject:

“[P]sychic trauma...attempts to make meaning out of a phenomenon that resists knowing. … [D]issociation [i]s a primarily relational process, which keeps traumatic experience
unformulated and ambiguously signified in both the mother and her child. … [It is] a defense against intolerably painful affective states,which manifests in the mother’s intrapsychic experience, and in the relationship between mother and child…[T]rauma [is]...an experience that overwhelms the individual with inassimilable affects.

“[E]lements of parental traumatic experience are passed on to their children …and… subsequent generations. …[D]issociation is a consequence of a disruption of the parent’s caregiving capacity. [The parent’s] disrupted capacity to be emotionally attuned to the child ...[and] may impact on the child’s expectations[.]... [W]hat may be dissociated are not only the emotions associated with the parent’s trauma, but also the child’s need for relationship with the parent. …[T]rauma [is] communicated through patterns of relationship. … [C]hildhood interpersonal trauma has implications for the development of a particular disruption in lived experience [going on being], affecting attachment relationships directly. [There is] a relation between attachment style and posttraumatic responses.

“[A]ttunement within the relationship between mother and child facilitates the development of a capacity to integrate and contain painful emotions. … [D]issociation [is] an experience of disruption of the... capacity to integrate painful affective experiences. [D]issociation [is] manifest in future interpersonal relationships. …[and] reflects the incommunicability of traumatic histories, with trauma being held in familial and individual narratives as something unformulated and nameless.”