The analyst's feeling of certainty is often tied to the idea that there exists a proper “analytic technique” derived from ideas passed down from one generation of analysts to the next (which may be codified by particular “schools” of analytic thinking). By contrast, think of “analytic style” as one's own personal creation that is loosely based on existing principles of analytic practice, but more importantly is a living process that has its origins in the personality and experience of the analyst.
Too many writers cannot come to terms with the ways in which the past, like the future, is dark. There is so much we don't know, and to write truthfully about a life, your own or your mother's, or a celebrated figure's, an event, a crisis, another culture is to engage repeatedly with those patches of darkness, those nights of history, those places of unknowing. They tell us that there are limits to knowledge, that there are essential mysteries, starting with the notion that we know just what someone thought or felt in the absence of exact information.
You know I went to school And I'm nobody's fool That is to say until I met you! I know a little bit about a lot o' things But I don't know enough about you
What follows is offered with humility during a worrisome time—a time with strains of Covid haunting the world, a time of global warming with its tragic effects, a time of fighting prejudice, of increasing gun violence, and a time of serious division in America that threatens democracy. How we react, adjust, protest, and survive depends a lot on how we use our energy effectively. Mental health must be a priority.
This collection is for anyone who is curious about how one psychoanalyst's thoughts have evolved after five decades in the field. Thanks to my own meandering journeys, my own on-going self-analysis, and thanks to my patients, to those I supervise and teach, and to my colleagues, I feel freer and more curious every day, and the design of this book reflects that. Longer essays, shorter riffs and even a poem will hopefully provide food for thought. After all these years I am increasingly interested in how the brain and the mind are related and how depth therapy figures in. I am most interested in how a dyad connects and what that connection can accomplish.
I must say up front that some of these ideas will seem old hat to many, and to some they will sound un-psychoanalytic, so my hope is for open-minded consideration. I respect many theories of technique because we are all unique and because we are exploring unchartered territory with each patient. My slant is just that: a slant. It is a perspective that I offer based on my work with patients, many of whom have experienced degrees of childhood strain trauma that interfered with optimal development. It is a perspective that is influenced by a basic knowledge about neural pathways in the brain; how the stress hormone cortisol, and the love hormone oxytocin affect the brain's development (Doidge, 2007); and by new research findings about development (Knight, 2021).
I have always believed that the emergence of negative transference and the rage upon which it is based needs expression, but the question is: how much and for how long. How the dyad deals with it, and what they learn from its expression, is one of the most important questions in our work because an ongoing expression of primitive rage can wear both parties down and may engrave an original trauma more deeply in the brain's neural pathways. Of course, the answers depend on the unique patient's history, but when development has been derailed, and I believe this happens more often than we recognize or realize, we must find ways
to get it back on track. This includes learning about our earliest days which is sometimes possible but most times not, along with our history of relationships. Think in terms of knitting a sweater. Dropped stitches in the beginning can be easily overlooked when the sweater is finished unless you look carefully. But will the sweater hold its shape over time? Unfinished or incomplete developmental tasks can be hard to spot in the adult patient, especially in the beginning stages of analytic treatment, but when impasse threatens or progress is stalled due to a patient's difficulty with reality, I have found that solid enough differentiation between self and object and incomplete separation and individuation need attention. So many things too numerous to list, including genetic disposition, how mother and baby match, illness, and early loss to name just a few, impinge upon how the child takes in and processes its surrounds. These things are what make us unique.
With this in mind, I am suggesting a level playing field with two people working together, where the analyst shares her strength with her partner until her partner feels increasingly stronger. In other words, I am considering how we redress the damage done by varieties of trauma which affect, to varying degrees, the tasks of differentiation between self and object, the separation-individuation process, and the formation of a self. I think that many patients reach impasses if this is overlooked. We are also faced with the serious dissociation that occurs in patients subjected to severe, ongoing trauma. Purcell (2019) informs us in his moving paper that with “unrepresented experience–something different is needed at the level of “technique”: a technical attitude—one of doing things to our patients—must largely be replaced by a way of being with our patients… being with his analysand in non-meaning as well as in symbolic communication. In being the analyst for traumatized people, technical rules and maneuvers must give way to improvisation and creativity, integral elements of an artistry that must find its place in the analyst's attitude.”
My imaginary reader shares with me the insatiable wish to understand the mysteries of why we are who we are. Having reached a certain age I realize that the more I see and the more I learn, the more I recognize how much more there is to discover. I have gained an increasing appreciation of how very complicated the human mind and brain are, and I am in awe of those who dedicate their time and energy to understanding
how the mind interacts with the brain, how the outside affects the inside, and how epigenetic change occurs. Psychoanalysis offers the most thorough approach to solving such mysteries, especially when scientific research is acknowledged. Cultivating and keeping an open mind makes almost everything seem possible.
These heretofore unpublished essays and riffs were written over the past ten plus years, some quite recently, and are now the chapters of this book. My focus is on how the connection between two people, known as the dyad, encourages the growth that leads to change. Even our most challenging patients hopefully come to know on some level when someone is listening without criticism. This book is a sequel to Deepening the Treatment, and the reader will see that my philosophy has shifted from a more classical view of our work to what I consider a more contemporary one that takes into consideration research in neuroscience, affects, and child development.
How two strangers connect, and the importance of that connection is the underlying theme of this book. Conversation connects us, whether in person, on Zoom-like platforms, via email or snail mail, or over the telephone. I think that all the words we use, even in one session or over the entire course of treatment, serve as the glue that bind the dyad together. And sometimes I think that if our hearts are in the right place, it matters not so much what we say to each other but how we say it. Angry words, loving words, fancy words, empty words, lack of words are important yet when all is said and done, neither party in the dyad remembers much of what was said when treatment has ended. What is remembered are the feelings beneath the words and the spontaneous moments of laughter, tears, and of feeling genuinely caring, cared about, and accepted.
About the couch: During analysis there are times when reading a person's facial expression is beneficial for both parties in the dyad. This is particularly important for the patient with an avoidant attachment style where the goal is connecting positively with a new object instead of reinforcing memories of the early, depriving and traumatic objects. When patients repeat the past in the transference instead of using it as a clue to the mystery, such repetition risks reinforcing the original trauma. As a new object relationship is formed by in depth, libidinal connection with the analyst over time, the brain's circuitry changes. The phrase ‘use it or
lose it’ applies here so if you had a bad object relationship with a parent, and then you develop a better one with a new object, the fact that you have a trace of the old one doesn't mean you have to use it (Doidge, 2007).
Our first conversations in life take the form of the cooing and crying of infancy and the way they are responded to. These earliest connections play a major part in determining the bond we form with our mothers/caretakers and serve as a major template for future relationships. There is solid evidence that human beings are inextricably intertwined with one another from the earliest moments of infancy. At birth, the infant appears hard-wired to seek human interaction. Along with words, conversation includes how we communicate with our eyes, our posture, odor, style, our facial expressions, silences, the way we listen, and especially our unconscious vibes. In psychoanalysis the conversation goes on consistently over time in a safe place with a non-judgmental, trustworthy other.
Analysis involves a certain amount of regression, so the couch is helpful for those who have frequent enough sessions. But at times it is useful to read a person's facial expression, particularly with the deprived adult with an avoidant attachment style. I like the idea of a swivel reclining chair for the patient who can then have a choice.
One of the most important things I have learned is that those who have grown up with unavailable, narcissistic, or abusive parents or caretakers have trouble giving and receiving love as adults. We get used to our earliest diets and have great difficulty in digesting new food. We seek out the same restaurants because the food is familiar and familiarity means safety, even when painful. We choose partners who echo the past because feeling safe is a basic need. I see no harm in mentioning this tendency to a patient at an appropriate time.
It is my hope that with these chapters I succeed in connecting with you, the reader, as I talk about my philosophy of clinical work, my experiences with patients, and what I have learned as a clinician, consultant, and teacher.
This collection is meant not only for depth psychotherapists, but also for anyone interested in psychoanalytic ideas. My pronouns switch at
random for the sake of brevity and out of respect for gender preferences. I use the word ‘patient’ out of habit. (A patient is any recipient of health care services that are performed by healthcare professionals.) I would prefer ‘learner’ or ‘adventurer’ or ‘partner in solving mysteries’ but I fear this would sound too futuristic. ‘Co-traveler’ would be good too because I see psychoanalytic work as a journey taken by two, a meandering journey (Chapter Three).
Why another book? The field is crowded with interesting, scholarly, and useful literature and I'm sure that just about everything has been said, one way or another. Many psychoanalysts are excellent writers who have even contributed fiction, memoir, and poetry. Ted Jacobs, Tom Ogden, Christopher Bollas, Arlene Heyman, Sandra Beuchler, Eugene Mahon, and Kerry Malawista come immediately to mind. Many erudite authors are sometimes more difficult to read but often well worth the effort. My style/voice is direct—no vibrato, just plain and simple. Speaking of voices, I use jazz music in Chapter Ten, On Listening, to encourage the idea of creating something new.
Hopefully, my slant, that has been developing over all these years will be of use. Also, I have been working on these essays and riffs for a long time with the hope that someone will get something from them. The song “T'ain't What You Do, It's the Way That You Do It” comes to mind because our voices make us unique. One more reason: psychoanalytic observations and theories have gained sophistication over the years and so have psychoanalytic clinicians. Our methods are now making use of the impressive research in child development and in neuroscience. I want to encourage therapists to fight the lure of received wisdom and to allow new findings to stretch their minds.
“…you work to turn the ghosts that haunt you into ancestors who accompany you. That takes hard work and a lot of love, but it is the way we lessen the burdens our children have to carry…I work to be an ancestor” said Bruce Springsteen in Born to Run. Hans Loewald also spoke of turning ghosts into ancestors. In fact, isn't that what all we clinicians do? Ghost busting is our business.
Freud deserves our deepest respect and appreciation. He will always accompany us but psychoanalytic work has advanced and branched out
to serve all kinds of people as I'm sure he would have wanted it to. By the way, Freud was far more relational than many of his followers have acknowledged. He conducted a number of walking analyses, according to Peter Gay in Freud: A Life for Our Time. (Gay 1988). Besides his four hours walk with Gustav Mahler, Freud conducted his first training analysis on Max Eitingon in 1907 through a series of evening walks. Eitingon went on to become president of the International Psychoanalytic Association and created a model of training still used today. I sometimes wonder whether some of our founding fathers and mothers analyzed their sadomasochistic tendencies with such short analyses; and how their influence affects us in today's analytic world.
Freud's phallocentric, oedipal focus has been challenged by Breger (2009), Barron (1991) Simon (1991), and Holtzman & Kulish (2000) among others. The research on attachment and the separation-individuation tasks of development featuring both the maternal and paternal influences has changed the phallocentric focus.
As I look at today's world with so many adamant believers in bizarre conspiracies, along with the rampant misogyny finally being brought to justice thanks to the “me too” movement, I believe that early childhood anxieties and the transmission of trauma play a large part. Paranoia can be seen as one result of early and ongoing anxiety. It has always been a part of society but social media fans its flames. With society's pressures increasing, many parents are unable to provide the safety and security that children need in order to differentiate and to individuate. Parents cannot help but pass on their own fears and anxiety to their children who often fail to develop a secure sense of self. This is not new, but the research is now available proving that children thrive under certain conditions. And even when parents are caring and available, things can go radically wrong due to certain social media platforms.
My ideas about leveling the playing field and distancing our techniques from the medical model harken back to when psychoanalysis came to America in 1911 as a medical sub-specialty. The analyst as a medical doctor, all too often took on the persona of a blank screen that was meant to help the patient develop a transference neurosis (an emotional relationship with the analyst based on childhood relationships). This has been referred to as classical or orthodox psychoanalysis. The results of a
lawsuit claiming restraint of trade, and settled in 1989, changed the profession by allowing psychologists, social workers, and qualified others to join the ranks by studying at the American Psychoanalytic training institutes. However, their teachers were M.D.s whose model featured diagnosis, prognosis, and cure. This model heavily influenced the field in America. I join many who question seeing the analyst in the role of the physician administering a treatment based upon a judgment of psychopathology which determines analyzability. The infantilization of the patient (and of the student in training) has seriously harmed this field. Even the word ‘training’ instead of education illustrates a less than humanistic attitude. So-called ‘lay analysts’ were ignored by the medical establishment despite Freud's impassioned plea (1926). Theodore Reik, a non-M.D., began his own independent institute, the National Psychological Association for Psychoanalysis dedicated to teaching non-physicians. Others soon followed suit.
The view I take is a continuation of Leo Stone's (1954) humanistic approach. I am most impressed by Sandor Ferenczi who envisioned the analysand as a co-participant in the dyad. I appreciate and support the emphasis on empathic reciprocity during the therapeutic encounter which is an important contribution from the evolution of the intersubjective/relational school of psychoanalysis. Both parties in the dyad must be free to share experiences when appropriate, in contrast to the abstinent/blank screen approach advocated by the orthodox analysts. I see the dyad as a partnership that leaves room for the evolving transferences to be understood and adjusted thus allowing for something new. Freud's followers in Berlin led by Max Eitingon did him a disservice by bringing an authoritarian approach to both students and patients.
I learned, practiced, and appreciate many ideas espoused by the classical model but differ with its analyst as blank screen approach because it deprives patients of forming a new human connection that I find indispensable to growth. The medical model initially practiced in America could not help but affect how the analyst and patient viewed each other and this patient/doctor image, understandable as it may be in other circumstances, is what I suggest needs adjusting. I propose in these essays and riffs a basic shift in the way many (not all) psychoanalysts still work with patients. The mindset of a doctor implies a top-down, authoritarian slant and our society bows to this approach. We want a doctor to cure us
and here is where I offer a different point of view. The idea of working together to get development back on track is very different from a doctor curing a patient by interpreting her free associations. It is different because as patients resume development it is they who do what is necessary to move forward in life. I see the therapist as facilitating development. Along these lines I propose that explanation and conversation take the place of interpretation. Yes, the analyst shares what she hears but not as a pronouncement.
The shift that I envision suggests a level playing field where two people view problems together—as co-workers. This does not preclude transference explanations; we all see the present influenced by past experience. But both partners use their transference vision in the service of going beyond. This approach is especially applicable to those whose early years were unsteady and traumatic. What I am proposing is that both parties in the dyad discuss possible ways of understanding the clues presented by the patient, rather than setting up the analyst as the authoritative interpreter—the one with the answers. The attitude that includes discussion in and of itself builds the patient's ego or sense of agency. This idea will not be new to many depth therapists who have not undergone classical analytic training that focuses on analysis of defense.
I am not concerned here with talking about theories, such as Intersubjective or Self-psychology or the structural versus the topographic, and so forth, and I don't dwell on differentiating psychoanalysis and psychoanalytic psychotherapy, a topic that has plagued this field for too many years. Beneath the theories lay the therapist's stance. Does she see disease/illness/pathology, or does she think in terms of derailed development and once necessary adaptations that are no longer useful or necessary? How a clinician views a patient's difficulties is what I suggest needs serious rethinking. Instead of focusing on what's wrong exclusively, I suggest seeing what's right. We all adapt as best we can to the cards, we've been dealt in childhood so why call this pathology? Early adaptations have been lifesaving if you think about it—but like childhood shoes, we outgrow them. The right to have new shoes is what therapists hope to instill. Benevolent curiosity is the bedrock of the method I am presenting. Her words:
“The urgency to reform, correct, or make different motivates the task of a reformer or educator, the urgency to cure motivates the physician, but free to range over every field of human experience and activity, free to recognize every unconscious impulse, with only one urgency, namely, a desire to know more, and still more. When we react to something that causes us to think ‘I cannot understand how a person can think or behave like that’ curiosity has ceased to be benevolent.”
Thanks to the research on child development (Knight, 2021; Tronick, 2011) and the discovery of the brain's plasticity, the psychoanalyst's palette is filled with more colors than our forefathers and mothers had available. I propose adding to or even replacing Freud's phallocentric, oedipal model with a developmental model, featuring the quality of the bond between the infant and its caretakers, the separation-individuation phase with its task of differentiating self from object, as central. To put it plainly: too many have not fully realized that there are ‘others’ who think differently and so are unable to respect diversity. I see the analytic goal as getting derailed development back on track. For those who find Mahler's model limited, I suggest Ed Tronick's (2001) Dyadic Expansion of Consciousness hypothesis. But both theories center on the child's early connection to the mothering figure. Thanks to Rona Knight's research we have learned that development continues throughout life and is not limited to specific ages.
My extensive experience with patients who suffered strain trauma in childhood has shaped many of the ideas in this book. Although I respect and consider the many theories available, I am committed to greeting each patient as unique. Our tendency to apply a diagnosis and then a theory to an individual limits what we see. The unique patient creates the theory (Nass, 1975).
Technique has changed gradually in that its elements, such as furniture and frequency, are no longer written in stone. But many training institutes guided by the Eitingon model still require these artifacts. Why do we cling to them? Yes, using the couch can be helpful but making its use a requirement is insensitive to the unique individual.
This book takes issue with the analyst as mostly silent interpreter of the patient's free associations. I picture two people facing the problems together as detectives solving mysteries? (See Lois in Chapter Three: Self-Murder.) This stance requires respect and benevolent curiosity. Over time the dyad develops a relationship that includes transference love, real love, hatred, and everything in between. Transferences serve as clues. When patients see the others in their lives only in terms of past relationships, their vision needs adjustment. The dyad works together to broaden their view. I must add that I respect the analyst's silence as well. Our patient's must have the opportunity to see where their minds go—so I hope for a flexible approach with the unique patient in mind. A rhythm evolves that accelerates at times and that slows at other times. No metronomes are required.
In essence, I propose that two people share the job of looking into how the past affects the present, with the resumption of development being the goal. The feelings and fantasies (conscious and unconscious) experienced by both parties are explored. One partner may hold the other's anxiety until it diminishes due to the connection that develops. Most of what goes on is unconscious and when enactments that are always happening become evident, the unconscious message is exposed. This exposure releases us from an action mode thus allowing insight. Tronick (1998) suggests that there are dyadic states of consciousness that develop between patient and therapist that he calls ‘something more’ – and that change is due to these new and unique dyadic states. Purcell (2019) speaks about “a way of being.”
Anxiety diminishes when criticism is not involved. In Chapter Nine: “How Long,” Lisa's constant tears in the beginning phase of analysis may have been expressing her fear of criticism. Love, not often enough mentioned in our literature, grows out of respect and serves to cushion the discomfort involved in negotiating separation and individuation. Benevolent curiosity is part of love.
We need the new discoveries about the brain and mind. Norman Doidge's message in The Brain That Changes Itself, is that during analytic work we choose different neural pathways when the old ones lead to trouble—a bold idea based on the evidence of the brain's plasticity. See Chapter One
of his book where he describes the stroke victim's recovery and what the brain autopsy showed after a long and productive life.
I have seen classical analysis help some people, but a combination of methods can be useful depending on the unique dyad. The analyst must feel free to titrate the treatment with the unique patient in mind while still calling the treatment psychoanalysis if she so wishes. I believe many of us already feel this freedom, so this is meant for those who have felt intimidated by their ‘training.’ What I suggest is partially based on my own personal experiences, one with an authoritarian training analyst followed by a vastly different personal telephone analysis with a highly respected and revered analyst who refused the title on principle. These experiences helped shape the ideas in these essays.
My major focus is the therapist's slant, attitude, and manner—a manner that is based on respect, a special kind of love, and benevolent curiosity, all three allowing us to experience the patient as unique.
Short riffs and longer essays and even a poem (though by no means am I a poet) express some of what I've learned. Neither textbook nor memoir—I present my personal slant on the journey including what I've learned from my experience. While doing research I was floored by the richness of our literature. The plethora of books and articles about psychoanalytic work can only mean that we are forever searching for and sharing ideas. And why not? The human mind is extremely complex, as is the brain and its outposts. Both deserve all the attention we can muster. There is no one way of thinking that captures its mysteries which relates to my feelings about the disadvantages and harm involved in measurement. The way we use the new discoveries mentioned above surely matters just as much as the evidence itself. Ed Tronick and Marjorie Beeghly (2011) speak of an instinct or drive towards making meaning that we are all born with and this makes perfect sense to me. There is so much to learn and see and experience. And sometimes, depending on how we use it, all our knowledge can actually impede us and even obscure what our partner is telling us.
Our most famous fictional detective, Sherlock Holmes, says as much in this story:
Holmes and Watson are on a camping trip. In the middle of the night Holmes wakes up and gives Dr. Watson a nudge. “Watson” he says, “look up…and tell me what you see.” “I see millions of stars, Holmes,” says Watson. “And what do you conclude from that, Watson?” Watson thinks for a moment. “Well,” he says, “astronomically, it tells me that there are millions of galaxies and potentially billions of planets. Astrologically, I observe that Saturn is in Leo. Horologically, I deduce that the time is approximately a quarter past three. Meteorologically, I suspect that we will have a beautiful day tomorrow. Theologically, I see that God is all-powerful, and we are small and insignificant. Uh, what does it tell you, Holmes?” “Watson, you idiot! Someone has stolen our tent!”
A recent reading in Jack Pankseep's work on affects, coupled with understanding more about the intersubjective/relational approach so well-articulated by Phillip Bromberg, Lew Aron, Stephen Mitchell, Donnel Stern, Jim Fossage, and so many others, and recognizing the plasticity of the brain have shifted my thinking to a broader comprehension of how we relate to each other and to our patients. Heart to heart communication is what matters most, and it often takes place without words. I repeat, more goes on unconsciously than we can ever know. This is why the therapist's hope is important. Our patient's pick it up subliminally.
I have always shied away from diagnostic categories because I fear boxing people in. They provide some advantages, as Nancy McWilliams (2011) has beautifully shown us, but for many therapists these categories can stand in the way of hope. Nancy says:
“Once one has learned to see clinical patterns that have been observed for decades, one can throw away the book and savor individual uniqueness.”
However, my concern is that such patterns can affect what we see and experience. I worry that we are too comfortable experiencing a unique individual as being just another hysteric or borderline or obsessive compulsive described in the DSMs. This may obscure other features and patterns that make discovery of the uniqueness of each individual quite difficult if not impossible. If Copernicus had stayed with the received
wisdom that the earth and not the sun was the center of our universe, science would not have advanced. Received wisdom can be wrong! My point is that the way people have seen things for decades, directs and clouds our vision. Of course, I realize that what we have learned will always influence us, but my plea is to be aware of the tendency to categorize, and to replace that tendency by cultivating an open mind. Hearing a person as a unique individual must come first. If we need a frame of reference how about this: the past determines the present and what cannot be articulated will be enacted or acted out. There is a natural course of development and when it has been compromised it is the dyad's job to clear the way for its resumption. Patients who are uncooperative have reasons!
I have not seen evidence that convinces me of the categories that DSM has devised even though they are compelling, and I have seen evidence that these categories tend to narrow our thinking, influence our perception, and leave us spinning our wheels. But most importantly, a label can obscure the uniqueness of each individual patient. So, although there is comfort in categories when used as shorthand, or for insurance companies, I fear that the patient and the therapist may get lost in the label. Boxes are like fences to me and a favorite song of mine is Don't Fence Me In. I think in terms of development, so separation-individuation and its sub-phases, along with object constancy, and differentiation, are helpful concepts. Did someone get stuck along the way, and if they did, how can they get back on track, I wonder? I use the word “wonder” a lot because it leaves the door open for new ideas and because I hope my co-traveler will wonder too. The arrogance of certainty cuts off so many options.
Phillip Bromberg's (1996) work with self-states makes great sense to me as does a favorite book by a non-analyst psychologist Stranger in the Mirror: the scientific search of the self, by Robert V. Levine . Both authors write from different backgrounds but come to similar conclusions: we have many self-states that are not problematic. One is not using the same self-state when facing an emergency as when learning a subject in school or when making love. In fact, what we deem pathology was once adaptive. If we see the adaptive aspects of defensive character structure, our ability to relate to our patients is enhanced. People often forget to think “What's right with you?” Seeing the glass half full helps me. I have said to a patient something like: “Hiding from the truth
(avoidance or denial) was helpful when you were a child but now it holds you back. It's like trying to walk in shoes you have outgrown. They helped then but now they pinch making it hard to move ahead.”
But you will say, what about the truly impossible patient, the patient who is hostile to the whole idea of therapy. Chapter One, Let's Fall in Love, discusses this dilemma. Bottom line, it is up to the therapist to find creative ways to respond. And sometimes treatment just doesn't get to first base. We do strike out. We are human.
Therapists, like their patients, like to feel safe, and because the familiar is safe, we often cling to it. What we learn in the psychoanalytic institute is difficult to forget. It took me many years to move beyond what I learned in the 1970s and 1980s. I question the set-up of our learning institutes. Just as each patient is unique, so is each student and I hope that can be taken into account. Tailoring our knowledge to the individual is an art that must be nurtured. Each dyad creates something unique. So, when I said in the beginning of this introduction that nothing is new, I also think everything is new when you expand your vision. I recently discovered David Eagleman, and I highly recommend his podcast Inner Cosmos, his TED Talks and books.
Readers who are dissatisfied, in pain, or curious about psychoanalytic work may be inspired to take a journey inward with an experienced companion. I know of no other journey that is more fulfilling. Chapter Three describes our work as a meandering journey, which will hopefully serve as an invitation.
Not many people leap onto our couches or into our chairs, or even understand our method of work, so degrees of explanation are in order, always tailored to the unique patient. Explanations have not been part of classical work, and I wonder why. Most analysts prefer interpretation, which tilts the field, putting the analyst on a higher plane. After a certain amount of time in therapy, it is the patient who will come up with ideas that contribute to growth.
People have a right to know something about what they're getting into, and the explanations offered and the ways they are offered can determine the outcome of a first meeting and even of a whole analysis. Everyone has stories to tell and the very act of telling them to an attentive
listener promotes growth and solves mysteries. Sherlock Holmes also said: “Nothing clears up a case so much as stating it to another person” . This holds true in working psychoanalytically where colleagues often see our blind spots. Enjoy Chapter Eleven on storytelling.
The fact that a person makes an appointment and keeps it indicates strength and courage. If we remember that each dyad is unique, improvisation is natural, and intuition guides us. Genuine spontaneity is important. Messiness is allowed when working this way, but the dyad works towards repair. Claudia Gold and Ed Tronick explore this idea in their book: The Power of Discord. This essential aspect of the dyad's work relies on the present, what we refer to as the here and now interaction, and it may even take precedence over revisiting the past. It may also include the past as reference point. “This reminds me of the time when my sister was born and I was supposed to be the big girl all of a sudden,” said one patient when discussing her experience at a new job. Her memory opened a new door quite naturally, a door that illustrated the past's influence on the present. “You just sounded like my father” said another patient leading to memories of a man who died long ago and who had not been mourned.
Psychoanalytic work is filled with stories, and I have found that at times the therapist's stories are a useful part of the relationship. We call this self-disclosure, and it has been frowned upon by classical analysts. Some might even call it a boundary crossing. But, when the analyst has something to share that is appropriate to what's going on, it seems only natural to do so, spontaneously and genuinely. I give an example in the Listening chapter. I think of my meeting with patients as containing both playfulness and heart-to-heart conversations along with my reflective capacity.
The therapist acts as a guide/companion on the trip of exploration. A crucial aspect of this journey is the motivation to inhabit the present, to envision the wished for or dreaded future while visiting the past when it sheds light on both. Exploring all three dimensions helps us understand ourselves without the need to master ‘string theory’ or ‘time travel.’ I think that saying “That reminds me of xyz” encourages us to use what comes to mind—what we call free association. Instead of making free association a rule, I see everything a patient says as free. And if he decides to withhold something, I assume he will figure out why as we go
along. I have said to patients: “As we meet, there will be things you wish to keep to yourself. When that happens, try thinking about why. What would happen if you just said whatever pops into your head?” Usually, things withheld involve shame or lack of trust and as the bond strengthens, the patient will feel more comfortable sharing what she thinks. Motivation is enhanced by the rapport established—and it is up to the guide to set a tone of benevolent curiosity. Before trusting one's travel companion, a period of assessment and testing occurs, and each party uses both their conscious intelligence and their gut feelings to determine whether the trip feels safe enough to embark on together. I talk about this testing in the Chapter Three: Self-Murder.
Developing trust takes varying amounts of time but it is indispensable when traveling. Patients test us, consciously and unconsciously, so the frame is necessary because it guarantees safety.
I think of the dyad's work as a long conversation, or as solving mysteries together. These analogies help me explain what I do. Struggling to get an idea across can get messy. Ed Tronick points out that Fred Astaire and his partners surely stepped on each other's toes while practicing before their performances. We make mistakes and we recover. In the recovery lies the growth. And when we goof, we apologize.
I begin this book with my first experience as a therapist, still in social work school, with Chapter One: Let's Fall In Love. I wrote these chapters with love—for the field, the patients, my colleagues, and those who I supervise and teach. Love does make the world go round; we just have to find it. I would like to see us all more comfortable with the basic love we feel—the libido Martin Bergmann and I spoke about in Chapter Twelve.
I realize that many ideas show up in multiple chapters which is why skipping around or reading at your leisure is okay.