Lullaby

    Clinicians just starting out often worry about saying the ‘right’ thing to a patient. I often tell supervisees that people come to us not for answers, and not necessarily for words, but for “something more,” such as a longing to be recognized, to have someone take an interest in their inner lives. As humans, we usually have an interest in others, and as therapists, a deep interest in others and in their inner lives. We have a desire to know more, and we make an effort not to impinge with our curiosity, to have a benevolent curiosity if you will. So far so good.

     People also come to us needing to be held in mind. Just as caregivers grow the brains of their infants by gazing at them, by enjoying them, by remembering and imagining what it was like to be such a baby with an inner life and with experiences, so the holding a patient in mind (even outside of the session) comes to us as we reflect on and imagine the past, present, and future experiences of our patients. The caregivers’ interest grows the baby’s inner life: the baby experiences itself as ‘I am interesting. I am important. I have a right to be here. I exist.’ 
Sometimes our patients need such things from us: to be held in mind, to be enjoyed, to hold our interest, to have their feelings “marked” (in the same direction of the affect, without being identical). These experiences are part of “implicit relational knowing” and do not require words to effect reconfigurations in brain anatomy and brain chemistry. 

Sometimes our most sorrowful of patients have missed out on some necessary pre-verbal experiences: of being gazed at, nursed, rocked, sung to, of being held in the caregiver’s arms, and being held in mind. Ogden called this very important fundamental stage of sensory experience the autistic-contiguous position. It is the foundation or sensory ‘floor’ upon which subsequent experience is integrated and organized.  

    I recall a 15 year old boy with a horrible history of abandonment, neglect and physical and sexual abuse, often in foster care, who was court ordered to see me after punching his father. (His father had called the police.)  The boy arrived for the first appointment very angry. He crossed his arms, declared emphatically that he was not going to talk to me, and promptly fell asleep on the couch for the entire session. 
Perhaps I had the autistic-contiguous position in mind. Perhaps I was thinking about this boy’s childhood (some of it previously revealed to me by his father when the father had made the appointment) and thus was imagining that this boy had probably never been held in the mind of a caregiver, never been held in a caregiver’s arms and been rocked and sung to, never had consistent opportunities for mutual regulation of distressing affects. But, whatever the 'reason,' I began to sing him a lullaby as he slept there immobile. When the session was over, he lept off the couch. He returned the following week and each week thereafter, and talked and told me his sorrows. (He even hoped to continue long past the six months ordered by the court.)

Ogden, TH. (1989) The Primitive Edge of Experience. Northvale, NJ: Jason Aronson.

Intersubjectivity and China

In psychoanalysis we talk a lot about intersubjectivity, seeing the other, the different other, as “an equivalent center of being” (Benjamin), the recognizing of difference. In the USA, with travel bans and threats to build walls between countries, we lament the negation of the other, the falling to one side of a polarity, failing to sustain the tension between differing subjectivities.

In 2010 I congratulated the talented Chinese therapist I supervised, for the Nobel Peace Prize had been bestowed on her fellow countryman Liu Xiaobo. She had not heard. 

Censorship was only one area against which human rights activist Liu struggled. He authored books on democracy and human rights.  Liu, imprisoned after co-authoring in 2008 ‘Charter 08’ -- a petition-manifesto signed by hundreds which criticized Chinese government and called for political reform -- was not allowed to receive the Prize in person. He died today, disallowed from receiving treatment outside of China for liver cancer. He is the first Nobel laureate to die in detention in almost eighty years. Liu had been previously imprisoned for over a decade after taking part in the 1989 Tiananmen Square protest, where students faced down tanks. He had been an activist for human rights in China since then.

Black Girl Interrupted, Black Girls’ Internalization

Internalization alludes to aspects of the other, including those projected, which can become part of the self, encoded experientially and procedurally in the brain, as do interactions or way of interacting with the other. What the other feels about the self, what is implicitly communicated, also becomes part of the sense of self, whether positive or negative feelings. It is the feeling (affect) more than the action that is encoded. Whether the self can come to expect soothing or neglect is also internalized. This procedural knowledge is carried forth into later life.

Black girls age 5-9 years are seen as older than their years, called ‘adultification,’ according to a recently published study by Jamilia J Blake, PhD, Associate Professor of Educational Psychology at Texas A&M University and Rebecca Epstein, Executive Director of Georgetown Law’s Center on Poverty and Inequality. Blake and Epstein found that black girls are seen by the school and juvenile justice systems as more adult and less innocent than their white peers. They are perceived as needing less protection and less comfort and nurturing, and were found to be punished more harshly than white peers, e.g. five times more likely than white girls and twice as likely as white boys to be suspended from school. Teachers were more likely to call the police on black girls and prosecutors less likely to drop cases against them than white girls. While a previous study by a separate research team [Perry] had shown a similar ‘adultification’ of black boys from about age ten years, black girls showed a higher disportionate rate of disciplinary action than even black boys, thought due to ‘gender transgressions’ (violating norms of femininity).

What adults project onto children affects the way children see themselves. So, what happens when children are seen as less innocent and more adult like (whether ‘adultified’ or parentified)? are punished more harshly? and given less nurturing? Do they grow up perceiving themselves to be ‘bad’ and unworthy of their longings for [inter]dependency, comfort, and help? Do they feel undeserving of tender caring and instead are the caregivers, or, worse, so bereft of receiving care that their subsequent and understandable resentment and anger lead to lashing out, even becoming the delinquents others expected all along?

Recognition

Recognition is the ability to take in the other person’s perspective, finding sameness and difference in the other’s mind and accepting it; to see the other as a separate self and the needs and desires of the other as equally valid (intersubjectivity). Recognition may be the deepest longing in a human being; and it is incumbent upon the analyst to provide it.

Last month I was felt both ‘recognized’ and embarrassed when on June 19 Germany’s international news organization DW (Deutsche Welle)’s Freedom of Speech Award went to a U.S. recipient: the White House Correspondents’ Association. 

[This award honors a journalist who toils under great oppression yet continues to stand for freedom of expression and human rights despite consequences, sometimes fatal ones. In 2015,  the Saudi blogger Badawi (imprisoned) was so honored; and, in 2016, it went to the Turkish editor Ergin who dared oppose Pres. Erdogan.] 

Journalists continue to hold governments accountable even when told, as currently in the U.S., that they are liars who disseminate  “fake news.” I felt ‘seen’ that, even across the ocean, a prestigious news organization recognizes our plight and sympathizes and encourages us. I felt embarrassed because I had complacently thought that the USA would/could never allow such an attack on a fundamental freedom. Freedom of the press is the mainstay of democracy, a necessary watchdog on government and private industry alike. Hopefully, we recognize this.

Bullies and Bystanders

Tomorrow June 25, St.Petersburg, FL celebrates diversity with its Gay Pride Parade. I am reminded of two old movies, Tea and Sympathy and Rebel Without A Cause, from a time in which diversity was not so celebrated.

Tea and Sympathy (1956)(directed by Vincente Minnelli, based on Robert Anderson’s 1953 play of the same name) is oppressive to watch when viewed from the 21st Century.  Difference is taunted and ostracized. A prep school senior, Tom Lee (John Kerr) is called “sister boy” [for what could be worse from the hypermasculine POV than being compared to a woman/girl] because he prefers music, theater and poetry to baseball and mountain climbing. He is bullied to suicidal thoughts. The coach and house headmaster’s wife Mrs. Reynolds (Deborah Kerr) takes Tom’s part. Defending Tom to her husband (Leif Erickson) and chastising him for being a bystander, she says “‘He’s not like me, therefore he’s capable of all possible crimes.’ ... [T]he tribe has to find a scapegoat to reaffirm your shaky position... If he could be manly, then you had to question your own definition of manliness.” Eschewing the false dichotomy, she rails against her husband’s black and white thinking. [Twemlow and Sacco write about bullying in their ebook Preventing Bullying and School Violence].  But should one mistake Tom for a homosexual, as his classmates do, one only need note the foreshadowing in Tom’s reading of Candida to confirm his love for Mrs. Reynolds. [Wikipedia’s author writes it is Voltaire’s Candide, but I think this is a mistake, for it is in GB Shaw’s play that a young man falls for, and seemingly desperately needs, the older, married woman. Candida chooses the man who needs her more, her husband, who must so desperately dissociate his need for her. Mrs. Reynolds, however, a modern woman, I suppose-- or perhaps riddled with the shame and guilt her constraining contemporary society demands -- chooses neither man.]

Also painful to watch is how women are treated in this film. Mrs. Reynolds, her opinions interrupted and disregarded and spoken to by her husband as if she were a child, is relegated to the keeper of men’s emotions and the one who attempts to smooth over painful feelings in her husband and Tom. The local soda shop’s server Ellie Martin, a former ‘a-dime-a-dance gal, is unrelentingly sexually harassed by the “regular guys” from the local prep school.

Rebel Without A Cause (1955) (directed by Nicholas Ray) also portrays the bullying of boys who are Other or different. In the 1950’s, a gay theme could appear only as subtext, but the bullying of Plato (Sal Mineo) was undoubtedly, in part, about his homosexuality (noted by the photo of Alan Ladd in his locker, and by his crush on Jim Stark (James Dean)). His torment ends with possible suicide by cop. Mineo, hailed today by the LGBT community as one of their own, was nominated for Best Supporting Actor for this role and, at that time, was the youngest actor (16 years old) ever to be nominated for an Oscar. James Dean, himself posthumously nominated for this role (and for Giant), was purported to have ‘experimented’ with homosexual liaisons, as well as to have been sexually abused when younger by a pastor. Dean, also an auto racer, died prematurely in a car accident at age twenty-four.

Here's hoping for better days, days when bystanders stand up to bullies and difference is celebrated.

Fargo

    My favorite TV show (on Fx), inspired by the Coen brothers’ film of the same name, set in Minnesota, always features a laudable female, police chief. Gloria Burgle (Carrie Coon) is that policewoman, only In this its third season, she is demoted from chief, has been left by her husband for a man, has a teenager who prefers the mall to her, and feels she does not exist. Confirmation of her non-existence comes from the sensors on automatic door openers,  soap dispensers, and faucets, none of which ever sense her presence, so do not open, dispense soap, nor turn the water on.

    It is only in the penultimate episode of the season, when Gloria has a listening ear in Winnie Lopez (Olivia Sandoval), a neighboring town’s police officer, that things change for her. Like Horatio to Hamlet, WInnie hears, really hears, and what she hears is Gloria’s fears about not existing. Subsequently, Gloria is able to engage with soap dispenser and faucet sensors. This reminds me, of course, of how infants (and adults) need to be seen and held in the mind of the other to feel one’s existence in the world, to feel part of something bigger than oneself. Good-enough caregivers provide this, as do good-enough therapists, by seeing and holding the experience of the other in mind.

    I was also reminded of Hegel’s understanding that a subject cannot be fully a subject until recognized by another equal subject [within independence is this dependence, that is, there is interdependence]; and of the title of a Dean Martin song, ‘You’re nobody ‘til somebody loves you;’ Here love is embodied in the seeing, accepting,and welcoming in of the other, all the parts of the whole other, without having to give up the self (that is, done whether we agree with the other or not). Yesterday, was a sad day in northern Virginia, when baseball practice became tragedy. Perhaps the good coming from it will be a bit more understanding of the other [side of the Congressional aisle].

New Cycle of Courses begins Sept 20, 2017

The Tampa Bay Institute for Psychoanalytic Studies (TBIPS) is pleased to announce a new cycle of its four year curriculum starting Sept 20, 2017. You can start at the beginning with 'Introduction to Psychoanalytic Concepts.' As you know,  theories and methodology in psychoanalysis have changed tremendously over the decades, thanks to contributions from caregiver-infant and attachment research, and from neuroscience.  While relationship and the 'unconscious' (or 'non-counscious') remain paramount, gone are the days of authoritarian and distant analysts who knew the secrets of the individual's mind. Instead, analysis is a collaborative effort of building safe and supportive relationships where  new ways of being in the world and healing  can take place. At TBIPS we emphasize an open and welcoming attitude, both for students and patients, and focus on development, attachment, and making whole the fragmentation caused by trauma.

Please know that TBIPS is happy to accept long distance candidates (courses, personal therapy, supervision0 for training and students for course work. We would be delighted to have you join us in the Fall. Further information can be found at tampapsychoanalytic.com.

Response to Co-creation of Dreams, posted May 22

One can imagine that the fences in the patient’s dream are less about “unspoken boundaries” between the patient and his father and more about those that stand between the patient and the therapist. One can imagine the patient feeling the intimate confines of the consulting office and a desire for therapeutic boundaries to vanish leaving him and the therapist free to explore the vast horizons beyond.

In my mind, the two benevolent white-haired men could symbolize wisdom and morality. They have perhaps ascended from above to give the patient an understanding of both the permeability of the boundaries that he and the therapist have co-created and his understanding their moral necessity. 

The therapist, too, in her dream, is reaching out past the boundaries and, like her patient, understands the need to maintain them and consequently turns away.

Interestingly, by disclosing her dream to the patient, she is in fact reaching past the boundaries and thereby simultaneously expanding them and reaffirming that they are there. Her disclosure reveals her trust that he understands the limits of the therapeutic relationship and the necessity of those limits. Her sadness demonstrates that, despite the application of clinical terminology like “transference,” “counter transference,” and “therapeutic alliance,” underneath are real people with real emotions, which are sometimes intense and sometimes bump up against the therapeutic boundaries. This is, as the patient says, romantic, at least in the sense that true love involves walking the boundary between the selfish desire to possess and the selfless sacrifice of putting the other’s happiness above that selfish desire.

Therapeutic relationships sometimes walk this line, but a patient whose relationship with his father was distant probably benefits more from experiencing the reality beneath the “therapeutic alliance” than he does from any clinical assessment of his psychological history. I suspect that while he most likely grieves the lack of a relationship with his father, what he desires now is real connectedness. The lack of a relationship with his father may explain his desires for connectedness, but it doesn't satisfy it. The emotional reality behind the therapeutic alliance demonstrates that such connectedness is possible, that he is a person who is worth investing in emotionally, and that limits around the connectedness do not diminish its worth. 

The emotions “stirred up” (dare I say ignited) in the therapeutic relationship are indeed the mutual property of the therapist and the patient, but I wonder if Dr. Alexander-Guerra understands her role in the co-creation process (for it is an evolving process). Does she understand that by making the therapist’s session with the patient blog-worthy, she has added a layer of legitimacy to the emotions? I wonder if as a result, the therapist feels more secure in her relationship with the patient and if the patient reciprocally feels more secure. I wonder if Dr. Alexander-Guerra understands if she is now part of the co-creation between the therapist and the patient. I wonder if the patient has read this and feels a mutuality with Dr. Alexander-Guerra. I would if I were the patient.

         submitted anonymously

Graduation

 On the TV show Major Crimes (Season 1: Episode 4,  aired 9/3/2012), a foster child, dealing with always having to leave and start over someplace new, that is, with always being a stranger, and, also, dealing with always expecting to be repeatedly sent away to a new place, requests, from his latest foster mother, thirty days notice before he is sent away again. She reassures him: “Whatever happens here, you will one day go off and be the new kid again. But no matter where you go, no matter when, you’ll never be a stranger to me. I will always know you.”  

That brief interchange resonated with me as a psychotherapist because for a short while we ‘foster’ the growth and development of our patients, temporarily providing safety and succor, while growing ourselves. The world is a better place for both of us. But despite this fostering of a most emotionally intimate of relationships, our patients, like our children grown, must leave us; and we are left to mourn. We take solace in the recognition that they will never be strangers, joy in that we have known and, in some ways, will always know them. We send them off and into the world with great pride, matched with loss.

The 100th Birthday of John F. Kennedy falls today on Memorial Day

This year’s Memorial Day also happens to be the 100th Birthday of John F. Kennedy. Born May 29, 1917, he was the 35th president of the United States, and himself a WWII veteran of the Navy. A quick study, having learning from the Bay of Pigs debacle and negotiations with the then Soviet Union to get missiles out of Cuba, under pressure from Freedom Riders, Martin Luther King, Jr, and many others, Kennedy turned his attention to Civil Rights. It was only after his assassination in November 1963 that his successor Lyndon B. Johnson was able to get passed through Congress the Civil Rights Act of 1964 which outlawed discrimination based on race, color, religion, sex, or national origin. [We might remember today just what types of discrimination were outlawed.]

Memorial Day is a time to pause and remember those who died as soldiers, Marines, Airmen and women, sailors, Coast and National Guard persons. We thank them. Today might also, perhaps, be a time to recommit ourselves to giving back for their service by offering an hour a week pro bono psychotherapy to the family members, or veterans who remain, through, for example, Tampa Bay Institute for Psychoanalytic Studies’ Veterans Family Initiative.  Many clinicians in the Tampa Bay area have generously given of their time and expertise to help families and wounded warriors afford much needed mental health services. We thank them as well.