I am honored to be asked to contribute this response to Henry Friedman essay titled “The Problem with Psychoanalytic Anonymity: The Obstacles Created by the Persistence of Traditional Technique” for a journal whose mission is laudable. The invitation comes because of my piping in, something I do occasionally, on APsA's list serve in response to Henry's post titled “Dividing Psychoanalysts into Categories” where he advocated for his point in this essay. I do that because I am a debater. I have been a debater since grade school. Not in any formal sense but as a means of relating to my father. I'm going to disclose some about that to frame my response, and as I was drafting this, I realized it may be able to make a point for Henry's case, or maybe not. We'll see.
In the first educational session I had as a psychoanalytic candidate we were introducing ourselves. I ended up being last, and I thought as I listen to everyone talk about their history and how they got there, I was out of place. I didn't, and don't, doubt that I can learn about and practice psychoanalysis. What I did feel is that I am different. I said to my fellow candidate, that there is nothing in my background, no previous analysis, no parents who were analyst, no academic exposure to Freud's ideas, save a lone class with a lone concept from somebody who followed Freud, which would indicate I would end up here.
At that point I had primarily been a substance use disorder therapist who had worked for too long with difficult cases. I was intentionally referred these cases and was dedicated to the work, but I was alone in it. My colleagues at the time were not as curious or invested in this kind of work. CBT, Family Systems, Client Centered, DBT and Gestalt methods were insufficient to the task at hand as I experienced them. When I found a community of psychoanalysts, I felt like I found somewhere that I could now share the process of trying to understand the inexplicable and intractable aspects of our patient's struggles and find out a way to help them.
As I have been deeply and gratefully involved in psychoanalytic practice and education over the years since, I have found something else. It is what seems to me to be the fallout of conflict that began with Freud and his colleagues but never got or gets worked through. It is like an active and open wound that gets played out over and over again, without seeming to heal or move forward. I have felt its sway many times, sometimes from a distance, and sometimes quite close. It seems to me that it has caused splits in our community and confusing branches of our theory that use different language to talk about the same thing and fight with or even dismiss one another when my impression is that they do not disagree as much as their arguments would indicate. As a case in point, I want to return to discussions on APsaA's list serv. I have often, when I can keep up with it, found many discussions there proceed with many of the same people, making the same points with more and more words that then escalate into hostility. This is followed by objections to the hostility and then objections to the objections. I want to take up the question of how we might better be able to move the discussions forward, evolve rather than devolve. I have no trouble with disagreement that is passionate, vehement and even hostile. It is the repetitiveness that gets my attention, particularly when I consider the impact of past wounds within the psychoanalytic community that I have encountered. Is the source of our being stuck with unresolved conflicts, unresolved trauma?
I'm going to try to say something about this in my response and offer, for your consideration, what I've learned from having engaged throughout my life in open and contentious debate with people I love. As a result of arguing for decades, I have come to different points of synthesis. I hope that by approaching this controversial debate from the novel angle of my personal experience, I can contribute something to the discussion moving forward.
I'll turn to some more self-disclosure. In the past decade, my husband and I have been members of The Prairie Club, a monthly member only dinner club where those members rotate presenting research papers that are out of their area of expertise. After the paper is read there is a significant period of discussion. In the early days of this 125-year-old club, which used to be exclusively, white men with rank and/or power, the debates would often become quite hostile and raucous. A cartoon depicting the club around that time showed members punching, choking,
knifing and swinging chairs at each other, while several others hid under the table. This tradition evolved when they began giving cryptic titles to prevent members doing research on the subject to aid them in mounting attack during the discussion. As a result, there was not an option to come to the discussion loaded for bear. It is my observation that many individuals within our community are hiding or loaded for bear. I think I observe this in Henry.
The first paper that I presented to the club was entitled BOTH (my version of a cryptic name where the topic was how to evolve our long-standing debate around capitalism versus socialism). Writing this paper gave me a chance to research areas related to the debate I've been having with my father from my early days in college until around a decade ago when our focus turned to dealing with aging and, as a retired engineer, his exploration of physics. I am going to excerpt heavily from that paper to lay out my experience and views. This title parallels my response to Henry on the list serve where I piped that I could not imagine working as a psychoanalyst without having the resources of engagement from a stance of some amount of anonymity and work in the real relationship.
Dialectical thinking is central to the awareness that I gained writing this paper. The discussions/debates I have had over the years, my own thinking about the nature of the associated conflicts and what I discovered as I researched this paper made me more and more appreciative of the value of ever evolving, dialectical dialogue. This developmental process involves a thesis that gives rise to its reaction, an antithesis, which contradicts or negates the thesis. Then the tension between the two is resolved by means of a synthesis. In APsA there seems to be plenty of tension. The question, as I see it, is how to proceed to more synthesis. How do we give due consideration to both the thesis and the antithesis? I see this as a necessary part of moving forward toward synthesis. Here is something of how I got there.
My father and I began debating long before I went to college. We drove my mother and my little sister crazy. But that was only part of the fun. In grade school it was whether our Mercury Comet was green or blue. The name of the color is Chrysler Turquoise. In high school it was whether you go through or over a mountain pass. I don't have any reference for that, and I don't remember whether I advocated for green and over or
blue and through, but I remember being passionate about it. When I decided to study social work in college, my father was concerned. He had been liberal in his thinking when I was younger but became an evangelical Christian during my high school years and his views had grown more conservative. He thought I would be swayed by secular humanism. He was right and our debates turned to more serious topics. Whoever was present in the household had to endure our raised voices over longer and longer periods of time. But because we knew and loved each other, our arguing was a form of play, and therefore this did not alienate me from my father but actually drew us closer.
This does not mean that I wasn't convinced of the absolute rightness of my case. Over time I found myself wondering why my dad's line of reasoning even existed. How could people think this way? But since this was my father, I was never loaded for bear. As I was vigorously advocating for my position, it was often reinforced in my coursework. On the one hand, I was becoming more and more convinced. At the same time, I was also ingesting other kinds of input. My senior year of college, I read through the whole Bible. I had a fair amount of time on my hands and achieving this goal took up some of it. I think it was in the context of arguing with my father the relative merits of a socialist versus a capitalist system that this verse stood out to me:
Leviticus 25:8–13 “And thou shalt number seven sabbaths of years unto thee, seven times seven years; and the space of the seven sabbaths of years shall be unto thee forty and nine years. Then shalt thou cause the trumpet of the jubilee to sound on the tenth day of the seventh month, in the day of atonement shall ye make the trumpet sound throughout all your land. And ye shall hallow the fiftieth year, and proclaim liberty throughout all the land unto all the inhabitants thereof: it shall be a jubilee unto you; and ye shall return every man unto his possession, and ye shall return every man unto his family. A jubilee shall that fiftieth year be unto you: ye shall not sow, neither reap that which groweth of itself in it, nor gather the grapes in it of thy vine undressed. For it is the jubile; it shall be holy unto you: ye shall eat the increase thereof out of the field. In the year of this jubile ye shall return every man unto his possession.”
I immediately interpreted this as a mix of the two; a period of capitalism interspersed with an act of socialism. Wouldn't this be a way to have
the best of both? Over the years I have asked many people if they were familiar with the year of jubilee and many were, but their understanding didn't include competition interspersed with redistribution. Why? Do we inherently have difficulty with the idea of integrating the two? Do we end up in our respective corners fighting for our chosen side without the capacity to consider the merits of the other's perspective?
Based on my limited research within Judaism, jubilee was never fully, and certainly not repeatedly, enacted over time. The corruption of this idea was furthered by its application within Catholicism where it was most consistently used to increase inequality with very few exceptions. Here, a seeming synthesis is offered at the outset. But I suppose it cannot be a synthesis since the process of the development of the thesis, then the antithesis, with the resulting conflict where they have it out, before integrating something from each into the synthesis.
The lack of synthesis of the ideas of capitalism and socialism can be seen in the United States in terms of ongoing conflict and division. The disruption remains even though we, like the vast majority of countries in the world, have a synthesis of the two in the form of mixed-market economies. This conflict, along with being disruptive in and of itself, limits our capacity to more meaningfully consider the relative merits and downsides which would allow us to improve our application of both.
Another reference point with an eye to conflict in my process of writing my Prairie Club paper is the only first line of a novel that ever got stuck in my mind. “It was the best of times; it was the worst of times.” This, I'm sure many of you recognize, is from A Tale of Two Cities. It, of course, refers to the two cities, London and Paris. At the outset circumstances were better in London than in Paris, of course depending on who you were. But Paris saw more revolutionary change of a kind that some idealize today. Liberty, Equality, Fraternity. What's not to like?
But Dickens was willing to include the ugliness that went along with rapid change to a horrific governing system. The ugliness can be summed up as “off with all their heads”. Though it took a long time for things to stabilize, we benefit from these changes to this day and I'm sure will well into the future. But does resistance to further change in the form of additional revolution stem from the violence that accompanied
this transformation? I understood the first line as declaring that in the course of positive change there is the potential for bad outcomes too; the unintended consequence that we ignore at our peril.
On the other hand, London was stable, a good thing, but good change was less possible, even though inequality was rampant there too.
We all want positive change, but I think it is a tricky thing. A famous quote from Will and Ariel Durant, Pulitzer Prize winners for general nonfiction and authors of The Story of Civilization, describe an aspect of this. “Nothing is clearer in history than the adoption by successful rebels of the methods they were accustomed to condemn in the forces they deposed.”
Of course, we know that the world is not black or white. Knowing that and living it are two different things. I think we tend to feel our approaches are right and other's approaches are wrong. It's difficult to maintain an open mind about more than one way to solve a problem and keep in mind that in each solution there are downsides. So, we cannot easily arrive at an option that includes both.
One way to cultivate the capacity to embrace both, giving us a chance to create a synthesis, is curiosity about the rest of the story. What is there that I don't know about the current situation or person I am dealing with? What is the rest of the story that is going to play out after this current event? What good might come from the application of the other's approach? What bad might come when things are solved my way?
The point I am trying to make is akin to one made by Grace Lee Boggs, someone I discovered while I was researching my paper, BOTH. I want to share what I learned from her thoughts about how to resolve impasses on a whole other level of magnitude.
She both turned 100 and passed away in 2015. Here is some of her history.
Grace was active in the communist and black rights movements since her days facing down rats to get to the basement of a Jewish woman's home where she lived for free in Chicago when she couldn't get professional work as a Chinese American woman. She was inspired by
A. Philip Randolph's 1941 threat to march on Washington that gave him leverage to extract from FDR an executive order to ban discrimination against African Americans in war era jobs. Hopeful about the potential to bring about change in the face of injustice, she espoused Malcolm X's brand of activism until she questioned the violence that erupted in the 60's civil rights movement when after 5 days, 43 people were dead. At this point she more fully considered Martin Luther King Junior's ideas of non-violence and ended up adding them to Malcolm's militancy.
As she observed the lack of sustained improvement and real change despite progress in the civil rights movement along with the impact of globalization, industrialization and urbanization, Grace lamented that now workers ended up with no sense of themselves as a part of a community as had been the case when unions were initially formed. As she saw it, they felt like victims. She developed her conviction that an activist “must not be just against something but must be for something.” This evolved in her thinking over time. In the 50's and 60's she worked for and watched revolutionary fights here and in Africa. As she saw the arc of events, she became aware of the illusion that uprising, rebellion and defiance were the solution since with them power structures could be collapsed. She began to realize that as yet there was little sense that something new had to be built. She was able to come to this realization in Detroit. She could see the shortcomings of rebellion that was “an explosion out of righteous grievance.” While rebellion involves an outburst of anger and resistance, it is not revolution.
Grace Lee Boggs' experience with revolution's potential and shortcomings enriched her thinking. She had always studied ideas but began to emphasize them as an integral part of successful change. She espoused that “when you take a position you should try and examine what the implications are.” As I have framed it, “what is the rest of the story?” Another way that she says this is “radical movements have overemphasized the role of activism and underemployed the role of reflection.” So, as she elaborates this, the issue is not just the “oppressed versus the oppressor, but we have to change ourselves to change the world.”
Grace pushes everyone to evolve their ideas, advocating that most people think ideas are fixed when ideas have power because they are not fixed. Once they become fixed they are already dead. James, her husband,
and she writes in their book Revolution and Evolution in The Twentieth Century written in 1974, “(t)he most dangerous enemy of the revolutionary theoretician is not the external enemy but the potential within all theory, and especially the boldest theories, to become dogma. The more a revolutionary thinker is isolated from systematic dialogue and practical interaction with revolutionary social forces, the greater this danger.”
Dialectical process is what I think Grace is describing when she talks about evolution. Evolution is by its nature is slow and unpredictable/uncontrollable since it is rooted in this dialectical, essentially developmental process. I think for synthesis to occur both parties need to remain engaged and to some degree open to one another. In the process of the evolution of The Prairie Club, they cultivated openness by preventing the collection of ammunition. A difficulty that we have is we've had the chance to load for bear over years and even decades.
This is my second to the last personal story. When I was new to Iowa, I was not used to all the large trucks in parking lots. They really don't fit. They take up more than one space most of the time, often because they aren't even parked straight. This bugged me. One day driving down the road near our home with my husband, I noticed a pickup truck parked about 3 feet from the curve. With the width of the street this meant that only one car could pass at a time. I began griping the first time we passed. When we returned, I was looking ahead to see if it was still there in the same spot. It was and my ire was escalating again. Then, as we got closer, I noticed an older gentleman sitting in the driver's seat. He didn't look like he was going anywhere; he was just sitting there. This new information changed my disposition toward the truck and, of course, the driver. There was a human face and one I couldn't as easily get mad at. But it still didn't make sense to me. Luckily, we had to go out again not long after returning home (my husband refuses to make a list for trips to the home improvement store—but that's another story). I was now more curious than worked up. As we approached the truck it was easy to see from a distance “the rest of the story”. There was a tow truck. With this information I could imagine that the driver might not have been able to work the truck into a “proper” parking position before it died.
This simple story, along with the other material that I have elaborated,
are meant to make a more complex point. Henry Friedman is advocating for change in the technique involving anonymity versus self-disclosure. This is an important question with the answer being better served by synthesis. We are responsible for the evolution of our theory and how we cultivate or fail to cultivate the capacity to integrate what is of value to our work from BOTH Freud's admonition against self-disclosure and Henry's, dare I say, demand for it.
I think we do ourselves and each other a disservice when we react to something before we fully understand it, as I am laying it out here, considering the rest of the story. Is mutual understanding of the proponent of the thesis and antithesis a valuable circumstance for eventually reaching a synthesis? It is important to understand that an antithesis in not yet a complete innovation. I believe innovation happens at the point of synthesis. Adaptive change is not just a matter of making things “right”. It is more complex than that, something I think we understand well in our work with our patients who strive to have something different than they grew up with only to in some form recreate those circumstances, sometimes by simply doing the opposite. This is due to not fully understanding or working through their history. If we just strive to simply correct the past, we just make the winners, losers and the losers, winners, a recipe for the next power shift. Change on the surface does not address the important considerations deeper down.
Now I want to give Henry's essay more due consideration. To begin, I am presuming that he does not fully understand contemporary ego psychology. I have two reasons. First, he depicts it as a “Mad Men” like theory practiced by white male psychoanalysts smoking cigarettes. This is a caricature that I do not believe represents us today. Secondly, he appreciates but does not believe Glen Gabbard and Thomas Ogden's advocacy for open engagement with explaining why. He is depicting the thesis he is representing the antithesis of, in a manner that feel dismissive to me. I propose, as a thought experiment, a conversation between Henry and one or both of these present-day psychoanalysts (we'll just skip the Mad Men) where he can ask them more about how they apply what they are laying out and they can ask Henry questions about what considerations he applies in determining how much, what and when to disclose to a patient.
Or actually I can ask him that question here. Henry, what considerations do you apply in determining how much, what and when to disclose to a patient? What do you understand the purpose to be? I am suspicious of the idea that self-disclosure in and of itself creates a real relationship that is therapeutic. How to you track or evaluate that?
I want to add more about Henry's depiction of the thesis he opposes. He declares that “(a)nalysts are creatures of habit and often prisoners of theory and basic assumptions” and asks us to “consider and acknowledge that most training in psychoanalysis doesn't encourage thinking that is critical of received wisdom about either the theory of that institute and certainly not the importance of technical rules…” I presume he has experienced this in interaction with one or more analysts and/or training institutes, but I object to the generalization. What I believe is at the heart of analytic thinking, the very act of being an analyst, is critical thinking. This is what floats my boat. And I have not been constrained in my tendency to think critically over the course of my training and engagement in the analytic community.
I see our plethora of theoretical and technical innovations as evidence of our capacity for critical thinking. I think I align with Henry that something prevents integration of this progression. So, we have Freud's original thesis (within which he made many iterations), many antitheses and very limited syntheses. Synthesis does take work. Both work by all the individuals involved and work in the form of interaction among the proponents of the thesis and the antithesis. I think it is hard but necessary to understand something one disagrees with. This is not an easy task, but we appreciate the value of it as, for example, we can see our patients beginning to relate to their parents more as fully fleshed out people (I was going to say whole objects but thought better of it). The latter takes being fully engaged with one's opponent without being loaded for bear. Killing the other idea can mean losing something that is essential for, as I see it, real innovation and stable adaptive change.
Over the decades of theoretical conflicts and developments, much of which Henry spans in his essay, it seems to me that we have had trouble coming up with a shared language and understanding. The trauma of the times (two world wars, the Great Depression, the holocaust, etc.), narcissistic needs, misunderstandings, the impact of psychoanalysis spreading
across the globe and mixing with different cultures are just some of the contributing factors I can brainstorm. I am sure there many more.
As I entered the field with no bones, in the form of previous exposure, and so no bones to pick, my reaction to all the different theoretical branches has been different. I do not have any trouble seeing Melanie Klein and Donald Winnicott's contributions as additive. They address stages of development that Freud did not fully get to, and I would say therefore did not see a way to treat the problems that could arise because of disruptions during these phases. As Freud strove to solidify his discoveries, I can appreciate his protectiveness of his theories and ideas about technique, particularly those that are difficult to consider, think infantile sexuality. Even as Freud discovered something new and left a previous idea behind, I do not think that he dismissed it completely. I would describe it as something like the old sofa that we relegated to the basement when we got a new one, but that continues to be an important piece of furniture. At some point the “old” sofa may prove it's worth as an antique and be the center piece of redecorating.
For many years now we have treated what was commonly termed widening scope cases—those who became more likely to seek our care based on their need, insurance constraints, and changes in what is popular for the bulk of the worried well. As a part of this transition, we modified our techniques whether we declared it in opposition to tradition (original thesis) or kept quiet about it as Freud seemed to have with his own modifications when he was talking about general technique. His generosity, in terms of openness about the variation in his technique, can be seen in what could be considered his widening scope cases.
Language is, of course, a major human achievement and, in its lack of capacity to fully represent what it is symbolizing, holds the seeds of many human problems. As a tool for connecting with each other in a meaning making manner, it has launched so much of our development, as individuals and communities, aided us in our survival and been a means whereby we create more and more advanced art and technology. But when we trust our words too much, they can confuse or disrupt interaction more than they facilitate it. When we are working at the abstract level of theory, I think this is amplified. I assume that most of you, as clinicians and/or patients, will relate to my experience of a meaningful
and rich metaphor becoming stale. I clearly remember an instance in my training analysis where my analyst objected to my continued use of a phrase we had arrived at in an emotionally intense moment in the work. I was upset at first and then could clearly see that I was trying to hang onto that past moment, to use it as a shortcut to get back to the experience of an affectively meaningful discovery. And as an analyst, I have caught myself trying to get the work going by using the same word or phrase that has been very useful in the past. I can feel that I'm trying to use a shortcut, not the kind that gets us there quickly and elegantly, but one that threatens to get us lost or there before we are ready to come together in a new shared space.
Keeping our theoretical language fresh is a challenge as well. I can easily see it when technical language is used too much as a shortcut. It tends to grow stale and contribute more to misunderstanding than understanding—resulting in our losing real contact with each other and/or the juice of our ideas.
Henry argues that there is a lack of proof for conservative theories while at the same time not presenting proof for his own. I think I can read between the lines that he has had experience in his consulting room with analysands who presented that they had been harmed by conservative, anonymous analysts. If this is the case, it may act as a kind of proof to him. I can appreciate that with the constraints of confidentiality, he is limited in terms of self-disclosure and therefore elaborating his proof. Unfortunately, his proof on that basis cannot serve as proof for me and I think it complicates reaching synthesis.
That said I have had or witnessed encounters where an analysis is privileged by the analyst over real-life considerations that I found objectionable and a lack of openness to new ideas and new or younger professionals that I found off-putting—particularly at national meetings. I will also note here that one instance of offense is due to Henry's characterization of nonphysicians as not being bound by consideration of the effectiveness of their work in helping their patients. As a mental health counselor by licensure, I am curious about the basis of this opinion and can say unequivocally that it is not my training, view or ethic to ignore what my patients say about how they are doing.
These instances support Henry's characterizations of our field as stuck in the past. I can imagine the impact on someone who's predominant experience was of this kind. I have found plenty that has been otherwise generative in my engagement in the field. How do we work this through and embrace the future we are inexorably moving toward and remaining sufficiently grounded in what our past has to offer.
As a function of a period of decline in interest in psychoanalysis that Henry described, I was recruited for training, teaching and becoming a training analyst. Two waivers were requested and obtained for my training. The first was to train as a master's level counselor and the second was to be able to conduct my training analysis, after the first nearly two years, by telephone. These occurred in 2004 and 2006 respectively. I graduated earlier than I would have when my institute adopted the Columbia model (alternative requirement for cases under training consultation). My immersion (amount of post graduate experience conducting analysis) was considered with flexibility by the committee that evaluated me for a training analyst appointment. I realize that I have benefited from the timing of my entry into our field.
To make my contribution to a dialectic dialogue on anonymity versus self-disclosure, I would like to draft my answer to the question I posed to Henry. What do I use to consider how anonymous, abstinent or neutral to be with any given patient at any given moment? The first place I went is to the question about my role as a good object and/or bad object. This can address whether I desire to be a good object (providing more direct help as I see it) at this moment and what that is about in me or whether having a bad object experience (allowing for the emergence or continuation of negative/painful responses to me) might be helpful for my patient in some way. But given our loaded language, my use of these terms may be less helpful rather than more. I could resort to gratifying versus frustrating but that is likely to be even more trouble.
As I am challenged to think about what I mean when I use these terms, I am reminded of how I contextualize these questions in my understanding of development as I try to assess whether my patient can benefit from me being directly or indirectly helpful. This is a judgement that parents are making all the time about different things over the course of their child's development. A classic example is a parent's response to a child,
who is learning to walk and falls or how to manage a tantrum. There are important considerations whether to jump in to help versus standing by and even enduring our anxiety or their attacks.
In any given moment, I use my best judgment, see how it goes and together my patient and I try to make sense of it. I am working on my own and with my patient to understand their developmental needs and provide an atmosphere that facilitates their growth. In moments of these kinds of consideration, I find myself working hard to be available. By that I mean striving to be available to the patient, able to not know what is happening (against Henry's stereotype), available to my inner experience and available in that moment. Of course, there is considerable variation in my capacity for this in any given session or moment within a session. But having cultivated this kind of focus and felt the benefit of it in the work, I trust it more and more. This is what I believe our real relationship is built on regardless of how much I self-disclose about my life and/or my internal experience. I think it is the life of the work that I share with each patient that is the basis for our real relationship, the kind of open relationship that Henry is advocating. It is within this that we work to explicate the impact of past experience for both of us on our ability to be together and tackle the question(s) at hand.
I want to share a case example to illustrate what I believe are the complexities around self-disclosure that need to be considered both at the outset and as the work proceeds. During the mid phase of a four-time-per-week analysis there were several instances where I was feeling particularly warm toward my patient. I ended up expressing this in two different ways with two different results, both meaningful and complex.
The first expression was in the form of what I intended as a gift. We had done some painful exploratory work and he had also referenced aspects of his own professional work. Since I knew that he was interested in psychoanalysis and there is a psychoanalytic term to describe both of these kinds of work, I told him the term. His response in that moment was positive and nothing else came of it until several weeks later as we were talking about the second expression of warmth. This time at the end of a rich session where I felt I better understood his experience in adolescence, I said the following: “When your mom insisted and frantically told you about the girls' side of sexual experiences, you felt she was saying
to you that she didn't trust you and that she wasn't able to see you as a sensitive, thoughtful young man.“
The next session was the last appointment before I would be gone for a week, followed by his planned absence for another week. To begin the session, I came to get him in the waiting area from the hall outside my suite instead of from my office like I usually would. He said, “I was expecting a client. I was surprised.” I asked him what that was like. He states that: “It took me off guard and I had to slow down.” I asked from what and he said eagerly: “From jumping up to be at your beckon call.” I replied, “That's a big thing that's always there.” He confirmed this and stated, “I won't see you for a couple of weeks.” I said, “That's right.” After a pause, he responded, “Which is sad,” and I said, “Can you say more?” He went on to say, “I'll miss you and our time together. It's grounding when I get to come here. I feel like I'll be fine. It was nice to hear what you said at the end of the session yesterday. I wrote it down. That I'm sensitive and thoughtful. That essentially, I can figure stuff out. It felt like that came from a nice place. It felt real and I trusted it. Even though it wasn't direct I took it as coming from you.” I said, “You took it that I saw those things.” To which he said, “It helped.” He talked about multiple intense emotional experiences at work and in his personal life with the focus on being able to tolerate these things without having to control or fix them. I asked him why he thought that my statement got in as well as it did the previous day. He said, “Huh—a couple of things. It felt real. I'm sensitive and you acknowledged it. You didn't say toughen up. You showed that I could handle it… . You acknowledged that I am a young man. I just turned 30. I was young when I was a kid. It was the feeling that I have a lot in front of me and I don't have to figure it out. It was the trust piece. That you trusted that I am able. You say it all the time by being present the way that you are. At times I get pissed, the times when it feels like you encroach on that.”
I ask how so. He answered, “Like the time that you said (here he names the term I used), I experience that as not trusting, that you were saying it needed a label.” I said, “It's like I thought you didn't know something.” He came back with, “I wanted to hit you with neurological research.” I asked him if he could stay with it. He responded, “Are we really going to do terms, I can kick your ass.” I kept with the theme: “It was like I pulled out the boxing gloves.” He replied, “Yeah, really, really, what you're 57”,
5'5“. Are you fucking kidding me—you don't have a prayer. You don't know how fucked you are. Maybe I'll hold back.” I continued: “You could totally crush me.” He did the same: “Yes, fuck you for putting me in that position. I don't want to do that at all. That's what I got from my mom, you, my boss—Be gentle'. I don't need someone to box with. I don't need you to toughen me up. I know.”
I said, “You've been training for this all your life.” He replied, “Totally—fuck that.” I said,
“You've been holding back, but you don't have to.” And he continued: “No, I can let it fly. I can crush people, people I love. I hate that they experience it as so mean. I'll be relentless. You may beat me up this round, but I've been training for this my whole life.
Even if I cry, I endure more than most people. You better look out. It's why I came here. I'm using it as boxing practice. I'm gonna find all the moves that can be done to me. If I get out into the world, I've already trained. Good luck using this against me.“
I commented, “So I've helped with the training.” He confirmed that I had inadvertently. As he began to wind down and after a pause, he wondered if he is tired then said, “I'm not tired, I know I'm not—I kind a love it.” I responded, “You're not ready to let it go,” and he said, “No, what would be there?” I repeat, “What would be there?” He answered, “The soft old me at the farmers market getting flowers and fruit to cook in a straw hat and looking like such a pussy.” Here we began work to integrate other parts of him and his response to my leaving, which ended up at the end of the session being soft and kind.
As analysts, we have all kinds of experience in our work with our patients. In this set of papers, we are wrestling with whether and how to disclose them. In this clinical example with J, my different forms of expression (the presentation of an analytic term as a gift to express tenderness and a displaced and indirect expression of trust) were experienced very differently by J from each other and over time. While we have in this example his ability to read my sentiment in both instances in the moment, I expressed them as I intended in one instance consciously and the other likely preconsciously, the gift of a psychoanalytic term did not remain in him as it had been received.
I think the important part is not what I initiated but what J did with them and then how we were able to establish and preserve space for him to express/self-disclose himself. As he put it, I communicated more to him by how I was with him than by what I tried to say to him. I think change happens via engagement rather than self-disclosure. I rely mainly on my patients' disclosure to do the work. My work is to provide the space for it, to hear and understand it, to allow it to engage me, consciously and unconsciously.
Part of my point is that I am working to be as present as I can be, bringing as much of my whole self as I am able. This is a kind of presence/expression/disclosure that makes space for my patient's experience and capacity to be present/express/disclose/experience and I think grow. As you can see from the example, I am not silent, but I am judicious about what I contribute from myself. I find that the value of my active presence in the form of talking varies from patient to patient and with each patient from moment to moment. I do not think that who I am, in terms of disclosing, helps my patients as much as what I provide. As result I can be quite different in each treatment or over the course of a treatment. Saying more can turn to saying less and vice versa.
As an analytic clinician I think that we need the capacity to self-disclose and to refrain from self-disclosure. This allows us greater freedom to consider what might work in any given situation and requires us to consider the benefits and costs of each option. Along these lines, I think our work is ultimately both a shared endeavor and at the same time I am working as a professional with clear responsibilities. They in fact include my need to make determinations about interventions I use and whether they are effective. That is the case self-disclosure or remaining anonymous, abstinent and neutral. In our clinical work to only be a real person in a real relationship, to my mind, is akin to breaking the incest taboo in the context of the family. It is our challenge to honor this professional responsibility and, at the same time, the essential integrity of those we work with. I heard Henry give a nod to this in his criticism of non-physicians I referenced above.
Grace exhorts us to think critically, particularly about ourselves, instead of reacting. I don't think that we get any easy directions in this work. To disclose or not to disclose? I believe we must always take up
this question and wrestle with its answer with each patient and in each moment. Additionally, I believe our real relationship with our patients is not based on what we disclose to them so much as it is based on what we experience together. I agree with Henry that being anonymous, not answering questions, is powerful, but answering them is also powerful.
We must conduct the hard work of determining what to try or realize what we tried before we knew it consciously, see how it goes and proceed from there with the same level of uncertainty, agonizing, creativity, spontaneity or impulsivity, as the case may be, and live a good amount of life with our patients on the path to seeing where this analysis will take both of us.
I'd like to close with my last personal story about relating across differences. I grew up visiting family ranches in Wyoming. This experience remained a home base for me during many moves over my growing years. I love riding horses, but I am not very good at it. I am also, most of the time the only Democrat around and this emerged during President Obama's first term, when I was called out about it. This did not prompt an extensive debate. Although I would indulge in that with one cousin when we were one on one, there was not much point in a larger group since no one was going to convince anyone of anything in that context. So, I was happy to stand my ground proudly and leave it at that when my cousin's teenage son in an ominous tone talked about there being some Democrats in the valley and he knew where they lived. I did not know him well enough to have any idea whether he was just trying to get my goat or expressing a sincere and dark sentiment.
One evening on this visit when I was out for a ride with my aunt and my cousin's teenage daughter—Emma, my horse hit his back leg on a metal culvert and was limping as we galloped into the barnyard. I felt awful! I didn't know how badly he was hurt. To make matters worse a woman from Texas who sells horses was there visiting and she was ranting and raving about mistreating horses as Emma and her set to treating the wound. Emma reassured me quietly on the side that it wasn't a big deal, but I was not relieved. Added to all of this was the fact that everyone was gathered at the main house, something I did not always have to encounter. I did not want to walk in there, but I was no help to my injured horse, so in I went. The oddest thing happened. My uncle who listened to Rush
Limbaugh daily and was the one that asked my dad what happened to me (that's how he called me out), responded to me announcing myself as the horse “hurter” by saying something about President Obama.
I do not remember what he said about Obama but suddenly I was ready for a fight. I noticed my internal change immediately and realized he had said that to free me from my guilt and the fury of a woman from Texas oddly enough named Hillary. My gratitude was expressed as I was able to just grin at him across the room and the conversation settled into its usual course. Better yet my horse was just fine. Our profound political difference was no match for the care and concern he had and adeptly expressed at a difficult moment for me. We knew each other as people first and that allowed for a difference to be a means to treat my wound in this case.
I am glad that we are having this kind of discussion since, I hope that along with hashing out controversies, we get to know each other better along with having a chance to hone our ideas. It seems to me that things are changing within psychoanalysis. I have had the fortune to be spared the traumatic experiences of many having to do with admission to training, graduation, certification (it was hard, but I found it to be a truly analytic and mutual critical thinking process) and being appointed as a TA even while my institute is working on dismantling this institution while trying to maintain what it adds. As I understand it the William Alanson White Institute that Henry mentioned was ejected from the American Psychoanalytic Association rejoined APsA in recent years. We just voted on expanded membership, and we have begun to benefit from the hard work and the wisdom of the Holmes Commission. One of the notable features they included in their report at the national meetings this year was the importance of having a process that addresses institutional prejudice and exclusion. I think we need new processes for multiple purposes.
As he closes his essay, Henry declares that if we allow ourselves the freedom to be ourselves, our patients will be able to maintain the growth that they gain to a degree that “far exceeds” traditional analysis. This feels to me akin to that idea that just being anonymous facilitates the emergence of a transference neurosis that can be worked through via interpretation. Both descriptions seem too simplistic to me.
I haven't found a way to not be myself in the intense engagement that is a part of our work whether I'm particularly self-disclosing or not. My challenge is to know myself and my patient as well as our relationship as much as I am able and for us to uncover and experience our shared humanity. This is not an easy process. As I have wrestled with many aspects of technique and worked to apply my own capacity to use dialectical thinking to the many contributors in our literature and meetings, I hope I have gleaned something of value from each. I find that each patient and in many ways each session evolves in unique ways. And while I think all this preparation is critical, ultimately it allows us to be more available and engaged. So, to both agree and disagree with Henry, I will close by saying that I believe it is our humanity that heals.
Final Note: Having completed a full draft of this prior to the Spring 2023 controversy in APsA, I find there is more I feel compelled to add as I finalize what I have to say here. The hope and promise of the work and change that was occurring leading up to the eruption was palpable but not as close at hand as it seemed. Controversial discussions have abounded in the course of events from that time until today in the context of a deeply painful history and present, and profoundly traumatic events. I believe that we have much to do to truly understand each other and find better ways to live together in equity and harmony. I hope that we will continue the labor of fulfilling the vision of the Holmes Commission Report and each of our purest desires to be a complete community.