Category Archives: Psychoanalytic theorizing

How does Therapy Help — The New

In my last blog, I considered psychoanalytic theorizing and its core understanding of repetition.  Today I’d like to consider the uniqueness of the therapeutic situation itself and the ways that it is different from whatever we presume happened between mother and infant, toddler and parents, etc.

For it may not be, as we largely assume, that parents have not had the ability to contain/digest/understand/empathize with what our client has brought to us to deal with.  Perhaps, they haven’t been given a chance.

For there is a profound difference between infanthood/childhood/teenagerdom and what happens in a therapeutic situation:  the client has chosen to be there, however ambivalently and reluctantly.

Even if our clients arrive expecting magical understanding or advice, they must, after some time, recognize that what we offer is more modest – the chance to think about and re-explore their lives and history, a chance to reinterpret events.  If they persist beyond this initial stage of disillusionment, they are choosing to go on a journey of understanding with us.

When the client continues to come, they are saying, however ambivalently, “bring it on.” And this may well be something that they have never been in a position to say, or think, or do, before.  It makes for an entirely new situation.

I don’t believe we have adequately thought through what this means and how it makes therapy essentially different from that of a child/infant with his/her parents.

A client who persists with therapy says “I choose you to be the person with whom:

  • I will attempt to feel and think things I have always avoided,
  • go to places no right-minded person will go,
  • share experiences that drive me  (and will probably drive you) crazy,
  • and if you prove understanding and trustworthy enough, to whom I will say things I have never said before.

It’s very likely our client has never said/done this before.  It is new, and will have profound consequences in enabling our client to find resources within themselves which they had never previously had cause to discover.

Though this new situation may inevitably involve repetition (for our behaviour/thought and feelings are not starting from scratch), it is profoundly different from what occurs with our parents, who are there, as a given, from the beginning.  If we’re lucky, they’re loving and thoughtful and mean well.  If we’re even luckier, they have some sense of what they have taken on in this most impossible of jobs, and are, in most ways, adequate to it

But I believe what parents sign up for is fundamentally different from that which analysts offer.  And so retrospectively understanding parents as inadequate analysts is a profound mistake.

If this isn’t obvious, there are a number of things that should make it more so:

  • It’s simply out of order for parents to “interpret” their children. I speak from experience here:  my daughter bristles (rightly, I’m afraid) whenever I’m tempted to do so.  She simply has not given me permission to do so, in the way a client gives a therapist.   Interpreting, in the words of Jay Haley, is a “power tactic,” and not one parents should use. I have permission to be her parent, but not her therapist. Thus the fundamental activity of therapists is denied to parents.
  • Of course, much of the “containing” that analysts feel parents haven’t done would be pre-verbal, from the earliest days, months and years of an infant’s life. But even here, I’m not sure we’ve adequately thought the difference between containing/digesting feelings which are formed before significant contact with language (what early mothers have to do) with containing “early” feelings of adults who are swimming in the sea of language, which is what therapists, at their best, do.
  • If being a good parent was simply a question of being an adequate analyst, you wouldn’t find many children of therapists who are messed up. Unfortunately, it is quite easy to do so.

Of course, I am not saying that there aren’t many ways bad or inadequate parents or even good parents in bad moments can’t mess up a child in ways they will still be struggling with years later.  In many of these cases, there will be a clear line of causation which it is possible to make:  for example, if a parent physically/verbally/sexually abuses a child, the scars which the adult bears years later can be traced back to the abuse, and what it meant to the child.

But a great deal of what analysts do, or take themselves to be doing, is dealing with  feelings/thoughts/perceptions/fears that are pre-verbal.   For example, Klein and Bion talk about the primitive fear of dying, which is attributed to the earliest months of a person’s life.   Such feelings may indeed need to be contained/digested/processed in a good analysis.

But here we are in quite different territory as far as causation goes.  We have no way of knowing whether this client’s early mother couldn’t deal with/contain/digest, his early hatred/fear of dying, etc.  This is true even if there is evidence the mother was depressed, preoccupied, grieving – absent in some major way.

All we really know is that there is work to be done, and if we, and the client are fortunate, we will be able to do it together, in a way that has never proved possible before.  But my suspicion is that a big part of why we are able to do that work is because the client has walked into our room under their own steam, sat in our chair (or laid on our couch) day after day, and has continued to do that until what they want/need has been accomplished.

For our clients, in our consulting room, everything they do/say/feel is understood as part of the work they have come to do.  This is an ennobling understanding. What has previously been understood as pathology is seen as attempted communication, as co-operation.  Even when clients seem to be working against us (resisting in its many forms), it is our belief as therapists that this is essentially working with us, presenting us with what we need to grapple with to help them.

All this makes for a unique situation, a proper “job” that clients can find themselves able to do however much previous “jobs” have been beyond them.  Being able to work with someone, in such a difficult situation with such difficult “material,” again, may be new for a client.  The sense of achievement they get from this and the support they get from being party to discovering the “truth” about themselves, may, and I believe is, much more important in their “cure” than the explanations in terms of repetition which we provide for them.

Repetition and Psychoanalytic Theorizing

A lot of psychoanalytic theorizing follows this basic path:  you try to understand (made a model for) what happens in the consulting room, say when a client who has been consumed by self-hatred gradually comes to hate themselves less, and then, you project backwards (often to early childhood) the absence of what you believe has happened between you and your client.

For example, some time ago I wrote about a “nightmare client” and of the moment in which, on reflection, her therapy changed.    However much a one-off this experience was, it’s inevitable I’ll find myself turning it over in my mind, trying to figure out what it was about this moment that made a difference.  And why it made a difference.  In other words, trying to understand what was lacking in my client’s history that was remedied by what happened between us.

But my success in doing the latter (trying to understand what was lacking in my client’s history), would very much depend on the “correctness” of my understanding of the moment where everything changed.  And there’s the rub.

First of all, unlike in the movies, (Ordinary People being a prime offender) there is rarely one blinding moment of insight, in which everything becomes clear (for both client and therapist). Further, in such movies, there is only one possible interpretation of this moment.

Secondly, the only instrument I have for understanding what happened is my own being – my thoughts/feelings/perceptions and ability to resonate (consciously and unconsciously) with the moment and my client.  Even if she should give an account of what happened for her, this too would be limited by her capacity to conceptualize what may essentially be an experience beyond her understanding/experience.

Third, it’s inevitable that my understanding will be shaped by the thinking of those who were involved in my education as a therapist – my analyst, my supervisors, teachers, and of course, what I’ve understood of the writings of the founders of my field – for me, Freud, Klein, Bion, Lacan on the psychoanalytic side, and Heidegger, Farber, Merleau-Ponty on the phenomenological.

So, when I try to understand correctly any moment of change, I am doing so through the lenses of my own perceptions and (my reaction to/comprehension of) the theories with which I have been graced/saddled with.

The “truth” of any psychoanalytic explanation that I arrive at, in other words is highly shaped/constrained by my personal openness to my thoughts/feelings/fantasies and by the theories/understandings that have become part of me.

For example, I’ve written in an earlier blog about a moment when a “nightmare client” walked out of a session to sit on the stairs outside my office.  I followed, sat down next to her, and then, consumed by despair at my inability to help/reach her, found tears running down my face.

Psychoanalytically speaking, I would say that this moment was one in which I allowed myself to fully experience/suffer my client’s utter despair at ever reaching me (or originally, I assume, her psychotic mother).   And that when she felt this, and my capacity to “contain” this moment, in a way that neither her mother nor her adopted parents had been able to do, something in her changed.

Her “undigested” maddening experience became one which had been altered by my taking it “in,” with compassion and love. (Those familiar with Bion can easily view this in terms of β elements and α elements.

This, I hasten to add, is only one possible interpretation of this moment, but it shows how the notion of repetition functions in psychoanalytic theorizing – that I, unlike her earlier parental figures, was able to contain (deal with emotionally) something which she had repeatedly tried to get someone to understand/feel/contain.  (I am very aware in writing this blog for the general public that this may not be convincing, or even much of an “explanation,” to someone not trained in my traditions.)

Another way repetition functions in psychoanalytic theorizing is in the notion of transference, basically, that clients “transfer” their past onto the therapist and thereby repeat it with them.

As it happens, my nightmare client spoke very little of her adopted family, and even less of her mother, who she only managed to trace and meet 2/3 of the way through therapy. In this case, psychoanalytic theorizing involves even more supposition, because I am trying to reconstruct her past by construing what is happening with me (or properly, what I understand of what is happening with me) as a repetition of it.

For example, early in the therapy, I frequently found myself reasoning with my client – explaining to her in reasonable terms why she shouldn’t be acting as she did.  (Often, as she was hanging out of my second floor window threatening to jump.)  Even as I did this, I recognized it was a rather stupid thing to do.  After a while, I began to think of this as something that my client’s adopted parents did with her, when she behaved passionately or angrily.  I made an interpretation based on this – “I seem to find myself trying to reason with you, even though I know it’s pointless.  I wonder if this isn’t something your father did, which drove you crazy in the same way as my being reasonable does.”  My client looked at me with soft eyes and nodded.   After this, I didn’t feel so compelled to be reasonable.

In other words, here the repetition of the past was played out in my behaviour.

The notion of repetition, in its many forms, dominates psychoanalytic interpretation, necessarily so, as psychoanalysis is based on trying to understand the present in terms of the past. But for all its power (and I don’t doubt that it’s real), such explanation involves repeatedly attributing to absent parents behaviour/thoughts/feelings/qualities for which we have very little external evidence.

I increasingly feel that this attribution is necessitated much more by our way of theorizing than by the “facts.”

Even if a client has spoken a great deal of their family (and clients vary enormously in this), I am very aware everything I hear is coming through a particular lens, and often is spoken to a particular end, to have me think/feel something.  More pointedly, most psychoanalytic theorizing focuses on the first year(s) of life, about which most clients “remember” almost nothing.

This time frame becomes the “blank screen” onto which analysts project their theories of repetition.

The “correctness” of these theories about early development becomes an issue of huge contention for analysts. I would argue that this is the wrong focus, as the “evidence” for these theories is not in early childhood but rather in the consulting room.

It is how we conceive of what goes on in the consulting room that is really important. And I increasingly feel that conceiving of this primarily in terms of repetition, underestimates the importance of the new. I will talk about this in my next blog.