Tuesday, December 12, 2017

Film: Three Billboards Outside Ebbing, Missouri

With Renee Fleming’s homage to Angela on the soundtrack, the opening of the film is of tattered billboards on a road that seems to lead to nowhere; One is of a baby like an unfinished jigsaw puzzle. This immensely entertaining film directed by Martin McDonagh [In Bruges] is written for our times, an allegory of the road America is on, and like the billboards, on a road “nobody ever goes down… unless [they are] lost or retards.”  And ‘retard’ is not the only politically incorrect utterance in this film. From “midget” to “Mexican,” Three Billboards conjures them all [emboldened much like our country has been by its current president].

Three Billboards has the ability to surprise, followed immediately by the satisfying feeling of  ‘of course!’  Frances McDormand as Mildred Hayes, is, as always, a woman of substance; Hayes lives out loud in her courageous determination to light a fire [literally, it turns out] under the law to [let’s say] ‘encourage’ Chief Willoughby (Woody Harrelson) to solve the rape and murder of her daughter Angela. In her grief and anger Hayes poses a solution: “pull blood from every man in town over eight,” every male child born, for a database of DNA, and, if it matches the crime, “kill him.” [Whether assaults on journalists, actors, Air Force Academy cadets, or a teenage girl walking home because her mother wouldn’t lend her the car, this solution is an understandable, though untenable, fantasy of survivors and their families.] [Hayes rebukes the Church, as well, for its sexual assaults against boys.] The Me,Too movement, and perhaps all women, will feel a bit of impolitic vindication, evident in something as simple as the change in singer of Buckskin Stallion Blues from male (Townes Van Zandt) early in the film to female (Amy Annelle) much later, or the he-said, she-said of the dentist and Hayes. The idyllic mountain lake scene of two female children on a blanket with fishing poles can not obliterate the uneasiness about what can happen to girls. Most disturbing is that their suspect does not have to be the perp, reminding us that rape and murder can happen anywhere, whether Ebbing or Afghanistan.

Every detail of this film is redolent: the name Angela; the later burned out building bringing to mind Angela Hayes’ earlier charred body; Red Welby reading Flannery O’Connor; Officer Dixon (Sam Rockwell) may not be wearing mirrored sunglasses but his persona is every bit as ominous as the officer in Psycho -- but he reads comic books [Dixon lives with his mom just as the police who beat and sodomized Abner Louima -- in real life -- did]; and especially Carter Burwell’s exquisite 
soundtrack. Wistful, melancholic, original music accompanies Willoughby [bearing no resemblance to Sense & Sensibility’s Willoughby] and we soon discover why -- It is not just because he is singled out by Hayes to solve this cold case. Renee Fleming sings Thomas Moore’s poem The Last Rose of Summer [for Hayes' daughter Angela]; the Four Tops’ Walk Away Renee begins “When I see the sign[s]” [for the billboards? have to smile.]

I have not yet seen the other films nominated for Golden Globe’s Best Drama, but watching Three Billboards, I had the same thrilling sensation as I did watching American Beauty, Crash, and No Country for Old Men, all Best Picture Oscar winners. As in the 2005 Crash, characters inThree Billboards are made up of multiple selves; villains can also be heroes. Willoughby guides the heretofore abhorrent Dixon in that direction via a posthumous letter when he writes: “What you need to become a detective is love” because love leads to calm and calm, to thought [reminding me a little of the psychotherapist’s mission, with her welcoming attitude and the regulation of right brain affects allowing in left brain thinking]. The final scene -- a road trip with two who have reached across an horrendous rupture, about life and life’s choices, “I guess we can decide on the way” -- my companion thought a too abrupt ending, but I thought it left open the possibility of a return to sanity, rationality and redemption.

Friday, December 1, 2017

Baldwin and Race Relations in America

The American writer, poet  and civil rights activist James Baldwin (Go Tell It on the Mountain, Giovanni’s Room} died thirty years ago today, and what he said about race relations in the USA is, hauntingly, still true today. In the PBS Newshour replay (on Feb 2, 2017) of a 1963 interview with him, Baldwin notes “I’m terrified at the moral apathy ---of the death of the heart--- which is happening in my country. These [white] people have deluded themselves for so long, they really don’t think I’m human.” 
Dissociated from our ‘not-me’ parts, projecting unwanted parts onto the Other, we view the Other as less than human (e.g. the historical, economic motivation to hold black slaves and to count black men as 3/5ths of a person; women were not counted). I imagine that these parts of self that later must be disavowed were originally unwelcomed by caregivers, such that we became ashamed. Treated by parental figures as less than fully human subjects with agency seems more likely to cause us to dehumanize others in turn. Baldwin had eight younger half-siblings and was treated harshly by his stepfather, and outside his impoverished home, he felt the crush of a racist society.

In the documentary “I Am Not Your Negro” -- directed by Raoul Peck about Baldwin, based on his writings, Baldwin notes  “What white people have to do is try to find out in their own hearts why it was necessary to have a nigger in the first place. ‘Cause I am not a nigger. I am a man.”

Sunday, November 26, 2017

"Delicate' Cutting

On November 18, 2017, the Tampa Bay Psychoanalytic Society, Inc hosted Shelly Doctors, PhD  who read a paper titled Advances in Understanding and Treating Self-Cutting in Adolescence. Doctors sees “delicate” (careful, superficial) cutting as a strategy for coping with overwhelming affects. With the lack of a reliable partner in mutual regulation, a child with insecure attachments learns from experience that others cannot be counted on to soothe and regulate painful feelings, so the child relies instead on strategies of self soothing.

Cutting can serve to both down regulate and up regulate extreme ends of arousal of the autonomic nervous system. This is how I understand it: The hyperarousal of the sympathetic (fight/flight) nervous system is calmed by the release, upon cutting, of endogenous opioids. The parasympathetic (freeze) nervous system’s numbing and deadness are up-regulated when it is likewise dampened by the brain’s opioid release.

Doctors notes that this kind of self “management” does not necessarily include suicidal ideation. What others see as problematic, the cutter sees as problem solving, a way of attending to an unbearable affect state or self state which, Doctors says, heralds self loss. This fragmentation of the sense of self is frightening, experienced as an assault on the self, and cutting, paradoxically, restores the self [by regulating overwhelming, that is, fragmenting, affect]. Cutting may be a response to separation, rejection, or loss, when the patient feels utterly alone, tense, or angry. Self-cutting increases when other means of self-regulation are blocked (for example, in prison, when drunk, etc).

Monday, November 20, 2017

Relational but not intersubjective?

Shelly Doctors, PhD, promoter of Self Psychology and of one of its daughters, Intersubjective Systems Theory, wrote a brief paper on Self Psychology’s “Earning a Seat at the Table (Again),”  which reminds us how Kohut’s paradigm shift from intrapsychic conflict to the importance of environmental surround was rejected by mainstream psychoanalysis of its day. Now Doctors notes a second struggle for Self Psychology: being accepted at the relational table. [She does not mention how earlier relational theorists, such as Ferenczi or Bowlby -- with his ideas on attachment and the importance of the environmental surround-- were also denied for decades ‘a seat at the table.’  Winnicott, also an early relational theorist, is likewise not mentioned (perhaps following in Kohut’s footsteps of not mentioning earlier theorists upon whom Kohut may have built his ideas), though Winnicott, wisely using classical language for his revolutionary ideas, was more palatable to his traditional peers.] Doctors also notes the irony of Self Psychology, having once been too relational, is now seemingly not relational enough.

Championing Kohut’s ‘selfobject’ as a unique contribution to psychoanalytic thought and as evidence of Self Psychology’s relationality, Doctors does not go further to discuss how ‘selfobject’ is not intersubjective. The selfobject experience is to the subject any person, thing, or idea which leads to an increased sense of self as cohesive, coherent,and continuous. The trouble is that it sees the other as a function and not as a subject in her or his own right. So while Self Psychology is relational in that it recognizes the importance of the human surround, it is not necessarily intersubjective when it emphasizes one of its greatest achievements to be the ‘selfobject’ concept.

Benjamin, on the other hand, sees intersubjectivity as a goal, if you will, or outcome of the psychoanalytic process, the precariously held capacity to both be a subject oneself and recognize the subjectivity of the other. Not only is this tension of subject-to-subject relating hard to sustain for any length of time, but may only be achieved in a particular self state and not other self states (or affective states), and only by that self state in a particular moment. Go figure.

Thursday, November 16, 2017


Happy Birthday, G!

From PBS NewsHour’s ‘Brief But Spectacular Series’ aired on August 10, 2017
G Yamazawa, Poet & Rapper, and teacher, said of the following piece, “I wanted to acknowledge this place in my life that i felt Iike I was proud of myself and all the things I’ve done up to this point”:

I think I’m starting
To rhyme more
‘Cause I want my life
To start connecting
‘Cause, see, I’ve learned
How to learn, so
Now I’m learning
How to teach
‘Cause I done learn how
To practice
Whatever I preach
Boy, I grew from a grain
Into a beach
And I knew
For the game
I’m playing for keeps
So whatever I say I say
What I mean
So whatever I speak
I’m able to reach
A place that bleeds
And a place that burns
And a place that knows
I got a lot
More to learn.

G Yamazawa

Shouts to Durham

Sunday, November 12, 2017


Marking the 50th anniversary of the 1967 Supreme Court landmark civil rights decision in Loving v. Virginia -- which struck down the 1660s  (300 years old!) anti-miscegenation law (prohibition against interracial marriage) in Virginia -- PBS NewsHour interviewed, on June 15, 2017, Sheryll Cashin, Georgetown University Law Professor and the author of Loving: Interracial Intimacy in America and the Threat to White Supremacy. The case was brought to the Supreme Court by the  Virginia couple, married in 1958, Richard and Mildred Loving, about whom the 2016 movie, Loving, was made. 
Cashin said some things in that interview that I thought very apropos of our work. For example, she defined “Cultural dexterity as “the ability to enter a situation where you are outnumbered by a different group and experience that with comfort, even wonder. An enhanced capacity for dealing with people of a different group. It is the opposite of colorblindness, it is the ability to see and understand difference and accept it rather than demanding that someone else assimilate to your cultural norm.” 

Isn’t this also demanded of us therapists, that we see, with wonder, and accept difference, and not expect patients to acquiesce to our agendas?
Cashin hopes that a critical mass, of particularly white people, will accept the loss of centrality of whiteness and join with growing populations of people of color to fight together for the common good. Cashin believes racists today are a minority and that there is a growing population of people who embrace diversity.

Monday, November 6, 2017

Listening Stance

Analysts listen. But in what ways?

Fosshage delineates, adding jargon to the lexicon, two modes: an empathic mode of perception which he calls “the subject-centered listening perspective;” and one from the vantage point of the other who listens, and who also experiences the patient as the other, called “the other-centered listening perspective.” What is required of the analyst by the patient is an ongoing (repetitive) experience of the analyst as empathically attuned. The analyst’s empathic listening implicitly affirms her/his interest in the patient; lends validation to the patient’s experience; regulates affects, thus creating a safe attachment and space; and conveys understanding of the patient’s experiences.

Fosshage, J.L. (1997). Chapter 4 Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness. Progress in Self Psychology, 13:33-55.

One problem with jargon is its inherent ‘narrowing-by-naming.’ For example, in ‘subject-centered’ listening, Fosshage means the patient as the ‘subject,’ as if this subject can be delineated from the relationship between the patient and analyst, and, moreover, from the co-created third, the shared unconscious that emerges as something bigger than either of the two separately. Of course, the patient is separate from the analyst, but the process is separate from neither.

Attunement and empathy, listening and perception, bring me to the major paradigm shifts in psychoanalysis from left brain (cognition, interpretation, insight) to right brain (affect and its regulation); from content to context; and from ‘how to’ (technique) to a way of being in relationship. More than Freud’s one-person “evenly hovering attention” to the patient’s narrative content is a shared affective state, shared dissociation and enactment in which attunement now speaks to a “contextualized perceptual experience.” (Bromberg) We 'listen' with more than our ears. We are hard-wired with the added capacity to perceive meaning in micro-expressions, in tone and prosody, and more.

Bromberg, P (2011) The Shadow of the Tsunami. Ch.6. Routledge, New York.

Listening, it turns out, includes who we are--- and who we are emerges uniquely with each unique patient.


Friday, October 27, 2017

Meadow's "Treatment Beginnings"

An elegant, little paper from 1990 by Phyllis W Meadow, simply titled “Treatment Beginnings,” shows the author’s perspicacity about contemporary psychoanalytic ideas. She encourages the therapist to consider “[w]hat quantity of stimulation will help the patient to be in the room with me and to talk.” [‘Quantity of stimulation’ is what is noted in infant research re: regulation: up or down, to engage or sooth, respectively, the  infant.] She writes, “the initial phase of treatment is… creating an environment in which the patient can give up his resistances to talking in the presence of the analyst.” Contemporary analysts might substitute for “give up his resistances...” the words ‘feel safe and participate in building a relationship,’  but the author’s meaning is clear: “Creating the relationship that will be therapeutic is the primary task of the analyst…”  It is the analyst who bears the lionshare to create the safe space and to keep the process alive. (Winnicott described the good-enough mother who adapts the environment to the infant’s needs.) Meadow’s ideas about awareness of the patient’s “patterns for making contact” speak to a utilization by the analyst of relational paradigms. In fact, she states explicitly, “change takes place within the doctor-patient relationship.”

I am particularly fond of her stating that “The projector does not need a contradictory perception…” because I think it speaks to the idea that the patient first needs us to join with him, to welcome his perspective [and only later, when intersubjectivity is accessible to the patient, introduce our otherness.]  Recently a patient accused me of being “vindictive and treacherous” which I could not initially wrap my head around until the patient added that she believed I was plotting with another patient to kill her. Owning that all of us have murderous impulses, I then could understand my treachery. Wearing her attributions, instead of contradicting them [Note: if I had contradicted them even silently, with right-brain to right-brain knowing she would have felt my opposition] had the effect of calming her fright. She was calmed somewhat perhaps because I was not contradicting her, not challenging her beliefs, not murdering her agency, if you will. Later, much later, in moments of mentalization (a necessary component of intersubjectivity), we were able to consider her ‘assumptions’ as thoughts, without a psychic equivalence.

Another lovely pearl was Meadow’s “Even the simplest mode of interpretation, confrontation, pointing out a patient’s behavior or explaining its effects, even this leaves the patient feeling criticized or attacked…” [and shamed, like a specimen under a microscope, less than fully human;
All interpretations in the classical sense, ‘you did this ---  because of that ---’ may serve to humiliate and criticize.] Meadow notes that such confrontations “may intensify self-doubts.” Don’t many of our patients already come to us with a history of having their hard-wired capacity for reading the intentions of others vitiated by parents who scolded, ‘You don’t mean that!’ or ‘You don’t feel that way.’? When analysts want patients to question assumptions and erroneous beliefs, we hope to find a way for the exploration to be a collaborated effort which includes the patient’s curiosity and not just our own ambitions. Meadow wrote, "More important than progress is the ability to resonate with a patient..."

Meadow, PW (1990)Treatment Beginnings. Mod. Psa. 15: 3-10.

Monday, October 23, 2017

Group Process

On Oct 21, 2017 Jeffrey Roth provided to the Tampa Bay Psychoanalytic Society an organizational group process consultation [akin to Tavistock groups]. Here were some of the things to be gleaned:

Groups are fertile ground for primary process. [By this, Roth meant sexuality and aggression, seeming less interested in attachment and affiliation.] Just as in individual treatment, there is the stated task and the “covert task” [explicit and implicit]. All that transpires is “data” [fair game, in this case]. There are no ‘as-ifs’--psychic reality is the reality of the group. Differing narratives are not destructive, but combined toward greater understanding. Individual members are ‘elected’ by the group to hold certain characteristics and affects [projections; projective identification] such as the inept one, the angry one, etc. This leaves the one doing the projecting bereft of being able to utilize that characteristic or feeling. What one member says about another is a disguise for what the speaker feels about her/himself. One question is to reflect on whether a projection serves to make the group more or less functional. Ideally, a well-functioning group is one which works to own its projected parts.

References by the leader to any individual is really a reference to the role that individual is playing on the group’s behalf. Issues of boundaries and autonomy come up. The leader speaks to the process of the group, removing the target off any one member. By questioning a member’s complaints of, for example, not having a voice or not wanting to be unkind, the leader challenges the abdication of agency by the complaining member. [Tavistock groups can serve to train leaders, facilitating recognition of what one is ‘made of’ and examining impediments to agency.] “False stupidity” [disavowal] or false muteness may serve an individual by hiding competitive strivings, avoiding risk of rejection, avoiding shame for competitive strivings or from rejection. The leader would amplify the implicit voice, eg. complaining someone was ‘long-winded’ might be interpreted as meaning a “wind-bag” and wanting to say, “Shut the F--- Up!” The leader added that, by the way, a windbag can fill the sails of another(‘s sadness, e.g.).

The group leader seeks “authorization” from the group or a member to make an interpretation about what is going on in the group. Roth would often say “pause” to stop the group and invite it to reflect. If leader does not stop to point out what is happening, then the leader is colluding. The leader does not assume to understand what any member or the group but instead offers hypotheses. He encourages each member to check out their hypotheses with other members. A leader who criticizes is not functioning well in the leader role. When asking questions, the leader reiterates that one is free to answer or not answer. “Experiments” are proposed, e.g. asking one member to speak in the voice of another member’s voice or role. The leader encourages the group to celebrate when an individual is willing to share her/his pain in service of the work of the group.

Friday, October 20, 2017


Bromberg writes that dissociation is both a structure and a process; it can be pathological--in its extreme, DID: Dissociative Identity Disorder, formerly known as Multiple Personality Disorder-- defensive, or normative, the latter occurring ubiquitously and a part of everyday life, such as putting aside our maternal selves while performing open-heart surgery or when we drive home with no memory of how we got from point A to point B.

When we think of dissociation as sequelae to attachment (relational) trauma, or to traumatic events, we consider overwhelming affect-- unmitigated, unshared, unsoothed-- that threatens to disrupt one’s sense of ‘going on being’ or continuity of self. Bromberg writes:

In order to preserve the attachment connection and protect mental stability, the mind triggers a survival solution, dissociation, that allows the person to bypass the mentally disorganizing struggle to self-reflect without hope of relieving the pain and fear caused by destabilization of selfhood.

Often patients have complained that they would feel ‘weak’ or ‘too dependent’ if they expressed their need for comfort (for shared affect) from an important other. Bromberg reminds of us the double shame inherent in the psychoanalytic process: the shame that comes from both seeking solace and from the belief that their needs are illegitimate, unreal to the other, and thus that the patients themselves are unreal and risk losing the attachment bond. He reminds us that, if the analyst does not recognize the patient’s desire to communicate to us the dissociated parts of the patient’s self, then the patient will continue to feel her needs are illegitimate and undeserving of solace.

Bromberg, P (2011) The Shadow of the Tsunami. Ch. 2. Routledge, New York & London.

Wednesday, October 11, 2017

A Dream, about Agency?

or what the Continuing Case course participants make of a dream.

A man in his mid thirties, a successful professional in a helping profession, has been working on trying to change about himself his ‘passivity” and there has come to light a hint of his resentment about having had to be so passive all his life, passive viz a viz his parents, and his parents viz a viz his grandparents. In an earlier session he had shared how ‘coming out’ years before to his mother about his homosexuality had sent her --two hours later-- to the hospital. The man brings to his male, heterosexual, therapist the following dream:

              I am at the funeral of my parents and I don’t feel connected to the loss of them,
              and I am worried that others will see that I am not sad, that I am disconnected
              from loss. My ex-boyfriend and my cousin are also at the funeral and the priest
              will not allow my cousin, because she is female, to sit with me, because women
              must sit separately from the men. I get the priest to allow my cousin to sit by me.

The patient then begins to talk about how, if his parents were dead, what he would do with all the money, items, and property he would inherit. He would sell what did not fit or what was a burden and keep only what was precious to him. Perhaps, with all the money, he would not have to work anymore.

One candidate noted in this dream the patient’s previous theme of exposure: others would know his thoughts and deficiencies, and the patient would feel shame. Funerals are about death, but this patient has felt enlivened by the therapy.

This dream could be what Kohut might consider a self-state dream, heralding a change in the patient’s capacity to be active: he asserts himself and gets the priest to allow his cousin to sit by him.

Does the priest represent his father? His strict grandfather who made the father acquiesce? The patient is able to get this traditional priest to make an exception for him. Does the patient feel, though, that he must emotionally kill off his parents if he is to be able to assert himself? Or must kill them off if he is to be with his own feminine selves (sit with his female cousin)? Or does the dream also speak to his fear of loss of relationship if he were to assert himself and, also, if he were to be with his feminine self? Is it a forward edge to be able to assert himself, free himself from his parents? Ideally, would we not wish intersubjectivity for him (to be himself while in relationship with others, that is, to have both agency and negotiated relationships)? And what about the oedipal aspect of a male authority figure keeping him away from the female relative?

A rich and lively discussion for the presenting candidate to add to his experience with the patient and this dream.

Wednesday, October 4, 2017

“Mirror in the sky, what is love?”*

In discussing an analytic attitude with beginning trainees, I find analytic love and hate must be included. Analytic love is not to be confused with romantic love or parent-child love. As part of analytic love, I advocate for a welcoming attitude. Natterson elaborates 'what is love.' While not  having repeatedly made explicit throughout his paper -- to remind the reader what he means by love -- Natterson nonetheless defines it early on (p.510), relying on Hegel and Honneth: “love is a relationship of mutual recognition.” [I love that definition!] Another excellent ‘definition’ appears towards the end of the paper (p.520), this time from his patient: taking in and honoring the patient’s experience. [welcoming, if you will]

Recognition of our subjectivity, by a parent able to hold us in mind (Bion/Winnicott) and able to survive (Winnicott) our attacks, begins in infancy. Intersubjectivity, an always precariously held position, will inevitably fall to the side of treating the other as an object (called ‘negation’ by Benjamin), and we must continually right ourselves back to subject-to-subject relating. Doing so is an act of love. Despite love, there will be moments [or days] when intersubjectivity will fail and will cause the parent, lover, friend, or analyst to treat the other subject as an object: ‘You must do what I say, must meet my needs, you must sacrifice your Self in order to stay in relationship to me.’ What gives analytic love the edge is the analyst’s continued striving to be attuned to the patient’s response to us, be self-reflective, admit our contribution to ruptures, and make timely repair, that is, to re-establish intersubjectivity.

I must add that Natterson’s paper fell short for me on two counts. One was his continued use of terms like ‘individuation’ or ‘fusion.’ Dan Stern and later infant research tell us we are born individuated, not fused, not symbiotic. It is when our early subjectivity goes unrecognized (and we are treated like an object instead of a subject) that we have the experience of being usurped by the other. I doubt anyone wishes for fusion except as a way to maintain a threatened relational tie (or, momentarily, in love-making). Merger, fusion, lack of individuation are indicators of failure of recognition of subjectivity.

The other way this paper fell short for me was Natterson’s mention of the “Oedipal guilt” in his patient without including the reality of her childhood sexual abuse and its complications to the Oedipal configuration. I do not disagree that children often have a wish to marry the opposite sex parent, especially heterosexual children. It  seems to me that children who endure childhood sexual abuse require reconciliation and restitution to find a way back, as his patient did, to a loving relationship to her abusive father.

I am grateful to Natterson for providing a paper on analytic love and recognition of subjectivity.

Natterson, J.M. (2003). Love in Psychotherapy. Psychoanal. Psychol., 20(3):509-521.

*Landslide-Stevie Nicks

Sunday, October 1, 2017

Intergenerational Transmission of Trauma

We often hear that certain things, such as cocaine addiction or violent behavior, are inherited. Then there is the fascinating idea of epigenetics which, reminiscent of Lamarck, indicates that behavior can change genetic expression and can then be passed down in the genes. What seems to go under-emphasized outside psychological psychoanalytic circles is the intergenerational transmission of trauma, particularly relational (attachment) trauma. Schore puts intergenerational transmission of trauma like this: “...the infant is matching the rhythmic structures of the mother’s dysregulated arousal states.”

While two excellent, long-term studies have shown that violent behavior needs both the genetic vulnerability and the environmental exposure to violence in the home (the latter which is also a relational trauma, the relational trauma of a parent not seeing the child’s feelings, not regulating the child’s feelings, etc), why is it not also likely that drug addiction is not simply a genetic vulnerability but also a way of regulating one’s emotions? The addicted parent could not be sufficiently present to recognize, attune and regulate the child’s emotions and thus that child grows up with its own dysregulation, perhaps later likewise finding some soothing from substances. This dysregulation is not simply genetic. It is an intergenerational transmission of trauma, just like with a child who is sexually abused and unprotected and un-comforted, maybe even un-validated in her experience and pain, who grows up and becomes unable to protect her own child from sexual abuse.

A parent’s dissociated states from unbearable affect can create a dissociation in her infant (and disorganized attachment). The infant is then at risk for “a lack of integration of sensorimotor experiences, reactions, and functions” as seen in the common sequelae of somatic disorders (such as pelvic pain, fibromyalgia, migraines) resulting from childhood sexual abuse. Does one then say that sexual abuse of children is inherited? Not usually. Perhaps other behaviors, such as substance abuse, and even anxiety and depression, show up in the next generation and the generation after that because a parent who is not present (drunk, dissociated, anxious, or depressed) transmits these same self states to the infant, right brain to right brain.

Wednesday, September 27, 2017

More about the co-creation of transference

In teaching and learning more about the co-creation of ‘transference’ in our Intro to Psychoanalytic Concepts I course, we used papers by Fosshage and by Slochower to further our discussion. While Fosshage helped the class rethink anonymity and abstinence from a more contemporary view, and nicely explicated a more contemporary idea of transference as an organizing activity from the classical displacement model of transference, the candidates and I agreed that the distinction between pathological and non-pathological forms of transference may not add to our clinical experience. Regardless of its form, we agreed that transference is always co-created.

A lovely example came, again, from a candidate. The candidate described that her patient had insulted her, the analyst’s, competence, then the patient additionally complained that the analyst was a ‘blank screen.’ The candidate-analyst found it “harder to hear” that she was viewed by her patient as not so human (capable of feeling) than to hear she was not so skilled as a therapist. The candidate then explained to her peers [who had heretofore failed to see the co-creation of the patient’s latter comment] how she, the therapist, had “refused the discomfort” of the insult to her competence and so had remained unmoved. “I did not feel my anger” so “my answer was not human.” The patient, having expected hurt or anger, or some response, and having read -right brain to right brain-  the therapist’s dissociation from uncomfortable human feeling, then complained about the ‘blank screen.’  

This segued nicely into Slochower’s paper where we see Slochower on the cusp of struggling to recognize her own contribution to the patient’s ‘hateful’ness, and struggling to ‘wear the attributions’ of incompetence, manipulativeness, and greed as she negotiates with her patient an attempt at a mutual understanding. A second candidate noted aloud how Slochower’s interrogation of ‘Why would I want to do that?” nonetheless leads to a deeper revelation about the patient’s fears: “Obviously, to get as much money from me as possible.” Slochower gives us an illustrative case example of just how very hard it is for analysts to see our own contribution and acknowledge it to patients and, thus, validate the patients’ experience of us. This is one way our patients are our best supervisors.

Slochower, J. (1992). A Hateful Borderline Patient and the Holding Environment. Contemp. Psychoanal., 28:72-88.

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.