“As a relational analyst, the exchange inevitably touched on who we are in the room: our race, ethnicity, class, gender and sexuality…” In the second of our series on race, Tara Chivukula, graduate of Manhattan Institute for Psychoanalysis, grapples with what it means to be considered the Buddha of Analysis.

The Buddha of Analysis

By Tara Chivukula, LCSW

Karen sank into the sofa, sighing deeply. Her shoulders slumped down as she looked up. Fixing a determined gaze on me, she announced: “You’re my Buddha.”

I paused, and considered her words: the note of possession. The exclusivity. And finally, the Buddha. The tone of her voice was affectionate, authoritative.

This wasn’t the first time that Karen had proclaimed me her Buddha. In prior sessions she had called me Swami (an honorific that contained, at least for me, latent associations to a charlatan). We had analyzed in the transference her choice of words and her choice of me, a straight-identified Indian-American woman as her therapist. Buddhas were serene, peaceful, sexually removed, wise. Buddhas didn’t deal with the romantic turmoil that plagued mere mortals. After all, the real Buddha himself, Siddhartha Gautama had abandoned his royal post, his wife and son for a life of asceticism. In Karen’s eyes, she was the seeker, and I the found.

As a relational analyst, the exchange inevitably touched on who we are in the room: our race, ethnicity, class, gender and sexuality. As a professional queer-identified woman of Jewish parentage in her 30’s, Karen experienced an upbringing that intersected with my own in many ways. We were both women raised in upper-middle class homes in suburbia and socialized in a patriarchal culture. However, Karen dealt with bigotry for being both Jewish and queer. Her grandparents were Holocaust survivors. She struggled with issues of sexuality and identity.

My parents were part of a wave of professional immigrants welcomed into the U.S. after implementation of the 1965 Immigration & Nationality Act. The Act abolished the national origins quota system (to no more than 20,000 visas per year from any one country) that had been in place restricting Asian immigration to the U.S. Upon arrival, they like many other immigrants and people of color, were subject to racism and discrimination in their professional and personal lives.

We hailed from cultures that were stereotypically clannish, family oriented, and focused on educational and professional achievement at all costs.

While such common ground was tacitly acknowledged, being a Buddha implied Otherness. My analyst silence deemed wise. My measured response deemed spiritual. The act of holding space in the consulting room deemed holy.

Karen, of course, was commenting on aspects of my personality. In contrast to the decidedly non-Buddha-like women in her life, I embodied an Orientalist trope—an inscrutable, wise, serene therapist residing in the office/dream space: static, frozen, fixed eternally.

As Edward Said notes in Orientalism:

The very possibility of development, transformation, human movement—is denied the Orient and the Oriental. As a known and ultimately an immobilized or unproductive quality, they come to be identified with a bad sort of eternality: hence, when the Orient is being approved, such phrases as “the wisdom of the East.”

As a sign of this supposed wisdom, near my Union Square office, a number of yoga studios have proliferated over the years. The emphasis on “Eastern spirituality,” pseudo or not, is strong. Buddhism is in vogue. Sankskrit words/concepts like karma, dharma, moksha, and samsara trip off the tongue. The message is clear: The East rejects materialism in favor of spirituality, religion, yoga, and self-knowledge/growth. This one-dimensional view did not square with the complexities of the India I knew. As Gita Mehta wryly notes of this exchange between East & West in Karma Cola:

The seduction lay in the chaos. They thought they were simple. We thought they were neon. They thought we were profound. We knew we were provincial. Everybody thought everybody else was ridiculously exotic and everybody got it wrong.

On the other hand, I could not deny that Karen was also commenting on those aspects of me that were essentially unknowable, unreachable. She had repeatedly despaired of the lack of truly being able to “know” me though some self-disclosure had been made over the years we’d been working together. She admittedly worried that one day I would reveal myself to be the “mess” that she knew most women in her life were. That is, emotionally volatile & deceitful. In some ways, unacknowledged, she preferred the racist trope to the sexist. In doing so, she kept safe from those destructive aspects of myself she was afraid to know (one could argue that I was afraid to know) and protected the men (her father) in her life who had failed her. She rendered me a man—A Buddha who had abandoned the material world.

I often wondered if I were not Indian-American, would Karen have called me a Buddha or Swami? Or did my personality, not to mention my profession, make such a comparison inevitable? After all, most people initially found me hard to read. As analysts we are very often more observer than participant, hidden away in asymmetrical relationships. It was hard to tell.

I wondered too, how much I had colluded in this perception. Had I unconsciously adhered to a Buddha-like persona? W.E.B Dubois coined the idea of a “double consciousness,” a term describing the psychological challenge faced by African-Americans ‘of always looking at oneself through the eyes’ of a racist white society and attempting to reconcile their race/ethnicity with an upbringing in a European-dominated society.’ This struggle to deal with a multi-faceted conception of self was something Karen and I undoubtedly shared.

Reflecting on our dyad from a relational standpoint, I noted feeling boxed in—unseen by her comment, as though I was an idea or an ideal that she needed me to be: unchanging and static in my steadiness. A feeling of despair ensued where I imagined never quite being known by her. And I understood that very likely she felt this way in her life—that I, like her primary caregivers, would never quite know or understand her. And she felt boxed in by her need to please and fulfill expectation.

I began to realize that I was not the only Buddha in the room. A Buddha symbolized some shameful aspects in her—static, passive, unchanging, never roused to anger—that Karen had projected onto me.

By opening up the discussion and considering the myriad meanings of a word, the opportunity for greater freedom and spontaneity arose, a welcome and necessary outcome for the both of us.

*Names and other details have been changed for reasons of confidentiality.

References

Double Consciousness. (March 31^st, 2016). In Wikipedia: Retrieved: April 23, 2016, from: https://en.wikipedia.org/wiki/Double_consciousness

Mehta, Gita (1979). Karma Cola: Marketing the Mystic East. New York: Simon & Schuster.

Said, Edward (1978). Orientalism. New York: Random House.

Tara Chivukula, LCSW is a graduate of the Manhattan Institute for Psychoanalysis. She is in private practice in New York City.

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For years, psychoanalytic institutes have been struggling with how to develop a more multi-culturally diverse Institute culture – in their candidate pool, faculty, and curriculum. In this light, John Turtz, PhD, Co-Director of the Manhattan Institute for Psychoanalysis, reflects on his personal responses to Ta-Nehisi Coates’ new book and National Book Award winner, Between the World and Me. He references psychoanalysis’ “history of exclusion” and discusses the need for psychoanalysts to struggle with these difficult issues around race.

Reflections on Between the World and Me, by Ta-Nehisi Coates

By John Turtz, PhD

Hatred is an ordinary human experience that has extraordinary results.
Kathleen Pogue White, Ph.D.

Ta-Nehisi Coates (2015), an African-American writer and journalist, has written an extraordinary book entitled Between the World and Me. It is a masterpiece in the form of a letter to his son. Coates writes of the subjugation of the Black body by the powers that be in white America. He writes about the social construction of race, stating, “But race is the child of racism, not the father” (p. 7). I recently listened to Coates read this letter himself in the audiobook version; this is a beautiful recording. The letter to his son is as much poetry as it is prose. It is, from my perspective, simply magnificent, and it led me to the following reflections.

The philosopher, Emmanuel Levinas has written about the importance of “the Other.” Colin Davis (1996), a scholar of twentieth century French literature, wrote, “The thought of Emmanuel Levinas is governed by one simple yet far-reaching idea: Western philosophy has consistently practiced a suppression of the Other” (p. 1). Through various means such as empathy and domination, we try to make the Other a part of ourselves. We attempt to eliminate the difference and assimilate the Other into the same. Levinas, on the other hand, focuses on the radical alterity of the Other and on how the Other simply cannot somehow be reduced to the familiar sameness of the subjective self’s personal domain. In fact, the subject is born only in recognition of the Other’s radical otherness.

The Lacanian psychoanalyst, Bruce Fink (2007), in a book on psychoanalytic technique, has written about the difficulty in listening and truly hearing and experiencing otherness. He writes, “We tend to hear everything in relation to ourselves” (p. 1) and “Most simply stated, our usual way of listening overlooks or rejects the otherness of the other” (p. 2). Fink then advises, in a similar vein as Edgar Levenson, “Stop trying to understand so quickly” (p. 6). Our tendency is to listen for the familiar, thereby making false assumptions that we then take to be fact.

Listening to Coates read his letter to his son made me even more aware of my own deficiencies in my attempts to deal with my own internal struggles around race and otherness. Lacan has asserted that inauthenticity leads to a power hierarchy (Ehrenberg, 1992, p. 83), and postmodernists have examined the nature of binaries and how they too lead to hierarchical power structures. We therefore need to move toward greater authenticity in dealing with race issues and toward the deconstruction of binaries with regard to race. Psychoanalysts of color, such as Kathleen Pogue White (2002) and Kirkland Vaughans, and white analysts such as Melanie Suchet (2007) and Neil Altman (2004) have initiated the difficult and challenging but essential dialogue on race issues. It is crucial for all psychoanalysts, I believe, to struggle to a much greater degree with these issues. Psychoanalysis itself has, since its origins, been a mostly white, often Jewish, culture with a great history of exclusion. Is it no wonder that we have a difficult time attracting people of color to come train with us? There are no easy answers (that’s perhaps the understatement of the year), but we must continue the struggle begun by analysts that have been courageous enough to sail into these stormy waters.

The American dream has generated a lot of trauma. From the Trail of Tears to the shackling of African-Americans in chattel slavery for centuries to Black men hanged by white men hiding behind white sheets or shot in the back by police officers empowered by the culture of whiteness, there is a deplorable side to America. It’s so much easier to not see what there is to be seen, to pretend that this is all in the past, to pretend that I am not at all responsible, to avoid otherness, and to hide from others as well as from myself what I feel are unacceptable aspects of myself.

I do not consider myself to be innocent. My hope is to struggle with these issues in a more open and authentic manner moving forward. Though it may be myth, it is told that Martin Luther said, “If I knew that tomorrow was the end of the world, I would plant an apple tree today!” Whether true or not, it is a beautiful expression of hope and the human spirit. In this spirit, I hope to work toward greater awareness of my own “not me” aspects, struggle to get to know these aspects of myself in a more intimate way, and thereby struggle to deal more constructively with that deeply ingrained white mask of privilege, power, dominance and subjugation.

References

Altman, N. (2004). Whiteness Uncovered. Psychoanalytic Dialogues, 14:439-446.

Coates, T. (2015). Between the World and Me. New York: Spiegel & Grau.

Davis, C. (1996). Levinas: An Introduction. Notre Dame, Indiana: University of Notre Dame Press.

Ehrenberg, D. B. (1992). The Intimate Edge: Extending the Reach of Psychoanalytic Interaction. New York: W. W. Norton & Company.

Fink, B. (2007). Fundamentals of Psychoanalytic Technique: A Lacanian Approach for Practitioners. New York: W. W. Norton & Company.

Suchet, M. (2007). Unraveling Whiteness. Psychoanalytic Dialogues, 17:867-886.

White, K. P. (2002). Surviving Hating and Being Hated. Contemporary Psychoanalysis, 38:401-422.

John Turtz, PhD is Co-director of the Manhattan Institute for Psychoanalysis and Director of the Couples Therapy Training Program at the Westchester Center for the Study of Psychoanalysis and Psychotherapy. He is in private practice in Manhattan and Larchmont, NY.

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On Reading

By Justine Duhr, MFA

“He opened the book; and as he did so it became not his own. He let his fingers riffle through the pages and felt a tingling, as if those pages were alive. The tingling came through his fingers and coursed through his flesh and bone; he was minutely aware of it, and he waited until it contained him, until the old excitement that was like terror fixed him where he lay. The sunlight, passing his window, shone upon the page, and he could not see what was written there.”

-from the closing lines of John Williams’ Stoner

It’s just past midnight on a Tuesday. I’m lying in bed with my dog on one side, a cooling cup of tea on the other. My husband is asleep, lightly snoring, having already embarked, no doubt, on tonight’s unconscious adventures. In the street below, it’s starting to rain. I can tell by the cling-clang of drops on the city’s metal and also by the new way sound seems to carry. A young woman’s playful shriek, a baby’s shrill cry, these sounds echo around the block and reach me finally, as if from a great distance.

I’ve just closed John Williams’ Stoner, just consumed the final delicious lines not for the first time nor nearly the last. Now I lie very quiet and very still with the book in my lap, feeling its precious weight in my hands, feeling the way I almost always feel upon finishing a novel: impossibly painfully irrevocably human.

That’s why I read, I think. In a highly collaborative effort of imagination and feeling, I connect with the story, the characters, the writer, and also with something deep inside myself.

Sandra Buechler in Making a Difference in Patients’ Lives: Emotional Experience in the Therapeutic Setting (2008) likens the role of the therapist to that of the poet. Buechler writes:

As analysts, our target, like the poet’s, is to evoke more than we say. This makes it more likely that phrases that resonate with the patient’s inner experience will be cocreated. The culture the patient and I have in common provides a dictionary that exists “outside” us. From it we create a kind of poetry by using highly evocative language. Layers of meaning come from experiences we have had with each other, or talked about. Like all poetry, its function, aside from giving us joy and helping us feel connected, is to prompt us to think just a bit beyond what we have already consciously known. (pp. 213-14)

Here we see the therapeutic dyad as a microcosm of the human experience, our perpetual search for connection, through the art of language in the case of psychoanalysis and poetry—and, I would argue, poetic prose. Just as patient and analyst work together to discover and examine the patient’s inner life (the cocreation Buechler points to), so too do author and reader collaborate to create an experience that is both illuminating and therapeutic in its own right. Through the act of reading we have the profound experience of connecting to something larger than ourselves.

In reading as in analysis, the experience is the thing. In interpersonal analysis especially, in which meaningful change depends so heavily upon the particular relationship that develops between therapist and patient, the experience is everything.

I remember one 11^th-grade English class during which my teacher, Mr. Scott, busied himself at the blackboard drawing diagram after diagram: plot in Toni Morrison’s Song of Solomon, character arc in Song of Solomon, symbolism in Song of Solomon, and so on. I had already by then fallen deeply in love with literature and, as was my habit in those days, had adopted my most recent read as my favorite. I felt defensive about the book, protective even, and silently rebelled against this rigid structure that I feared would explain my experience away. This can’t be what this book is about, I thought, surveying the tidy chalk lines that seemed to me like a death sentence. I wanted not hard knowledge, not facts, but acknowledgement of my feelings as I read this great work. I understood in my heart before I did in my head that charts and diagrams couldn’t possibly do justice to my experience, my personal connection with the novel, which was for better or worse uniquely my own.

I felt changed by Song of Solomon, and by countless reading experiences after—Housekeeping, Frankenstein, Crime and Punishment, The Lover, to name just a few. These encounters became part of me. I was altered by them, no matter that I didn’t know then and don’t know now and likely won’t ever know precisely how. Morrison, Robinson, Shelley, Dostoevsky, Duras, these authors and I worked together to create the unique reading experiences that conspired to make me who I am. I read, and their stories became entwined with my own.

In this way, reading keeps me connected. I read to know others. I read to know myself.

But what it is to know is, of course, not so simple. Knowledge, insight, and experience are fickle and fleeting. Illumination can obscure as much as it reveals, as Stoner’s sunlight that “shone upon the page, and he could not see what was written there.” And so we keep trying, searching for connection, striving towards meaning, because we’re human and that’s what we do. Thankfully, in books and in analysis, there is no end of stories to tell.

Buechler, S. (2008). Making a difference in patients’ lives: Emotional experience in the therapeutic setting. New York, NY: Routledge.

Justine Duhr, MFA, is a psychoanalytic candidate at the Manhattan Institute for Psychoanalysis. Her fiction and nonfiction has appeared in the Texas Observer, Publishing Perspectives, The Review Review, Whiskey Island, Fringe Magazine, and beyond. She owns and operates WriteByNight, a writers’ service dedicated to helping people achieve their creative potential and literary goals.

Click here for more information about the Licensure Qualifying Program at the Manhattan Institute for Psychoanalysis.

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January: A Perfect Time to Ask About Drinking

By Emily Damron, LCSW

“There’s no problem that can’t be made worse with alcohol.”

When I use this line with clients, they look a bit startled and then laugh with recognition. Like any good interpretation, this pithy saying from Alcoholics Anonymous makes its point without being preachy or judgmental. It often leads us into further exploration and reflection about the patient’s relationship to alcohol.

January is the perfect month for therapists to follow up, “How were your holidays?” with some questions about the patient’s drinking. Many people see the old year out with a bang, or with a binge, or with a series of binges. They wake up in the New Year with a massive hangover, a crateful of regrets, and a boatload of resolutions. Some discover their closest relationships are in a shambles and that they’ve gotten themselves into a mess they can’t remember, let alone sort out. Remorse and resolutions are why gyms are so full the first weeks of January. It’s also why newcomers appear at AA meetings with their “day counts” in the single digits.

Therapists are uniquely positioned to help their alcohol-abusing patients recognize the problem before they actually “hit bottom”. But historically, psychoanalysts have been leery of wading into the troubled waters of substance abuse (Freimuth 2003). “I know they have a problem, but I’m not sure how to talk to them about it,” they often say. Sometimes a therapist’s reticence has to do with not wanting to depart from customary techniques, such as following the patient’s associations, careful listening, and avoiding ‘leading the patient’ at any cost. “I don’t want to impose my agenda on them,” is what I sometimes hear.

Interpersonalists have an edge in this regard. Because of our comfort in asking questions, we can easily adapt the detailed inquiry to an assessment of someone’s substance use or abuse. We know from experience that if we don’t ask, the patient often won’t volunteer the data. But when we do, all sorts of useful information come out that can further the treatment.

God (or the devil) is in the details

There are two other obstacles to our conducting a detailed assessment of a person’s drinking or drug use. “I don’t want to come across as critical or moralistic,” therapists will say. Naturally, we all want to maintain an empathic stance with our patients. But I’ve found it possible to do this while sensitively exploring a person’s important, and often hidden, relationship to alcohol. The approach I use is to ask people to talk about their own concerns about their drinking, focusing specifically on harmful consequences they’ve experienced (Damron 2003).

For the last obstacle, “What questions should I ask?” there are several assessment tools that have enabled therapists, doctors, and other helping professionals to quickly ascertain whether a patient’s alcohol use has crossed over into dependence. Two of the simplest ones are the four-question CAGE questionnaire, developed by Dr. John Ewing (1984) and the 10-question AUDIT, which targets quantities, harmful consequences, and loss of control. Psychotherapists who have an already-established relationship with a patient who drinks or drugs will probably want to adapt these questions to their own way of speaking.

For example, when someone mentions loss of control while drinking, I’ll ask if this happened recently. If the patient alludes to a three-day binge, I’ll say, “Can you walk me through it? (i.e., what time did it start, how much did you drink, at what point did you fall asleep, etc.). Following up with, “Did anything happen during the binge that wouldn’t have happened if alcohol hadn’t been involved?” may highlight for the patient the way alcohol abuse is making them betray their own values. Such a realization can act as a powerful motivator for cutting back or stopping altogether (Frankfeldt 2002). In this way, therapists can assist in raising a patient’s “bottom”. A detailed inquiry about a patient’s substance use or abuse can last several sessions, and might even become an important and ongoing theme in the treatment.

If someone does come in this month expressing concern about how much they partied over the holidays, this would be the perfect time to start exploring it with them.

CAGE & AUDIT Questionnaires:

www.addictionsandrecovery.org/addiction-self-test.htm

Damron, E. (2003). A Guideline for Understanding & Assessing Addiction. The Participant Observer: The Newsletter of The Manhattan Institute for Psychoanalysis, 2:2, Spring Issue. 4 pp.

Freimuth, M. (2003). The Unseen Diagnosis: Addiction Assessment, The Psychotherapy Bulletin, 37: 38-42.

Frankfeldt, V. (2002). Complex Problems Require Complex Solutions: Donnie: A Life Apart, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. A. Tatarsky, Ed., NY: Jason Aronson, pp. 137-159.

Emily Damron, LCSW is a graduate of Manhattan Institute for Psychoanalysis. She is a supervisor and is on the faculty at Psychoanalytic Psychotherapy Study Center, where she also founded the Committee on Psychoanalysis and Addictions Treatment. Ms. Damron is in private practice in Chelsea and Park Slope. She also provides individual and group consultations.

Click here to learn more about the 4-Week Seminar Series offered by the Manhattan Institute for Psychoanalysis.

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The Whole is Greater than the Sum of Its Parts: The Complexity of Couple Therapy

By Wendy Greenspun, Ph.D.

How do we understand the complex nature of problems in romantic relationships? And what theoretical framework can help us navigate our clinical work with couples? In couple therapy, the whole is definitely greater than the sum of its parts. Eric Fromm (1956) aptly stated that in a romantic relationship, one plus one equals three, similarly suggesting that basic mathematical assumptions don’t apply when examining couples. Couple treatment requires knowledge of how to understand each member of the dyad, with his or her unique history and internal world, as well as the complex system that they co-create and are embedded in together.

Classical psychoanalysts look at the couple relationship as a receptacle of ongoing transference experiences, with each individual distorting his or her perception of the partner in a manner consistent with the drama of early family life. For example, in my work with a (composite) married, same-sex couple I will call Joan and Joelle, Joan complained that Joelle was needy and dependent. Joan had grown up the only child of a single mother, who turned to Joan to meet her emotional needs. Such a parallel provided fertile ground for exploring how she responded to her partner based on childhood experiences. Elucidation of such distortions is often a necessary component of change, but not sufficient to address all relationship difficulties.

Family systems theorists, utilizing principles gleaned from biology, describe couples and families as forming their own unique systems. Along with structural components, such as boundaries, hierarchies and alliances, they elucidate ways that an individual can carry out certain functions for the system, and how partners mutually influence each other’s behavior. The systemic concept of circularity describes the vicious cycles seen in this mutually-determined process: Joan retreats because Joelle wants closer contact; Joelle wants closer contact because Joan retreats. Seeing how an individual’s behavior inadvertently brings about the unwanted response in the partner can open up new possibilities for intervention. Systems theorists also describe the notion of complementarity in couples: the more Joan is strict in parenting their son, the more Joelle compensates by becoming lenient. In its most extreme form, complementarity can lead to the polarization often seen in intractable relationship conflicts. Helping each member of the couple soften their stance can facilitate both moving closer to the middle. Yet a family systems approach fails to address the complex recreation of an individual’s internalized past within their current relationship.

The relational turn in psychoanalysis has allowed us to bridge the internal, unconscious focus of classical psychoanalysis with the external, behavioral focus of family systems theory by looking at the various ways a dyad co-creates a shared emotional system. Through this more comprehensive understanding, contemporary psychoanalytic theories allow us to address the myriad influences on relational functioning.

Unconscious mechanisms that recreate internalized object relations have been delineated by both object relations and attachment theories. Early object relations theorists who studied marital interactions (see Dicks, 1967) recognized ways that symptoms could be carried by one partner for the other. They began to explicate how the sharing or volleying of symptoms occurs via the process of projective identification, where an individual’s unwanted internal objects are projected into the other, stimulating the partner to behave in a manner consistent with the ejected object. In the case of my couple, Joelle expressed a lack of sexual desire at the start of treatment, but as soon as her sexual interest returned, Joan became anorgasmic for the first time. Understanding the nature of the projections and helping both partners better contain or metabolize the unwanted aspects of self provides a useful way to approach these often confusing dynamics. Attachment theorists describe how early parent-child experiences lead to an internal working model of relational security, which then becomes the blueprint for what individuals expect and respond to with their adult partners. Particularly relevant when attachment injuries, such as betrayals and losses, occur within a romantic relationship, the impact of the rupture can be understood with the exploration of early attachment experiences. For my couple, an episode of Joan leaving suddenly on a business trip led to an increase in Joelle’s clinging protests, an exaggeration of her insecure attachment behavior; conversely, Joan exhibited her avoidant style whenever she sensed distress in their connection.

Interpersonal analytic theorists posit less about specific unconscious mechanisms, but instead look at how early relational expectations get recreated interpersonally. Through a process of selectively attending to cues from the partner that conform to early relational experiences, then continuing to interpret as well as to subtly influence the partner to behave in ways that are consistent with those experiences, each member of the couple lives out her internal object world in the present interpersonal context (Goldklank, 2009.) With my couple, Joan was keenly attuned to any way that Joelle seemed dependent, and subtly questioned Joelle’s more autonomous actions, leading the dynamic between them to closely mirror Joan’s relationship with her mother. In a complementary manner, Joelle attended most to ways that Joan was dominant and critical like her father, and may have unconsciously invited such negative scrutiny through presenting herself as helpless or incapable. Interpersonal analysts may also look at ways individuals often choose a partner who embodies some important aspect of a familiar internal struggle.

Further developments in contemporary analytic theories have broadened our understanding of the complexities within relationships. Relational psychoanalysis has explicated the role of dissociative mechanisms in individual and couple functioning. Understanding the amalgam of self-states that each individual may bring to his or her romantic partnership can help each person make sense of seemingly disjunctive emotional reactions in self and other (Ringstrom, 2014). When Joelle felt unwanted by Joan, she became like an inconsolable child, consistent with her emotional experience following the early death of her mother. Recognition of this child self-state helped Joan react less negatively to Joelle at these moments.

Findings in neurobiology have supported the analytic notion of a shared emotional system in couples. Mirror neurons point to the ways we are wired to be responsive to others. Neuroscientists have also noted that the release of the hormone oxytocin during close physical contact in intimate relationships can provide an emotional regulatory function for both members of a couple. This knowledge helped Joan and Joelle learn to calm each other at the start of arguments by holding hands, utilizing this shared capacity for affect management.

We’ve also learned that one plus one often adds up to more than three. Extending the interpersonal and relational understanding of co-created systems to the larger social environment within which the couple is embedded helps to contextualize certain relational struggles. In my couple, delving into Joan and Joelle’s religious differences, as well the impact of being lesbian in a heteronormative culture, helped to deepen our understanding of factors that were adding stress to their partnership.

Indeed, the whole is significantly larger than the sum of its parts. Working with couples exposes us to the panoply of influences, past and present, internal and external, which inform dyadic functioning. With the relational turn in psychoanalysis, we have the theoretical framework and concomitant tools that allow us address the inherent complexities of treating romantic pairs.

Dicks, H. (1967). Marital tensions: Clinical studies towards a psychological theory of interaction. London: Routledge & Kegan Paul Ltd.

Fromm, E. (1956). The Art of Loving. NY: Harper and Row.

Goldklank, S. (2009). The shoop-shoop song: A guide to psychoanalytic-systemic couple therapy. Contemporary Psychoanalysis, 45(1), 3-25.

Ringstrom, P. (2014). A Relational Psychoanalytic Approach to Couples Therapy. NY: Routledge.

Wendy Greenspun, Ph.D. is on the faculty of the Manhattan Institute for Psychoanalysis Certificate Program, the Adelphi University Postgraduate program in Marriage and Couple Therapy, and at the Training Institute for Mental Health. She is a graduate of the Manhattan Institute for Psychoanalysis Certificate Program in Psychoanalysis, and also trained at the Ackerman Institute for the Family. She is couple therapy supervisor at Columbia University Counseling and Psychological Services. She has published and presented extensively on couple treatment and violence in couples and families, and is in private practice in NYC.

Wendy will be teaching a course on couple therapy for the analytically-oriented clinician as part of MIP’s 4-week seminar series. This seminar provides 6 CE credit hours.

Click below to register for Wendy’s course “One Plus One Equals Three: Couple Therapy for the Analytically-Oriented Clinician.”

To register and pay click here.  Candidates click here.  Proof of institute affiliation required.

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Lama Khouri, candidate at Manhattan Institute for Psychoanalysis, reflects on the idea of personal narrative and the formation of our identities, relationships, and experiences.

Whose Narrative Is It, Anyway?

By Lama Z. Khouri CAPC, LMSW, MS

Sullivan is quoted as saying “we have as many selves as we have relationships” (Lionells, 1995). As I think about contemporary psychoanalytic theory, these relationships could be with our parents, siblings, and teachers, as well as with cultural, social, and state structures, policies, media, ideology, and many other dynamics that create the landscape of our lives. When we live day in and day out within this landscape we begin to develop our own narratives and monologues (Kirmayer, 2006). Based on such narratives we write our own stories that become central in the formation of our identity, interpersonal relationships, and intersubjective experiences, and, in doing so, they create the multiple selves Sullivan and other interpersonalists described.

Thirty years ago I moved out of my country Jordan and headed west. Initially, I wanted to dissociate from my own narratives and monologues because the reality of them was too dangerous to own. It wasn’t until I began to work with other Arab immigrants that I began to become aware of these narratives and the selves they created.

My first experience took place twenty years after my arrival. It was an experience that changed me forever (Khouri, 2012) At the time I was working with five adolescent immigrant boys who came from the same country. I used to hold the meetings at the school where the boys studied. The goal of treatment was to help them adjust to life in the United States. The group often ostracized one of the boys, whom I will call Basem. Basem had an accent; he didn’t look “cool.” He didn’t know hip-hop or rap. He came from a rural society when all the other boys came from urban areas. Basem came to the US with his father, and left his mother and siblings back home. His father used to travel often. Consequently, Basem lived with his adult male cousins who barely took care of him, leaving him to fend for himself. Basem was alone. And because of his aloneness, he would try to connect with others by intruding into their spaces, often rubbing them the wrong way. As a result, he was visible in the school, and not for good reasons.

In the beginning of my work with the group, I dreaded the sessions. The boys came on time but could barely sit still. I would spend most of the session trying to keep them in their seats, stop them from hurting each other, and deal with the sexually tinged remarks that were flying all over the place. The anxiety in the room was palpable. I attributed my lack of enthusiasm to the difficulty in managing the group, but there was more to the picture than meets the eye.

One day, the principal of the school dropped by. He seemed to just want to help himself to the snacks and chat.  But in his chat he singled out Basem. The principal said that although Basem was working hard he was misbehaving. He added: “Basem is not behaving like a man. Manhood is important in your culture, isn’t that so? In fact, I think men are given special privileges over women just because they are born male.” That comment made me feel small, demeaned, judged and disregarded. I felt his comment stripped me of my status as the adult in the room—after all I am an Arab female among Arab males.

Judging by the boys’ reaction after the principal left, I believe his comment reminded them of their stigma, their separateness, and the dangers that come with being an Arab. The boys went on to instruct Basem on how to behave appropriately. He symbolized everything they wanted to deny. They were talking to him with such intensity that it felt as if they wanted to beat into him traits an American teenager should have.

One of the boys who had been standing, and whom I will call Tamer, leaned over the table, faced me, and said in a frightened, angry tone: “We are Arab adolescent boys. We need to be careful!” I understood him to say: “We are Arabs and we cannot afford to stand out.”

As the boys fired fear filled stories about unfair arrests, deportations and misfortunes besetting Arab immigrants, I went into a reverie about my own fears of being visible and arrested. I recalled what a harrowing ordeal it is to go through customs at JFK Airport. Often I would be riddled with anxiety and guilt when no crime had been committed.

Following the session and on my way to my next appointment, I found myself wondering if I were on some FBI list somewhere. Am I safe? Am I being followed? I reflected further on the boys’ reaction to Basem and the principal, and realized I related to the group the way the group related to Basem—I wanted to discredit them because they were making me aware of parts of myself that were too hard and painful to own. Gradually, as I began to become aware of the fear of being an Arab in a western world, my relationship to the boys shifted. I was no longer different. I understood their anxiety, and mine.

My work with the group lasted for three years. For our last session, in addition to the usual snacks, I brought bandanas. I thought they were a somewhat masculine item that the boys could sign for each other and keep as a memento of the group. When Tamer saw them, he said, “This could kill you.” “What do you mean?” I asked. “Gang members might suspect you belong to a gang that is competing with them.” Anxiously I replied, “I didn’t realize that. Please don’t wear them publically!” “Don’t worry, Miss Lama, this will be our sign as a family and not a gang,” another boy said. “Let’s call it the Tamer’s gang,” said Tamer—as if challenging us to have strength from being together. They signed each other’s bandanas, and when it was time to say goodbye, their farewell was a nonchalant “See ya!”(Khouri, 2012)

Lionells, M. (1995). The Interpersonal Self, Uniqueness, Will and Intentionality. In M. Lionells, J. Fiscalini, C. Mann, & D. Stern (Eds.) Handbook of Interpersonal Psychoanalysis. Hillsdale, NJ: Analytic Press, 31-63.

Kirmayer, L. J. (2006). Beyond the New Cross-Cultural Psychiatry: Cultural Biology, Discursive Psychology and the Ironies of Globalization. Transcultural Psychiatry, 43: 126–44.

Khouri, Lama Z. (2012). Immigrant’s Neverland: Commuting from Amman to Brooklyn. Contemporary Psychoanalysis 48 (2), 213–37.

Lama Z. Khouri CAPC, LMSW, MS is a psychoanalytic candidate at Manhattan Institute for Psychoanalysis, Executive Director of Circle OASIS LLC, and student and researcher at Teachers College, Columbia University.

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E.O. WILSON: OF ANTS AND MEN

Thoughts on the Childhood Roots of Greatness

By Sue Erikson Bloland, LCSW

I recently tuned in, quite by accident, to the PBS broadcast of the film “E.O. Wilson: Of Ants and Men” (9/29/15). I was soon transfixed by the unfolding story of Edmund Wilson as a boy, aged seven, whose parents were in the process of divorcing (at a time when that was most uncommon), and whose reaction to this personal catastrophe was to immerse himself in the study of the natural world around him. Already, at the age of seven, Wilson was spending long hours alone in nature, where he felt more of a sense of belonging, it seems, than he felt at home.

In fact, in the same year that his parents were divorcing, Wilson had quite a terrible accident while fishing, and did not bother to go home to be cared for. A fish he pulled abruptly from the water hit him in the face, damaging his right eye. It is reported that “he suffered for hours, but he continued fishing…because he was anxious to stay outdoors.” The suggestion is strong that he sought refuge from a home life that promised little comfort, and his greatest solace came from just being in nature, even when he was hurt.

Shortly thereafter, Wilson was sent away to a military academy for boys, an institution which he remembers as a “carefully planned nightmare.” He returned to his study of nature when brought to live eventually with his father and stepmother

The fishing accident cost Wilson the sight in his right eye, and this loss of stereoscopic vision was to determine the focus of his life-long career as a naturalist. Unable to see animals or birds at a distance, he could, nevertheless, focus very clearly on small insects. He soon became completely enthralled with the social behavior of ants, admiring their ability to develop highly complex societies, and to function so harmoniously in doing so. (Harmony was likely in short supply in his own family life.)

Wilson knew by the time he was nine that he wanted to become a biologist, and he eventually propelled his obsession with insects into a distinguished career at Harvard, where he studied, taught and wrote about, not only the social behavior of ants, but the profound insights that the study of ant behavior offered for the understanding of human behavior–its essential nature and its origins. Along the way, he stirred up enormous intellectual controversy (with his assertions about the genetic origins of human social behavior), won two Pulitzer prizes, and, his colleagues agree, “changed the way all of us view the world.” It is no exaggeration to say that Wilson has been one of the most important thinkers of our time. And I believe his story is indicative of a pattern in the lives of many great achievers in human history.

In his book entitled Greatness: Who Makes History and Why (1994), the psychologist Dean Keith Simonton comes to a profound conclusion about the nature of genius. Ultimately, he proclaims, what distinguishes geniuses from their colleagues of lesser achievement is the “huge motivational forces” that drive their work, and that far eclipse the efforts of others. (P. 140) Most essentially, they share a “monomaniacal preoccupation” with their chosen pursuits. Simonton does not claim to understand the source of the “huge motivational forces” he has identified. This, he suggests, “is one of the great mysteries of psychology.” (140)

I don’t think Edmund Wilson would be at all offended at the suggestion that his obsession with ant social behavior has been “monomaniacal.” And I would suggest that the childhood he describes in “Of Ants and Men” is typical in some major respects of the kind of childhood that has promoted a “monomaniacal” devotion to work in many extreme achievers.   Clearly, one avenue of solace for children who suffer parental loss, neglect or abuse (what we would call “relational trauma”) is the adoption of an obsessive interest or activity which provides distraction and relief from emotional pain as well as an escape from demoralizing family circumstances. Functioning in some ways as a substitute for a more nourishing connection with parents, these preoccupations take on an enormous emotional intensity that lasts a lifetime. They are life saving. At the same time, the isolation of the desperate child provides an opportunity for intensive “practicing” of the skills needed to pursue his or her interest with exceptional success.

Wilson, of course, began very early to study ants. Napoleon was sent away from his family home in Corsica to a military school in France when he was nine. Alone and very lonely in France, he buried himself in books, reading voraciously about military history.  Mikhail Baryshnikov threw himself into an obsessive study of dance at the age of ten, when his mother committed suicide, leaving him alone in the care of an abusive father. He spent every free hour of his remaining youth in the dance studio relentlessly practicing his art.  Ansel Adams retreated from an intolerable family drama into the darkroom, becoming remarkably skilled at the development of photographs by the age of 14.

Clearly, some kinds of childhood trauma are more likely to have a disorganizing and debilitating effect on the functioning of a child than they are to have a motivating effect, so there is still much to be understood about the circumstances under which early relational trauma has the potential to trigger an exceptionally focused and driven pursuit of a passionate interest.

Two recently released films, “Listen to me Marlon,” about Marlon Brando, and “Pawn Sacrifice,” about Bobby Fischer, illustrate beautifully the delicate psychological balance involved in the childhood scenario I have described. In both films, we see the connection between childhood trauma and the genius that was fueled by it, but the emotional damage has been too great for either of these tortured men to be able to live stable, gratifying lives.

Perhaps one of the most moving and uplifting aspects of “E.O. Wilson: Of Ants and Men” is the impression we get that Wilson has led a deeply satisfying (though at times embattled) life as he continues–into old age—to pursue his childhood obsession. He describes himself as a “happy man” who has lived in a disastrous century (referring primarily to the destruction of the earth’s biosphere) without losing his optimism. At the end of the film he sits looking out over the recently restored Gorongosa Park in Mozambique, and his boyish delight in that primordial natural setting is touching, indeed. “We pursue dreams that go back to childhood,” he says. “Mine was simple. I look for lost worlds.” He is referring to the vast, hidden world of insects, which has fascinated him all his life, but I could not help thinking about the world that was lost to him when he was seven.

Sue Erikson Bloland, LCSW, is faculty and Co-Director of Admissions at the Manhattan Institute for Psychoanaysis. Her memoir, In the Shadow of Fame, was published by Viking Penguin in 2005, and she has published articles on the connection between childhood trauma and fame, or the achievement of “greatness,” in The Atlantic Monthly, Psychoanalytic Dialogues, and Psychoanalytic Inquiry.

Click here to learn more about Sue’s course Psychoanalytic Perspectives on Fame.

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From the International to the Interpersonal

By Lama Z. Khouri CAPC, LMSW, MS

Like many psychoanalytic candidates and psychoanalysts, this was a career change for me. My previous work life was at the United Nations (UN) in New York. I spent most of my fourteen years there as a political affairs officer in the Department of Peacekeeping Operations. I headed the desks of Georgia and the Republic of Haiti (two small countries in the backyards of superpowers). Heading a desk meant following and reporting on the implementation of the Security Council’s requests of the Secretary-General (SG).

I have of late been considering the plight of my part of the world—the Middle East—and what can be the motivating factor that compels individuals to join the so-called Islamic States and to commit such heinous acts. As my analyst often reminds me, this is the nature of the human beast. We have committed such atrocities since the humans first appeared on this planet. If so, what are the psychic mechanisms that motivate them? Can we apply psychoanalytic theory and techniques to international relations?

In one of his weekly Tuesday seminars, the psychoanalyst, writer, and poet Michael Eigen spoke of “how ubiquitously psychic life is deflected. The war or trauma world within may be enacted in the outside world, perhaps in hopes that it will be noticed, but also as a means of evacuating or deflecting it  –  partly out of lack of capacity to tolerate and work with internal dramas. To build such capacity is an evolutionary challenge and at this point of history, a necessity. How to develop such capacity is, hopefully, a work in progress, or needs to be.”(1)

Elaborating on Michael Eigen’s rich observation would require a full article, but for the purpose of this blog entry, I would like to just scratch the surface. Leaders of Member States and their actions can be just as dysfunctional as many of our clients: They can be delusional (the second Gulf War), sadistic (the self-proclaimed Islamic State), or paranoid (Guantanamo Bay, North Korea, Russian/West relations). I would like to add that perhaps international relations are more primitive than human ones. International relations are governed by the law of the jungle: The big countries have the final say. How so? The resolutions and statements of the General Assembly, which includes the 193 Members of the organization, are non-binding. In other words, Member States can complain until they are blue in the face, the final say is always with the Security Council. Although the Council, at any given time, always has fifteen Members, the Permanent Five (China, France, Russia, United Kingdom, and the United States) can veto any decision. Thus, the world’s body is really ruled by the Permanent Five.

For the sake of argument, I would like to venture and say that the UN is like the field of psychoanalysis: They are both viewed by many as ineffective and inefficient. Goals are not reached fast enough; actions take a long time to be implemented; change appears miniscule. As in the early years of psychoanalysis, the UN continues to demand of its staff a neutral mind, a detached and objective approach, and an emotional distance. Like a psychoanalyst, the SG and his staff, being neutral arbitrators, are a voice for the voiceless. As psychotherapists or psychoanalysts we can be a voice for the parts of the self our clients do not want to hear, feel, or see.

The Member States are like our internal objects fighting for supremacy: Who’s going to take you over, your internalized bad object or your good one? Which part of yourself are you going to listen to? Which is going to win, your instinctual wishes and desires, or your lofty ideals and standards? Our clients, like Member States, often struggle with internal wars, ambivalence, and self-destructiveness.

The SG and the psychoanalyst are misunderstood: both of them have autonomous clients who have free will, and both of them are “hired” to observe, verbalize, and make their clients aware of the causes of disputes and struggles. Neither of them can make decisions on behalf of his/her clients; as the joke goes, no one can change the light bulb unless the light bulb wants to change. Yet, both the analyst and the SG are blamed for their clients’ lack of tangible progress.

The SG, like the psychoanalyst, is a participant-observer, albeit from a different angle. The SG is often called upon to observe disputes, negotiations, or agreements, and to participate by helping the parties reach a balanced and peaceful state. At times, the psychoanalyst and the SG must serve as a bad object: Former SG Kofi Annan has been quoted as saying that “SG” stood for scapegoat. Serving as the scapegoat allows for a positive triangulation because it helps Member States to join together and reduces tension.

Wars have always existed. The UN, like psychoanalysis, cannot cure the ills of the world, but perhaps it can minimize the damage or rebuild the destroyed.

I have been working, studying, and writing in the field of psychoanalysis since 2004. Leaving the UN was one of the hardest decisions I’ve ever had to make. Over the years there were times when I wondered whether I had made the right decision to leave the UN. Why leave a cushy and fulfilling career? Why sacrifice a monthly paycheck and excellent benefits? My answers continue to change and evolve: I left because I wanted to spend more time with my children, because I am fascinated by the psyche and by people, and because psychotherapy and psychoanalysis allow me to bring all the aspects of myself to my career.  This field feels more natural to me; I wanted to be neither neutral nor objective, nor did I want to keep my emotions out of the equation. The list continues.

I carry my experience with the UN to the consulting room. My fourteen years with the organization taught me to appreciate the different: What is OK in Jordan may not be OK in Germany; what is acceptable to me is not necessarily acceptable to my client. Living in a war, internal or external, is different from observing it from a distance. Verbalized thoughts always mean something. Just as what is recorded in history can never be erased, what I do not say I still have a chance to say, but what I do say I can never take back. I cannot know what is best for my clients or what the ripple effects of any action can be.

My work at the UN was challenging, fulfilling, and exciting, but I know I made the right decision moving to psychoanalysis: I would like to believe that I play a positive and direct role in the lives of my clients, even if it is a small one. I hope that, through our work together, they get closer to a sense of peace and serenity. Each of my clients has left an indelible mark on my psyche. I grow with my clients and learn about myself as I am learning about them. I am a better person as a result of my work with them.

Most important, I chose psychoanalysis and remain in the field because I believe that “to redeem one person is to redeem the world” (Hornstein 2000). (2)

1. Michael Eigen Weekly Seminars.
2. Hornstein, G. To Redeem One Person is to Redeem the World. New York: Free Press, 2000.

Lama Z. Khouri CAPC, LMSW, MS is a psychoanalytic candidate at Manhattan Institute for Psychoanalysis, Executive Director of Circle OASIS LLC, and student and researcher at Teachers College, Columbia University.

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Love & Mercy: A Psychoanalyst Reviews

How can musician/composer Brian Wilson of The Beach Boys survive an environment of terrible physical and emotional abuse at the hands of his alcoholic father and emerge to write such beautiful ballads as “God Only Knows,” “Good Vibrations” and later, much later, “Love & Mercy?” The movie Love & Mercy directed by Bill Pohlad brings us into Wilson’s aural world and the richly creative musings that inspired him, and the dark auditory hallucinations that haunted him.

Played by two actors, Paul Dano as the younger Wilson and John Cusack as the over-medicated, aging recluse, the film moves back and forth in time between the actors in a fluid reflection of Wilson’s alternating “self-states” (Bromberg). Dano is particularly remarkable in his portrayal of Wilson’s rapture in the recording studio and awkward discomfort with the rest of his world.

As a psychoanalyst I found one early scene to be of particular interest. The older Wilson decides to buy a new car. The saleswoman, Melinda (a luminescent performance by Elizabeth Banks), engages Wilson with such warmth and curiosity that we understand why Wilson asks her to sit in the showroom car with him. She obliges. He shuts his car door, so she shuts her car door, and they just sit in the silence. Unaware of his celebrity status she is simply responding to his cues for contact. Wilson begins what could feel like an initial analytic session as he tells her he is still mourning the drowning death of his brother. He also confesses he is not married anymore; he is a lonely man in terrible grief and Melinda responds with a calm and tenderness that we will find has been sorely lacking in Wilson’s life.

When Wilson power-locks the doors at the start of their “session,” Melinda responds with a mix of wariness and humor. She seems to have assessed his behavior as quirky but his intentions as harmless. So where is the danger? Is it Wilson’s “bodyguards” we see lurking outside the car, or his omnipresent therapist Dr. Eugene Landy (Paul Giametti) who approaches the car in a menacing manner? In this “confusion of tongues” (Ferenczi), the lines between security and danger, care and manipulation, protector or predator, are blurred. It is Landy’s imperious rapping on the car window that interrupts their “session” but not before Wilson has had a chance to leave Melinda a secret note describing in three adjectives his tortured emotional state.

Daniel Shaw’s book Traumatic Narcissism, Relational Systems of Subjugation (Routledge, 2014) speaks to this film’s repeating refrain of the influence of the traumatizing narcissist on the vulnerable other. Wilson’s father and then his therapist, fueled by their evident envy of Wilson’s extraordinary musical gifts, demean and diminish him, projecting their fury and shame on to him. Wilson’s father physically beat him as a child so severely that he caused the loss of 92 % of Wilson’s hearing in one ear. Physical abuse transitioned into emotional abuse or what the Wilson brothers’ called their father’s black magic. These beginnings primed Wilson to be the masochistic object of Landy’s abuse.

Shaw, a psychoanalyst and cultic expert, describes the very features of the cult leader that Dr. Landy presents in his exploitative treatment of Wilson. Along with denying Wilson access to his daughters, controlling his budding romance with Melinda, claiming the better of the two California homes, Landy restricts Wilson’s food allowance while over-sedating him on medication. When a starving Wilson asks to be fed during a beach barbecue, Landy is so busy extolling his (meager) accomplishments to Melinda that he refuses to acknowledge Wilson’s desperate hunger. He berates Wilson as if he were a small child as he spews his shame-inducing invectives–a harrowing scene of subjugation.

Landy gradually appropriates a variety of roles in Wilson’s life: private investigator of his friends and staff, legal guardian with the power to re-hospitalize him, executor of his will and even an attempt at music producer. There is a dramatic contrast between Wilson’s early scenes of playfulness and bliss in the recording studio surrounded by the legendary studio musicians known as The Wrecking Crew versus the dark, heavily sedated scenes in a home studio as a solitary musician being verbally abused by Landy, who demands immediate musical output.

It is here, in his home studio that Melinda responds to Wilson’s messengered requests for help. And it is her recognition of his suffering and her heroic efforts at rescue that ultimately saves Wilson’s life. While Landy has been surveilling and “caring for” Wilson, it is Melinda who truly sees and ultimately rescues him.

Susan Obrecht, LCSW is Faculty, Supervisor and Training Analyst at Manhattan Institute for Psychoanalysis and NIP. She teaches courses in Dreams and loves film because, as Orson Welles says, “a film is a ribbon of dreams.” She has a private practice in Greenwich Village.

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For the 3rd and final post in our launch of Analysis Now, Blair Casdin talks about her decision to pursue psychoanalytic training after 15+ years working as a licensed clinical social worker in mental health clinics and hospitals.

Why Analytic Training?

By Blair Casdin, LCSW

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 4^th 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.

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