Gender Development

In this time of self and imposed quarantine and isolation, TBIPS’ classes continue on in their communion and discussion. This morning the Gender course participants concentrated on Benjamin’s (1995) trajectory of gender development. Remembering that gender is fluid, not fixed, and that the socially constructed binary (masculine/feminine) creates a power differential within this hierarchy, health, then, is the ability to hold in tension difference/sameness and to stand in the space of the multiplicity of genders and selves. How might one develop such a capacity?

Benjamin explicates four phases of gender development: 1) nominal gender-identification formation;2) early differentiation of identifications in the context of separation—individuation; 3) the preoedipal overinclusive phase;  4) the oedipal phase. 

Early on, children may have nominal awareness of gender differentiation or [?] nominal identification. With developing awareness, the child becomes “overinclusive,” wanting to possess both (perhaps  partly out of envy) and begins to have identifications with both. In the preoedipal rapprochement phase boys and girls identify with father, his otherness, subjectivity with its agency and desire. [We are here not discussing the otherness the mother brings in adding to the dyad her thinking as a third.]  This otherness of the father now becomes part of the child’s self identity (made up of multiple identifications) and is utilized to aid seeing self as different from mother. Benjamin (1991) states the importance for the girl of this identificatory love, different from object love, for the father, with identificatory love as a precursor to object love. Rejection by the father of identificatory love, or its disallowal by the mother, impedes the boy's identification with the father. For the girl, these impediments to identificatory love may lead to diminished agency and desire. The child, beginning to ascertain the meaning attributed to gender difference, begins to fall to one side of the gender binary. In the early oedipal phase, phallic phase, the binary split seems reified and the other is repudiated. Repudiation heralds loss, a giving up (denial, dissociation, split) of parts of the self. In healthy development, the late oedipal phase can allow for an increased capacity to hold the tension between differences and likeness, and to regain them, the capacity being further consolidated in adolescence.

Stamatina Kaidantzi asks: If identifying with the rapprochement father opens the space for otherness for both the boy and girl, is it then easier for the girl to maintain this otherness for she is also like the mother? The girl is both other than the mother and similar to the mother. The boy is other than the mother but is also like the one who confers the otherness, while the girl gets otherness from someone not like her. The boy does not have a sharply demarcated otherness because he is also similar to the other. This may explain why masculinity is more precarious. Euripides Gavras notes how the (positive) oedipal boy attacks the father to gain the opposite sex love object. Perhaps the boy also attacks the father in service of bulwarking the boy’s otherness. 

Benjamin, J. (1995). Sameness and Difference: Toward an “Overinclusive” Model of Gender Development. Psychoanal. Inq., 15(1):125-142.

Benjamin, J. (1991). Father and Daughter: Identification with Difference — A Contribution to Gender Heterodoxy. Psychoanal. Dial., 1(3):277-299.

Trauma and Psychosis: Gorney's take on Davoine/Gaudilliere on Lacan

On Saturday, March 7, 2020, the Tampa Bay Psychoanalytic Society hosted James Gorney, PhD who introduced us to the delightful work of Francoise Davoine and Jean-Max Gaudilliere. In their book History Beyond Trauma we learn that trauma is a place, a crossroads much like the one where Oedipus meets Tiresias, which is opened up with the therapist as ‘therapon.’  Gorney tells us that a therapon in ancient Greece was one’s battle “buddy” who keeps the warrior spiritually and physically up for the task at hand, like the manager in the corner of the ring who attends to the boxer between rounds. [The dictionary defines therapon as “an attendant (minister) giving ‘willing service’... a faithful attendant who voluntarily serves another...in a tender, noble way.”  I think these aptly apply to our work.] 

In Part I ‘Lessons of Madness,’ Davoine and Gaudilliere emphasize the relationship between social trauma, intergenerational trauma, and the historical effect on the traumatized individual. Like Lacan, they see psychosis as the foreclosure of the Symbolic, existing in the realm of the Real, only able to be represented in the Imaginary’s delusions and hallucinations. What I found most intriguing was their approach to psychosis: Psychosis is the mode of investigation, claiming that trauma is at the root of ‘madness’ and lives in unrepresented states. Thus psychosis is a means of research, with its co-investigator the analyst. Madness, employed as the means of research, investigates the disavowed signifiers of trauma. Signifiers are relational and ensure entry into the Symbolic order. [According to Gorney, the “symbolon” in ancient Greece was a gesture, breaking a vessel between two allies, each fitting together a broken shard, to pledge their mutual hospitality.] The psychotic symptoms are the markers, pointing to the place of unspeakable trauma. “Trauma speaks to trauma and only to trauma.” The analyst must also be with the trauma within. [Gorney gave a lovely metaphor for projective identification: it is the hat of the patient hung on the hook of the analyst.] Davoine and Gaudilliere claim trauma must be “inscribed” to be remembered and brought into a social link. [I wonder if the Boston Change Process Study Group would agree that symbolization of any kind is always necessary, given that a change in implicit relational knowing can occur procedurally without inscription.]

Because trauma is a “war zone,” in Part II ‘Lessons from the Front,’ we learn of four principles drawn from work of  WWI American psychiatrist Thomas Salmon: proximity, immediacy, expectancy, and simplicity. Proximity opens up the space for safety and trust amidst the chaotic trauma. Gorney: ‘I am here with you. We are in this together.’ It is not just the physical proximity, but the willingness to take up the battle together, side by side, and to take care of one another, the therapon. It is also the survival [Winnicott] of the analyst. Medicating symptoms, without investigation and research, is the opposite of proximity. Immediacy allows us to live in the temporal context of the patient’s urgency. Gorney: ‘I will meet you at the place of pain and anxiety.’ Gaudilliere saw madness as the potential for hope and reintegration, the place to begin. Davoine saw delusion as a way of knowledge. Expectancy “constructs a welcome to the return from hell.” Gorney: ‘I say “yes” to you.’ It is the interpersonal place with a trustworthy other of mutual respect, a “primal affirmation,” the validation that yes, something horrible happened. Simplicity refers to speaking directly without jargon. Gorney: ‘I will tell it to you like it is.’ The therapon communicates, always respectfully, without moralizing, without reassuring, without showing-off cleverness, speaking honestly and slicing through the Imaginary.

[Gorney’s rich clinical examples (not related here for confidentiality’s sake) were beautiful, poetic, and moving and I recommend you read his papers.]

Davoine, F. and Gaudilliere, J-M. (2004) History Beyond Trauma. New York: Other Press.

Racism, Intersubjectivity, and Multiple Selves

Interviewed by Hari Shreenivasan on Amanpour and Company, February 14, 2020, the author of How to Be an Anti-Racist (2019) Ibram X. Kendi understands the multiplicity of selves. Racism is structural says Kendi. It is not about a person’s make up (no such thing as a ‘racist bone’) but instead is about ideas and actions. Kendi eschews essentialism and says, “No one becomes a racist or even an anti-racist. It is a reflection of what a person is doing in each moment. And people change. And so if, in one moment, a person is saying that a particular racial group is inferior, they’re being a racist. In the very next moment, if they’re supporting a policy that’s leading to equity and justice, they’re being anti-racist. There are so many people with both racist and anti-racist ideas who support racist and anti-racist policies and because of that we can’t label them one or the other permanently. We can only say what they’re being in each moment.“  

[One might say Kendi is a phenomenologist, determining by an observable outcome or effect whether a person or a policy is racist. The disparities in health care, criminal justice, employment, banking and real estate practices, education, and income all speak to racist politics at the local and federal levels. It is not biology, but racist policies which incur distinct disadvantages to people of color.]

When Kendi notes that “...striving for anti-racism is an ongoing journey” I think about how precariously we all hold intersubjectivity; The tension held between subject-to-subject relating and subject-to-object relating always finds us falling to the side where we treat others like objects, thus we struggle to right ourselves atop that tightrope again, holding that tension.

Kendi posits that to say ‘I am not a racist’ is insufficient. To relegate this part of one self to the Not-me vitiates one’s capacity to self reflect on the possibility of holding, inadvertently or otherwise, racists ideas or having racist actions. Moreover, Kendi encourages that each of us move actively toward articluating and embracing anti-racist views and policies and toward actively fighting inequities. 

Kendi, a historian at American University, won the National book Award for Nonfiction in 2018 for Stamped from the Beginning: The Definitive History of Racist Ideas in America.

Intergenerational Transmission of Trauma as a Function of Dissociative Attachment Patterns

Dissociation is a relational process that keeps traumatic experience unformulated and thus experience is not fully integrated into consciousness and into a sense of self. Dissociation is a defense [defense here is used colloquially as it is not so much conflictual as it is the brain's response to traumatic experience -- a response which hyperactivates the brain’s limbic system (particularly, the right amydala) to encode experience emotionally, perceptually and procedurally while at the same time impairing the left hippocampus’ ability to symbolize and contextualize the experience. This change is brain functioning is mediated through hormones, the HPA axis, and neurochemicals and change in blood flow to brain centers.] Dissociated self states inaccessible to consciousness, and therefore to self reflection, keep self states from being in dialogue with one another.

Unresolved, dissociated trauma in the caregiver impairs her/his capacity to regulate affects in the child. Overwhelming affects can remain unintegrated into the child’s sense of self (they become the Brombergian Not-Me). Chronic misattunement from the caregiver is traumatic for the infant, setting the child’s psyche up for dissociative processes. While Bradfield states that it is not only painful affect that is dissociated but also the child’s need for relationship with the caregiver, I prefer to think in terms of attachment patterns (for example, avoidant attachment when an infant has learned that the caregiver is predictably unavailable to regulate distress). Later, such a child may continue to experience feeling “abandoned, abused, isolated, and fearful of others” with a self that is disconnected with parts of the self “sealed off.”  

Intergenerational transmission of trauma is “a function of patterns of attachment relationship.” Consciousness and unconsciousness are co-created reciprocally, if asymmetrically, and a caregiver with unresolved trauma can not respond to the infant’s distress. Instead s/he may be frightened or frightening to the infant and “may demonstrate incoherence, inconsistency, disintegration and fragmented expression of intense and contradictory affects.” Consequently, the infant develops specific strategies to manage its own distress, usually, with a dissociated parent, a disorganized attachment which predicts future dissociation in the child. Recall that dissociation is the hallmark of trauma. ‘Voila! intergenerational transmission of trauma!’

Traumatic experience, dissociated because it has not found a relational home [what Kohut called self-selfobject experience; Mitchell, the relational matrix; and Stolorow, the intersubjective context], is communicated to the therapist through relational patterns in behavior and in the body. It also enters the therapeutic relationship through enactments. 

Bradfield, B. (2011). The Dissociation of Lived Experience: A Relational Psychoanalytic Analysis of the Intergenerational Transmission of Trauma. Int. J. Psychoanal. Self Psychol., 6(4):531-550

An Object Relations approach to Intergenerational Transmission of Trauma

One of my favorite courses at the Tampa Bay Institute for Psychoanalytic Studies is the third year’s course on Trauma, probably because trauma accompanies most, if not all, of our patients into our offices. Trauma is ubiquitous, and we struggle with making sense of our own, sometimes simultaneously, just as we struggle with aiding patients make sense of theirs.

When we discuss intergenerational transmission of trauma in class an interesting paper is one by Alessandra Cavalli. While clearly steeped in Object Relations theory with its concomitant metapsychology, I especially liked the metaphor of the “void” or the “deadly” for it brought to mind Donnell Stern’s “unformulated experience,” Christopher Bollas’ “unthought known” and, as Cavalli notes, Bion’s “nameless dread.” To become known requires a “matrix,” or what Robert Stolorow calls a “context,” a relational home. Cavalli notes that she uses the patient’s past not for reconstruction so much as to link, give meaning, and that words and representations need a safe space in which to come into being.

Annihilation anxiety is great in children of traumatized and dissociated caregivers. Just as Andre Green’s “dead mother,” depressed and offering only deprivation, cannot create meaning for the infant (such that the infant itself is deadened), a caregiver with unresolved trauma cannot respond, see, recognize the infant’s experience (can not hold the infant in mind, cannot mentalize nor foster mentalization) and so the infant brain does not sufficiently develop a sense of self. (Winnicott described a disruption in “going on being.”) Additionally, parental anxiety gives the child the experience that the world is dangerous and possibly can destroy the infant. The caregiver’s failure to regulate the infant’s overwhelming affects, likewise, produces anxiety in the child. [I particularly liked the author’s idea of the enduring presence of absence (in the mother) creates a “dead third.”]

The analyst is tasked with developing an increased capacity to tolerate affects and to withstand identification with the patient’s experience, that is, connecting with the void, while also helping to give form (representation and words) to experience and thereby integrate disparate self states; the adult self and the child self can be in conversation. By bearing witness, the analyst helps the patient withstand seeing more parts of herself. The analyst’s curiosity and holding in mind the patient fosters growth of the patient’s mind, that is, promotes mentalization. 

One note of disagreement is the author’s statement that there can be no separation if there is not representation. This seems like old-fashioned Mahlerian language to me. As Daniel Stern pointed out, an infant has a sense of separateness very early on, so this idea might better be phrased in terms of insecure attachment, such as either a denied or debilitating longing for a mother able to be present.

Cavalli, A. (2012). Transgenerational Transmission of Indigestible Facts: From Trauma, Deadly Ghosts and Mental Voids to Meaning-Making Interpretations. J. Anal. Psychol., 57(5):597-614

Politics and psychoanalysis

What an interesting day at the Tampa Bay Psychoanalytic Society when it hosted Katie Gentile on Saturday, January 11, 2020. Gentile, bucking the western religions that claim dominion over beasts and plants and the Earth, reminded us, as Searles did, that we are all made of the same molecules and thus could be mindful of our shared being. Ideally, were we to practice such mindfulness, we might be more inclined to eschew racism, sexism, carnivorism, and violence of all kinds. Our mistreatment of the planet, including animals and the environment, may stem from “human exceptionalism,” the narcissistic need for us to feel omnipotent and special. Sharply distinguishing ourselves from ‘nonhumans’ -- and even the inanimate-- ignores how we are shaped by our interactions with ‘nonhuman’ beings. Even inanimate objects have ‘agency.’

Gentile additionally advocated for, not only individual mindfulness, but for communities to engage in the practices of “bystander intervention” and of “restorative justice.” A systems approach reminds us that the whole community is responsible for creating and allowing an environment where transgressions occur. For example, when the Catholic Church, a television network, or a psychoanalytic institute turns a blind eye to sexual assault, harrassment, misconduct and boundary violations, the victim experiences “institutional betrayal” in addition to the other injuries. Cultures, too, can normalize violence, such as the killing in U.S. of black men, needing the “Black Lives Matter” movement to bring this atrocity into more mindful awareness, or the sexual harassment of women, highlighted by the “#Me, too” movement. A witnessing space is created in the culture, just as therapists attempt to create in the clinical situation.

While we may be trained to recognize individuals’ risk factors, Gentile points out that we are not always so prepared to recognize organizations’ risk factors. Some risk factors, though, have been delineated: 
1. The more stringent the requirements for membership 
2. The greater the investment in the organization and its reputation 
3.The greater its prestige 
4. The more rigid the hierarchical structure

The Neurobiology of 'Stuckness' by Steven Graham, PhD

What Happened to Me When I Was Little? The Neurobiology of "Stuckness"

Psychoanalysis has at times been referred to as the “forbidden journey” because it takes us places we (and our early caregivers) would rather not see or feel or remember. Psychoanalytic treatment is not for the timid. It takes courage even to attempt it. We can look at such work as an expedition or an adventure, and know we will not be alone as we walk through it. In fact, it is impossible to make such a trip successfully alone. The quality of the journey requires a trusted and competent and caring other. More on that in the next installment. Most of us dare to risk the venture because we find ourselves stuck: in a depression, with anxiety, with a sense of negativity or meaninglessness, in a painful relationship, in a dead-end job, or with thoughts, memories, or feelings that intrude upon us unbidden. Dr. Allan Schore is a psychologist, psychoanalyst, and researcher whose work has attempted to integrate neurobiology, attachment theory, and trauma research with psychoanalysis and psychotherapy. He is the author of numerous articles and books (listed below), along with many YouTube videos in which he explains why people get stuck and how we can become unstuck. In addition to introducing you to this outstanding clinician and researcher, I also want to highlight a few of his insights that might prove meaningful to you. One of the important but often unasked questions I discover in my work with others is this: So, what happened to me when I was little? Schore’s insights help us begin to answer this all-important question. The First Thousand Days is Crucial When we add the nine months of in-utero development together with the first two years of the baby’s post-natal life, we are exploring these first 1000 days when the infant’s brain, particularly the right-brain, is expanding at a phenomenal rate. Schore’s research shows that it is the right hemisphere of the brain that is largely responsible for affect regulation (or emotional and body-based regulation) while the left brain (which develops more rapidly in the infant’s third year of life) is responsible for logic, language, and linear thought.  Contrary to those who believe that infants are oblivious to the world around them, they are soaking it up. This is the pre-verbal stage when communication is primarily body-to-body and right-brain to right-brain. This is when children learn how it feels to be a human being, if and how they are special, loved, or worthy, what to expect from relationships, and whether their world is secure or insecure. Later Emotional and Psychological Struggles Usually Begin During the First Thousand Days I have heard people express with confidence how “resilient” babies are, that they can endure absent, depressed, misattuned, preoccupied, or chaotic caregivers and families during this first 1000 days and turn out to be just fine. The research proves just the opposite. It is during these early months and years of a child’s life that they are most vulnerable. We have all seen how important it is to support the back of the baby’s head and neck when holding them because they are so young and fragile. If we must take extra care with the child’s head, we must do even more so with the child’s mind. Emotional Regulation is Crucial  One of the most important gifts we bring to the child’s life is affect regulation, the ability to regulate the self during times of stress. Anyone who has been around a baby for any time at all knows one truth: the baby does NOT know how to self-regulate. It is up to the caregiver(s) to do this. These three processes are essential: soothing, vitalizing, and repairing. #1. Soothing. When negative feelings (both emotional and physical) overwhelm the child, the caregiver must soothe. This requires the caregiver to show empathy, but also confidence that the distressing state is bearable and will pass. Perhaps rocking, singing, holding, feeding, or changing the diaper will eventually return the baby to a peaceful state. Over time, the baby will eventually develop the capacity to tolerate increasingly negative states of distress. #2. Vitalizing. When babies smile or coo or want to play, it is up to the caregiver to expand this capacity as well. And so we play peak-a-boo, “this little piggie,” and other games with the baby. This will equip the developing child to experience the upper limits of the emotional range and learn to regulate it as well. #3. Repairing. Unfortunately, caregivers cannot attune perfectly with their babies all the time. When we do misunderstand, we take responsibility: “Oh, I’m sorry. I thought you just wanted to be held, but I guess you are hungry. Let’s take care of that right now.” When we as caregivers learn to repair these misattunements, we help our babies trust that problems can be solved, especially the interpersonal ones. They also internalize the ability to show empathy toward others, which offers them a rich life in so many ways. The degree to which a child has learned affect regulation may very well dictate that child’s future psychological well-being.  Intergenerational Transmission of Trauma is Real  Most of us as parents want to do everything we can to protect our children from any of the trauma. But what if we have not worked through our own trauma? While many whom I see in therapy easily recall painful interactions with their caregivers, others cannot remember anything out of the ordinary in their relationships with their parents at all, but then begin to tell stories about the significant trauma that their parents lived through. When we experience trauma, we may learn to dissociate, or disconnect, part of ourselves from the horrors around us in order to survive emotionally. This becomes part of our psychological way of being in the world. When caregivers who have been traumatized themselves (perhaps as children) hold their babies, they may at times dissociate, and the child’s sensitive right brain notices that mom or dad is not all there. Most often, the parent has absolutely no idea this is happening. This may also occur if the caregiver is depressed or anxious or distracted. Right-brain to right-brain, the baby is taking it all in: the sense of dread, profound sadness, overwhelming responsibility, inability to stay focused. The newborn has, of course, no words for these feelings: they live in the child’s nonverbal brain centers and often in the child’s body. Repairing Such Damage from Childhood is Very Possible!  It is likely as we are reading these research findings that we are asking two essential questions: 1) what have I done to my children? and, 2) what happened to me? What I tell most parents I see in therapy is that it is not a matter of “if” they have wounded their children, but “how” they have done so … because we all have. One of the greatest gifts a parent of an adult child can give is the offer of repair: to recognize mistakes that were made, own them, ask for forgiveness, and attempt to restore the damaged trust to the extent that we can. The truth is that when we are parenting, we simply cannot see or know everything: this is part of the painful existential truth with which we all live. We are finite and limited, and it causes pain to ourselves and to our precious children. The good news is that these brains of ours (and our children) are “plastic,” meaning they continue to change over time. And they can change toward health despite the trauma or neglect we may have received in our childhoods. Even though patterns were deeply established in our infancies, the first 1000 days of our lives, we have something that we did not have as infants: an intact brain which includes a fully operational left hemisphere along with the prefrontal cortex which does our thinking and planning for us. In essence, this means we can choose, in effect, to be re-parented. I will explain this in the next installment, coming out next week. Selected Articles: Schore, A.N. (1991). Early Superego Development: The Emergence of Shame and Narcissistic Affect Regulation in the Practicing Period. Psychoanal. Contemp. Thought, 14(2):187-250. Schore, A.N. (1997). A Century After Freud’s Project: Is A Rapprochement Between Psychoanalysis And Neurobiology At Hand? J. Amer. Psychoanal. Assn., 45:807-840. Schore, A.N. (2001). Minds in the Making: Attachment, the Self-Organizing Brain, and Developmentally-Oriented Psychoanalytic Psychotherapy. Brit. J. Psychother., 17(3):299-328. Shore, A.N. (2002). Advances in Neuropsychoanalysis, Attachment Theory, and Trauma Research: Implications for Self Psychology. Psychoanal. Inq., 22(3):433-484. Schore, A.N. (2011). The Right Brain Implicit Self Lies at the Core of Psychoanalysis. Psychoanal. Dial., 21(1):75-100. Selected Books: Schore, A. (1994). Affect Regulation and the Origin of the Self. Mahway, NJ: Lawrence Erlbaum Associates Schore, A. (2003a). Affect Regulation and Disorders of the Self. Ed., New York: W.W. Norton & Company Schore, A. (2003b). Affect Regulation and the Repair of the Self. Ed., New York: W.W. Norton & Company Schore, A. (2019). Right Brain Psychotherapy. New York: W.W. Norton & Company Schore, A. (2012). The Science of the Art of Psychotherapy. New York: W.W. Norton & Company Schore, A. (2019). The Development of the Unconscious Mind. New York: W.W. Norton & Company.  by Steven Graham, PhD

Attachment theory and clinical work

A ready advocate for the importance of understanding attachment in the clinical situation, I quote from Wallin’s (2007) Attachment in Psychotherapy: 

For patients whose healthy development was derailed by the shortcomings of … formative relationships, psychotherapy may recreate an interactive matrix of attachment in which the self can potentially be healed.

...attachment research enhances our ability as therapists to generate a developmentally facilitative relationship with our patients in which we are at once reworking old experiences and co-creating new ones.

Because many of our foundational experiences occur pre-verbally and became ‘internal working models’ (Bowlby), ‘representations of interactions that have been generalized’/RIGs (Stern), or ‘implicit relational knowing’ (Lyons-Ruth), Wallin suggests that therapists aid patients in integrating implicit bodily, emotional, and procedurally enacted experience [sometimes called ‘non-conscious’ to distinguish from the dynamic unconscious] - as well as symbolic, explicit experience - by attuning to these bodily, emotional, and enacted experiences of, and with, our patients as well as to the verbal and other symbolic experience. 

Foreign Climes

I recently had the privilege of guest teaching a clinical case course, this time to fourth year students, at a psychoanalytic training program separate from my home at the Tampa Bay Institute for Psychoanalytic Studies (a relational institute with an emphasis on trauma and attachment). Surprisingly, while these students had heard of attachment -- one had even translated the BCPSG’s Change in Psychotherapy into a foreign language, they seemed to have very little interest in it. The presenter went so far as to say any talk about attachment was mere theory (metapsychology) and did not have a place in psychoanalysis where “making the unconscious conscious” was the aim of treatment. Deepening treatment meant diving into the unconscious.  (Had this other institute not yet embraced the paradigm shifts in psychoanalysis from left brain narrative/interpretation/insight to co-created right brain implicit/procedural/often nonverbal communication?) 

I was reminded of the BCPSG’s ideas that 1. experiences do not always need to be verbalized for changes in implicit relational knowing to take place, and 2. that relationship may be foundational, while conflict (the contents of the Freudian dynamic unconscious) comes secondarily out of experience in relationships (as evident in attachment patterns observed at 12 months of age in the Strange Situation). In particular, I recalled Stern’s idea that a verbal/conscious search for meaning may sometimes actually impede the deepening of experience. Had the centrality of relationship in treatment eluded the curriculum of this strange (to me) institute? I will note that, when having taught clinical case seminars to its first and second year classes, the students seemed more interested, even excited by, ideas less well known to them.

The presenter in this fourth year seminar, on the other hand, eschewed attachment research and was certain that it was the patient’s responsibility, and hers alone, (in a blaming sort of way) to choose her own life, regardless of the patient’s early experiences and regardless of the present moment and the therapeutic relationship. The analyst was to make interpretations in order to bring unconscious motivations to consciousness. The class, upon hearing the case, could observe that the patient had been deprived of both a nurturing mother and of being allowed the opportunity for identificatory love with her father, yet the class saw no place for the therapist to provide a new attachment relationship where unfinished developmental business could safely be revisited. The therapist was decidedly uncomfortable with the idea of being either for the patient. The class mostly interpreted the rocky relationship between therapist and patient as the patient’s bent toward “competitiveness” (e.g. when the patient wanted to read a book the therapist mentioned) and thought it odd that I might, in addition, see the patient’s wish to identify with, be like the therapist. (And, of course, the rocky relationship between me and the class is a parallel process which humbles me.)

When the Analyst is Sexually Aroused

Continuing with the presentation to the Tampa Bay Psychoanalytic Society by Janine de Peyer on October 5, 2019, the afternoon session was about the analyst’s sexual arousal in the therapeutic session, a rarely discussed topic among mental health professionals. The ‘erotic transference’ is commonly discussed, but not ‘erotic countertransference.’ The analyst’s anger, fear, and love all seem more mentionable; we strive to refrain from being inappropriate, seductive or exploitative with our patients. Because the therapist must not act on her sexual desire, what becomes of this natural human response? Does one disclose it to the patient (Davies) despite a cultural prohibition to do so?  What about the dangers? 

[So many questions...] Can one ‘neutralize’ her erotic attraction without becoming overly constricted? Is the maternal countertransference safer, particularly when the erotic may connote the female sterotype of submission? Is the analyst comfortable being the object of desire? Was there trauma associated with this in the analyst’s own history? (The aging female analyst, unlike her male counterpart, must grapple with becoming less and less likely to be an erotic object for the patient.) Is there a co-created avoidance of the erotic transference? Also, the analyst might consider whether she is the one in the room holding the erotic feelings for a patient who has dissociated them. Sometimes for the patient, too, the maternal transference seems safer. Perhaps the patient needs to fend off hostility, impotence or felt power. In what ways might the analyst be inhibiting the patient’s erotic transference? Can the analyst be open to self states without causing trauma? Does the analyst want the patient to titillate her? 

Some of the countertransferential behaviors noted by de Peyer when attracted to a patient included presenting one’s best self (wardrobe, posture), and feeling resentful or betrayed when the patient recounts sexual encounters. 

Holding longing in contempt, desire may mean weakness. [This author sees the erotic transference/countertransference as an opportunity for mourning the loss of what one cannot have.] One attendee noted that, were the erotic feelings in the clinical situation to remain unmentioned, they might be acted out in life outside the therapy. [I might then, ala Lewis Aron, place the dilemma of the erotic countertransference on the table letting the patient know, for example, that while I share his joy I worry I might have had undue influence.] When there is shame surrounding erotic feelings, the other may have to hold the shame. de Peyer notes that perhaps the greatest gift an analyst can give her patient is her own shame. [owning it].

Davies, J.M. (1994). Love in the Afternoon: A Relational Reconsideration of Desire and Dread in the Countertransference. Psychoanal. Dial., 4(2):153-170. […]