Candidate praises training

I found TBIPS as I looked on-line for a psychoanalytic community to call home after moving to Jacksonville, FL following my Psy.D. program at Rutgers University in New Jersey. Despite numerous psychoanalytic supervisors, psychoanalytic courses, and personal psychoanalytic psychotherapy while in graduate school, I still felt not quite ripe with my own education and training. I honestly appreciated in myself that nagging feeling of wanting more, intellectually and professionally. The clinicians I’ve admired most have been the ones with endless amounts of training and they paradoxically combined their experience and expertise with humble disclosures of feeling they didn’t know enough and needed to know more.

 My clients have also indirectly nudged me toward getting more training, as their efforts to get better and their “faith” and “belief” in my ability to help them were all taken as hints as “Go get more training, girl!” I was drawn to TBIPS, in part, by its offerings of long distance training via Skype and telephone. I am deeply grateful to TBIPS for being my intellectual home, and an answer to this need for professional sustenance and support. I’m a Filipino American woman, and there’s a saying in Filipino called “utang na loob.” It is translated as “debt of gratitude” and signifies the Filipino cultural trait of “reciprocity” in relationships or the “debt of one’s inner self.” I feel indebted so, and deeply grateful for TBIPS’ psychoanalytic training and for supervision.

Training and supervision at TBIPS have helped me feel more connected to my clients, helped me to express that connection, to be more human with my clients, and to listen in a particular way that makes sense of our clients’ most troubling symptoms. Psychoanalytic supervision has sensitized me to the ways that I may unintentionally shame clients in well-meaning attempts to be helpful, and how to normalize intense feelings and emotions reported by clients and mutually felt by myself as therapist. It has brought the world of psychoanalytic literature to my home, suggesting relevant articles by contemporary relational psychoanalysts, which I feel have connected me with a wider psychoanalytic community that has such a rich history of thinking deeply about common, difficult, tricky clinical scenarios. Ultimately I feel stimulated and nurtured, and much less isolated as I do the day-to-day work of inching towards emotional intimacy and understanding of clients. Clients report feeling understood, accepted, seen, recognized, as we attempt to bear witness to their emotional suffering. The results have been longer patient lengths of treatment due to decreased premature terminations, more spontaneous expressions of gratitude by clients, greater retention and return rates of clients, and lower no-show rates.

Rose Zayco, PsyD

Pussy Riot: Because She is not a sinful creature

Psychoanalysis strives toward increasing freedom to live an increasingly broadened, enriched life. I am glad to be an American citizen, born in the USA, in the country whose Constitution has survived longer than any other. It was hammered out and became the law of the land more than a decade after the Continental Congress signed the Declaration of Independence-- the latter, of course, the event we today celebrate. Last week the Supreme Court broadened our freedoms by striking down DOMA (the Defense of Marriage Act which narrowly defined marriage so as to discriminate against homosexual couples). I have long awaited the day when women would be free of their minority status, too. I have wondered why nations don’t rise up in outrage against rape as a weapon of war, against female genital mutilation, glass ceilings, sex slaves, child brides, and other socially sanctioned violence against women.

So I smile when I think of the Feminist - punk rock - protest - performance group Pussy Riot, formed the day Russian President Medvedev announced that power would be handed back to Putin for six more years. Mass protests ensued. Members of Pussy Riot were arrested six months later for their performance on Feb 21, 2012 in Christ the Savior Cathedral. This hooliganism garnered a two year prison sentence for two of its members. Pussy Riot accused Putin of depriving Russia the right to decide its fate. ‘Nadia’ says the alter of the cathedral where the feminists performed was chosen because “a woman should occupy it.” [the altar] “I believe that a woman should be allowed to run services and that a woman should stand at the altar because she is not a sinful creature.” What a concept: egalitarianism in religions.

Called “demons” by those who support the Russian Orthodox Church, Pussy Riot says, “As artists, our goal is to change humanity,…to free society from prejudices and stereotypes, to be the voice of the voiceless….We are jokers, jester, holy fools.” Their offensiveness, to some, was meant to challenge complacency and ask uneasy questions. Psychoanalysts ask uneasy questions, striving not to give offense. Still, I applaud these exuberant, brave, questioning, young women, fundamentally non violent, their guerilla performances, colorfully clad and masked (in balaclava), waving purple flag, fisted as they scream their protest to electric guitar. A favorite is Putin Zassel, written in response to regime troops being sent out to contain anti-Putin demonstrators of Dec 24, 2011. Performed in Red Square Jan 2012:

Lyrics (to Performance No. 4

The masses rise up and move on the Kremlin

Explosions set off at Security headquarters

Bitches piss themselves behind red walls

Riot is here to abort the system

An attack at dawn? Don’t mind if I do

When we’re whipped for our freedom

The Mother of God will learn how to fight

Magdalene the feminist will join the demonstration

Uprising in Russia

The charm of protest

Uprising in Russia

Putin pissed himself

Uprising in Russia

We exist

Uprising in Russia

Riot! Riot!

Take to the streets!

Occupy Red Square

Show them your freedom

A citizen’s anger

Uprising in Russia

Riot! Riot!

Take to the streets

Occupy Red Square!

Show them your freedom

A citizen’s anger

As Egypt struggles to find its way, having ousted Morsi yesterday, perhaps the huddled masses yearning to breathe free will one day no longer need to be on U.S. soil to do so. I hope Egypt strives in its future toward a more inclusive constitution where woman are equal under the law and toward a democracy that does not solve its mistakes with military powers. Do Pussy Riot members Nadia and Masha  smile from their respective jail cells? Thomas Jefferson who, as you know, penned the Declaration of Independence, advocated revolution, “The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.”  

Exuberance and surrender

For me, part of an analytic attitude is to lean into the patient’s point of view and open myself to the logical reasoning to be found in otherwise unfathomable behavior. It is in the transitional space that all is possible. Here we play with the idea of what it would be like were patient and I to be family or friends, enemies or lovers. No affect is banned, no sentiment eschewed. We aspire to unflinchingly explore limitless facets. If only our humanness did not get in the way. Ah, but there it is, to be bumped up against and used as an edge to see where is my beginning and my end, the boundary, the psychological skin.

For me, empathy is finding the good reason in the bad behavior. I want to go there, to be there, with my patients. It is an act of love. Despite its painfulness at times, that attitude usually reminds me of the joyful exuberance in the Angels and Airwaves song “Lifeline” The refrain is

We all make mistakes.
Here's your Lifeline.
If you want it, I want to.

I rephrase:

We all make mistakes.
Here's all I’ve learned.
If you want, I want to.

The song ends with the repeating, resounding

If you want, I want to.

If you want, I want to.

If you want, I want to.

If you want, I want to.

That’s what I want with my patients: if you want me to, I will go there with you.

Justices and Analysts

Today is the birthday of Sonia Sotomayor, the newest member to the U.S. Supreme Court and first Hispanic Supreme Court Justice. She is fifty-nine years old.  In My Beloved World (2013) Sotomayor writes “I was fifteen years old when I understood how it is that things break down. People can’t understand someone else’s point of view.”  In discussing with Gwen Ifill on the PBS Newshour (Feb 20, 2013) an incident from her adolescence where “people do things without imagining the impact it’s having on the other person” –she is discussing a prank where she saw others, lying about an affair, cause havoc in a home— Sotomayor says, “If you don’t imagine what the person you’re speaking to might be thinking, you can’t anticipate how that person is reacting to you.”  [She is discussing mentalization and the capacity for intersubjectivity.] Sotomayor said she seeks to build bridges where other people see chasms. She looks at ways to connect instead of seeing differences, particularly apropos when seeking solutions. [Sotomayor is describing relationality.]

These words call to mind what contemporary psychoanalysts consider. In our profession we do not seek to overpower others with our point of view, our value system, or a singularly envisioned path. Instead, we strive to consider the other’s point of view, holding it in balance or tension with our own. We hope to keep in mind and imagine the impact we are having on the other, as well as to pay attention to the impact of our words in the moment that follows their having been spoken. We are also striving to be mindful of the impact the other’s words have on us.

Just as analysts are, Sotomayor is aware how her judicial duties call upon her to be self reflective about her personal experiences and biases and how these influence her thinking about a case. She tells Ifill, “We have to know those moments when our personal bias is seeping into our decision making.”  She adds, “It doesn’t mean that our personal experiences can’t permit us, and don’t permit us, to see arguments that others might miss.” She asks, “…When are we listening with an open mind and when has our mind been closed because of a bias?”— a question therapists might ask themselves every moment as well.

Movies: an Opportunity for Empathy

Perhaps the best known film critic of his time, Roger Ebert died this year on April 4, 2013 of thyroid cancer. Had he lived he would have been seventy-one years old today. Writing from the Chicago Sun Times, and syndicated in more than two hundred newspapers, he was the first movie critic to win the Pulitzer Prize. His TV show on public television At the Movies with rival critic Gene Siskel became a template for dialogue for future TV productions.

In 2005 he received a Star on the Hollywood Walk of Fame and said this:

Movies are the most powerful empathy machine of all the arts. When I go to a great movie I can live somebody else’s life. A little bit, for a while, I can walk in somebody else’s shoes. I can see what it feels like to be a member of a different gender, a different race, a different economic class, to live in a different time, to have a different belief. 

I couldn’t help but think how psychoanalytic work allows the same opportunity. Analysts are privileged to hear the inner most workings of the human soul, its lofty spirit and it heinous or heroic reactions to the slings and arrows of misfortune. A lover of film, literature, and theater, I know all these media pale compared to the privileged observer-participant role of the psychoanalyst. Still, I continue to have a love affair with the movies. Thanks, Roger, for adding when I was a girl, the critical dimension to so many beloved movies. I remember you today.

Harriet Beecher Stowe, born June 14, 1811

From her capacity for empathy, when as a young woman she traveled from Cincinnati over the free state border of Ohio into the slave state of Kentucky, Harriet Beecher never forgot seeing the auction block and slave women’s babies wrested from their arms.  She would be tormented by its memory. The death of her own beloved small son Charlie from cholera gave her first hand knowledge of the pain of having a child wrested from your arms. From her grief, and remembering the cries of those slave mothers, Harriett Beecher Stowe was to write her bestselling novel Uncle Tom’s Cabin, first published March 20, 1852.

Her vision, in part to come to terms with what lesson her God might teach by such cruelty as taking Charlie from her, was not of Christ on the cross, but of a slave being whipped.  Uncle Tom’s Cabin, like Frederick Douglass’ autobiography before it, would acquaint many more Americans with the evils of slavery. It reached an even greater audience when it was adapted into a popular play. Millions of Americans would rethink slavery. Frederick Douglass held it in gratitude. William Lloyd Garrison saw it change previously hardened hearts. The Fugitive Slave Law began to crumble. Abraham Lincoln upon meeting Stowe is purported to have said, “So you are the little woman who wrote the book that started this great war."

What I find fascinating is how one’s own pain can open up one to an other’s pain. It speaks to an analytic attitude where the therapist must grapple with dissociated parts of her/himself to enlarge the capacity to explore that of the patient’s. Our blind spots may inadvertently foreclose the transitional space into which might have been invited the unspeakable experience of the patient. An analysand of mine once asked if we might find “home” together, by which was meant a relational home, one where recognition of my pain might help us recognize his deeply ensconced pain. Easier said than done.

Hail the China American Psychoanalytic Alliance

This is written to encourage any psychoanalytically oriented therapist, no matter how experienced or confident, to consider volunteering time supervising budding therapists in China via the China American Psychoanalytic Alliance. Sharing the professional life we love, helping it flourish around the globe, and consolidating our own ideas about the work we do are among the many gifts we receive when we give our time to nurturing young professionals in China.

It was intriguing to me that psychoanalysis was being disseminated in China. I thought how exotic Freud might be to many parts of China just as names like Beijing and Shanghai seemed exotic to me.  I thought that no matter how little I might know, I was sure to know more than an entire culture which might never have grown up with id and ego and oedipal complex in its lexicon. I was eager to share what I know, partly because I love psychoanalysis and partly because I am a teacher already at my local psychoanalytic institute. I was excited to meet the young woman who had decided to dedicate herself to training in a culture where her interest would be pioneering. I imagined my supervisee must be heroic, or, at the very least, highly motivated. I might be available to her at 9:30 in the morning, but she saw me at 930pm after a long day. I was moved by her dedication.

We met first by Skype and it took a number of meetings for my ear to acclimate to her accent. I wondered how she was able to hear me, English being foreign to her. She always would have an English to Chinese dictionary on hand.  I always made an effort to enunciate each word carefully. It was sometimes slow going, but in a peaceful and meandering way, like tubing down a shady, spring fed river on a hot summer’s day. Frustration came from the internet Skype connection which too frequently dropped calls, lost video, or had whirring noises which obliterated our conversation. We soldiered on, calling back numerous times, sometimes giving up and confirming by email to meet again next week. It was a privilege to be part of this neophyte’s growth and development and we worked together for almost two years. When the sixty required supervisory sessions were up and she had to move on to a new supervisor, we took a half dozen more sessions for termination. There were tears on both our parts at our final goodbye.

Blossom and I got to know each other. What had drawn us to psychoanalysis? How might she and I make use of our time together? How did she conceive that people benefit from treatment? Blossom was quick to offer that patients, in the presence of the therapist, might better become aware of themselves and their feelings. Blossom hoped to help them face things in their minds and hearts that were difficult to face. There was always an opportunity for me to say something taken as smart as she had so little theory yet on which to rely, compare and contrast. This can be very confidence boosting for the supervisor. And nothing helps us grapple more with our theories than having to teach them. Thus, I highly recommend to all the supervising of a younger colleague.

Sometimes we discussed particular topics like ambivalence or empathy.  I told her empathy was about understanding the good sense of bad behavior, this long before we ever expect the patient to change behavior.  Sometimes Blossom would read papers she had asked me to recommend and we would discuss them. Sometimes she expressed disappointment that many of her patients did not stay in treatment as long as she had hoped.  Sometimes she wondered how to manage the angry and disappointed feelings in her patients who were dissatisfied with their treatments. In other words, Blossom was becoming a therapist, struggling with all the same issues as any American therapist beginning to learn how to be with patients.

Sometimes supervision includes, as it does for the therapist vis a vis the patient, creating together a safe space to discuss one’s fears and fantasies. The medium is the message in supervision too.  The supervisor must create a reliable and accepting space which invites in all possible content. Over the course of Blossom’s work with her patient, Blossom was courageously candid about times when her understanding and empathy flagged, her wish for the patient to hurry up and get better, and about her desire sometimes, such as when the patient did not improve or cancelled sessions, to transfer her patient to a different therapist. We discussed enactments, and managing the therapist’s helplessness and sense of incompetence. Blossom could recognize that her patient’s new struggles indicated a forward edge for the patient, a finding of her own voice. Blossom too was finding a voice and I was gratified to be part of that.

One example of Blossom finding her voice occurred in the tenth month of our supervision when she had to present her case before her coworkers and to the psychiatrist in charge of the clinic. The psychiatrist was somewhat famous, was more experienced, and was very aware of his authority. Nonetheless, Blossom was able to joke with the psychiatrist about his criticisms which she thought misunderstood the case and, to her delight and surprise, the psychiatrist changed his tone and encouraged her to be herself with her patient. Blossom, likewise, reported she was able to be more openly questioning and critical about information presented in her classes. She felt more engaged with the training.

When it came time to say goodbye, Blossom reported that her patient, also reaching termination, had said to Blossom, ‘What else do we need to do? Nothing, so I leave my case material to you as a gift. The only thing I can do for you is to give my private material to you as a gift.’ I acknowledged that it had been a gift to me to work with her in supervision. Blossom noted that she too had received gifts, from me, that would last, as what one gains from therapy lasts, after treatment ends.

Poem

O' But The Best

"And all the air a solemn stillness holds"

                                                Thomas Gray

O'  but the best

to capture what is inmost

and feel the rise unknown,

of what is born in the stillness,

that's always hushed at the edge,

of cloaked and cleaved awareness.

This poem was inspired by a line from an 18th century poem by Thomas Gray, The words "solemn stillness"  suggest how  we are brought to a reflective awareness through the analytic experience. At some point there may come a silent sharing, that solemn stillness where out of nothing comes something: understanding.

Ben Feldman

Hate and the erotic countertransference

One of those most difficult negotiations in the treatment is that of the erotic transference-countertransference dialectic. Davies writes eloquently and candidly about it. Celenza writes pointedly about it. I look back to Harold Searles’ encouragement on the subject. Searles, from the Freudian perspective, states that the analyst also goes through a kind of Oedipal phase vis a vis the patient.  Just like the patient fantasizes about marrying the analyst, so too does the analyst feel toward the patient. Searles says that this type of love by the analyst is helpful when it aids the patient in her/his struggle to accept, then give up, these feelings. He discouraged disclosing such feelings. Today we might recognize the real component, that is, the part that is not solely transferred from previous relationships, in the love between patient and analyst as something that is not relinquished but negotiated, and its lack of fruition, mourned. The analyst’s suffering and sadness helps the patient with mourning. 

Kohut saw an oedipal phase as normative, only developing into a neurotic complex when parents have failed to welcome the child’s oedipal strivings. Telling, for example, a boy what a fine husband he will make welcomes his love-driven fantasies.  Telling a boy that he will have to find his own age-appropriate partner once grown up insidiously rejects his ardent feelings. In treatment, how to encourage the feelings when the outcome will always end in rebuff? How then to proceed in the erotic transference-countertransference dialectic? How to jump into the depths of a crater without losing one’s grip on the rim? to hold both the truth of the love (and hate) between you and your patient and to hold the truth of nothing more than a moment of meeting or understanding can become of this?  A colleague recently asked me in earnest, why again do we not have sex with our patients?

Celenza writes that it is out of hopelessness for the treatment, a sense that there is nothing left to try that leads to boundary violations. It is an attack on psychoanalysis itself. In an earlier paper she writes of a longer list, including an intolerance of the negative transference and the reaction formation towards one’s own countertransference hate, sobering reasons all. All this by way of saying it behooves the analyst, when working with unremittingly attacking patients, to reread Winnicott’s papers on hate in the counter transference and its survival.

Celenza, A. (1998). Precursors to Therapist Sexual Misconduct: Preliminary Findings. Psychoanal. Psychol., 15:378-395.

Celenza, A (2006) Sexual Boundary Violations in the Office: When is a Couch Just a Couch?. Psa. Dial., 16:113-128.

Searles, H (1959) Oedipal Love in the Countertransference. International Journal of Psychoanalysis. XL, 180-190.

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74.

Winnicott, D.W. (1969). The Use of an Object. Int. J. Psycho-Anal., 50:711-716.

American Poet Walt Whitman

Walt Whitman, the great American poet and essayist, was born on this date in 1819. He brought free verse to poetry. He also brought a sensuality and sexuality that in his time was considered obscene. His collection of poems Leaves of Grass, including Song of Myself and I Sing the Body Electric, is hailed today as egalitarian and humanistic with its gender diverse experience and its praise of the common citizen. He wrote from everyday experience, including the nursing of wounded soldiers in the Civil War, and, when Lincoln was assassinated, composed the elegy "O Captain! My Captain!".

His poem To You speaks with the love and acceptance coveted by an analytic attitude in which he sees in the other more than the other sees yet in her/himself. He respects. He encourages. I have included a few verses (I added bold) from To You:

Whoever you are, I fear you are walking the walks of dreams,
I fear these supposed realities are to melt from under your feet and hands,
Even now your features, joys, speech, house, trade, manners,
troubles, follies, costume, crimes, dissipate away from you,
Your true soul and body appear before me.
They stand forth out of affairs, out of commerce, shops, work,
farms, clothes, the house, buying, selling, eating, drinking,
suffering, dying.

…

I … find no imperfection in you,
…

O I could sing such grandeurs and glories about you!
You have not known what you are--you have slumber'd upon yourself all
your life;
Your eye-lids have been the same as closed most of the time;
What you have done returns already in mockeries;
…
The mockeries are not you;
Underneath them, and within them, I see you lurk;
I pursue you where none else has pursued you;
…
Whoever you are! claim your own at any hazard!
These shows of the east and west are tame, compared to you;
These immense meadows--these interminable rivers--you are immense and
interminable as they;
These furies, elements, storms, motions of Nature, throes of apparent
dissolution--you are he or she who is master or mistress over
them,
Master or mistress in your own right over Nature, elements, pain,
passion, dissolution.

The hopples fall from your ankles--you find an unfailing sufficiency;
Old or young, male or female, rude, low, rejected by the rest,
whatever you are promulges itself;
Through birth, life, death, burial, the means are provided, nothing
is scanted;
Through angers, losses, ambition, ignorance, ennui, what you are
picks its way.