Monday, February 26, 2018

Film: The Shape of Water

Reportedly inspired by Creature from the Black Lagoon, with the wish that 
this time the monster gets the girl, Guillermo del Toro said The Shape of Water (2017) is "a movie in love with love and in love with cinema... [it is] a musical, a thriller, a comedy." Co-written with Vanessa Taylor and directed by del Toro and nominated for Best Picture it rivals Three 
Billboards for its original screenplay. Not so dark as Pan’s Labyrinth, but a 
fairytale nonetheless, this, like many fairytales, is a heterosex-ual love story, set not in Spain following its Civil War but in Baltimore during the Cold War when the USA was in a space race with Russia. The soundtrack, like the amphibious creature, is magical. It transports you, sometimes deliriously, from scene to scene with a smile.

While a twist on Disney’s Little Mermaid-it is the male creature who lives in the water, and the female is mute- still, it is the woman who must follow the male creature to his world. In this love story, love is about recognition. Elisa-who is mute-(Sally Hawkins) says about the creature (Doug Jones): “When he looks at me he doesn’t know how I am incomplete. He sees me as I am.” del Toro said that "Stories help us heal." This story is also about the magic of love to heal. del Toro said 
"When we admit love exists and is the most powerful force in the's like water and it has no shape until it takes it.

del Toro and Taylor speak to the sexual harassment of womenin low paying jobs, and of people without a voice, and paint their villain as sadistic. But we know that ordinary men need not be so wholly villainous to want their women silent. The co-writers also give a nod to the homophobia and racism of 1962 but we know that these heinous creatures still exist today. del Toro wants lines that have been drawn in the sand to be erased: "The other has always been us."

If the nominees for Best Picture were Olympic speed racing, this would lose to Three Billboards by only four hundreths of a second.

Wednesday, February 21, 2018

Why attachment theory

Schore writes that affect regulation is attachment, attachment is affect regulation. To create a secure attachment in the treatment relationship requires mutual regulation of affect. Regulation of affect is mostly a right brain to right brain experience, that is, it is done not through words but through a way of being (procedure, perception, affect) with another. It requires a willingness to ‘mark’ in the same affective trajectory, though not match with the same intensity, the emotional experience of the patient. We thus must be emotionally present. It is recommended that therapists be welcoming, accepting, open to the patient’s experience, and emotionally present (authentic).  A secure attachment includes trust, safety, and authenticity. From a secure base, one can explore novel, even scary, experience. Consider, of course, that a secure attachment in one self state may be insecure in a different self state.

It may be useful to know that Ainsworth described, in her Strange Situation research, three attachment patterns (one secure, and two insecure: avoidant and resistant-ambivalent-anxious) detailing the responses of 12 month olds upon being separated from mother with attempts to be comforted by the returning parent and by a stranger. Main described a fourth attachment pattern, another insecure one, called disorganized attachment. Main also devised the Adult Attachment Interview (AAI) which asks the adult to describe her or his relationship with her or his own parental figures. It is the coherence of the narrative, and not the content, which deems a secure attachment in childhood. It turns out that the AAI predicts what type of attachment the infant of that adult will have! Secure attachment on the AAI predicts a secure attachment in the Strange Situation. A dismissive style on the AAI predicts an avoidantly attached infant in the Strange Situation while a preoccupied parent predicts a resistant-ambivalent infant.

More important, perhaps, than knowing attachment styles as per the Strange Situation and the Adult Attachment Interview, is recognizing patterns of how-to-be-with-another. Like any ‘non-conscious’ experience (i.e., procedural, perceptual, emotional experience), right brain phenomena may be better accessed by non-verbal right brain to right brain communications. These right brain interactions are the “something more” that Stern, et al of the Boston Change Process Study Group describe. This means that interpretation and its promised subsequent insight (both left brain, verbal phenomena) may be insufficient, perhaps even unhelpful, in addressing a procedural way of being in relationship.

A note: Here in Florida (Parkland), another mass shooting took place where a 19 year old boy killed seventeen people at Douglas High School and wounded many more. My first thought upon hearing of this tragedy was not about gun safety laws and gun accessibility, though I think about those as well, but wondering about what sort of attachments this boy had had. It seems to me that one must have been somehow dehumanized in childhood in order to be capable of so dehumanizing others enough to kill them. Can dehumanizing and a deadening inside take place from an extremely dismissing, preoccupied, frightened or frightening parent? Now, high school students across Florida, and spreading to other states, are organizing protests against gun violence, reminiscent of the 1960s when college student protested against the Viet Nam War. Both are/were fighting for their lives. While gun accessibility and safety, and mental health all need to be addressed, I was wondering if another important prevention might not be teaching parents (and students from preschool onwards) how to be emotionally present with infants and one another. Perhaps if we could nip in the bud the trauma of chronic misattuenement (relational trauma) children would grow up feeling alive with others and cherishing lives.

Sunday, February 11, 2018

help with formatting?

Dear Readers:

I do not know why the past couple months that the words are cut in middle to start on next line.
My apologies.
If anyone knows how to fix, please let me know.

Apparently, though, the entire (future) post will come to your email if you enter your email address in the requested space at bottom, right hand corner.

Thanking you in advance.

PS: to reach me directly and so that I might have your email address you may contact me at

Smoking cigarettes, eating glass

The local Tampa Bay Psychoanalytic Society was privileged to host the author of Smoking Cigarettes, Eating Glass (2015) Annita Perez Sawyer who read excerpts from her humorous and poignant book about the perils of misdiagnosis and treatment and the iatrogenic harm they cause.
Being read to in her soft, melodious voice transported me back to childhood memories of bedtime stories read aloud by my parents, but in conjunction with the painfully disturbing content it was a disorganizing experience to have disparate elements: voice and words, juxtaposed. Perhaps that was the point, for her memoir tells of her dissociative experiences resulting from childhood trauma. Hospitalized in the 1960s with symptoms of derealization, depersonalization, and suicidal behavior desperate to communicate what was happening at home, and no understanding yet of PTSD as a result of childhood trauma, she was misdiagnosed with schizophrenia-- a diagnosis which, at the time, dictated treatment with ECT (shock treatment). Thus, Sawyer’s memoir makes a plea to clinicians to see, not symptoms or diagnosis, but the individual. Sawyer writes that the admitting psychiatrist during her first hospitalization at the age of seventeen had read aloud her diary to her as evidence of her need to be hospitalized. Her memoir states this intrusive authority had been “defiling what might have been mine but now was his” -- prescient of the much later recognition of her childhood incestuous sexual abuse.

Also welcome in this memoir is more anecdotal evidence of relationship over technique: despite having been hospitalized in the heyday of classical Freudian psychoanalysis, it was not neutrality, abstinence or anonymity, nor interpretation and insight which jump-started her recovery. Instead it was her (eighth) psychiatric resident who had the courage to see her as a person, and to be authentic, spontaneous--he laughed at her puns-- as well as attempt to understood that her disruptive and self destructive behavior was a communication of her history of childhood trauma.

This resident’s supervisor was Harold Searles who -- as Philip Bromberg now so elegantly elaborates -- shared his feelings evoked by Sawyer (the patient) with her. He noted that Annita as a patient was so innocent, so frightened like a fawn and so shy, that he felt like a dirty old man, and that bad feeling about himself had made him want to kill himself, just as the Sawyer herself had also been suicidal. Later, as a clinician, she decided this had been a kind of projective identification. She felt Searles had made contact [with her guilt], and she felt her [heretofore helpless] self able to have an effect on others.

Tuesday, February 6, 2018

Some mutual regulation

The traditional psychoanalytic opinion that insight leads to change has been challenged of late by contemporary writers who think behavioral change precedes insight. It is as if the latter are saying: First one has the procedural, non-conscious (right brain) experience (not a cognitive thought or realization) of a new way to be with an other -- such as trusting someone for a moment or feeling someone is proud of me-- and the subsequent encoding in the brain of this new experience has a calming effect, which in turn allows for blood flow to the left brain where symbolization, explicit thought, (insight) takes place. In writing about the film Three Billboards Outside Ebbing, Missouri, (Post on 12-12-17) I quoted Chief Willoughby opining that love leads to calm and calm, to thought. Felicitously a clinical example from a supervisee presented itself.

A supervisee asked me to help her think about shifting self states in a patient of hers who was often fidgety and affectively dysregulated. What was going on with her patient who one week had been sobbing and angry about a break-up and felt so awful that the patient was going to run out of the room before the session was over, and, in the next session, the patient was calm and even offered an insight about her dating habits? In the first session the therapist had invited her patient to stay with the therapist and sit together in her distress, which the patient was able to do. How did the patient return in a calm state, able to sit with stretches of relative silence?

I was reminded of how affective regulation contributes to a secure attachment and how a secure attachment leads to calm. If Chief Willoughby knows anything, calm leads to insight. While love calms, I also see where calm, in attachment parlance, leads to love. The patient, soothed by the therapist in the first session, returned more securely attached, more able to trust, and to feel love for the therapist, all unspoken. The supervisee said that she had felt love for her patient in that second session. Ah! Mutual regulation. The mother calms the distressed baby and feels competent, useful, meaningful to the baby, and she feels love for her baby, just as the calmed baby feels important to the mother, and they share meaning and joy in their soothed state.