Never was the contrast between classical and contemporary psychoanalysis more stark than in the chapter chosen for a beginning course in technique* by CAPA (China American Psychoanalytic Association). The chapter --- (#2) “Assessments, Indications and Formulation” --- appears in Long-Term Psychoanalytic Psychotherapy, Third Edition (2017) by the renowned psychiatrist and psychoanalyst Glenn O. Gabbard, MD where he formulates the case of a 38 year-old woman “to explain the patient’s clinical picture.”
The patient presented with depression and the beginning of a new, troubled, heterosexual relationship. Her mother ”had never really been able to take care of her because her mother was emotionally unstable and upset all the time.” Her father was an alcoholic and a womanizer who would comment on the patient’s looks, and the patient was contemptuous of him. The parents divorced when she was 12 years old. The patient had been using alcohol from a young age and had intercourse at age 13 years with a man who bought her alcohol. Subsequently she began using illicit drugs. She described herself as “highly ‘promiscuous’” and said she is addicted to alcohol and sex.
The patient presented with depression and the beginning of a new, troubled, heterosexual relationship. Her mother ”had never really been able to take care of her because her mother was emotionally unstable and upset all the time.” Her father was an alcoholic and a womanizer who would comment on the patient’s looks, and the patient was contemptuous of him. The parents divorced when she was 12 years old. The patient had been using alcohol from a young age and had intercourse at age 13 years with a man who bought her alcohol. Subsequently she began using illicit drugs. She described herself as “highly ‘promiscuous’” and said she is addicted to alcohol and sex.
Gabbard makes a lot of the woman’s sexualness and seductiveness, in her dress and in her attitude toward her male therapist. In his formulation, his “psychological hypothesis” is: “Ms. A grew up in a tumultuous childhood situation where she felt neglected by her mother, so she attempted to get love and admiration from her father by attending to her appearance and sexualizing their relationship.” Even if we decide to ignore the patient’s contempt for her father--- and his behavior toward her and others--- and surmise that a part of her, of course, is longing to be loved and recognized by him, nowhere does Gabbard mention in his formulation her rape at age 13. Instead, there appears to be an implicit blaming of her.
Other than “a tumultuous childhood situation where she felt neglected by her mother” Gabbard does not find the history of this rape significant enough to include in his formulation. He does not include anywhere in his formulation anything about insecure attachment or the dissociation and incoherence that result when a mother could not attune, regulate or protect the patient as a little girl, all of which likely contributed to the patient’s inability to understand the intentions of others in a self protecting way. That the patient seeks recognition and tenderness seemed to have been confused [Ferenczi] by Gabbard, as seen in his emphasis on ‘sexual’ behavior. Would a clinician not wonder if her “promiscuity” were not an enactment of her childhood sexual traumas [plural, as I imagine more than one]. Gabbard's formulation at best indicates he is wedded to drive and Oedipal theory and at worst intimates that the child unconsciously orchestrated her own rape as a consenting [as if the age of consent in an equitable and civil society were 13] seducer of men; and why? because she longed for her father's attention. And what about her mother’s attention in this formulation?
Are we still living in this kind of world?
* [does ‘Technique’ imply we apply one set of actions to all patients?]
No comments:
Post a Comment