Many of us recall a time when analysts warned their patients not to make any major life changes until after the analysis was completed. Many years later, we find ourselves sometimes putting the analysis on hold, or making some significant structural changes in how we conduct analysis to accommodate the unfolding demands and shifts in our patients' work life.
The nature and structure of work has always shifted over generations. Recent changes in how and where people work and shifts in what people do for work have created some real opportunities for the conduct of our psychoanalytic work, as well as some serious challenges.
Just in the past year I have personally confronted the following dilemmas: How do I conduct an analysis for a financial analyst whose job demands he frequently travel abroad for week-long stretches? How do I accommodate a physician whose work and on-call schedules shift each week with short notice? How do I conduct a treatment for a professional woman caught between the demands of a full-time career and full-time household responsibility for managing her family? How do I confront the expectations of a young student whose friends have dropped out, started new companies, and quickly become millionaires? How do I help someone understand the abusive nature of his relationship with his spouse when the rest of the world regards the couple with awe and admiration for their ability to repeatedly start successful businesses that earn them millions of dollars? How do I talk about self-denial and limits when financial and material rewards may be boundless?
Travel and scheduling present one set of difficulties. Maintaining continuity in the face of travel may lead to erratic scheduling — extra hours when the patient is in town, telephone hours to maintain continuity when away, and an analyst's tolerance of uncertainty in his or her own schedule. Some patients have a hard time appreciating the importance of frequency and continuity of sessions when their chaotic work life leads them to expect and tolerate constant disruptions and shifts. Their work responsibilities shift. Their schedules vary from week to week. They are asked to travel with little warning. We try to accommodate them in our work with them but urge them to try to accommodate the need for regularity and constancy in the treatment if it is to be helpful.
One patient uses e-mail and “snail-mail” to continue her analytic journey while posted for extended stays in third-world outposts, where either treatment is unavailable or her position of prominence and leadership makes her an inappropriate candidate for local treatment. Several patients of mine start out each month blocking out days and hours for the approaching weeks. One patient “reserves” his hours a year in advance, then cancels or changes them each month as he gets notice of work travel and unchangeable meetings.
In today's work world, organizational loyalty is transient. People switch from job to job as new and better opportunities present themselves. Employers hire someone in a burst of excitement and expectation, only to lay them off the next month when the company is acquired, a new boss takes over, or a new strategic plan makes the position expendable. What's valued at work one day is irrelevant the next. People's stars rise and fall with slight shifts in the marketplace or changes of management. Commitment to job or employer is almost a thing of the past. Workers must look out for themselves first. Building and consolidating skills, flexibility, and competency in a variety of work tasks are essential to be ready for subsequent work opportunities. Along with continual career changes, people come to recognize that they need to fortify themselves defensively against the inevitable losses that accompany such changes. This cultural reality applies to the analysis as well. Culturally reinforced resistance to attachment spills over to resistance to the analytic process and to involvement in any long-term treatment.
When jobs and employers shift abruptly, people must quickly make their mark to prove themselves to their employers or their investors. This expectation can extend to the analytic treatment. “Fix me quick; I must quickly fix problems at work.”
The cultural validation of the pursuit of fast money often leaves people feeling empty. They are caught between pursuing something they value and respect vs. pursuing a track that will lead to quick wealth and material gratification. As people are drawn to the prospect of phenomenal wealth, they often express deep conflict, guilt, and regret; they see themselves selling their career dreams for materialistic opportunities.
One problem of the new wealth is that with the sense of boundless opportunity, narcissistic expectations may be mirrored and affirmed by the reality of their circumstances — “you can have what you want on demand.” If enough money can buy anything, is this true for happiness and satisfaction?
One man I see in analysis finds himself conflicted in his career as a financial analyst. His skills are highly prized, and he is continually recruited for ever more lucrative positions. He sees the content of his work as superficial and not touching on human and spiritual issues. He dreams of a meaningful career in an area that doesn't involve the study and pursuit of more and more money for investors and for himself. Yet the lure of financial security and an early retirement keeps him going in his current career. He hates the loud-mouthed people he encounters who brag about their wealth and expensive toys. Yet he lives in a world where getting rich is the key to social acceptance and admiration.
Another man I treat sees that he missed out on the most important moments of his children's development as he traveled from coast to coast, building his empire. Beyond making himself more physically available to them, his compromise solution to running a transcontinental company has been partially assisted by technology. He has connected his children with their own cellular telephones, each with his private cellular telephone number. He is now accessible and in communication with them night and day.
Kenneth M. Settel, M.D., is co-chair of the Ad Hoc Committee for Corporate and Organizational Consultation. He is on the faculty of PINE and serves as a clinical instructor in psychiatry at Harvard Medical School and principal of Spectrum OED, a group of analysts consulting to business, in Brookline, Mass.
Patients begin to wonder if all the pressure and family sacrifice is really worth it. Lawyers may trade in the high-paying partnership position for the lower-paying, less demanding in-house career. Some women may resign from their corporate jobs that demand long hours to spend a few years at home. A few enlightened employers even allow part-time or job-sharing positions for those who opt for a more balanced life. Although these people often find themselves struggling with the results of putting their careers on a slower track, many feel grateful for the opportunity to choose an alternative course for a few years or longer. As analysts we observe, explore, and follow the process as we clarify and interpret. Our perspectives and our patient's expectations are profoundly influenced by the new cultural norms. These culturally conditioned expectations have been altered by changes in the nature of work. They will continue to shift as technology and social patterns affect how we pursue our careers.