A physician claims psychiatric disability with a $20,000 monthly benefit at stake. A talented golfer has inexplicable troubles with three-foot putts. An employee sues for damages for psychiatric injury allegedly caused by a hostile work environment. A consulting firm seeks team cohesion. An executive has difficulty delegating. Since 1985, I have applied clinical skills to a variety of such situations. Psychoanalytic understanding both informs my work and distinguishes my approach from many organizational, forensic and sports psychiatrists/psychologists. This article addresses the application of psychoanalytic thinking to sports, business and law.
In team sports, a phenomenon I call “motivational mismatch” has characteristics of empathic disruption. The mismatch is inherent to the player-coach relationship. As one coach correctly noted in addressing the team the morning after a tough loss, “I bet I was the only one who lost sleep last night.” The inherent mismatch is accentuated by the fact that athletes show variability in motivational intensity as they do in physical/athletic attributes. The coach doesn't usually ride a player for lack of speed or jumping ability. He understands and accepts physical limitations but is typically less tolerant of psychological limitations, especially regarding motivation-intensity.
In working with a coach who starred at every level of basketball, I alerted him to psychological factors by noting that his exceptionality was not only due to his shooting skills but also his great drive and passion. The characteristically driven coach tends to see certain players as not sufficiently intense and sometimes viciously critiques the player's drive. The perceived and real mismatch creates tension, as the player may be playing as hard as he can. The tension leads to problems variously described as player “burnout”, players “quitting on the coach” or the coach “losing his players.” I address the related “mis-attunement” seen in the contrast between coach and player perception of reality, e.g., player heart/guts, by recommending that coaches provide concrete evidence to the player of his lack of intensity. In basketball, objective markers of motivational intensity exist like offensive rebounds, fighting through screens, taking charges, diving for loose balls, and limiting the scoring of the opposing player.
In performing disability, fitness-for-duty, threat of violence and forensic assessments, I seek to understand and tell the “story” of the claim or problem. Determining only symptoms and diagnosis rarely provides information sufficient for addressing the important questions. In addition to the story of the immediate problem, I am interested in the individual's story as in the colloquial, “what's his story?”
“I am interested in the individual's story as in the colloquial, ”what's his story?“ The individual's story is largely about characterology.”
The individual's story is largely about characterology. The two stories are important because the problems prompting consultation typically arise from the interaction of characterology and current environmental factors. In other words, both “forces” require understanding for purposes of rendering an assertive, data-based conclusion. My natural interest in these stories is related to the psychoanalytic interest in psychodynamics, the narrative and characterology.
I understand resistance as processes limiting the patient's self-awareness, self-revelation and/or greater engagement in the analytic interaction. Because of these processes, information is unavailable. Disability and forensic assessments are challenging partly because of inevitable information deficits. Individuals may exaggerate, lie, consciously withhold as well as be disorganized and non-reflective. Owing to a psychoanalytic perspective, I am tolerant of and particularly interested in the processes that underlie the information lacuna. Regarding tolerance, psychoanalysts are used to experiencing lengthy periods of not knowing and even confusion.
I have difficulty writing some assessment reports because of an initial problem organizing the data into a coherent story. I begin such reports by writing that “something is missing” or the story “doesn't hang together.” I also assert that directly addressing the confusion or information deficit will lead to answering the pertinent questions. As such, the conclusion section often begins with my “interpretation” of the information deficit or “resistance.”
A coach considered demoting his starting shooting guard but had reservations about the second string player. He liked the starting guard better because the other player was distant and less obviously responsive. The engaging starter was a talker with a great smile. Having interviewed all the players in depth, I told the coach that the starter did have a winning smile and apparent enthusiasm. The other player was less superficially available but not as distant as the coach thought. I agreed that he was not as easily likeable due to his reserve and furthermore, I understood how the coach might experience the reserve as disinterest or even disdain. I reassured him that although more introverted, the player was nonetheless a thoughtful and committed individual who would be dependable and responsive.
I liken psychoanalytic treatment and theory to a sophisticated art form that appeals to and/or is understandable to a relatively small group or subculture. The central creative challenge of applying psychoanalysis to commercial sectors is translating knowledge in a manner that both expresses the psychoanalytic perspective and is usable to a wide range of consumers. A company had difficulty managing a withholding and procrastinating top executive, also described as “emotionally constricted.” After an extensive consultation process, among other conclusions, I thought the executive had a strong obsessive-compulsive orientation. As in the clinical setting, our theories and nomenclature only allow for finite choices in labeling the existing psychological processes, complexes, and psychopathologies. However, limitless combinations of wording, vocal dynamics, and affect exist for translating our understanding through statements of opinion like interpretations. Out of that infinite universe, we decide how to most effectively communicate our thinking.
In the case of the executive, I told the executive committee, absent referencing the source (James Brown), the executive can't, “give it up or turn it loose”, with strong emphasis on and
Richard P. Harris, M.D. has a psychoanalytic and consultative practice in Chicago. He is on the faculty of the Chicago Institute and teaches the course on clinical writing.
repetition of the word can't. The committee responded with hints of incredulity and perhaps disappointment, undoubtedly fueled by years of frustration with responses that led to no easy solution and failed to disabuse them of the idea that the executive's infuriating behavior was consciously and willfully intended. To that, I slowly shook my cocked head and with a mixture of sympathy and apology, I raised my eyebrows while saying, “He just can't” — with an ascendingly pitched can't.
A musical analogy provides an apt synthesis of this article's central elements; elements that include a writing strategy and style intended to both explain my work and demonstrate my communicative goal — simplicity with requisite edge. I am a jazz musician and have played at nursing homes. I have to tailor my playing for the audience, meaning I can't improvise as I would before a self-selected audience of jazz minded listeners. I limit the depth of improvisation and resulting degree of abstraction so that the listener doesn't lose the melody and with it, pleasing memories associated with the great standards of popular music. However, as in applied psychoanalysis where I make use of core psychoanalytic concepts like resistance, story elucidation and subjectivity, I play at nursing homes in a manner that retains and makes use of key jazz elements like harmonic complexity, tasteful phrasing, swing and inevitable liberty with the melody. I may not plumb to the depths in the described applications of the two disciplines, but I provide valued services, make contact with people whom I would not typically encounter if I limited myself to traditional settings, and do so using my training, experience and creativity.
On a final note and pertinent to recent national discussion, applied psychoanalysis is a natural marketing opportunity. The work provides an avenue to show a way of thinking and present the person of the psychoanalyst. Of the latter, isn't that medium the ultimate message?