Tag Archives: Freud

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.

Confused? You Won’t Be!

Most of us locate confusion in our heads.  But that’s not what language, and our experience, when we look at them closely, tell us.

The word “confuse” comes from the Latin confound.  “Confusus,” a past participle, meant “to pour together, mix, mingle, to join together.” So confused literally means to be fused or joined together with someone else.

The dictionary meaning that comes closest to this is “to fail to distinguish between”” as in “he always confuses the twins.”

Confusion is therefore not something that exists “in your head” but is a result of you being uncertainly located between your head and another’s.

Don’t take my word for it.  Notice the next time you’re confused.  I bet you’ll discover that you’re trying to please/avoid annoying someone else, in a situation in which, if you know your own mind, there will be conflict.  So rather than know your own mind, you become con-fused.  Which, while unpleasant, does have the benefit of letting you avoid speaking and thus incurring the other’s displeasure.

Of course, the habit (or should we call it a strategy?) of being confused starts early.  The first person with whom we’re “fused” in our mother.  For a period, we cannot tell where we begin and they end.  Then gradually (if things go well) and abruptly (if they don’t), we begin to realize we are not self-sufficient, but rather scarily dependent on this person (who we later learn to call “mum”) to keep us alive.

And this is the origin of our later problems with confusion.  Because this kind of dependence, in which we need the other to keep us alive, becomes an unconscious template.  Which is evoked in later confusions.  Thirty/forty/fifty years later, it may be called into being when we’re with someone we “need” in some way — a partner, friend, colleague, boss, etc.

For example, you may become “confused” when your boss tells you that you don’t need a raise, because you’re already well paid.  In the moment of confusion, you’re conflating your boss with your mother, in that you feel you need his/her approval and incurring his displeasure is life-threateningly dangerous.  It doesn’t matter that your mother is dead or thousands of miles away — you’re still responding to an important “other” as if you’re a child and they are the adult crucial to your survival.

Rather than recognize an understandable conflict of interest — your boss may want one thing and you another — you get confused and think he/she knows best. You’re mixing and mingling yourself with him/her so that you don’t know where he/she ends and you begin.  Because if you do recognize that you and he/she are standing in different shoes, there is going to be conflict.  And you imagine, using your unconscious model, that this trouble will be life-threatening, that conflict/trouble will mean we will lose them forever/die/face an unknown but cataclysmic disaster.

Psychically separating from one’s mother is one of the most important elements in becoming your own person.  And naturally,  it’s one of the most complex and difficult to achieve.

Because amongst other things, it means coming to terms with all those feelings/thoughts that were unexpressed (and maybe even unthought) in relation to one’s mother as one grew up — wishing she was dead, hating/loving her with a scary passion, seeing her as the devil/god incarnate alternatively,  envying and being jealous of her, despising her, wanting to gobble her up and keep her forever in your tummy etc. etc.  We unconsciously fear that these thoughts make us bad and unworthy of anyone’s love, that if we allow ourselves to be separate, and voice our thoughts, this terrible truth will come out. And we will forfeit her life-giving love.

Patients often fear even speaking such thoughts in the consulting room — as if their mothers will know, or be stricken down, at a distance.

But avoiding the truth of us being separate beings doesn’t make life easier.  It produces a plague of other ills — anxiety, indecisiveness, confusion, hopelessness, despair.

When we are truly separate, we recognize there are inevitably differences between people, and that these will have consequences.  But we are not tempted to fuse with the other to avoid them.

This makes life simpler.  There’s what you want, your ability to say it, and the consequences you face for speaking your truth.  You don’t get caught up in the anxiety that agreement, or persuading the other that you’re right, is a life or death issue. Which means there is space which can result in understanding, compromise, or simply agreeing to disagree.

(For those of you who vaguely recognize the reference in my title, it’s from Soap, the American tv sitcom in the late 70’s.)

 

Is There Such A Thing As An Accident?

No I don’t believe in luck
No I don’t believe in circumstance no more
Accidents never happen in a perfect world

Jimmy Destri, of Blondie

Lately, in connection with another project, I’ve been reading a number of books by ex-residents of Bruno Bettleheim’s Orthogenic School in Chicago.  One thing that each resident takes up in their own way is one of the Bettleheim’s guiding principles:  there is no such thing as an accident.

Bettleheim took this quite far.  If during a hectic dodgeball game, you jumped out of the way of the ball and your elbow encountered another person’s ribs, the game would be stopped and you’d be asked why you had done this.  Saying “it was an accident,” or “I didn’t mean to hit him,” were not allowed as responses.  Rather, you were required to reflect on your unconscious motivation for this aggressive act.

Most people’s response to hearing a story like this is to say it’s absurd. A demonstration of how mad psychoanalysis can be when taken to an extreme.  I can understand this response.  And yet, I think meditating on both the principle and our response to it will pay dividends, illuminating the correct and incorrect use of psychoanalytic ideas, the limits of psychoanalytic explanation.

First of all, is it correct to say that in psychoanalysis that there is no such thing as an accident?  Certainly Freud and many other analysts (including myself) have found that many actions, originally thought to be accidental or inadvertent, can be discovered, through the application of the psychoanalytic method, to have been unconsciously motivated, meant if you like, or at least, meaningful.

But it is important to note here that “explaining” actions in this way is not the point of an analysis.  One doesn’t want a client to come out of an analysis full of lovely explanations for why they do what they do, but behaving exactly the same.

Rather the point of understanding actions differently is the coming to “own” them retrospectively.  So, for example, I’m late by fifteen minutes to meet a friend.  In my mind, it’s an accident, and I tell myself if I’d been luckier with the Underground I would have been on time.

But when I meet him, he says, “Still pissed off about what I said about your story?” I then remember how angry I was about his criticism during our last meeting, how I stewed on it for days, repeating it in my mind and stoking the anger again.  I immediately see — and own — how my being late was in fact, an expression of my anger and reluctance to see him again.  I smile, chagrined.  “I don’t hold a grudge, do I?”

The experience of many such incidents, both in your own life and in the analyses you conduct, does tend to produce some scepticism about the explanation “it’s an accident.”   But does it rule it out of court?  Given “a perfect world,” infinite time to reflect on our lives, and a completely enlightened, unjudgemental mind,  perhaps…

In other words, no.

I’m sceptical about “accidents” because of repeated experience of discovering that what I (and others) once thought was accidental, turned out, not to be.   It may be the case that Bruno Bettleheim had similar experiences to me, and had come to believe a more extreme version of what I do,  that accidents never happen.

No problem so far.

He, and I, can believe what we want.  It’s when Bettleheim attempts to impose his understanding on another that this becomes problematic.  Especially when the others are children in his care/power.

Let’s say, I believe Freud is the bee’s knees.  I may believe a lot of what he says is true. In spite of my wealth of experience justifying these beliefs to myself, I am not entitled to insist that you share them. Even if I believe it would greatly improve your life to know the wonderful truths of Freud, I have no mandate to impose my beliefs on you, any more than I can insist that you agree with me about Barack Obama, David Cameron, or anything else.

If you come to me for help, our work together may result in your sharing my admiration of Freud.   You may have experiences which make you believe that accidents never happen.  (You may not of course.  You may end up thinking Freud, and I, am bonkers!)

I cannot shortcut the process by which you arrive at your own understanding of the truth of whether accidents are possible (and everything else).  If I attempt to do so, and insist you believe something or act as if it is true and I have power over you, you can only identify with me or comply with me — pretend that you agree that what I say is true and give me explanations that might satisfy me.

Since the aim of psychoanalysis is to increase your freedom, identification (technically, identification with the aggressor) as an outcome is unsatisfactory — as it limits your understanding to that of the person you are identifying with.

The latter is largely what seems to have happened at Bettleheim’s school.  Residents learned not to say “it was an accident” and instead to say things like “Yes, I guess I was angry that my mother used to shout at me,” or “I did feel aggressive after my session with my counsellor.”

Having to comply in this way is antithetical to the whole psychoanalytic enterprise, which is founded on telling the truth.   In other words, ideally residents would have been rewarded for saying “I believe it was an accident, Dr. Bettleheim, whatever you think. Maybe I will come to understand differently in the fullness of time, but at the moment I think it is quite wrong for you to insist I produce explanations that relate this to my past.  It completely devalues the currency of explanation, and of this school.  And if you don’t mind, I’d like to go back to my game of dodgeball.”

Of course, the young children at the school were not in a position to say this. Neither are vulnerable and dependent patients. That is why it’s so important that therapists maintain a high degree of awareness of the limits of their explanatory principles, and of the largeness of their power in the therapeutic situation.

Rationalizing and Reason

Rationality and reason have gotten a lot of bad press lately.  They’ve come to be associated with being “in the head” and “cut off from one’s emotions”, with “male” thinking as opposed to”female” thinking.

But I think another reason that reason has gotten a bad name for itself is because it’s become confused with rationalizing.  Being able to tell the difference between these two is essential in any pursuit of self knowledge.  It’s especially crucial in a therapist.

That’s because however much they may appear similar, rationality and rationalizing have different masters, are driven by different impulses.

Let me explain:  In Freud’s early thinking, he talked about the “pleasure principle,” the way in which babies are driven to seek pleasure and avoid unpleasure (hunger, anxiety, overstimulation, dread, fear, loss of connection).  Though it’s called the “pleasure” principle, the avoidance of unpleasure is perhaps more important in Freud’s thinking.

As we grow, this primary principle, or drive, may be replaced, at least in some areas of our life, by the ability to control our impulses, delay gratification and deal with the reality of the world – the reality principle.  We come to see the value of truth and knowledge.  At times, Freud seems to explain this as a development of the pleasure principle – we pursue knowledge because we begin to see how it will ultimately give us more pleasure, or at least avoid unpleasure.  Later psychotherapists (for example, Bion) talk about the drive for truth in a more positive sense — as one of the highest expressions of our humanity.

People usually come to therapy principally out of a desire for a magic solution to their problem. They want themselves, others or their worlds to change without having to undergo personal pain.  In other words, they are dominated by the pleasure principle.

In a successful therapy, this transformed into a seeking of truth, as the client realizes, at least to some extent, that, in the words of x,  the pleasure of truth etc.

Back to rationalizing and rationality:  When we give reasons for something we don’t really have a choice about, we’re rationalizing.  We’re using a simulacrum of reasoning to blind ourselves to our lack of choice, and to the unconscious pleasure our present way of being gives us.  So, for example, an extremely driven client produced the following “reasons” to justify the amount of time he spent at work: many men at his age were working this hard as they were in their prime earning years, he had to do this to support his family, he couldn’t do an adequate job unless he worked this much.  A mother, who felt trapped at home, told me she couldn’t do anything different because her partner wanted dinner on the table at 6, and her teenage children “needed” her as otherwise they wouldn’t do their homework.

In both these cases, the person wants to continue in a pleasurable course of action, unconsciously aimed at avoiding a painful possibility, often one from their earlier lives. For the man, poverty, losing; for the woman, loss of love.  However if they realized how irrational their choices are (in present circumstances), they would be unable to do so.  So they give “reasons” for what they’re doing.  And they defend the truth of this false reasoning.

When we’re more interested in seeking truth, we may also give reasons for what we do.  But there is an open-endedness to this.  We’re not attached to our reasons, and are willing to give them up if better or more adequate ones show up later.  We don’t know where our pursuit of an understanding will lead us. And in general, we’re more curious about what is the case, rather than in defending ourselves from some feared outcome/shame/humiliation etc.

Of course, few of us are at one end of this spectrum or another.  And it’s also true that what was once a true enquiry can end up becoming a rationalization. For example, I have talked to people who have “been through” therapy and who can reel off the “reasons” they feel and behave as they do – their mother did this, their father did this.

One said complacently, “I behave this way because I was abandoned by my other during a holiday (vacation for my American readers).”  Here, what may have been a true past understanding has come to serve the pleasure principle – removing the necessity of enquiring into what is the case; excusing, rather than enabling confrontation, with painful/’bad behaviour.

Because of our desire to avoid unpleasure, it’s a constant struggle to extend the area in which we’re more interested in finding out the truth rather than in persisting in patterns of behaviour aimed at avoiding pain or past traumatic situations which are projected into the future.

The ability to tell the difference between rationalization and reason is one of our key allies in this struggle.