Discussing on the morning of Nov 10, 2018 the Film Room in her presentation about mutual vulnerability at the Tampa Bay Psychoanalytic Society’s monthly speaker meeting, Lauren Levine, PhD noted how the protagonist (ironically named Joy), abducted and held captive and raped for seven years, must both stay enlivened for her five year old son Jack while also surviving her own deadening suffering. But how does one bear unspeakable trauma and stay enlivened when stuck in “the endless now,” Levine asks.
Listening, witnessing, taking in our patients’ narratives about their trauma gives voice, Levine says, to unfreeze time for them. But “therapists are penetrated by shards of the patient’s trauma,” resonating with the therapist’s own past. As Levine notes from Harris’ paper You Must Remember This: “the inevitable presence in the analyst of wounds that must serve as tools” (2009), it follows then we are thus also called upon to be mindful of our own self-care. In the discussion that followed a profound and amazing thing happened: The attendees enacted self-care by revealing their own horrific past traumas to a receptive, witnessing audience, a room full of clinicians.
Returning to the film Room, I had been struck by the lack of articles (a, the) when characters spoke about ‘room’ or ‘rug’ or ‘skylight.’ In Levine’s afternoon presentation titled ”The Faraway Nearby” a possible meaning for this dawned on me. In using the writings of Rebecca Solnit - stories are geography and anchor us to place-- Levine helped me see that using articles would have made the place, the room which imprisoned Joy and Jack, too present, too real, thwarting Joy’s need to keep from their psyches the horrific thing happening in the now. http://tbips.blogspot.com/2018/11/lauren-levine-and-film-room.html
Members of the Tampa Bay Psychoanalytic Society and attendees to its presentation were treated to Invited speaker Jill Gentile on Sept 15, 2018. In the earliest discussion of the day “Desire, Agency, and the Eternal Validity of Psychoanalysis” Gentile emphasized a change in psychoanalysis from viewing agency as the purview of an autonomous subject to that of the dialectically constituted subject, stating that agency cannot be claimed as a one person phenomenon but instead emerges within intersubjectivity. Agency is associated with initiative and intentionality and what Winnicott called the “spontaneous gesture.”
Additionally, how we become semiotic agents, able to communicate through signs and symbols our very selves, is of great interest to Gentile. Through being held [imagistic symbols] in infancy in the mind of an other, and through naming (verbal symbols) the physical and psychological parts of ourselves (including our genitals), we are aided in the emergence of self. It made enormous sense to me when Gentile posited that the failure to freely name aloud female genitals and inner space (vagina), leaves a “void” or “gap” in discourse, and vitiates the subjectivity, therefore the agency, of women, i.e. if materiality leads to subjectivity [her interpretation of Winnicott], and material things must be named to have substance, to be substantively held in mind, then society’s inability to name and symbolize, to speak freely about the female genitalia and female inner spaces vitiates woman as substantive, vitiates her ability to participate in the conversation.
Yet, despite psychoanalysis’ “hierarchy of patriarchy,” Gentile says Freud derived the fundamental rule from his treatment of women, hysterics whose symptoms were bodily based, and as such, speaks to a feminine law based in Nature, rooted in the Lacanian Real [the feminine], not in Totem law [masculine]. She also notes that the discovery of anatomical differences does not merely lead to penis envy but, more importantly, evokes curiosity in children. The ‘gap’ [of the missing penis], she says, inspires scientific inquiry in children, leading to a quest for knowledge, truth, and a “reckoning of speech.” A child has questions and seeks answers, skeptical of parents’ inauthentic explanations. Gentile states that children seek out their own truth, [Bion’s truth telling instinct]. [My own father handled my question gracefully, filling me with pride, when he answered my curiosity at age three with ‘Girls are of modern design; They have indoor plumbing.’] When a child has something to be curious about, a desire for knowledge is kindled. She posits that this may be truer for girls who ‘get it’ and do not deny the ‘gap’ as boys do -- boys fantasize, according to Freud, that it was cut off -- foreclosing further explanation and exploration of the mystery. http://tbips.blogspot.com/2018/09/jill-gentile-and-feminine-gap.html
It was the pleasure of the Tampa Bay Psychoanalytic Society to host on March 17, 2018 Sandra Beuchler, PhD at its monthly Speaker Program Meeting. In the intimate setting at 8:15 am of a 'Conversation with the Speaker' Buechler shared "Poems that Inspire Clinical Work." She opened with an excerpt from "The Four Quartets," specifically "East Coker," by T.S. Elliott which eloquently captures the psychoanalytic process with its shared struggles:
Trying to learn to use words, and every attempt Is a wholly new start, and a different kind of failureBecause one has only learnt to get the better of wordsFor the thing one no longer has to say, or the way in whichOne is no longer disposed to say it. And so each ventureIs a new beginning, a raid on the inarticulateWith shabby equipment always deterioratingIn the general mess of imprecision of feeling,Undisciplined squads of emotion. http://tbips.blogspot.com/2018/03/poetry-and-psychoanalysis.htmlLast month, on December 10, the local (Tampa Bay) psychoanalytic society hosted presenter Jack Foehl, PhD. He shared his ideas on phenomenology (the study of phenomena, that is, that which is manifest in experience) and how it informs clinical work. Philosophical questions such as : ‘What does it mean to know? How do we know we know? How does one know oneself? [How does one know another?] How does one study experience? What does it mean to be human?’ all pertain to our psychological work. “What is the nature of meaning from a phenomenological perspective?
The German philosopher Hegel (1770-18310), Foehl informed us, wrote in The Phenomenology of the Spirit, that we can only know ourselves through the experience with another. Without the other reflecting upon us [and holding us in mind?] we cannot fully experience ourselves. But it was another German (Czech) philosopher, Husserl (1859-1938)-- who was greatly influenced, as was Freud, by Brentano-- who is considered the founder of Phenomenology. Husserl developed a method for describing experience which he called phenomenology.
Foehl encouraged us to remember that an attitude [e.g. psychoanalytic attitude] is a way of seeing and describing the world, but reality requires multiple perspectives and is a function of the way it is perceived. As analysts we “suspend the positing of reality” in order to situate ourselves in the present moment, in the experience, not just in the telling by the patient, but with the patient. Phenomenology suspends judgment (epoche) about the natural state in order that, paradoxically, it can be highlighted. The process constitutes, that is, things are not prefigured to be found, but, instead, we are always in the process of bringing into being. [Experience is co-created moment to moment with our patients.] Psychoanalysis is a process which facilitates both participants to experience more deeply.
I found Foehl’s philosophical discussion intriguing and felicitous, and applicable to the philosophy of psychoanalysis. But I am neither an academician nor a scholar. I am simply a clinician, and a flawed one at that. As much as I enjoyed phenomenology’s new names which inform and enliven “intellectuals” and as much as I greatly enjoyed the clinical material, it seemed additionally heartening to me that if we pay sufficient attention to moment to moment changes in our patients and ourselves, including our sensory perceptions, and practice some reflection and intersubjectivity, we might arrive at similar reveries without contemplating that we are employing phenomenology. http://tbips.blogspot.com/2017/01/phenomenology.html
On Oct 21, 2017 Jeffrey Roth provided to the Tampa Bay Psychoanalytic Society an organizational group process consultation [akin to Tavistock groups]. Here were some of the things to be gleaned:
Groups are fertile ground for primary process. [By this, Roth meant sexuality and aggression, seeming less interested in attachment and affiliation.] Just as in individual treatment, there is the stated task and the “covert task” [explicit and implicit]. All that transpires is “data” [fair game, in this case]. There are no ‘as-ifs’--psychic reality is the reality of the group. Differing narratives are not destructive, but combined toward greater understanding. Individual members are ‘elected’ by the group to hold certain characteristics and affects [projections; projective identification] such as the inept one, the angry one, etc. This leaves the one doing the projecting bereft of being able to utilize that characteristic or feeling. What one member says about another is a disguise for what the speaker feels about her/himself. One question is to reflect on whether a projection serves to make the group more or less functional. Ideally, a well-functioning group is one which works to own its projected parts.
References by the leader to any individual is really a reference to the role that individual is playing on the group’s behalf. Issues of boundaries and autonomy come up. The leader speaks to the process of the group, removing the target off any one member. By questioning a member’s complaints of, for example, not having a voice or not wanting to be unkind, the leader challenges the abdication of agency by the complaining member. [Tavistock groups can serve to train leaders, facilitating recognition of what one is ‘made of’ and examining impediments to agency.] “False stupidity” [disavowal] or false muteness may serve an individual by hiding competitive strivings, avoiding risk of rejection, avoiding shame for competitive strivings or from rejection. The leader would amplify the implicit voice, eg. complaining someone was ‘long-winded’ might be interpreted as meaning a “wind-bag” and wanting to say, “Shut the F--- Up!” The leader added that, by the way, a windbag can fill the sails of another(‘s sadness, e.g.).
The group leader seeks “authorization” from the group or a member to make an interpretation about what is going on in the group. Roth would often say “pause” to stop the group and invite it to reflect. If leader does not stop to point out what is happening, then the leader is colluding. The leader does not assume to understand what any member or the group but instead offers hypotheses. He encourages each member to check out their hypotheses with other members. A leader who criticizes is not functioning well in the leader role. When asking questions, the leader reiterates that one is free to answer or not answer. “Experiments” are proposed, e.g. asking one member to speak in the voice of another member’s voice or role. The leader encourages the group to celebrate when an individual is willing to share her/his pain in service of the work of the group. http://tbips.blogspot.com/2017/10/group-process.html
This past Saturday (10/15/16), psychoanalyst and author Jane Hall explored with the Tampa Bay Psychoanalytic Society the concept of “attachment to abuse,” specifically the incredible bind in which many patients abused as children find themselves as adults when seeking to live a freer, more constructive life. Hall posed both psychological and physiological factors that continue to “haunt” abused children across their lifespan. Psychologically, these children have internalized within both the abuse and the abuser, coloring how they will experience themselves, others, and themselves in relationship with others. Physiologically, the sustained dis-ease of home life triggers high levels of cortisol, now shown to negatively affect the developing brains of children. Each of these factors alone, let alone the interactive effect of both together, shape the way in which these individuals think, feel, and behave in the world. Hall noted that such individuals will respond somewhere on a continuum: from mild self-punishment all the way to psychopathy. Put more succinctly, the sustained childhood abuse eventually will leave somebody dead. This death may manifest in extreme cases as either suicide or homicide, including acts of terrorism. Other types of death include the loss of the self (an absence of self-esteem) and the loss of the object (an inability to form intimate relationships).
Hall postulated that as psychoanalysts, our role is to listen – with benign curiosity, and this type of listening will, over time, enable the early childhood wound to form a scar, and with continued listening, that scar will eventually shrink. Our consistent frame and benignly curious listening can ultimately allow not only the mind to change as noted above, but, Hall citing recent neurological research, posits that the very brain itself can change because of its inherent neuroplasticity.
The challenge for a patient to move from such a wound to a diminishing scar is significant. Because of the painful parental treatment (e.g., controlling, neglecting, cold), these abused children fashion ways to protect themselves from such harm. These defenses, however, keep out not only that which is harmful, but that which is necessary and good. As adults, these children are unable to absorb love, though they are desperate for it. The challenge of treatment is to invite these children-turned-adults to “loosen ties to their original object,” as Hall explained. This is the only path forward to prevent them from finding ways of repeating their abuse – as abuser/abused or both. This way of safety and protection learned in childhood has become a character trait that prevents a fulfilling adult life.
Contrasted with Winnicott’s “good enough mother,” Hall described the “bad enough mother,” who for a host of reasons may not have been able to meet the normal developmental needs of her child. This mother, herself, may have had a “bad enough mother,” passing onto the next generation the familiar and familial trauma. Hall noted that we as therapists may find ourselves sucked into the role of the bad enough mother and, as a result, dealing with the patient punishing us in a variety of ways. One of the most effective punishments, she illustrated, is the patient's refusal to get better, thereby torturing the analyst.
Hall cautioned us that this move from the attachment to abuse to a more secure attachment with the analyst and others in the patient’s life is not easily achieved. The patient will fight to hold onto that which is familiar while at the same time desperately longing for something healthier. She suggested that we must find ways to survive the onslaught of the patient’s hopelessness, rage, and helplessness likely with the help of a support system ourselves. Hall concluded the morning presentation with two case studies with patients she had seen in analysis over many years, both of whom have found ways of living meaningful lives after living through significant traumata as children. http://tbips.blogspot.com/2016/10/insights-from-jane-hall-lcsw.html
Steven D. Graham, PhD, DMin
On Sept 10, 2016 the Tampa Bay Psychoanalytic Society hosted Donna Bentolila at its monthly, all day seminar where she presented two riveting cases. A native of Argentina and a Lacanian by self-report, Bentolila, despite the privileging of left brain (the Symbolic) over right, and despite her reluctance to locate herself squarely in the co-creation of the experience of her patients, nonetheless, worked closely and beautifully in the lives of these two patients and their analytic relationships with her. Due perhaps to the severity of their illnesses and to complicated issues in both cases, Bentolila found herself repeatedly having to bend the frame to fit both the needs of these two very disturbed people and the limits of her capacity to endure their demands. For confidentiality sake, I will give no details, but wish you all had been there to become wholly engrossed in the presentation.
Lacan, like Freud, chose phallocentric terms to explain human experience, and I was pleased to see Bentolila try to soften Lacan’s ideas as metaphor. For example, the ‘name of the father’, Bentolila claimed, is not necessarily the biological father, but the function that transcends him. Still, this function, in addition to “constraints and proscriptions,” is to “break the fusion between mother and child." [But the idea of ‘fusion’ (or merger or symbiosis) has been reassessed since the understanding by Stern (1985) -and Benjamin- of the normal development of a sense of separateness from a very early age.]
Bentolila explained Lacan’s distinction between acting out and passage à l'acte: Acting out is done by a subject as an attempt to communicate something to the Other which could not be heard, or said, in words. Because it remains as an attempt at communication, it thus retains the Symbolic order. Passage à l'acte (passage to [into] action), on the other hand, exits from the Symbolic Order with behavior which is not meant to communicate to the Other (the Other does not enter into consideration in the act, sometimes because there has been a dissolution of connection to the Other) for even the subject is un-situated from the scene in a desperate and irreversible attempt to resolve some unbearable anxiety (this loss of self as subject sometimes heralds psychosis), such as in the case Bentolila described.
What a wonderful reminder, as her clinical examples depicted, of how being listened to about one’s impulses makes it less likely those impulses will be acted upon. Acting out is a message to the analyst: an appeal or demand for recognition from the analyst; an attempt to communicate what the analyst had heretofore been unable to hear; an unspoken and/or unconscious invitation to dialogue about a subject that could not find a place in their discourse, perhaps because it remained dissociated (or outside the Symbolic order per Lacanians). I suppose that were the analyst to disallow space for validation, or abdicate responsibility for her own location in the fray, the patient might feel so violated and destroyed as to abandon further attempts at communication and enter instead into the real passage à l'acte. http://tbips.blogspot.com/2016/09/acting-out-and-passage-lacte.html
The Tampa Bay Psychoanalytic Society, Inc hosted an unusual speaker last weekend at its monthly speaker program meeting. Peter Rudnytsky, UF professor, Shakespeare and Freud scholar, long time honorary American Psychoanalytic Association member, and long time, former editor of American Imago, explicated in his paper “Freud as Milton’s God…” the long running critical debate over an inherent contradiction in Milton’s Paradise Lost. The contradiction concerns whether humankind had free will to choose to disobey God or whether the Fall was predetermined, even put into motion by God’s actions, God in Milton’s poem failing intersubjectively to take responsibility for situating himself* in the outcome. Quoting Rumrich’s take on the epic poem – “negotiations between narcissistic longings for perfect recognition and the recalcitrance of an unresponsive reality” – Rudnytsky adds that God is portrayed as a controlling and narcissistic parent, demanding obedience, which if not freely given will be exacted through punishment.
We now know that it is failure to provide sufficient response to longings for recognition which sets up narcissistic longings for perfection. The narcissistic parent has been unable to accept the imperfect child as good enough, and the child, humiliatingly aware of its deficiencies, grows up seeking to overcome or to hide what its parents made glaringly shameful, often requiring, as Milton’s God seems to, “an insatiable need for praise.” [But what if the injured God was also seeking healing or, naively, reconciliation?]
Rudnytsky notes that Freud, too, exacted loyalty, or else followers were extruded from his inner circle.Freud, in anointing Jung the ‘crown prince’ both elevated Jung above all his other followers and, at the same time, made Jung subordinate to himself. In subordinating another, rebellion is engendered, as is the Oedipal struggle and sibling rivalry. God, too, in Milton’s poem, by anointing Christ, created Satan from a passed over Lucifer.
*While for Milton, and for many, God is the Father, an interesting discussion ensued about womb envy and the need for men to erect a male Creator in compensation for the fact that it is from women’s bodies that we come into this world; An interesting reversal of this fact is Eve springing from Adam’s rib; or Athena from Zeus’ head. http://tbips.blogspot.com/2015/10/rudnytsky-and-miltons-paradise-lost.html
If Freud said our personal ideologies are our “private religion” (convictions with unfaltering ritualization of behavior, repetition compulsion, if you will), Shaw adds that our private religions spring from our attachment story for we are all subjugated by our internal objects. Shaw defines traumatic narcissism as the need to defend against dependency, for dependency is intolerably shameful and humiliating, and must be disavowed. Instead, dependency and neediness is seen in the other for the traumatic narcissist has everything within the self and needs no one. Traumatic narcissism is a relational dynamic requiring both the narcissist and its object to be subjugated. The easiest target is its child.
While all parents may sometimes attack the reality of their children, self aggrandize the child’s accomplishments, and have hope that the child will make up for their own failures, the traumatic narcissist can never admit fallibility, can never apologize, and continually attempts to control and erase the subjectivity of their children. This is the cumulative relational trauma. The traumatic narcissist despises the child’s neediness, yet, paradoxically, any attempts by the child towards independence and agency are punished (by withdrawal or retaliation) for the narcissist requires the child to be the container for shameful neediness, Bateson’s classic double bind. This child, shamed for its dependence (and what is a child but dependent?), made to feel selfish and greedy, recognizing that only the attachment figure’s needs are deemed valid, grows up to identify with the hated, but much needed, aggressor, an intergenerational transmission of traumatic narcissism.
Objectification of the child by the traumatic narcissist is an absence of recognition, or a presence of negation. In analytic love, the therapist envisions the potential that cannot be realized, much like the good enough parent sees what the child can become. The children of traumatic narcissists, when they become our patients, demand not only that we recognize their trauma, but that we recognize our own disavowed traumatic narcissism! What a dangerously fraught journey for both patient and analyst as we struggle together toward freedom from the tyranny of our inner objects. http://tbips.blogspot.com/2014/11/daniel-shaw-on-traumatic-narcissism.html
Additional important lessons for individual therapists to be taken from participation (procedural learning; 'the medium is the message') and understanding of group process as demonstrated by Roth on Oct 25, 2014 include:
1. The assignment (or acquisition) of authority (power).
The group facilitator often asked permission of the group and individuals to make comments on certain behaviors, e.g. pairing, before actually making said comments. He also, on occasion, made it clear that these were his point of view and open to review by the group with the possibility of a different outcome.
2. The use of data that was present and available for all to make use of.
The facilitator skillfully used exact words and phrases from group participants to call events of individuals to the entire group's attention, always reminding the group that one member may have been designated by the whole group to hold or contain something for the entire group (e.g. loss, trauma, sadness, aggression). Unfortunately, for some, this method was too exposing, felt to be too personal, and, therefore, narcissistically injurious, something the individual therapist strives to avoid but inevitably finds her/himself inflicting. Since injury is inevitable, what is valuable is the reparation. Reparation cannot occur if admitting injury is further humiliation. Likewise, the disappearance of the consultant, like the end of a session, feels, to some, being 'kicked to the curb' and we have no next session with the facilitator. The group will have to make use of the consultant through object constancy. http://tbips.blogspot.com/2014/10/group-process-2.html
Many psychoanalysts eschew group therapy, but yesterday the Tampa Bay Psychoanalytic Society, Inc had an experiential look at group processes provided by its guest 'speaker' Jeffrey Roth, MD. Based on Wilfred Bion’s basic assumptions about groups, as taught in the U.S. by the A.K. Rice Institute for the Study of Social Systems, we had firsthand experience with the impact about how our behavior and unconscious processes organize experience intrapsychically, interpersonally and en masse.
Bion posited three basic assumptions for group behavior:
1) Fight/flight, where the group hostilely engages authority
2) Dependency, where the group does nothing but expect that the all powerful authority will provide for everything, and
3) Pairing, where the group deems authority as incapable of providing what is needed and so two in the group are ‘elected’ as the pair who will now make provision of group needs.
A fourth group, the work group which functions to accomplish tasks, is often thwarted by these three basic assumptions, while paradoxically illuminating (through consultation) what the work group needs to address.
How did our use of group process help us in our work as individual therapists? We procedurally learned that everything that emerges (data) is useful and has meaning, contributing to the richness of the dyadic interaction, if the therapist welcomes it in, and can make use of it, instead of being bored as if nothing ‘deep’ is being related. All data signals what would like to be taken in or pushed away. Groups function around ‘BART’, boundaries, authority, roles, and tasks. How these four entities are negotiated by the group are experienced, studied, elucidated, and may be transformative. While the group experience is transformative, and may continue to be so, old roles and skill sets (leader, scapegoat, etc) remain available. We are made up of multiple selves, after all. http://tbips.blogspot.com/2014/10/group-process.html
It was fortuitous to have had John Auerbach, PhD in Tampa yesterday speaking at the local (Tampa Bay) Psychoanalytic Society, for the Institute begins its Fall Semester this week and we are reading on Wednesday, in the Narcissism and Shame course, a review by Auerbach. Speaking to Bach’s ideas on the subject, Auerbach highlights the disruption of reflective self-awareness in those with narcissistic disturbances.
Bach tells us that the grandiose, inflated narcissist exists in a state of subjectivity (increased subjective awareness, ‘it’s all about me’), with the sense of worthlessness in the background. Subjective self-awareness alternates with objective self awareness in which the narcissist denigrates the self, feeling deflated and worthless. Auerbach notes the paradox of these two states of reflective self-awareness: “subjective awareness increases the sense of aliveness but decreases objective knowledge of self, and objective self-awareness, by increasing knowledge of one’s place (and smallness) in the world, decreases self esteem.” This very paradox is what causes in the narcissist fragmentation of the sense of self. Interpretation (of, for example, the difficulty) is experienced “as an attack upon the self, a narcissistic injury.” Instead, the transitional space between objective and subjective can be utilized to develop and maintain self cohesion.
Self reflection is the ability to view oneself as if looking on (objectively) from the outside. Bach notes two states of self awareness: subjective and objective, and how difficult it is to move easily between them if early caregivers did not help regulate the transition between them smoothly enough to prevent abrupt shifts in autonomic and limbic systems’ firing. Auerbach, too, in his review of Nathanson’s The Many Faces of Shame, tells us that sudden interruption of excitement or joy can induce shame, the hallmark affect of narcissism, and Auerbach writes, “shame is the ineluctable consequence of objective self awareness…” And isn’t that what psychoanalytic therapy partly endeavors to do, to increase objective self-awareness, all the while inadvertently engendering shame? This semester, we endeavor to discuss how to minimize shame in our patients and ourselves as we struggle to become.
Auerbach, J.S. (1990). Narcissism: Reflections on Others' Images of an Elusive Concept. Psychoanal. Psychol., 7:545-564.
Bach, S. (1998).Two Ways of Being. Psychoanal. Dial., 8:657-673. http://tbips.blogspot.com/2014/09/narcissism-and-shame-1.html
In bringing front and center to psychoanalytic discourse the subjectivityof the mother (not just the mother as object to the infant), Jessica Benjamin, adding to Daniel Stern’s paradigm of play, elaborates the importance, the imperativeness, of mutual recognition in the clinical encounter. What an honor (made possible by a contribution from the Florida Organization for Relational Studies) to have such a gifted and renowned thinker at the December 7, 2013 local Tampa Bay Psychoanalytic Society program meeting.
Attachment and infant-caregiver research have shown that sharing of affective states, where one experiences and understands that another ‘feels the same as I do,’ co-creates a rhythm of interaction—what Benjamin calls the rhythmic third (formerly called the one in the third)—which diminishes existential fear and isolation. The rhythmic third, the up and down orientation of affect in the same direction— which is soothing in its recognition, lets the analyst, as well, know that s/he is not alone in the universe.
It is through recognition, of shared affective states, that affect regulation occurs. Intersubjectivity is the sharing of affective states. It transforms complementarity such that one can feel empowered with a sense of agency because, not only is one recognized but, one can recognize the other’s feeling in a way that can be shared and creates joy. Mutual recognition can be effected and empowers the self by seeing the self as recognizer, more powerful than simply being mirrored (recognized). Benjamin says recognition and regulation are “twins,” that is, are interdependent. As such, mutuality needs to be in the foreground. Affect regulation is necessary but not sufficient, for we do not want only to keep affects within a tolerable, manageable range. We want additionally to create meaning, acquired within the communion of mutual recognition.
A cornerstone of mutuality is the recognition of impact. It is the realization by the mother that the child actually needs to discover something about her responses, what it is like for her to be a real human being in a real world. Recognition adds to regulation when the analyst can manifest the impact of the analysand such that the analysand experiences both the analyst and her/himself as a subject with feelings and agency. Sometimes recognition of affects at all from the analyst is a new experience for the patient.
Incumbent on the analyst is survival (Winnicott) so that the analysand does not have confirmation of the fear that her/his feelings can destroy the other. Yet, as Benjamin notes, it is not always easy for the clinician to tolerate and bear the affective state of another, particularly the pull to despair. To help mark (Gergely ) –similar enough to help the patient know you are on the same page, but dissimilar enough so patient does not fear you yourself will be dysregulated and overwhelmed; the mother marks her response to the infant’s distress by showing that she is not distressed in the same way but also that she knows the infant is distressed— affect, Benjamin looks to the third. By acknowledging what is happening [e.g. ‘Your expectation that I not disappoint you is not unreasonable, you deserve understanding; and yet I am not perfect and so cannot always live up to your expectation.’] creates a sense of the moral third, a sense of a lawful world where meaning exists and, though expectations can be violated, attachment can be recreated.
Breakdowns in mutuality occur when complementarity prevails. It is as if only one can survive. It is the belief that only one subjectivity is in the room, as if the other is not allowed to have thoughts, or as if one is making the other feel something. This is a breakdown of the moral third where it seems the other can only submit or resist. Benjamin advocates the need for parents to implicitly communicate to their children (or analysts to their analysands) that there is a lawful world in which other subjectivities can exist, a world of mutual understanding where everyone has a right to live, called a moral third. Sharing of affect allows us a way out of an impasse.
[The third, an unfelicitous term which has not ‘jumped’ to common psychoanalytic parlance, seeks, noted Benjamin, another word to capture that area where negotiation can occur, where two are united to transcend destruction, where the analyst is not under the sway of projective identification and can retain the capacity to think, and where the analyst can tolerate greater degrees of vulnerability. At dinner last night, Paulina Robalina suggested “intermedium.”] http://tbips.blogspot.com/2013/12/benjamin-on-recognition-and-regulation.html
The Tampa Bay psychoanalytic community will be enriched on December 7, 2013 by “A Day with Jessica Benjamin” hosted by the Tampa Bay Psychoanalytic Society. Psychoanalyst, philosopher, feminist, and a remarkable theoretician and author, Benjamin has reminded developmental psychoanalysts that mother is not simply an object to baby but a subject in her own right who—along with soothing, mutual regulation, reverie, and developmental impetus—also brings language, law, and thirdness to the dyad. When the mother identifies with her baby (because she was once a baby) and she experiences herself as the adult mother holding her baby, thirdness (of baby, mother once baby, and present mother) ensues, that is, mother’s ability to hold two positions simultaneously adds to the dyad the third vertex of a triangle, creating potential space for new things between both members of the dyad. Thirdness, says Benjamin, orients the intersubjective analytic work, both as communion experience (one in the third) and symbolic experience toward differentiation (third in the one dyad). When thirdness breaks down in the therapeutic situation, complementarity leads to impasses and enactments.
Benjamin defines intersubjectivity as a developmental achievement of mutual recognition, as when the baby—much like the effect, described by Winnicott, of the mother’s survival creating for the infant externality—sees the mother as a separate other no longer under his omnipotent control. While there is some sadness with the loss of fantasized omnipotent control over the other, there is joy that the other as a subject is now worthy to recognize in turn, and greater joy still that this separate other sometimes shares like-mindedness, choosing communion and not simply united by subjugation of will. Now each subject in the dyad can recognize the other as a subject, not merely an object to serve the needs of the self. This subject to subject interacting is highly precarious, for each subject keeps falling to the side of treating the other as if an object. “Holding the tension” then becomes the Herculean task of the analyst as she tries to refrain from oppressing the analysand with her expectations, her theories, and her will and strives instead to keep thirdness viable.
Benjamin, J. (2004). Beyond Doer and Done to: An Intersubjective View of Thirdness. Psychoanal Q., 73:5-46. http://tbips.blogspot.com/2013/11/benjamin-elaborates-third.html
Bion’s ideas resonate for me with Zen and other metaphysical ideas about being and ways of being, but they are, in their descriptions, too often over burdened with jargon. Those who embrace and write about Bionian theory (e.g. Grotstein) can make it unnecessarily more difficult to comprehend when they continue to use Bionian jargon. I personally prefer how Ogden illuminates Bion (see below). While I may be fluent enough in alpha and beta and L, H, K, O, and their impediments (or negatives), and decades ago I may even have excelled in theoretical calculus, I nonetheless find jargon in a conference setting obfuscating instead of elucidating. It is as if a secret language has been learned by some and is expected all should have learned it or be excluded.
On Saturday, Oct 6, 2012 at the local Tampa Bay Psychoanalytic Society Speaker Program Meeting Walton Ehrhardt. EdD from New Orleans did make some of Bion’s principles more accessible. These were my favorites from the day:
1. Thinking is driven by the human need to know the truth.
I do not necessarily cotton to the idea that there is a the truth, as truth is varied and contextual to each therapeutic relationship, but I accept the inclination.
2. It requires two minds to think disturbing thoughts.
I especially like this idea, as it applies so well to the therapeutic dyad. What one finds untenable to bear alone may be shared, made bearable, with another.
3. The capacity for thinking is developed in order to come to terms with thoughts derived from disturbing emotional experience.
A little broad reaching, but certainly one of the motivators for thought. And thought, symbolized in language, can help one “contain” disturbing experience. Ehrhardt emphasized that for Bion thought and emotion are inextricably intertwined. I think there exist ineffable experiences that are sometimes not traumatic.
I longed for Ehrhardt to metabolize terms such as container, reverie, alpha function, beta, and K and re-present them to us in usable form so that the attendees might make use of them and more easily dialogue.
Ehrhardt did elaborate three of many types of projective Identification, all of which are, of course, are about relationship. [I was unsure what Ehrhardt intended to illustrate clinically with these]:
1. Projective Identification as communication: the content of words, thoughts, ideas, dreams-- both waking and sleep dreams [Bion believed we were always dreaming] --projected, then introjected by the recipient, and, if a good fit, a relationship ensues.
2. Evacuative type: The unconscious wish to rid oneself of unacceptable parts, so these unwanted aspects of the self are projected on the other. The other accepts the projections whether through identifying or despising them.
3. Through Control and Possession of the Object: when the other is treated as an object, related to not as a subject but as function, or a good or bad part-self or -object representing otherness.
Here is what Ogden says about it:
The idea that there is something therapeutic about the therapist's containment of the patient's projective identifications is based upon an interpersonal conception of psychological growth: one learns from … another person on the basis of interactions in which the projector ultimately takes back … an aspect of himself that has been integrated and slightly modified by the recipient. (Ogden, 1982, p. 40)
[Ogden refers here to the alpha function]
Bion’s basic assumptions about groups were also thrown in:
1. Dependence: group members behave passively as if the leader = parent; then resent, undermine, finally topple the leader; then begin again choosing a new leader;
2. Pairing: the group expects something new to be produced as if met only for a reproductive or sexual purpose. Two group members or two subgroups do the work; others watch, relieved they do not have to work, and await the product of the ‘couple’ (a messiah, a rescuer of the group, a savior).
3. Fight or flight: The group may be bonded by aggression (gangs, teams) or in flight (late arrivals, stories that occupy all’s attention, or avoidance of personal involvement of one’s emotional being).
What I found most fascinating was contemplating Bion’s idea that intrapsychically we are all made up of ‘groups’ which can behave according to these same basic assumptions.
Still the struggling as a group to apprehend some of these concepts was invigorating, and taught empathy for those who were not fluent in ‘Bionese.’ http://tbips.blogspot.com/2012/10/do-you-speak-bionese.html
Doris Brothers spoke to the Tampa Bay Psychoanalytic Society, Inc on March 10, 2012 on uncertainty and trauma. Brothers notes that people are motivated to reduce uncertainty--despite there is no certainty in the world-- by simplifying experience, accomplished by dissociation. We think, feel, fantasize, and make decisions, all regulatory processes created to have a sense that we will go-on- being [WInnicott]…until trauma shatters this sense.
Brothers defines trauma as that which threatens our going-on-being, threatens us with the fear of annihilation. Trauma threatens us with uncertainty. While her formulations about trauma are ongoing, she says a few ideas about trauma persist for her:
1. Trauma is relational, that is, trauma always has a relational meaning.
2. We always make restorative efforts, however faulty, that give us a sense of certainty that we will go-on-being, and that the relational surround will be there so we can go-on-being. We restore ourselves by clinging to convictions (certainties), from which we cannot be dissuaded.
3. Trauma goes hand in hand with dissociation. Brothers says dissociation is a restorative effort to reduce uncertainty by simplifying that which is complex. For example, while others purport that feelings are often too intense to be born, Brothers says it is the range of feelings, often contradictory, that we cannot bear. (As a colleague noted, perhaps all defenses, and all symptoms, are restorative attempts.) I agree with Brothers that therapists need to respect symptoms, which Brothers says allow for safety and certainty that otherwise would not exist. Therapists ought not seek to take away prematurely what is necessary to the patient to stave off terror of annihilation.
4. Shame is an inevitable companion of trauma.
On a note of self disclosure, such as therapists admitting to failures of empathy brought to our attention by our patients, Brothers notes an implicit ‘Ah, you notice my humanity, it may be safe to show me yours.’
Brothers also spoke of trauma as having a before, during, and aftermath, and what’s more, the before can have occurred before conception, as in intergenerational transmission of trauma. As Winnicott noted in The theory of the parent–infant relationship (1960, NY, IUP) “If maternal care is not good enough, then the infant does not really come into existence, since there is no continuity in being…” Winnicott (1958, IJP: The capacity to be alone) also noted that when a mother is depressed or dissociated (perhaps from her own past trauma or that of her mother’s) and unable to provide mutual regulation of experience, the infant, in matching its mother’s state, is devoid of subjectivity at a time critical in development. An infant who has extreme fluctuations in subjectivity, a traumatically dissociated infant, experiences discontinuity and threats to its going-on-being. http://tbips.blogspot.com/2012/03/reducing-uncertainty.html
POSTED ON FRIDAY, DECEMBER 16, 2011-Steven Graham PhD
Last month at our Tampa Bay Psychoanalytic Society, Inc meeting, I found myself literally jolted by a concept. Many of our speakers have left indelible ideas and memories within me, but this notion explored on a November Saturday morning struck me as profound and clear and pervasive. Dr. Shelley Doctors elucidated the psychological process called "pathological accommodation," in which a person, likely from infancy onward, learns essentially to erase him- or herself in order to have a relationship with an important other. In other words, a child grows up knowing that in order to maintain a relationship with a caregiver, he or she must deny longings, feelings, and opinions that reside authentically within: "I will accommodate to you, my mother, so that I can have a relationship with you and thereby survive, but I do so at the cost of my very self and its development. I will do this because to be rejected by you, I fear, will be the very end of me. So, this is my choice, the lesser of two evils, between having no self and having nothing at all."
The Impact of Pathological Accommodation
It was not the idea of pathological accommodation per se that rocked me, but rather, the developmental course that this may take in one's life. Authors Brandchaft, Doctors, and Sorter1 describe these possible trajectories:
The child may attempt to preserve and protect this core of individualized vitality at the expense of object ties by determined non-conformism or rebellion. That is a path of isolation and ultimate estrangement. Alternatively, the child may abandon or fatally compromise his central strivings in order to maintain indispensable ties. That is the path of submission. Or the child may oscillate
between these two . . . Depression becomes the dominant affect in a person whom such a conflict has become chronic and internalized. It signals the loss of hope where no synthesis can be found between intimate connectedness with important others and the pursuit of a program of individualized selfhood. (p. 56)
It is deep within this quandary where I see many precious people. Those who disconnect relationally may do so because they have come to the conclusion that the price tag surrounding personal connections, especially intimate ones, is simply too high: it requires a submission of self-ness, authentic personhood. Those who remain in unhappy intimate situations may do so because they have concluded that it is better to have a relationship that is smothering and controlling (or abusive), than to disconnect from it and risk alienation or worse. And the third group: those who cannot be at peace in isolation or stultifying relationship. These try one approach until the pain of their current dynamic overwhelms them and then they flee---either into nonconformity in a brave attempt to find and hold onto their own voice, or into a painful intimacy in an attempt to feel less alien, less disconnected from.
Perhaps as you read about this process, you might identify with it, if only to some degree; perhaps you have noticed themes in your life not altogether different than the process of pathological accommodation. Coming to a point in life where you dare to believe that you can indeed have relationships that are mutual and reciprocal, that do not require a forfeiture of self, is not only a life-changing moment, but a life-giving one.
Steve Graham, PhD
1. Brandchaft, B., Doctors, S., & Sorter, D. (2010), Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision. London: Routledge. http://tbips.blogspot.com/2011/12/pathological-accommodation.html
Donna Orange, in her visit on April 9, 2011 to the Tampa Bay Psychoanalytic Society, spent most of the day discussing her take on the philosophy of Emanuelis Levinas (a student of the Talmud and a contemporary constructivist and phenomenologist , he believed in a hermeneutics of lived experience) who wrote about the "wisdom of love" (as opposed to the ‘love of wisdom’). Levinas believed that ethical responsibility is integral to the encounter with the Other, [and consequently, to intersubjectivity], a responsibility that is constitutive to our own being and interiority, that is, that subjectivity is formed, in part, through the encounter with the other. In this privileged encounter with the other, one feels both the relatedness with and the alterity of the other. Unlike what Self Psychology would purport about the confrontation with otherness, Levinas wrote: "The Other precisely reveals himself in his alterity not in a shock negating the I, but as the primordial phenomenon of gentleness."
In discussing Levinasian ethics, in particular Levinas’ idea of transcendence and the belief that one instantly recognizes the transcendence of the Other, Orange emphasized putting the other above oneself. As Orange’s form of intersubjectivity, like that of Stolorow’s/Atwood’s, with its influence from Self Psychology wherein the focus on the analyst's subjectivity is as a source of understanding, and where the need of the patient for the analyst as a selfobject is paramount, it came as no surprise that Orange would be enamored of this facet of Levinasian ethics. In fact, for me, her heavy emphasis was seen as a justification for empathic immersion and for the analyst to function predominantly as a selfobject experience for the patient.
While I agree that placing the suffering other above oneself (who would not open the door for someone struggling with crutches to get through it?) is, for those not so preoccupied with themselves as to be aware of their surroundings, a natural response, I think it is a hard philosophy to adopt when the other is not a suffering other. Orange, taking from Levinas his holding the other above self, even being responsible for the sins of others [here I am reminded both of Christ dying for the sinners’ sins and of the self blame of victims; Levinas, as a Lithuanian Jew, had survived the Holocaust but his family, sadly, did not] advocates a philosophy beyond ‘love thy neighbor as thy self’ to “love thy neighbor more than thy self.”
More than one audience member asked: how does one avoid masochism in this philosophy? Her advice to read Emmanuel Ghent’s 1990 paper on Masochism, Submission, Surrender did not suffice to further the dialogue (though his brilliant paper does). Had Orange made explicit the inference to the clinical applicability of Levinasian ethics, given that the patient is seen as the suffering other, then the attendees might have better embraced the philosophy Orange touted. Had clinical examples been supplied to illustrate the practical application of such ethics, then the audience would have been won over by her scholarly explication of Levinas’ ideas of transcendence.
Ghent, E. (1990). Masochism, Submission, Surrender—Masochism as a Perversion of Surrender. Contemp. Psychoanal., 26:108-136. http://tbips.blogspot.com/2011/04/orange-on-levinas.html
On the afternoon of September 11, 2010, Sanford Shapiro, MD , referring to his paper “Psychoanalytic Process” explored what is mutative. Shapiro recalled that Ego psychology teaches that interpretation of defense leads to insight. But he reminded us that many experiences, trauma, disorganized attachments, chronic and severe lack of mentalization, may occur before language acquisition, leaving the experiences implicitly encoded but without connection to symbolization or language and, so, unavailable to interpretation. Many experiences are non-conscious (implicitly encoded) such that they never make it to consciousness. These experiences do not follow Freud’s model of the unconscious, that is, are not made up of what was once conscious but repressed.
Additionally, Shapiro has given up allegiance to an intrapsychic experience, recognizing that all experience is contextualized in an interpersonal world (Atwood, Orange, Stolorow).
Implicit relational knowing (Daniel Stern) is not conscious, and, therefore, not accessible to interpretation and insight. [must be enacted and made explicit.] Benjamin writes: what can’t be told must be shown. These automatic behaviors impact all subsequent relationships, including transference, throughout life.
Neuroscience now knows that our neurons are both plastic and their number is not fixed at birth. We know that the development of the brain is context dependent. This allows the possibility for the hope of changing neuronal dendritic branching and neuronal connections through psychoanalytic therapies. What this means is that new relational experiences offer options to automatically triggered relational patterns.
The analyst helps the patient develop reflective curiosity about automatic relational paradigms, often done by ‘perturbations’ (systems theory) which may disorganize a stable system and momentarily allow for the possibility to reconfigure experience in a new way. Patients can be very forgiving when we do not blame them for ruptures and we allow for repair.
Shapiro also spoke about pathological accommodation (Brandchaft). He noted that normal accommodation is a negotiation between two people such that neither feels the integrity of either individual has been compromised. He referred to Ghent’s paper on masochism, submission, and surrender, noting that surrender is not at one’s expense, but that submission is when one subverts one’s own integrity to someone else’s authority. Brandchaft agrees with Mahler’s individuation process (but disagrees about separation): parents must negotiate the child’s individuation so that the child remains safe and can be assertive. If negotiation does not occur, the child complies or is rebellious, and pays the price with isolation.
Clinically, says Shapiro, pathological accommodation is triggered by certain events and are signaled by subtle shifts in affect (not content). Shapiro says it is important to go back and see what happened immediately before the shift, inviting the patient‘s curiosity, and admitting a mistake was made by the analyst. Taking responsibility for the rupture is sometimes a new emotional response, and the patient may begin to experience that h/she does not have to go along or comply to stay connected. It is also important to take the shame out of any rupture, e.g reframing a motivational experience from aggression (about which one can be ashamed) to a survival mechanism or a way of regulating tension (about which one might feel good).
The empathic introspective mode helps a patient “feel mentalized by the analyst." This, in turn, helps the patient begin to get a sense of self. The patient finds her/himself in the therapist’s mind. Mentalization (Fonagy) elaborates the intersubjective capacity to know that another has a separate mind with differing contents. Stern says we are born with the capacity to be intersubjective; Benjamin sees it as a developmental achievement, created via the third. http://tbips.blogspot.com/2010/09/psychoanalytic-process.html
On Sept 11, 2010 the Tampa Bay Psychoanalytic Society, Inc hosted Sanford Shapiro, MD referred to his paper on “The Evolution of Contemporary Psychoanalysis—A Fifty Year Perspective.” Author of Talking to Patients, a self psychological view of creative intuition and analytic discipline, (Jason Aronson) the revised edition 2008, includes implicit memory and relational psychoanalytic thinking. Referring to Victoria Hamilton’s The Analyst’s PreConscious , Shapiro noted that theory helps us stay calm in face of patient assaults and added: Do not underestimate the ability to stay calm.
Shapiro, approaches each session ‘without memory or desire’ (Bion)and asks himself: how is this patient planning to use me at this moment? He notes how patients test us. The initial test is about safety. Patients expect from us what they got from their parents (the transference test). This is sometimes evident when the patient, turning passive into active, attacks e.g. our competence. Just ‘survive’ (Winnicott); surviving (without retaliation or withdrawal) the test is passing the test. Weiss noted that analysts confirm or disconfirm patients’ beliefs; when we respond in new way, we may disconfirm their beliefs.
Using empathic introspection, we need to ask ourselves: How are the patients to feel good about themselves if we are always pointing out their shortcomings? Sometimes patients comply with our theories to avoid further hurtful interpretations.
Reenactments or enactments were classically thought to be disruptions. Donnel Stern (relational) believes they are necessary before they can be made explicit and then interpreted. Frank Lachmann (self) calls them ‘rupture and repair’ . This contemporary psychoanalytic acceptance of enactments has allowed analysts to ‘come out of the closet’ into the public forum about their private theories.
Shapiro says his theory is simply investigation, or inquiry. He tries to avoid being loyal to a theory or technique so as to allow himself to be with the other. Shapiro follows the moment to moment affective response of the patient to his interpretations to know if he is on track.
***
In his paper, “The Evolution of Contemporary Psychoanalysis” Shapiro states that Contemporary Psychoanalysis is a two person psychology born out of the cross-fertilization between interpersonal and self psychologies. He also juxtaposed interpersonal and relational theories against Freudian, Kleinian, Ego and Self psychologies, Intersubjective, and social constructionists.
Shapiro, a student of Sterba, interpreted Sterba’s “The Fate of the Ego in Psychoanalysis” (1934)as a pioneering relational perspective because Sterba describes dissociation as the split between observing ego and experiencing ego, the former which allies itself with the analyst’s ego. But the analyst is an active participant, not an objective observer.
Shapiro explored contributions from Winnicott, Kohut, and Intersubjectivity which he had found personally useful in his professional helping of patients. For example, seeing things from the perspective of the patient (empathy) helps the patient to feel understood, more confident, and opens up explorations with lessened shame or guilt; or focusing on the impact the analyst has on the patient before interpreting transference distortions. From relational (Mitchell) was added the focus on the patient’s impact on the analyst. Because patients can sense analysts’ reactions, sometimes acknowledging what the patient already knows in self disclosure can be useful.
Shapiro changed his view of resistance. Classically, resistance was seen as arising from instinctual wishes from within the patient. Ego psychologists interpret this resistance and other defenses. But intersubjectivists [like Benjamin] view resistance as also, in part, the patient’s fear of the therapist’s response. In a two person model, we are interested, then, in exploring as well what contribution the therapist may have made to the patient’s fear. Shapiro’s clinical example illustrated staying with the patient’s perspective instead of confronting the distortion. [He did this by what sounded like ‘wearing the attributions of the patient’ ala Lichtenberg.]
Shapiro also changed his views on motivations. Likewise, he re-examined his belief in his analytic authority and expertise and became more of a facilitator, helping others overcome obstacles to resume their growth and development. He recognized that sometimes the relationship itself, and implicit communication, is mutative, and that interpretations were not always necessary. In his technique, Shapiro draws on the empathic-introspective mode from Self Psychology and the impact the patient and he have on each other from relational theory. http://tbips.blogspot.com/2010/09/evolution-of-contemporary.html
On April 17, 2010 I attended the Tampa Bay Psychoanalytic Society’s “Day with Lauren Levine, PhD.” Dr. Levine, both a delightful person and a sensitive and talented clinician, eloquently managed to convey, both implicitly and explicitly, her relational approach to psychoanalytic psychotherapy. Weaving throughout her clinical paper the story of her patient and herself with the ideas of her teachers and mentors at the NYU Post Doc she elucidated the use of the analyst’s self to facilitate transformation in the patient. Noting from Adrienne Harris that ‘the analyst’s wounds that must serve as tools,’ Dr.Levine said, “Our own relational stories at times facilitate, and at times hinder, our capacity to engage deeply in the analytic process.”
In her paper, Dr. Levine explores the ways in which, as analysts, "transformative aspects of our personal analyses reside, often unconsciously, or preconsciously in the analyst, creating unexpected opportunities in our work with patients." She describes how a profound piece of work in her own analysis around efforts to connect with her young son "resonated in her work with a patient, enlivening and deepening the treatment." "In the process, her patient discovered new places within herself which enabled her to reach out to her teenage son in new and reparative ways."
From Dr. Levine's relational perspective, it is critical for the analyst to have the capacity, and the courage to go to those darker places within herself, and draw from that emotional reservoir in deconstructing enactments, so that the analysis is "safe, but not too safe" (Bromberg) for analyst as well as patient.
Dr. Levine used the experiences in her own analysis and with her son to open up the analytic space with her patient, seeking, as Stephanie Solow Glennon proposed, ‘to foster authenticity, aliveness, and creativity.’ Recognizing the wisdom of Emanuel Ghent’s words that each of us has ‘a deep yearning to be found and recognized,’ Dr. Levine strives to create the safety, as suggested by Adrienne Harris, necessary ‘to open access to unbearable affects.’ She strives to help her patients “begin to feel less ashamed and humiliated of those split-off, unacceptable parts of oneself.”
Darlene Ehrenberg described the ‘intimate edge’ as 'not simply at the boundary between self and other; it is also at the boundary of self-awareness…. It is a point of expanding self-discovery, at which one can become more intimate with one’s own experience through the evolving relationship with the other, and then more intimate with the other as one becomes more attuned to oneself. '
For the complete and eloquent illustration of the use of the self by Lauren Levine, see her paper "Transformative Aspects of Our Own Analyses and Their Resonance in Our Work With Our Patients” in Psychoanalytic Dialogues, 19:454–462, 2009. http://tbips.blogspot.com/2010/04/therapists-use-of-self.html
On April 26, 2008, Nancy Goodman, Ph.D. spoke to the Tampa Bay Psychoanalytic Society about "Love that Hurts: When Sadomasochism Organizes the Psyche." What was clear is that Goodman experienced the analysand's detachment and silences as sadistic; she felt "tortured." What was not clear was why this was theorized as an anal fixation or even as an intent to treat the analyst sadistically. It is true that the analysand had early childhood experiences that centered around the alimentary canal (power struggles: 'forced' feedings and enemas), but the connection between these early experiences, the material, and the theory was not made clear.
What was truly refreshing was the subsequent discussion, and the presentor's graciousness regarding genuine openness to other perspectives. The attendees seemed to emphasize the early misattunement between mother and child. Mother's controlling and intrusive behavior may have led the small child, who later appears "autistic" as an adult analysand, to detach, not as a sadistic manuever to control the object, but as a self-preservation to contain unbearable affect (Lewis Aron, who, by the way, will visit Tampa October 17, 2008). Goodman herself recognized that a fetish (she proposed that the object-relationship was itself a fetish in this case) was an attempt to "keep away disorganizing terror." [I do acknowledge the defense of 'turning the tables,' (or as a colleague once cogently slipped, "What comes around, goes around"), that this analysand's behavior could communicate to and engender in the analyst the feelings he had felt as a child vis a vis his mother. But I wondered, as did others, what participation by the analyst helped entrench for so long this dynamic between them?]
The audience also noted that when a mother treats a baby not as a baby, but as an object, this may be indicative of the mother's inability to participate in reverie and to hold the baby in her mind (Thomas Ogden), a problem noted in the analysis: it was as if the analyst did not feel held in the analysand's mind and felt objectified. Detachment was also considered by some attendees, not as anally sadistic, but instead as anaclitic, a reaction of depression from an infant whose needs are so ignored, or misunderstood.
Goodman repeatedly evoked disavowal ("a desire to disavow difference") but did not explore that this disavowal may have been a co-creation, e.g. when an analyst can not allow certain topics or affects to be explored because of her own discomfort, a discomfort which the analysand implicitly perceives through tone, facial expression, body language, etc. (Goodman did evoke Wilfred Bion's concept ("alpha" function), but did not connect it to the material presented, nor to recent research on right brain communication and implicit knowing.)
Christopher Bollas, referring to Freud's early cases, speculated that the erotic transference may have been an attempt to enliven the analyst (out of the stance of abstinence). If indeed sadistic, could there not also have been in this presented case the additional possibility that an analysand uses sadistic behavior as an attempt to search for the surviving other (D.W.Winnicott; Jessica Benjamin), an attempt to break through to the other (analyst)? The turning point in the analysis was seen to be when the analyst spontaneously expressed "shock" that the analysand was quitting treatment. Could this have been pivotal, in part, because the analysand could now perceive an (affective) effect on the analyst?
On a more personal note: When a presentation allows for such lively, interesting, and fun discussion, I applaud the group's ability to sustain the tension between differing ideas. Perhaps the Tampa Bay Psychoanalytic Society possesses within it, after all, the ability to refrain from privileging one theoretical perspective as more refreshing than other equally evocative and useful ones. I also applaud Goodman's ability to be open to do so.
http://tbips.blogspot.com/2008/04/on-april-26-2008-nancy-goodman-ph.html
On Saturday, September 13, 2008 the Tampa Bay Psychoanalytic Society hosted their friend and colleague from Miami's Florida Psychoanalytic Institute and Society, Peggy Hutson, M.D. who has written extensively on Shame.
It is the discrepancy between one's self representations [who one thinks one is] and one's ego ideals [what one hopes to be] that leads to shame, she notes, deeply influencing self esteem and one's ability to have needs met. When self esteem diminishes, so does one's capacity for empathy. Ego ideals, housed in the superego, but separate from the "superego proper" (concerned with prohibition of drives), exercises a "need satisfying agency" (Freud) for good feelings about the self. One set of ego ideals is about gender. Some of these ideals are conscious, many are early introjections. Some are helpful, some hurtful, some considered the norm even when they are limiting.
Shame (as) Conflict was described. One difficulty that may arise, from a history of success leading to rejection by the envious, narcissistic primary object, is for one to feel shame when they do not succeed, but threatened with loss of safety and security (attachment) when they do. Also, when one envies an other: there may first be experienced a diminution of one's self esteem, with the signal affect of shame, followed by one coveting for oneself what the other has. One may then become adaptively ambitious. Or, without such an adaptation, envy may lead to aggression.
Dr Hutson notes that shame can be manifest in a variety of ways: as haughtiness or arrogance, snobbery, or over achieving, as denigration or envy. When the need for safety and security is threatened, one can react with rage. She distinguishes this threat from the threat to the cohesion of self. Early losses of safety and security, hearkening back to early separation difficulties, may, when present day experience threatens to repeat such a loss, lead to panic attacks. Severe anxiety can then lead to loss of cohesiveness.
When working with shame, Dr. Hutson employs analysis of the superego and of defense, such as projection, by using close process monitoring ( ala Paul Gray, based on Freud's psychic determinism). An example might be when a patient's criticism of and anger at another is immediately swept away by complaints of guilt (as a defense against the anger). Dr. Hutson also works with reruns/templates (transference) with the goal of achieving "transmuting internalizations."
While Dr. Hutson's talk on shame was appreciated, and she did note that gender ideals are "man-made," I personally was hoping to hear more about gender. Gender itself is a construct. Muriel Dimen (In Psychoanalytic Dialogues 1(3): 335-352) writes that gender has at its core "difference, not essence, the relationship between masculinity and femininity as culturally conceived, interpersonally negotiated, and intrapsychically experienced." A dialogue about gender would be welcomed by me at the Tampa Bay Psychoanalytic Society.
http://tbips.blogspot.com/2008/09/peggy-hutson-on-unconscious-gender.html