There is no greater agony than bearing an untold story inside you.
-Zora Neale Hurston
Strange as it may sound, my filing system reflects my journey from psychotherapist to psychoanalyst. Last month, I was going through my old folders, dating back to my days as a therapist at psychiatric hospitals and mental health clinics, and changing the tabs. Categories, such as ADHD, Anxiety, Bulimia, Depression, OCD, Panic Disorders, and Schizophrenia, changed to names of influential psychoanalytic writers and thinkers, like Bromberg, Ehrenberg, Freud, Hirsch, Hoffman, Levenson, Stern, Sullivan, and Winnicott. My transformation was here in front of me, from a focus on disorders and treatment plans to thinking about the whole person and patterns of relating between analyst and client.
And I can now see that the transformation began years ago with Mr. L. He was my patient at a community mental health clinic and had developed an erotic transference towards me. After a few months, he confessed that he loved me and fantasized about me all day long. Despite the fact that he had a deep connection with his wife, and was at least 20 years older than me, he was convinced that we belonged together.
At that time I was working with 2 supervisors, one at the clinic, and one a psychoanalyst in private practice. Why two supervisors? Well, my work in the clinic had me seeing 8 clients a day back-to-back, chasing down psychiatrists for their signatures on treatment plans, and working out of a windowless basement office. I was headed down the path to burnout. To combat this I enrolled in a one-year psychoanalytic psychotherapy program that met one evening per week and provided weekly supervision with a psychoanalytic supervisor.
I presented Mr. L to both supervisors. “Shut it down,” said my clinic supervisor. “Don’t encourage it, focus only on his treatment plan goals”: getting back to work, learning coping skills to combat his depression, managing his anger, and communicating better with his wife. True, Mr. L did need to address these goals, but his erotic transference was getting in the way.
My psychoanalytic supervisor responded not with direct advice but with questions: “When does he think about you, and what is this bringing up for you? What is he thinking, what are his fantasies? Has this happened with other therapists? How is this affecting the work? Is this a re-enactment of his past…?” The questions to explore seemed limitless.
Looking back, that was the moment I committed to five year analytic training. By avoiding Mr. L’s feelings about me, could we really focus on his relationship with his wife let alone his going back to work? And talking about these goals when he was more interested in seducing me seemed like we were both conspiring to avoid talking about a secret. Wasn’t this similar to his experience as a child? For years, Mr. L had been sexually abused by an older cousin. Everyone knew it, but no one talked about it. My psychoanalytic training was pushing me to explore ways of relating and to bring them into focus, which I hoped would help Mr. L. understand how aspects of his past may have been repeating in his current life and relationships.
Early in my career, a mentor advised me to train in a psychiatric hospital. He was right. Where else could I work closely with people suffering from nearly every disorder in the book. And I learned a range of approaches to treatment. At the Stanford Hospital’s day treatment program, I trained with one of Marsha Linehan’s early protégé’s (Linehan developed dialectical behavioral therapy, or DBT). At the Kaiser Permanente Psychiatry Clinic, I learned cognitive behavioral therapy from David Burns himself, CBT guru and author of The Feeling Good Handbook. These treatment strategies came in handy. People suffering from acute psychiatric disorders need relief, and these treatments provide a way out of immediate suffering. And anyone who’s worked in a hospital or outpatient psychiatric setting knows the pressure of having to work quickly and provide relief before a patient is discharged. Yet I began to feel that there is more to working with people than providing immediate relief or attaining concrete goals.
So what to do about Mr. L? I felt strongly that he needed to explore the way in which he was relating to me. I soon found, of course, that I was not the first therapist that he had fallen in love with. In fact, he told me that he had fallen for every one of his therapists. Yet not one was willing to talk about his feelings and fantasies, no doubt for reasons similar to those I was given. Sadly, I could not explore his erotic transference, either. My clinic was struggling financially. Medicaid cuts were coming, and I was told to cut down his visits to every other week. While I feel I let Mr. L down, I believe that my decision to become a psychoanalyst benefits all the other Mr. L’s.
Do I still talk to patients about how to alleviate their symptoms? Sure I do. But while we are discussing alternative coping mechanisms, I keep the focus on the way we are relating to one another, on the fact that in our work together we are also creating a new type of relationship, which, if kept in our awareness, discussed openly, and transferred to their everyday life will lead to much longer-lasting and more fulfilling change.
Blair Casdin, LCSW, is a 4th year candidate at the Manhattan Institute for Psychoanalysis and in private practice in Manhattan. Blair is one of the co-editors of the Analysis Now blog, along with Willa Cobert, PhD.
Curious about psychoanalytic training? Come to an Open House for the Manhattan Institute for Psychoanalysis this Sunday, June 7 from 11 to 1.