An earthquake measuring 7.0 on the Richter scale struck the San Francisco Bay Area on October 17, 1989. Almost 70 persons died, and the communities of the area sustained substantial physical damage and disruption. Although other recent earthquakes, such as those in Mexico City, Soviet Armenia, and Iran have wrought far more terrible destruction, the impact of the Northern California quake has been significant for those living in the area.
In talking with others in the local psychoanalytic community, I began to wonder what the earthquake might have revealed about the psychoanalytic relationship, and how fresh perceptions gained about this relationship might have, in turn, affected the process of an analysis or analytic psychotherapy. “After a traumatic event, people attempt to reorient and in so doing may look at their attachments with a new eye.” Hitherto unconscious aspects of their relationships may emerge into greater awareness. Disastrous events also call for new responses, which may allow for the emergence of facets of the relationship that might otherwise have gone undiscovered in the regularity of treatment.
To look into what could be learned about the analytic relationship, I asked my colleagues who among them had observed something of interest in the aftermath of the quake and would be willing to tell me about it. I spoke with a number of analysts practicing in the area. Their experiences and observations highlighted several different phenomena. These included (1) the “crystalization” of a transference (a term I borrow from an article by Stanley Weiss, 1975), at times related to the fuller recovery of an earlier trauma; (2) the effects of the analyst's actions that were construed by patients as expressions of caring or concern; (3) the realization by the analyst of hitherto less conscious aspects of the countertransference or the real relationship; and (4) the patient's realization of the intimacy of the relationship and the “reality” of the analyst in a way which is often defended against.
One analyst, Dr. A, described the clearer emergence of a transference in conjunction with the recollection of an early trauma following the quake. A young woman who was employed coordinating certain civic services became increasingly involved in care-taking activities after the quake. She plunged herself into these activities and in the ensuing weeks was in an excited state. She began to consult on problems outside her immediate workplace, and there was no request for help that she would turn down. It became clear in the treatment that she became upset if she was unable to fill all requests for consultation.
Of note in this woman's history was that her mother had died when the patient was a young child; throughout the analysis the patient and the analyst had dealt with an ebb and flow of feelings and wishes that seemed related to that early period. One transference aspect of her current activity was that she seemed concerned with showing herself to Dr. A in a wonderful light. Dr. A, noting a “little girl” quality in the patient's zeal to present her dedication, thought that perhaps the patient felt that through this work she could revive her dead mother.
Three or four weeks after the quake, she had become increasingly irritable, a bit frantic, and somewhat depressed. She then dreamed of going into a cave with a subterranean chamber and finding the body of her mother stretched out on the ground. Initially it was not clear whether her mother was alive or dead; it later appeared that she was closer to being dead but in a preserved state. Dr. A interpreted that the patient had hoped to get her mother back through her good works and was disappointed that it could not be done. The patient became further depressed but began to work through some of these themes. It appeared that dealing with the earthquake and other peoples' trauma had allowed the atient greater access to the unconscious fantasy of a mother in suspended animation and the possibility of reunion, given the “right” behavior.
Another analyst described the effects on treatment of the ordinary, caring, humane acts that one finds in the wake of a shared disaster. Dr. D was seeing a woman in analysis when the earthquake struck half way through an hour. The patient, an English professor in her mid-50s, had been in analysis for two years. The building shook significantly during the quake, and the patient was quite upset. She needed to cross the Bay Bridge to return home. That evening around ten o'clock Dr. D and his wife were having dinner in the dark when the patient came to the door and explained that she had found the Bay Bridge closed and then had spent several hours in traffic waiting to get to the Golden Gate Bridge. Knowing that the analyst lived in this neighborhood, she had come to ask if she could spend the night. Dr. D did not feel that he could deny such a request so he invited her in, and after finishing dinner and talking for a while, everyone turned in for the evening. After that incident, the patient began to do better in the analysis and was able to remember more about her love for her father. She attributed these changes to a feeling that the analyst cared about her; Dr. D also felt that her feeling that the analyst cared had helped the treatment improve.
The reorientation and scanning of the environment following the quake brought certain attachments into increased awareness for a number of analysts. One analyst spoke of how she became aware of knowing many details of her patients' lives, such as who might have been commuting in dangerous areas at the precise time of the quake, or particular ways her patients' lives would be affected by the pursuant destruction or disruption. She became more aware of the intimacy of the therapeutic relationship, especially in terms of the tremendously diverse lines of connection, which may often be in the form of preconscious
knowledge. She also noted that she found reason (her absence from her office for several days) to contact all of her patients, even those without appointments that would be affected, and incidentally learn of their welfare. Her impression was that this contact had had a small but positive effect on the treatments, except in the case of one woman patient for whom the call seemed to be an unwelcome penetration of her bubble of denial about the impact of the earthquake.
Another analyst, Dr. E, told of the day following the quake. The electricity and the telephone service had been cut during the day of the earthquake, and the telephone only partially restored the next morning. He had returned to his office and decided to wait to hear from patients about whether or not they would be coming in. He later decided to call the ones he had not heard from by the end of the day. He was aware by then of the fire and the building collapses in the Marina District and found himself especially concerned about a patient who lived in the affected portion of that district with his wife and month-old baby. Dr. E. decided to call. It was a lucky call, as the patient's apartment had been just about flattened, and the patient and his wife had just come into the apartment at that moment to pick up some things and then go somewhere else. Dr. E asked how the patient and his family were, and the patient responded that they were all right. He and his patient they arranged to meet the next day at the usual time.
On hanging up the phone, Dr. E realized how relieved he was to hear that this man and his family were safe. He also reflected on his sense of concern for those he had not yet heard from. For him, the experience was a vivid reminder of the emotional importance that patients have to us as analysts. He did not feel that he had ever minimized the role that patients play in our mental lives, particularly unconsciously, but this experience brought it to the fore. He noted that “whatever we choose to call it, countertransference or whatever, the fact is that they have considerable importance to us and become, in a way, family. That experience pushed into awareness something that had been there, but not as clear and has since faded.” (Dr. E and I spoke in February 1990.)
In trying to assess the effect of the phone conversation on the analysis, Dr. E felt that it had proven to be quite important. The patient had speculated earlier in the psychoanalysis about how much Dr. E cared about him, and this telephone exchange was quite moving to him. A transference shift ensued, permitting further analysis, in a different context, of particular resistances to the transference. Dr. E remarked that one might anticipate other transference reverberations, such as feelings of seduction by the analyst in the incident, but noted that no further evidence of that kind had appeared yet.
An instance of discovering unusually strong feelings toward a patient was described by Dr. G. He told about a young architect who had begun analysis in July 1989. The patient was a talented, bright man, who had noted early in treatment that he seemed to be “screwing up things” that might otherwise have gone well in his work and relationship life. The early months of treatment revealed that the patient had reached a level of job performance well beyond that of his siblings, and it became clear that he felt responsible for his father's death when he was in his midteens. In a fairly straightforward way he said that he had become the man of the house after that. By October, Dr. G had a general sense that the treatment was enjoyable and would probably work out, but was not cognizant of any particularly strong or unusual response beyond that.
On the night of the earthquake, the patient, not unexpectedly, did not show up for his evening appointment. Dr. G anticipated a message, perhaps joking, saying that the patient would see him on Thursday (the quake took place on a Tuesday evening at 5:04 pm). On Tuesday evening it occurred to him that the patient lived in a section of the Marina that was burning. The patient did not call Wednesday and then did not show for his Thursday morning appointment. Dr. G began to get extremely worried and started thinking what a tragic loss it would be if he were killed. The worry and concern built through the day until Dr. G decided that not knowing was more than he was willing to put up with.
He called the patient's home. There was no answer. Then Dr. G called the patient's workplace; an automated message system informed him that the voice-mail was full and could not accept any more messages. After several more hours of worry and mounting sadness, he called the main number of his patient's firm. A co-worker explained that no one had seen or heard from the patient, that there had been hundreds of calls inquiring after him, and, worse, that his keys and wallet had been found in his office. Dr.G spent the rest of the day and evening suffering with his sense of loss and reflected that these feelings were of an intensity he would more expect to have about a loved family member.
Friday morning, when he went to his waiting room at that patient's appointment time, he found him smiling sheepishly. The patient told of being caught by the quake away from his office, then finding his home destroyed, and eventually feeling reluctant to return to work, in part because he had learned of all the messages awaiting him. He said he could not bear the thought of returning to tell his story and listening to his co-workers' expressions of sympathy, goodwill and concern, and listening to the messages to that effect.
At this point, Dr. G began to realize, in a way he had not realized before, how much he liked this patient and, in fact, how generally likable this man was. Clearly, most of the people in this man's world felt the same way about him, and it was about this very issue that the patient felt such conflict (though Dr. G notes that this was a complex compromise formation, and there were ways in which the patient elicited sympathy and anger as well). On reflection, Dr. G felt that one of the reasons he had not been aware of liking the patient so much was precisely because this patient was made uncomfortable by being greatly liked, defended against awareness of it in various ways, and behaved in ways that helped to obscure that aspect of the countertransference.
Just as the analyst may defend against an awareness of intimate feelings, we might expect our patients to do so as much or more. Dr. H described his experience when he returned to his office the day after the quake. His patients by and large asked him how he was, and, after giving brief thought to the impact of answering, he said he was okay. He also answered the questions that some asked regarding whether he was in the office at the time of the quake and how the office had fared. Although he had spoken with colleagues who felt that the
appropriate course would be to take a more immediately exploratory stance and inquire into the fantasies and thoughts of the patient rather than answering, Dr. H felt that the situation concerned a shared communal reality rather than an inquiry into his private life, and hence he looked at it somewhat differently:
“I didn't know how you could handle that without making the patient feel stifled; even with the most dexterous attempt, I think the patient would get the message that you're not supposed to ask, or you're asking about my personal life, or you've crossed some line.” He illustrated what he felt were the benefits of his stance in the following description of his interaction with an obsessive man who came in the day after the earthquake:
“This is a man who mostly wards off the transference, in fact there are times that he and I have talked about how his transference; is that he doesn't have a transference. He comes in and says, ‘Where did I leave off yesterday,‘ and almost always after thinking about it, he can remember exactly where he left off, and he starts back on whatever he was obsessively thinking about, which is almost always his girlfriend.
“On the day after the earthquake, he plowed into almost a litany of sorts, and after about five minutes I said, ‘It's interesting that you didn't mention anything about the earthquake.’ He stopped and said, ‘That's right’ and made some sort of comment about what it had been like for him and how he thought he had handled it pretty well. He gave me a little of the nuts and bolts of the whole thing and then went back to talking about his girlfriend.
“After a while I said to him, ‘It doesn't seem as if you have any thoughts about what it might have been like for me.’ He answered. ‘No I haven't.’ Then he said, ‘Now that you mention it, since it happened, the first thing people say is “What happened to you?” When I was in the waiting room I did sort of look around to see if anything had happened. When I saw you it didn't occur to me—come to think of it, I did kind of look around the office too. I think I kind of wondered, but it didn't really occur to me to ask if you were okay or if everything was okay.”
“Then he stopped and thought that it must have been on his mind because he did think about it in the waiting room and he did think about it for a split second in the office. But he wasn't thinking about it vis a vis me. So I asked something like, ‘What do you think about the fact that you thought that?’ Immediately he answered, ‘That I'm not supposed to,’ that it would be against the rules, that it would be intrusive of him, that I would tell him it was not his place. He spoke with real poignancy.
“In all the years that we had talked about him and me, we had never gotten into the idea that I was off limits. He knows about transference and that some people have analyses that are different from his. Sometimes he wonders why he's not having a transference as the people in these books have, but this was the first time that he said, ‘I'm not supposed to wonder or ask about that. You have your role; I have mine. I'm not supposed to ask about yours; it's personal, private.‘ He seemed to be aware of a certain curiosity, but at the same time seemed to feel that to ask about me was forbidden, bad. He wanted to know about something private—it wasn't business; it wasn't what you were supposed to talk about.
At the same time that didn't quite make sense to him. He knew from reading, for example, Janet Malcolm, that other people in their analyses talked about their analysts and talked about their fantasies and thoughts about their analysts; but for him to do the same felt like crossing over, and he was really uncomfortable with it. He kept this topic going for at east the rest of that week. It felt to him personal and private, At one point he said, ‘It would be like calling your home, and, of course I could never imagine calling your home.‘
“I think this man uses his obsessive character and defense to defend against his making connections between any kind of thoughts and feelings in the transference. The feelings, for the most part, stay outside his awareness. They are isolated and minimized. What I make of all this is that the external event frightened him and momentarily jostled the transference. It was the kind of thing that happens when you run into your analyst outside of the office—you share an external event that has different meanings for each of you but can have an impact on the transference and defenses against the transference.
“This patient suddenly and unexpectedly tapped into feelings he had been having about me that had been, by and large, outside his awareness. I think he felt a short of wistfulness about how unusual this was for him and a sense of disquiet about how much he had marshaled his defenses against it.”
“The earthquake confronted us with our own humanity, our reality; and for all those things that are defended against, the defenses were, for a moment, not working. The earth can open up; people can get killed. For some people such an event can be an opportunity to do work that might not otherwise get done. That there was a a real event that affected both people opened up a window that isn't usually there, and the reality of the analyst cannot be denied. The idealization is not going to work out. Most people are going to realize that you're going to be frightened or upset, certainly you're not going to be in a cape flying around doing everything, or making the right interpretation to make the earthquake stop.
“I was taught, not that there was a rule, but that you were not supposed to answer certain questions directly. You were supposed to say something like, ‘What are your thoughts?’ or ‘What are your fantasies?’ I can remember asking my analyst if he had seen a certain movie, and I can recall his response as clear as day:” Why don't you tell me about it?’ He didn't answer yes or no. He didn't ask me about my fantasies. I took his response to be that I wasn't supposed to ask a question about his private life. If he said yes, then I'd know that he liked to see movies, and I wasn't supposed to know that; I was supposed to have a fantasy that he did or didn't. I'm not saying that this was what was intended, but this is what I thought. As a result, I never asked a question again. More important, I never explored what I had made of his never answering the question.
“To return to the earthquake, there was a common reality, some feeling of reality more intense than the usual feeling about reality, and I think that was the profound part of it. An earthquake is one of the things that everyone is afraid of, but it's real. We have fantasies about it, but it's not like the devouring breast or merger, or the psychic things we fear; this is real! And it's shared. Not that I thought any of this through initially or beforehand, but eventually I came to think that this is a large opportunity to explore what is it like for this person and me to be in reality at the same time and have whatever our personal reactions are to it. This is not what usually goes on when patients deal with their fantasies. Of course they know you're real, but they usually keep that knowledge at some safe distance.
“I believe in transference and I believe in fantasies, but I think at times we should also be interested in the reality between the analyst and the patient. It is the reality of these two people locked in this very intense relationship. Both analyst and patient sometimes try to dilute that relationship with all the fantastic stuff. I'm not saying that isn't important, I'm saying we don't pay enough attention to the real part.”
Most of the interactions described in this report seem to have had, overall, a positive effect on the progress of the treatments. There are undoubtedly various additional factors contributing to this impression, including perhaps, our desire to find an arena of response to a frightening tragedy, as well as our motivations to discuss the positive effects of our work. Even so, there are several ways we might make sense of the forward movement or increased understanding in these analyses and analytic psychotherapies. The first is the simplest and is not unlike what we observe when a present loss reawakens an incomplete mourning process. For some patients, the earthquake echoed an earlier trauma; and in the context of an ongoing treatment, they were able to understand more of what they had put out of awareness concerning earlier losses. Second, the analysts'
spontaneous, authentic expressions construed by the patients as caring played a role in the patients' reassessment of certain beliefs and made it more difficult for them to continue to avoid feelings of being cared for or loved. We do not know the long-range impact of the analysts' spontaneous expressions in the situations described, but the positive responses reported outweigh the negatives at this point. Third, the reorientation or scanning of their environment following the earthquake seemed to allow some analysts to see more clearly into the strength and nature of their feelings toward their patients, which in turn promoted the process of understanding. Finally, the undeniably shared reality of the earthquake brought into focus the motivations that we and our patients sometimes have to avoid clear recognition each other's reality. “The reality of the other may itself be a particular source of anxiety that often receives short shrift in our usual emphasis on fantasy and the unreal.”
I would like to thank the eight analysts who spoke in detail with me about their experiences relating to the earthquake, as well as Mardi Horowitz and Charles Marmar for sharing their expertise on PTSD and its relation to the earthquake.