Cancer, Candidacy, and the Couch

I was thrilled and honored to receive the Affiliate Council 2009 Scientific Paper Prize at the American Psychoanalytic Association 2010 National Meeting in January. When Carmela Pérez, president of the Affiliate Council, asked me if I would write about how I was “inspired” to write that paper, I gladly agreed, thinking that writing would afford me an even greater appreciation of the motivations and factors influencing my writing. The title of my paper, “Cancer, Candidacy, and the Couch,” has to do with my experience as a candidate working analytically with patients, in supervision and in analysis, after being diagnosed and treated for breast cancer. It addresses the impact of the disclosure of a cancer diagnosis on the analyst/candidate, the patient, the transference/countertransference, the therapeutic alliance, and treatment process. I actually began writing the paper after completion of chemotherapy and radiation, but the idea of writing occurred much earlier.

So, how was I inspired? The first and simplest motivation was that I like to write. I find the writing process useful in organizing my thoughts and revealing more to me about what I think and know. I must thank Mel Bornstein, in part, for making writing an easier process by encouraging my candidate class to write as a way of discerning/learning more of what we know about a patient. He would say: “Just write. Go with what you are thinking. You know more than you think you know. Writing will help you see more of what you are preconsciously and unconsciously picking up. Trust it.”

Mastery

The most significant factor that inspired me to write my paper was that I had cancer. I believed that I had something to offer as a result of my experience of being a candidate, in supervision, undergoing an analysis and working with patients while being treated for cancer. Writing was a form of intellectual mastery, a form of action at a time where I had earlier felt so little in control. It was a way of making a contribution to the literature, of sharing my experiences with other therapists and analysts. My own psychoanalytic identity became stronger as I read what other analysts had said and done at times of illness. Long before I began to write my paper, I not only researched all that I could about cancer but also reviewed the professional literature on how other analysts, beginning with Freud, dealt with their own illnesses and cancer while working with patients. Fortunately, at the time of my diagnosis I had the benefit of being in my training analysis. I had a safe space to talk about my feelings, fears, and fantasies about my cancer, my candidacy, and my future. As I was synthesizing and thinking about all that I was going through, and about how it would impact my patients, it was my analyst who encouraged me to keep good clinical notes of my sessions with patients. My supervisors also expected me to keep good notes for supervision. However, it seemed that my analyst was thinking about my future because she knew how helpful such a record would be if I later chose to write about it. To me, it was a vote of confidence that helped seal my determination to generate some perks from a cancer diagnosis.

Limited Self-Disclosure

In addition, I needed to write a graduation paper for my institute. It was the last requirement I had before I could graduate from the Michigan Psychoanalytic Institute. I had previously started with a different topic, but once I learned that I had cancer, I was motivated to focus on what was closest to my experience, interests, emotions, and needs. I remember reading and agreeing with Evelyn Schwaber who had written in JAPA in 1998: “I have found, generally, that it is only when something feels affectively immediate that I am able to speak or write in any meaningful way; my cognitive functions alone don't allow me to express my ideas. Though I tried to do so, I could not make myself write of issues removed from where my feelings were. If I was going to speak, I would have to find a way to bring head and heart together.” I found her writing of her experience with illness as both inspiring and useful as I forged my own understanding of the kind of analytic working space that I needed to best function as an analyst who could be helpful to her patients.

I found that a limited form of self-disclosure of my breast cancer diagnosis and treatment strengthened trust and the therapeutic alliance. Most importantly, to name “the elephant in the room” gave me a sense of freedom and space to emotionally engage with my patients…It allowed me to listen more easily to their associations and interpret more freely their reactions to my cancer diagnosis, both as a real life threat to their analyses as well as a stimulus to multiple fantasies fashioned along transference lines.

Lastly, what inspired me to write and present my paper was the hope that my experience and reflections upon it would be a useful contribution to candidates and analysts, especially to those clinicians facing life-threatening illnesses themselves. I hoped that it would further add to the literature about the types of self-disclosure that support the therapeutic alliance and the analyst's ability to analyze. Since writing the paper, I have presented at cancer workshops and given presentations locally as well as at APsaA. These presentations have helped open up discussions on illness, self-disclosure, and how one works clinically under such conditions. I have had a number of therapists and analysts consult with and reveal to me their past or present struggles with serious health conditions and the impact it has had on their lives and clinical work. My experience with cancer and writing about it has contributed to greater involvement in working with women breast cancer patients. It has impressed upon me how valuable and helpful (emotionally and physically) it is to be in psychoanalysis or psychotherapy at the time one is going through cancer treatment.

So, as I hope I have made clear, my “inspiration to write” has come to me as a result of trying to turn adversity into something more meaningful and hopeful. Inspiration also rests upon the shoulders of the many who were thoughtful and supportive of me, especially my husband, my analyst, my supervisors, and my candidate colleagues. I am grateful to these and to the Affiliate Council for recognizing my paper with its 2009 First Place Award.