“Since my sister's death, I struggle to stay present with my patients. My body is in the chair, but my mind is in my garden. I took off as much time as I could to be with her during her dying, and now I have to work. How can I make room for my reactions to her passing without allowing them to intrude excessively in my clinical work?”
“I feel this woman is ready for termination, but she's not talking about it. I know she's been traumatized by sudden losses, yet she's gradually become quite attached to me. Should I continue to wait for her to bring the issue up, or would that be implicitly endorsing her avoidance?”
Often alone in the struggle, we can have difficulty assessing the impact, for better or worse, of our own subjectivity on our clinical interventions.
These are the kinds of questions the psychoanalytically oriented clinician struggles with daily. Often alone in the struggle, we can have difficulty assessing the impact, for better or worse, of our own subjectivity on our clinical interventions. In order to provide a space where analysts and psychoanalytically oriented therapists could explore these questions together, the Sacramento Psychoanalytic Study Group was organized in the fall of 2002. The 15 group members include seven psychiatrists, three clinical psychologists, and six clinical social workers. Seven of the members are analysts, four of them in a consulting role. We have met three Fridays a month, nine months a year for the past three years.
The questions explored so far encompass all phases of a psychoanalytic treatment. We have puzzled over how to begin with a reluctant patient, struggled with how to sustain and deepen the therapeutic process in the face of various and intense midphase resistances, and pondered how to approach termination with a thriving yet reluctant patient. Providing a holding environment and creative play space for therapists attempting to provide the same for their patients has emerged as perhaps the most important function of the group. How we might optimally provide that space is one of the most important questions the group members attend to during the various presentations.
In this process of thinking and feeling together, we have benefited as much or more than our patients. Members have presented case material reflecting differing theoretical orientations, led discussions on classic papers and psychoanalytic topics of current interest, and shared personal writing of a psychoanalytic nature. As a rule, the presentations occur over three consecutive Fridays, with presenters and topics changing monthly. A consultant, usually another group member, attends to the group process and helps guide the discussion.
Often, a particular presentation will inspire other members to explore different aspects of the same topic. For example, two years ago the member quoted in the opening paragraph presented a moving paper she had written about the death of a sister, examining the impact of this event on herself, her relationships with other family members, and on her clinical work. Supported by the group, the author presented the paper at a national conference. Inspired in part by this paper, two members shared aspects of their work with patients grieving the loss of close family members the following year. These courageous presentations led to a group decision to reserve a month this year to re-read and examine in detail the ideas contained in Mourning and Melancholia.
The group has also set aside two or three Saturdays each academic year for daylong case conferences, in which a group member presents a clinical problem to an invited consultant. The invited consultants have included Steve Purcell and Barbara McSwain, training and supervising analysts at the San Francisco Psychoanalytic Institute, and Neil Skolnick, training and supervising analyst at the NYU Psychoanalytic Institute. In addition, Madeleine Sprengnether, professor of English at the University of Minnesota, was invited for an evening discussion of her book, Crying at the Movies, in which she investigates her intense reactions to specific movies from a psychoanalytic perspective.
An ongoing and, as yet unresolved, question is what it means to us to be an Affiliated Study Group. At the end of every year, the members gather for a daylong retreat to review lessons learned and set goals for the following year. Consistently, the top priority has been to preserve the group as a resource for learning and clinical consultation, but we have also looked at several possible ways to engage with the broader community of therapists in the Sacramento/Davis area. For example, group members have gathered three or four Friday evenings a year to discuss a provocative movie, such as Lolita, American Beauty, and Mystic River. We are considering extending these movie evenings to the wider mental health community, perhaps with invited discussants. Consideration is also being given to offering seminars on contemporary psychoanalytic topics.
As questions regarding our identity, focus, and goals continue to arise, we might draw some encouragement from the advice given to a young poet by the German existentialist Rainer Maria Rilke. “…Be patient toward all that is unsolved in your heart and try to love the questions themselves…. Perhaps you will…live along some distant day into the answer.”
John A. Booth, M.D., is a graduate of the San Francisco Psychoanalytic Institute and clinical professor of psychiatry at the University of California Davis School of Medicine. He has a private practice of adult psychiatry and psychoanalysis in Sacramento, California.