MSK: What I want to do in these sessions with you Jane is, maybe just as you suggest, focus on the book and then branch out from there. I have some questions but you're free to improvise. So that this is not fully structured. This conversation is about you and this work of yours and it can go in any direction it will take us. Is there anything you want to start with in the today's meeting
JH: do you want to know like who I am or a little bit about me?
MSK: I think you're well-known, but it would help the reader to give them some idea. I definitely want to know and as much as you think is pertinent.
JH: OK. well, I'm semi-retired so I have time to reflect. I still do supervision, consultation, and I teach but I stopped seeing patients about four years ago. Because, when I work with people I see them for long periods of time, and when I turned 80, I started thinking about how long I would be alert and around and so I stopped accepting new patients and started winding down. I ended with my last analytic case after a planned termination in July 2019 and with bitter-sweet feelings, closed my office door for the last time. I was looking forward to some travel, seeing old friends, and pursuing more knowledge, especially about the brain.
Also, I have been writing on and off over my professional career—actually since second grade when I wrote a mystery story in installments for the weekly class paper—and I had a few papers that I hadn't published over the years, so this book is a compilation of some of those papers. The idea of third book was a little scary because I had changed much of my thinking, but Arnie Richards really encouraged me.
I kind of critiqued the classical technique and theory I had learned. I graduated from a classical institute in 1981. It was very strict; I mean we weren't allowed to mention Melanie Klein so that's how strict it was. Bion, so popular today, was not even on our horizon. Winnicott yes! I
always had four or five analytic cases that had started in psychotherapy and my colleagues (at NYFS) wanted to know how come. I knew I paid attention to what I had been taught but I had also studied and graduated from Ruben and Gertrude Blank's Institute, ISP, before and during my early NYFS years. So, I think the blending of these two approaches, one where the focus was on the “less structured” patients—the so-called borderline—and the other on the so-called neurotic level patients. Building the ego versus analysis of defense at first confused me but as I synthesized these approaches I became a good clinician. I think more patients than we realize need both at different moments in a treatment. I hadn't been aware of how I evolved but as I look back, I see the roots. We were taught to just interpret the patient's material—not to answer questions —and to be like a blank screen at CFS. I remember one teacher who told us that we shouldn't even have paintings on our wall in the office because that would tell too much about us. I'm sure none of us followed that advice but we were taught that patients would find it easier to develop the transference neurosis with the blank slate therapist. I found that transference is ubiquitous and how it is used is the question. Now I guess I could never be too blank, so I never went along with that. My patients usually stayed in treatment, and they all began in therapy except for two who came for analysis. The others worked their way into analysis so that was how it happened for me. I think most beginners have real conviction in the process which patients pick up on.
So, my first book was about how I worked, I called it ‘Deepening the Treatment’—how to do that, how I thought I did it. That was what I tried to address, and it was very popular. It still sells; I still get checks for it which is nice.
MSK: that's impressive.
JH: I just got one the other day. I mean they're not huge but it's nice to know that people are still finding it valuable. It was published in China some years ago and that provided me with many Chinese students. This book is quite different, and I thought the first chapter might explain how I got to thinking this way.
To begin with, I was very lucky in social work school. I had a wonderful internship at a clinic called Greenwich House Counseling Center and it
specialized in treating people with drug related problems. They hired me after graduation so that was my first job. Patients didn't have to be junkies or drug addicts; we saw family members; some who used LSD or just marijuana; cocaine and barbiturate users; so, I saw a wide range of patients and I knew nothing. I worked with transvestites, prostitutes, lawyers, professors, a young man who was an exhibitionist, a cocaine addicted air traffic controller (that was scary,); a famous homosexual designer arrested in a public mens' room for lewd behavior addicted to amphetamines and placidil, and sent to my clinic to avoid jail time; a few artists, a middle class college student drug dealer who wanted to be popular and who eventually was able to tell me that his mother sexually abused him, and the list goes on.
I was a beginner, and I learned that connecting came easy to me. I mean I always made friends easily even though I have a shy side. And I have always been curious so one principle I learned in the very beginning of my education by reading the late Ella Freeman Sharpe, was called benevolent curiosity. That has been my lodestar. I am naturally curious but benevolent curiosity means without criticism, so I found that it worked for me. I didn't even think diagnostically. I just listened and talked to the person in a natural way and this book is pretty much about that. At GHCC one of my first patients – a young man in his late twenties, leaned in and asked me if I could hear the garbage machine in his head. I leaned in, said no and then asked him where he grew up etc. We needed a focus and though his question really threw me, I just sort of did the best I could.
In this book I use the term leveling the playing field. That was in stark contrast to the way I was taught. You know the doctor was up there and the patient was down here, and we made the interpretation, and the patient gave the material. I thought, you know, it's infantilizing. It's sort of like the way we treat our students too. I saw analytic work as a partnership rather than me being the all-knowing doctor and they just giving me the material that I would put together. I came up with the phrase ‘let's figure it out’. If a patient wanted to quit or was always late, I'd say “let's figure out why. You have a right to do what you want to do, but let's figure out why and then you decide.” I saw things as a mystery. Let's figure out this mystery. I think I'm talking too much right now. I want you to ask me some questions.
MSK: I don't have a sense that you are talking too much, not from my angle. I mean you already gave me two major themes and plenty other ideas that I am thinking about, so please just go ahead.
JH: Thanks Sagman—you're easy to talk with.
The ideas expressed in the book are inspired by my patients, my supervisees and their patients, my students, and the vast psychoanalytic literature beginning with Freud and including our most contemporary thinkers.
When I was a student—no computers or PEP-CD Rom—I would spend hours in the New School Library reading the assigned articles. Back then, probably due to an as yet unanalyzed rebelliousness combined with a deep curiosity, I would read a lot of the other articles in the bound volumes, saving the assigned ones for last. In other words, I wandered through the fields “picking up lots of forget-me-nots” (from a song You Make Me Feel So Young that Sinatra sang) that I stored away for later use.
Also, before, during, and after formal coursework I was in two long term ongoing seminars with Gertrude Blanck for five years and Martin Bergmann for about seven. I think I'm always learning and of course my patients taught me the most.
Only in the last fifteen years my learning curve changed, and it began with Norman Doidge's book “The Brain that Changes Itself.” I reviewed the book—it's about the plasticity of the brain. It gave credence to what I was learning. Norman says “use it or lose it” meaning the new object-analyst is like a new pathway in the brain and as you use that new object and all the experiences that come with it, the old pathway diminishes and becomes a tiny scar—fading away. I see it as involving internalization and new experiences and vistas take over the early ones.
I mention, with immense gratitude, the ideas of the following authors whose contributions, some of them well researched, have made a deep impression: Joseph Sandler, Norman Doidge, Rona Knight, Jaak Pankseep, Sandor Ferenczi, W.R.D. Fairbairn, Ed Tronick, Ella Sharpe, Bernard Berliner, Hans Loewald, and Leonard Shengold. Actually, there are many others too numerous to mention.
I also began questioning Freud who I think was obviously a brilliant man and we wouldn't be here without him probably. But I think we tended to revere him as though he were a God or something like that. I can look up to people, but not to that degree and I hold on to my right to be curious and even questioning. As an example, I never liked the concept of the Oedipus complex being focal. And the phallo-centric theory that he developed, I took issue with, and I found a few papers who agreed with me so that was nice. I think today in the twenty-first century we pay attention to the mother's influence more and I think so many of my patients all had problematic mothers so that if you want to use only the Oedipus complex it doesn't work. And we must learn about Laius who tried to kill him.
You know if your mother is a problem, and you love your father it's scarier than if you have a nice mother and so I kind of challenged that theory as being central. I think the mother has a huge influence on character and I think most analyses I have conducted or been a part of as a supervisor fit what Ernst Kris called strain trauma as opposed to shock trauma. Shock trauma is if you get raped or something horrible happens once. Strain trauma is ongoing and becomes an undercurrent of a child's life. So, if a child grows up in a what is called a dysfunctional family, he may not be abused physically but the climate that he grows up in is anxiety provoking. PTSD. You never know when the mother is going to blow up or the father is going to come home drunk and angry, those kinds of things. But the mom's helplessness in such cases was as injurious as the dad's abuse.
My patients, pretty much all of them, had such early situations. Even the ones who functioned beautifully. People can function very well but as you go along after a while you realize that they have trouble with relationships. They can be the CEO of a hugely successful company, but they can't really sustain a relationship, especially in marriage or even a real close friendship. They may have superficial friends but because they're always worried unconsciously that whatever happened in childhood is going to happen again with the person they choose, they shy away from developing intimate and deep relationships. Trusting another is frightening.
I think a famous tech-billionaire who is in the headlines nowadays is a perfect example. Here's a guy who had a crazy childhood plus he was a genius so you know you can just look at him and see how his brilliance was compromised by his pathology. His hunger for attention is enormous and I wait for him to crash and burn. His many followers will be devastated because they sort of lived through him. To me it is quite plausible that he wants to go into outer space—that's how far one can go to avoid psychic pain. For good personal and unconscious or split off reasons.
Phillip Bromberg is important in understanding dissociated states.
MSK: that's a good point and let me ask you a question. You already highlighted half a dozen things that catch my ear. There's something when I read your book. It's as though there's a subtle theory of yours that I understand quite well because in some ways it's also very similar to the way I think. It's as if you learn from yourself—like this gentleman and your first patient who was an ex-drug addict. The encounter you described was very touching for some reason.
Now, it is a fact that at that moment in your life you were a very green social worker. The way in which he related to you, and you related to him, feels quite ordinary in our intimate relationships, be it a love relationship or friendship. And perhaps for some good reasons it is something extremely rare in professional relationships.
There is something centrally and deeply human about the way you relate, or “connect” as you would put it. It's not psychoanalytic per se, not a technique or stance but it's a very common, well known, unarticulated interest in humans. A very basic human interest. You know what you said about ‘benevolent curiosity’ in other discussions we had. In our corporatized world of treatments, it has become a rarity. So, when you were 18 you were talking with your doctor. But that is an anomaly now. It is interesting that as psychoanalytic clinicians, one central function we serve in places like medical schools is to remind, re-teach the young clinicians on how to listen to and talk with patients. A prominent analyst Brian Bird has a book about this—from 70's I believe.
Me and my wife we wrote and presented a draft about this what they call the real relationship versus transference. You know how we subtly demean real relationship and emphasize the transformative power of
the transference relationship. It is interesting that when you go back to Freud, and you read his papers on technique very carefully there he talks about a very basic relationship that you kind of mentioned about that curiosity. It is almost like an inborn curiosity we have in others. He calls it effective transference and he says everything is built on that we're curious about others and then you just let it go and then the therapy unfolds
JH: I think the same thing goes in our own analyses, yes, we are our best analyst. I mean the analyst opens certain doors for us. Sometimes we go through them to look at what we may not have considered but I think once we get that idea at least for me that was what happened—we're on our own.
I had three analyses. I started when I was 18 years old, and I didn't know a damn thing about analysis. I had just come home from my honeymoon. I got married when I was 18 and I and I wasn't very happy. I couldn't sleep, all my friends were at college where I had been planning to go and here, I was at home without any friends and I was not the happiest camper, so I went to my regular doctor. He said go talk to somebody. I remember very well that I said, “well I'm talking to you”. I was fresh because he seemed to be rejecting me. He said no go talk to somebody who knows about these things, so I went to my first analyst.
He was nice enough you know, and he pointed to the couch. I said I didn't understand why I should use the couch. I didn't know a thing! I mean I really didn't know. And so, I used it and all I could do was look at his ceiling and see all the cracks. I said well you have a terrible ceiling, it is all cracked—why don't you fix that, and I went on like that I mean I didn't know what else to do so. As I look back that had meaning but he didn't pick up on it so that's why right away you know there was stuff there that he missed completely and eventually he let me sit in the chair. Then I would look out the window and talk about the weathervane outside and he thought that was resistance. I was just using what I could see—a weathervane.
Now as I look back, he might have used weather as a metaphor. I was really talking about the weather in my home life when I grew up. We never knew when a hurricane was coming or when it was going to be a sunny weather, so that fed into my character. Being on guard. And here I was
talking about the weather, and he didn't pick up on that. And although he was a nice man, I think maybe he thought I wasn't ready to hear it as a metaphor. If a patient of mine was like that I think I'd find a way to share my thoughts. Not as interpretations but as a partner. I might say something like:” Let's see if it has more meaning—like stormy or sunny or rainy” This way I offer my thought, and she can take it or leave it—but she might consider it. I didn't get much in my first analysis. I got the idea that he would listen to me and that he was a nice person, but I didn't really get anything. We couldn't talk with one another; he couldn't read me. We couldn't be on each other's wavelength so to speak. On the other hand, he was there for me and that was very important.
He was into the Oedipus complex, and though I adored my father because he was the steady one in the house, and he loved me, my mother didn't. She never wanted kids and so I had a skewed family. I don't impose the Oedipus myth that Freud chose though of course it had a place. Narcissus was a better myth I think that he should have explored more. Oedipus's parents abandoned him as a baby—and Freud never focusses on that. Child abuse and neglect goes on today way more than we like to face. Statistics are horrifying and they only count physical abuse.
MSK: I honestly think they're interpreting the myth of Oedipus Rex quite partially. As an example, they don't understand the seduction of the mother in Oedipus. I think it can be interpreted in many different ways and that the dominant interpretation is I think very partial.
JH: Jocasta and the Laius father both let their baby go and left him on the mountain. I mean maybe in those days that was customary but in Freud's Vienna you didn't do that. The other thing that I must mention is I got very interested in child development which I think he saw only through the psychosexual phases. I mean he had the oral, anal, phallic phases and all that stuff. OK that's interesting but I think he missed how a child developed—how the brain is formed. Not long ago I got very interested in David Eagleman's podcast on the brain. At the same time, I was very inspired by Norman Doidge who talked about the brain's plasticity. The Freud I learned was into drives and death instinct and with Anna the defenses that were to be analyzed. I don't know what else to say. They impressed me but so much more has happened with neuroscience, and we must incorporate it. Tronick has given me so much to think about.
MSK: I feel like I have a question that is coming to mind as we speak Jane. You seem to have kept a rebellious and independent spirit alive. Was it hidden or were you able to talk about this in the analysis or with some others?
JH: I'm rebellious in that I don't buy everything that I'm fed. If I don't get it, I'll search more. I won't just be a ‘good’ student all the time. As I told you before it is easy to define me as a “good, warm” person. And that is probably true about me. But I am not a “goody two shoes” at all. I've analyzed that but Hartmann talked about ‘change in function’ and although I've forgotten it exactly, maybe it applies too. The ego somehow changes the instincts into higher level activities.
When I was a student, we didn't have computers, so we had to go to the library to do our reading and the journals were in these big bound volumes. I would go and I would read everything else before the assigned literature. I learned a lot that way. I would just read an article, and I said that's interesting. I would just flip through a journal and read all the articles that caught my attention so that was a rebellious thing I think in my character. Someone I used to know said it had to do with the primal scene—maybe so but so what?
MSK: how did you read them? I have the fantasy that it was a secret relationship you had outside of the confines of the institute one may say.
JH: I don't know I would read the International Journal, or any journal and they were all in this big bound volume so I would just open a page, and I would find an article and I would read it. I didn't discuss it I just thought about it and went on.
MSK: You thought about it on your own.
JH: Yes of course. I don't know how I can explain it. There are many angles—wanting to know more… being competitive—being hungry—I would read about techniques, and I would read about other theories, and I don't remember what I read—this was a long time ago, but I can say it was an absorbing interest. And sure, I can relate this to my mother who probably had a mood disorder which scared me and also angered me.
MSK: You took the reading seriously it's not like you did it read it for the sake of reading it.
JH: Took it very seriously, would spend hours at the library.
MSK: You gave serious attention to it, so you secretly had more teachers you were talking with. That was secretive and rebellious and here I use rebellion in a creative way. To me it seems that during those times you don't say your criticisms, disagreements out loud, right? They would treat you as a heretic of sorts I assume.
JH: Of course. In school I went along with the line in the program and uh I think today students they're a little different. The manners were different before the sixties. We didn't challenge the teacher, but I mean we would talk together in the elevator after class. That spirit of not challenging the authority still persists as a powerful undertone. But that is a whole other topic, and it's still the same way about diagnosis. I believe that to give a patient a diagnosis like in the DSM diagnosis you see through that lens and it's still the same way about diagnosis. I believe that to give a patient a diagnosis like in the DSM diagnosis you see through that lens of borderline or obsessive you know whatever they have in there. I can understand that could be helpful, but you'll miss other things when you put a person into a box no matter how hard you try. Nancy McWilliams has written beautifully about how helpful it is—but it does a disservice to a patient for me. What one can learn in diagnosis is often true, but a sensitive therapist will know intuitively, I think. Kohut did give us good advice about working with the narcissistic patient which is always frustrating and often impossible.
MSK: After many years I understood the following. In a session if I start thinking about diagnosis and theory, I am as a rule, feeling stuck. That is when diagnosis and theory emerge as a preoccupation in my thoughts. One may say I'm calling some higher powers, diagnosis, my teachers or Freud for help So I take it as diagnostic of my situation that I am confused or feel stuck.
Jane, I can't fully articulate this, but it is as if we think similarly, there's a common trend here. I think you're an eternal apprentice in the work. You learn from the patient and the way you work as a dyad. Thus, a main teacher becomes you, Jane Hall in relation to the patient. Of course,
theory is very helpful but if you start with the theory and go to a patient then I think you'll lose the experience you are immersed in. If you go from the experience to theory than you are in terra firma. Sullivan named this as participant observer, but I believe we can add another word participant observer thinker. Something like that.
With this stance, in my opinion you avoid becoming self-psychologist or object relationist or one of many such schools. But you become who you are, and I think we, at the bottom, are at our best when we are our ordinary professional selves. And that defies any school of psychoanalysis.
JH: Agree fully. I was lucky to study with Martin Bergmann for years. He used to say ‘Even if you don't like an article or you don't agree with the author, you learn something. Every article has something of value’ and that to me is an open mind. We need to have more open minds. You know how they argue at meetings; I wonder why they can't say “tell me more about that. I just need to hear, let me think about it let me consider it. I don't usually think that way but it's interesting let me think about it”. Instead of just knocking it down. There's so much nastiness in this field, have you picked that up?
MSK: Yeah, we're like political parties.
JH: How can we believe in analysis if we're so nasty to each other. What kind of analysis have people had? I mean the narcissism is unbelievable. And I don't think you can really help that much, a real narcissist is very difficult to treat, if they decide to come to treatment, which is rare in itself. I mean I supervise several people who have narcissistic patients and it's really difficult for them…and me.
MSK: I think one of the wonderful things about your book is you make how you are with and work with the patient very clear. Jane Hall appears as a therapist as a unique individual and thinker and a clinician so that's really very generous of you for the interested reader. You manage to not hide behind jargon and heavy words but say ‘this is how I think about it, and this is what I do with it’.
JH: Maybe I can end by saying I think we do not remember enough that everybody is unique. You just said, unique in the way we connect. I mean one person will connect with you differently than with me, so the dyad
creates a unique body you know—I use the word uniquity—I made that up I think—I don't know if that's a word. And that's how jazz music came into this book because the jazz musician will play something differently every time. Every performance is unique and even the same song they'll play it differently; they're free to improvise. JIM
MSK: I like your concept of “uniquity”. It is wonderfully apt and creative.
JH: Thank you, Sagman, for talking with me—you made it fun and comfortable. I'd like to add one idea that really impressed me from Warren Poland—he speaks of “Witnessing” and I think this an incredibly useful concept that no one seems to talk about. So, I end by recommending his paper.