Contemporary Psychoanalytic Musings

Psychoanalysis - On the Front Lines of the Experience of Reality

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Tue, 31 May 2011 10:28:00 +0000

It has been my experience and observation that personal pain, unexpressed and unshared, is a root cause of much malaise and suffering in the world. To the extent this can be remedied on a personal level, people can experience more freedom and become more empathic, kind and caring individuals.

To the extent that analysands can explore there own misery and suffering, share and express their pain, psychoanalysis is a tool to provide more freedom, empathy and kindness in the world.

I believe the potential collective amount of suffering in the world is boundless. It can be limitless. It is relative and thus can always improve or decline.

Thus I see psychoanalysts on the frontlines of pushing the collective experience of life in one direction or another. It's the only school of therapy I've surveyed that gives people a chance to explore deep misery and pain.

Throughout history, we have observed enormous human tragedy inflicted on humanity by it's own participants. Hitler, for example, was a person who had intense pain buried within, unshared and unaddressed (Dorpat, 2007). We all know the incredible misery he inflicted upon mankind.

Humans alone among all species (Becker, 1971) must confront their own mortality. This painful truth had led many to run from reality and lead quiet lives of misery. Projected fear of mortality has lead to all manner of collective abuse, collective denial and maladaptive behavior on a societal level.

Just as the personal experience of reality can be profoundly changed by confronting one's own deepest fears and pain, so too can the collective experience of reality be profoundly changed.

Psychoanalysis has incredible potential for humankind. Suffering is here to stay for homo sapiens. How we express it, constructively or destructively, is entirely our collective choice. As a tool for meaningful social change, psychoanalysis is the most promising frontier for mankind. Analysts and analysands alike stand at the frontlines of our collective pain and suffering.

As a tool for fighting poverty, I think psychoanalysis may be a potent tool. As a tool for alleviating social stratification and collective alienation, psychoanalysis may be the best we can offer ourselves.

All this assumes that psychoanalysis is performed with patience, respect and kindness. No school of thought has a monopoly on these traits. It also assumes that psychoanalysis can become less of a tool of, by and for those of great means, insomuch as it is just that.

Finally, I do believe psychoanalysis has an unparalleled modern voice of kindness and reason, a light that points it in the right direction. I humbly suggest this voice is that of the late Dr. Theo L. Dorpat. It is my hope that I can send as many clinicians and patients alike straight to his works. I firmly believe Dr. Dorpat shows us all the way forward to 'a more peaceful, just, and verdant society.'

-- Tim LaDuca

ParentWise by Loren Buckner

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 02 Jun 2011 10:47:00 +0000

Tampa psychotherapy colleague Loren Buckner, MSW, is author of ParentWise: The Emotional Challenges of Family Life and How to Deal With Them. ParentWise is a most unusual parenting book in that it does not tell people how to parent but instead explores what it feels like to be a parent. Writing on May 31, 2011 for the Orlando Sentinel as a guest columnist, Buckner shares some thoughts from ParentWise in the article entitled “Lessons from the Anthony trial: Inner reflection can help conflicted parents:

“…There's a risk, though, to pointing our fingers at other so-called "bad" parents. Focusing on their problems can lead to minimizing our own. Most of us admit to a certain amount of everyday anger. But we avoid confronting the deeper feelings, the ones that keep us up at night.

The Anthony case, and others that periodically dominate the news, center on parents who have lost their way. After every tragedy, we wonder: How could something like this possibly happen? This response is problematic, too, because as long as the question remains unfathomable, we can avoid thinking about it seriously.
The truth is we hear about families and children in crisis practically every day. We read about parents who hurt their children and about kids who are violent. To help them deal with their emotions, doctors prescribe antidepressants to kids and parents who are overwhelmed by how they feel and at a loss as to what do about it. Over-eating, under-eating and addictions of varying kinds have become common but unhealthy ways to cope.

This tragic case presents an opportunity to bring to light a painful truth that is hard to admit even in the privacy of our own thoughts, never mind say out loud. Normal, everyday kinds of parents sometimes hate their children.

Hatred feels awful. It fills parents with such unspeakable guilt and shame that hiding this excruciating feeling seems like the only respectable thing to do.

The word "hate," usually believed to be a horrid, immoral emotion, is difficult to use without cringing. Admitting that there are times when we do, in fact, hate being parents or hate our children may seem appalling. However, there's a type of hate that's different from the evil kind.

Like other strong feelings, hate is as much a part of life as any other emotion. Not only is hate a normal feeling, hate and love aren't mutually exclusive. We feel happy and sad, relieved and disappointed, and we feel love and hate, too. Most people have mixed feelings about all sorts of things. Parenthood is no exception. Containing the hate and anger we feel toward the people we love the most — our own children — is one of the most gut-wrenching parts of parenting, making it vital to understand.

Feelings, even disagreeable ones, do not determine our character. How we react and how we interact with others, especially when we're upset, is what's telling. We know in our hearts when something is wrong inside. We need to listen to these feelings instead of drowning them out. Pretending that everything is fine when we're confused and unhappy can lead to serious consequences.

People tend to think they wouldn't feel bad inside if they had stayed married, had a more traditional family, or had more money. Parents believe that somewhere out there are moms and dads who don't suffer with bouts of anger, guilt or self-doubt.

In reality, we all have to learn to manage painful feelings. Individual circumstances vary, but disturbing emotions are an integral part of a family's journey. Feelings, even negative ones, are not character flaws or signs of weakness; they are signs of life.

As parents, we have a responsibility to look into our own personal stories. We need to understand and learn how to cope with the complicated and conflicting feelings we have. Our kids deserve this degree of dedication.

And even if we haven't been committed to a self-reflective parenting style, we can certainly honor Caylee Anthony's memory by developing one now.”

I am grateful to Loren Buckner for sharing her much needed ideas in such an accessible manner for all to read and to the Orlando Sentinel for publishing her work.

Psychoanalysis and Compassion: the Death Penalty

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Tue, 07 Jun 2011 10:15:00 +0000

With the two recent posts on this blog, one by Tim LaDuca on May 31, 2011 (about the compassion of psychoanalysis), and one by Loren Buckner on June 2, 2011, (describing --regarding the Anthony case-- how even good parents can sometimes harbor hateful, even murderous thoughts, toward their children), I was reminded of an article I had read.

Appearing in the May 9, 2011 issue of The New Yorker, the article The Mitigator by Jeffrey Toobin reported on the decline of the use of the death penalty, particularly in Texas, where defense attorneys have, in the last decade, finally begun to utilize the opportunity to present mitigating evidence to the prosecutor before the charging decision is made. In addition to medical history, MRIs, and character witnesses, an extensive life history is conducted and used to help explain how “'a beloved brother and husband and father and son can also commit a terrible act.’” This enables the jury to have mercy, both on the defendant and the defendant’s family members.

Scharlette Holdman, an anthropologist and “a pioneer in the field” of providing into evidence a mitigation narrative (e.g. for Ted Kaczynski the Unabomber) said, “'That narrative is not there for the asking…It requires not just knowledge and skill but experience in how you search for, identify, locate, recognize, and preserve the information.’” Having read this article, my first thought as an analyst was: who is better to help identify, recognize, and construct a compassionate life story than a psychoanalyst? Forensic work is not my favorite, but it seems to me that the mitigation narrative screams out for the skill of the psychoanalyst, especially one with experience in childhood traumas, who is an expert in co-constructing a compelling story of a person’s life and is able “to create a complex portrait of a haunted and troubled defendant.”

The article featured Danalynn Recer, a Texas attorney and defense strategist for capital cases, who is quoted as saying, “'I don’t apologize for saying I love my clients in all their complexity. We insist on seeing their humanity despite what they’ve done.'” Now couldn’t that also be said by analysts about their clients/patients?

Michael Poff comments on Hiroshima, Mon Amour

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Wed, 15 Jun 2011 11:36:00 +0000

It was not oedipal conflicts that I believed remained unsuccessfully resolved. My observation was that although there were triangular features to the relationship in Hiroshima Mon Amour (see April 4, 2011) that might typically suggest Oedipal-level repetitions (i.e., references to cheated-upon third party/spouse/dead lover; Lui’s thrill at being special to Ella compared to all her past lovers; the recurring subject of lying; the central theme of sleeping with the forbidden/the enemy), much more obvious, in this case, were the effects of the later trauma in early adulthood (the pervasive dissociative affect, the intensity to the repetition compulsion, an inexpressible humiliation and rage isolated behind the glassy “reasonable” defense). In fact, in the absence of other history, it was only the massive quality of that trauma that made more understandable the pervasive regressive and pre-oedipal emotional atmosphere of the affair (i.e., repetitive fantasies of annihilation by being consumed/devoured; borderline psychotic-like confusion of past/present, loss of self/other boundaries, etc.). Elle’s early refrain, “Without a record, there’s only reconstruction”, highlighted for me the parallel between her ‘remembering’, first in action then in words, with Lui and reconstruction in analysis. I see no inherent problem calling this a co-construction (But I was using Elle’s words.) so long as some conceptual principle for the asymmetrical relationship and the ideal of (relative) neutrality on the part of the analyst is preserved for the protection of the patient. It was Lui’s reference to what he will remember of Elle when he is compelled by habit into future affairs, and Elle’s staying ‘reasonable’ for the remainder of their relationship after he slaps her just as she risked expressing her anger, that signaled the unresolved quality of the problems each was attempting some mastery over with the affair. I agree wholeheartedly with you that there was much caring in the ‘play’ and healing (for Elle, most obviously, given her resolution in the end to return home to Nevere) that came of the encounter between the two lovers. Michael Poff MA, MSW

Film: Tree of Life

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 26 Jun 2011 09:42:00 +0000

No film has ever been so evocative of a childhood: walking on cans tied with thick string; torturing small amphibia and reptiles with cherry bombs and firecrackers; running chest forward, arms outstretched, into mosquito-killing DDT clouds. These were the long, languorous days of southern summers before play dates and gated communities and the expectation of kidnappers and child molesters around every corner. Without standard plot or dialogue, the observer, like the analyst, is drawn into memory with Jack (Sean Penn), invited to lean in toward his experience of sprinkler drops on the skin, ligustrum hedge tops on the fingertips, or the jarring, contemptuous shouting of a father at a mother. One immerses oneself, the visual and auditory so penetrating as to be tactile. It is dream-like, hallucinogenic, poetical.

A nipple. An eye socket. A crater on the moon. Mud pots and phosphorescent pools. Molten lava and microbials. A nipple. The protruding umbilicus of a pregnant woman. Jupiter’s moon. What do we make of creation? Of the tree of life? This film intimates the interconnectedness of all creation. But the thread of loss and trauma flies in the face of connectedness, aggravated when one suffers in isolation, disconnecting us from the fabric of life.

Jack as a middle edged man remains connected to his childhood in the drops of water and the drops of sunlight of his glass-and-steel grownup world. His luminous mother (Jessica Chastain) had urged him to “love everything.”

The Tree of Life, written and directed by Terrence Malick (Badlands, Days of Heaven, and The Thin Red Line) is a wonder, visually, and its soundtrack magnificent. That Malick was a philosophy major and a Rhodes scholar is no surprise. But Malick must be a connoisseur of great music as well, with soundtrack by Alexandre Desplat, connecting Mahler, Bach, Smetena’s Die Moldau, Holst’s The Planets, Berlioz’ Requiem, Bach, and Brahms. The mystical ‘Tree of Life’ in religion, philosophy, mythology, connects all things in spirit and evolution. It brings eternal life. Malick ambitiously illustrates this conceptual interconnectedness of the ‘Tree of Life’ in his film thusly named, juxtaposing it with a singular, 1950s, Texas family, the O’Briens. Its eldest son Jack (Hunter McCracken) questions, in whispered voiceover, God or the universe and the meaning of existence. How Malick coaxed such a veridical performance from McCracken and Laramie Eppler as R.L. is a marvel,and the cinematography by Emmanuel Lubezki, exquisite. This is the best picture of 2011, or, perhaps,ever.

Poet Laureate Philip Levine

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 11 Aug 2011 11:06:00 +0000

Yesterday the former Detroit factory worker, 83 year-old, Phillip Levine was named the 18th Poet Laureate of the United States and will begin his one year term in October. The PBS Newshour last evening replayed its interview, from last year, on Levine. In that profile, Levine credited his shift from the metal press to the pen, as “pure luck,” pure luck to have met his wife on his 26th birthday, who worked to support him while he wrote, and perhaps more importantly, Levine noted, “She honors what I’m doing. And I think that is the most crucial thing-- to be honored as a poet, not by a nation, because a nation is an abstraction, but just to be honored by this person or that person…”

His words “to be honored” struck a deep chord with me as an analyst because, for me,an analytic attitude includes, not interpretation as accusation but, love and acceptance, an honoring of all the patient has been through, utilizes in present day to cope, and will one day be. Levine asked incredulously about his wife of, then, 55 years, “How many women would stay with a guy who has no prospects and wants to write poetry…?” I was reminded of a fine marriage of analyst and analysand, sticking with one another through the rough and ready years, honoring each other and the work as best and as tenaciously as each can in minutes of uncertainty and pain, with the hope that something is in the process, like a poem, of becoming.

Here is an excerpt from Any Night

…I will have to learn
to sing in the voices of pure joy
and pure pain. I will have to forget
my name, my childhood, the years
under the cold dominion of the clock
so that this voice, torn and cracked,
can reach the low hills that shielded
the orange trees once. I will stand
on the back porch as the cold
drifts in, and sing, not for joy,
not for love, not even to be heard.
I will sing so that the darkness
can take hold and whatever
is left, the fallen fruit, the last
leaf, the puzzled squirrel, the child
far from home, lost, will believe
this could be any night. That boy,
walking alone, thinking of nothing
or reciting his favorite names
to the moon and stars, let him
find the home he left this morning,
let him hear a prayer out
of the raging mouth of the wind.
Let him repeat that prayer,
the prayer that night follows day,
that life follows death, that in time
we find our lives. Don't let him see
all that has gone. Let him love
the darkness. Look, he's running
and singing too. He could be happy.

Create Date: Monday, January 13, 2003
by Philip Levine

Let Freedom Ring: Psychoanalysis and Politics

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Tue, 23 Aug 2011 10:14:00 +0000

While USA unveiled its Martin Luther King, Jr monument yesterday August 22, 2011, Libyan rebels, after six months of fighting, captured the capital of Tripoli. Of this victory US President Barack Obama said, "The pursuit of human dignity is stronger than any dictator." The PBS Newshour aired last night at least ten minutes of footage of Libyan men rejoicing in the streets, on rooftops, and in cars. In the footage of these hundreds of men I noted, maybe, a half dozen women and wondered to myself if women of Libya, 42 years under dictator Momar Gadhafi, will have a voice as Libya reinvents itself in its striving toward democracy. UK Prime Minister David Cameron intimated as much in his support of a "free, democratic, inclusive Libya." UN Secretary General Ban Ki-moon called this a "hopeful moment."

In the consulting room, freedom is described more personally, whether freedom from unconscious conflict, or freedom to embrace our multiple selves, or even freedom from the tyranny of the procrustean bed of analysts who hold too tightly to their theories. Individuals require what countries transforming themselves require: access to frozen assets, building of infrastructure, secure enough borders, and (an international) community. Therapists help patients develop their voices. In this moment of hope, my hope for Libya is that the international community aids Libya in including female voices for a truly inclusive endeavor.

Perspectival Realism and Rape

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Wed, 24 Aug 2011 10:48:00 +0000

Whose reality is it? Whose truth? As is often the case with sexual assault (a crime which usually occurs with few witnesses) it comes down to a battle of credibility, seeming, then, to put the complaining victim, not the defendant, on trial. Yesterday, August 23, 2011, after three months of investigation, the sexual assault charges against former IMF President and likely French presidential hopeful Dominique Strauss- Kahn were dropped. His accuser Nifassatou Diallo, an immigrant from Guinea, Africa was the hotel maid where Strauss-Kahn was staying. The NY prosecutors, perhaps having rushed to charge a man who was getting on a plane to France (a country without an extradition agreement with the USA), yesterday sounded angry at the accuser for the changes, for which she was discredited, in her story.

Certainly defendants can be falsely accused. With changes in the justice system over the decades, the victim is no longer accused of dressing provocatively or 'asking for' the sexual encounter. But questions will always remain in the case of Strauss-Kahn about what happened in that ten minutes. So many questions! Is Diallo a person who could seize the opportunity of a powerful man's sexual activity for her own financial gain? Can't liars and druggies be raped? And while it is said that there are men who would pursue a sexual encounter with anyone at any time, I ask myself: why would such a powerful and wealthy man be so indiscriminate, so pressing with motivation at that moment?

At the time of her report to coworkers, boss, and police, Diallo appeared credible and credibly shaken and injured. "Beyond a reasonable doubt" favors the defense, as is should. But therapists know that trauma causes disorientation and dissociation, making memory patchy. I can therefore understand Diallo moving to clean the next hotel room or returning to clean the room where the alleged attack occurred. I know that people are known to be motivated to please authority, whether the police or the prosecutor (or the rapist) by telling them what they want to hear. Many people can possibly understand lying to gain asylum as Diallo did to stay in the United States. I ask myself: Will this case set back courage to report crimes such as rape or crimes perpetrated against immigrants?

Martin Luther King, Jr Memorial and the Arab Spring

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 28 Aug 2011 11:51:00 +0000

The Martin Luther King, Jr National Memorial, conceived in 1984 by King’s college fraternity and signed into legislation in 1996 by President Clinton, was to be dedicated today, but its dedication was postponed by the vast width of the rains of Hurricane Irene. It stands at 1964 Independence Ave, adjacent to the tidal basin and situated between the Lincoln and Jefferson Memorials. (1964 is the year President Johnson signed, with King at his side, Civil Rights legislation.) Forty-eight years ago, on the steps of the Lincoln Memorial, King gave his “I Have A Dream” speech.

Two huge, granite stones, like a mountain, flank the Memorial’s entrance, symbolic of King’s words: “hew out of the mountain of despair a stone of hope,” and a thirty foot sculpture of King is carved in this ‘stone of hope.’ A 450 foot wall boasts fourteen quotes, no less relevant today, from King. At its ground breaking in 2006, President Clinton said of the monument to be built there, “The monument … will be but a physical manifestation of the monument already constructed in the lives and hearts of millions of Americans who are more just … because he lived.”

Johnetta Cole, Director of the Smithsonian National Museum of African Art, said of the monument that it conveys the “power and possibility of change.” She sees as apropos that “Dr. King rises out of a rock … solid and unshakeable.” “To honor and celebrate him,’ she adds, is done “not by our words but by our actions.” Rev. Jesse Jackson, activist and personal friend of King’s, intimates that this memorial compells Americans to “unfinished business” to “fight poverty, illiteracy, disease…”

Sculptor Lei Yixin of China, hoped to convey in King’s serious expression King’s “passion…for hope for the future.” But I think King would have smiled to have his memorial completed and unveiled in the year of the Arab Spring. Despite the violence in Libya, this popular uprising of the Arab world, especially in North Africa, is a bid for justice and liberty, a bid King knew much about.

The Monkey and the Fish

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Wed, 31 Aug 2011 09:51:00 +0000

As the Tampa Bay Institute for Psychoanalytic Studies, Inc, a contemporary training program, gears up for classes to begin September 21, 2011, I often muse about how to convey to candidates and students an open attitude toward patients, an attitude which often includes ‘letting go’ of the bastion of [pejorative, accusatory] interpretation in its attempt to rid patients of “defenses” as if we are the authority on what is best for a patient.

My colleague, Horacio Arias, and I have, more than once, discussed the idea, captured beautifully in his pithy statement ‘there is no such thing as pathology,’ that patients have established their ways of being in the world (whether nuanced and called symptoms, defenses, transference, organizing principles, RIGS, relational paradigms, etc) for very good reason, and, as such, we therapists best be respectful of the necessary purposes these serve to maintain the psyche’s functioning, however precarious or constraining that functioning may be (or seem to us). Rushing in to interpret may not be at all fortuitous, and may create a less safe –and inadvertently humiliating-- psychoanalytic space, or even result in bringing down a house of cards.

To bulwark my patience, I remind myself of a little story told on Mt. Gorongosa in central Mozambique about white colonists and modern philanthropists who thought they knew what is best for the local African people. It is the story of The Monkey and the Fish and it goes like this:

A monkey was walking beside a river one day and notices a fish in the water. The monkey thinks to itself, “Oh, no! That poor animal will drown! I must do something.” The monkey scoops up the fish and the fish begins flailing in the monkey’s hands. The monkey says to itself, “Look how happy I have made it. It leaps for joy.” The fish dies, and the monkey thinks, “If only I had gotten here sooner, I might have saved its life.”

I try to remember to not be the monkey in this story when I am tempted to think I know what is best for my patients to do, like when I think they should give up drug use, leave a battering spouse, or stop being so stubborn.

"Super Vision" by Peter Wilkins (Blog)

noreply@blogger.com (Heather Pyle, PsyD) — Fri, 09 Sep 2011 22:53:00 +0000

A provocative account of an imaginary supervision session invites therapists, both novice and seasoned, to examine the rich complexity of our feelings towards our patients.

"Super Vision"

Several people have alluded to the emotional costs of being a therapist. ‘How do you cope,’ they have asked, ‘having to face other people’s distress day after day?’ It is a very pertinent question. How do we, as therapists, manage to survive our own feelings generated by our encounter with the other? (cont.)

Read the rest of the post at http://bit.ly/qrpwyA

Post from "Peter Wilkins Blog"

Poetry

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 11 Sep 2011 17:26:00 +0000

Reflective, pensive, sad in the week preceding this tenth anniversary, my words seem inadequate. Instead I will post those of Ben Feldman, a colleague, a poet, and a student at TBIPS.

On Compassion

Compassion salvages the heart,
Wounded.
But revenge, vindictive,
Tears and tastes the meat
Like lions.

Practice
If compassion is to create
an antitoxin in the soul
then it must be played and practiced
like a cello in love
under stars with kin in soul
and harmonies woven in heart.

--Ben Feldman

Self and Relational Psychologies Face-off

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 18 Sep 2011 10:40:00 +0000

Soon after Labor Day each year, The Tampa Bay Institute for Psychoanalytic Studies, Inc (T-BIPS) recommences its two (Self and Relational) Study Groups. On Friday, September 16, the TBIPS Self Psychology Study Group read the 2005 paper by Israeli analyst David G. Kitron The Unacknowledged Knowledge and the Need for a Sanity-Confirming Selfobject. It made for a lively discussion about whether or not an analyst could actually “temporarily” or “partially” “suspend his or her own subjective experience.” Self psychologists and the Stolorow et al Intersubjectivists tend to intimate that we can. Relational Intersubjectivists claim this is not possible.

No doubt that our profession aims at being helpful to our patients, which means being toward a focus, even with our own subjective experience, on the patient’s experience. Kitron aptly commends Ghent’s (1990) surrender over submission. He also reminds us that survivors of childhood trauma have had their reality-testing attacked, what he calls a failure of a sanity confirming self object. I applaud when he writes, “It is the therapist’s duty…to search for any mistake he might have made.” Not to do so would attack again the patient’s reality-testing (gas lighting) and re-traumatize. The analyst’s mistake, if denied by the analyst, becomes part of the “unacknowledged knowledge.”

Where Kitron and Relational thinkers may diverge is when does the therapist deem that “a side-by-side coexistence of two subjectivities is gradually made possible.” Kitron says “the therapist has to ‘step aside’ and suspend his subjectivity temporarily” until the patient has developed the capacity for intersubjectivity [mentalization, Fonagy would contend, is a component of this capacity]. I tend from the very beginning to lean toward the “hold in tension” philosophy. What I mean is that I do not want to obfuscate the part of the patient that is inevitably aware of my subjectivity [as even psychotic patients are] even while, because the patient has had the repeated experience of attack on her/his reality testing, the patient finds any other’s subjectivity unwelcome, even noxious or traumatic. To “suspend” my subjectivity might then be a mere reversal of where one “dominates and paralyzes the other.” I try, then, to hold my subjectivity in tension with the need of the patient to have her/his subjectivity exalted.

Nobel Laureate

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sat, 08 Oct 2011 10:35:00 +0000

It is hard to be an instructor in psychoanalysis. It is a struggle to hold lightly to our theories while attempting to impart key psychoanalytic concepts, and while simultaneously hoping to co-create an open inquiry in the classroom in order to both model open inquiry and to facilitate the procedural learning of it. The comments this week of Isreali born scientist Dan Schechtman may have helped.

Dan Schechtman, in 1982, described a new chemical structure “quasicrystals” which then defied the expectation that crystals are to be regular and repeating, and for this he lost his place on a US research team. In 1982 his idea was too unorthodox to be credible. Almost thirty years later, quasicrystals are being studied as a way to convert heat into electricity. Schechtman is not only vindicated, but honored when this week he was awarded the Nobel Prize in Chemistry.

Schechtman, now 70 years old, said about his work, “A good scientist is a humble and a listening scientist, and not one who is sure 100% in what he reads in the textbooks; and this is a lesson also to students to be open.”

Ethics and Outrage

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 13 Oct 2011 11:41:00 +0000

A few weeks ago at brunch at the home of friends we were expressing our disappointment with the US President. We agreed that Obama seemed to lack outrage, a righteous indignation, at what is happening all around us. It seems Obama has not expressed outrage since the unfortunate arrest of Harvard professor Henry Louis Gates, Jr in Cambridge, MA in July 2009.

So I was very happy to come across the interview with Stephane Hessel two evenings ago on the PBS Newshour. Hessel, a German born Jew raised in Paris, a member of the French Resistance, and a concentration camp survivor, was cogently speaking about his book Time for Outrage--Indignez-Vous! In Time for Outrage, published in October 2010, Hessel asked people to get angry and indignant when their government is not doing what is necessary to preserve the dignity of people.

The subsequent Arab Spring and, later, Occupy Wall Street, hearten him, and he encourages younger people -- now 94 years old, he quips that almost everyone is younger than he—to engage in a cause with outrage, not by violence, but by a determined will. He believes that international law, encouraged by Franklin Roosevelt and the UN charter, the ideals for which WWII was fought, are the values now threatened by failing financial fidelity and corruption around the world. He also sees as unacceptable the treatment of Palestinians by Israel, treatment of the world’s immigrants, that social security does not cover requirements of living, and the organization of lobbyists to oppress our governments.

Just yesterday, in TBIPS’ Practical Analytic Subjectivity course, the class was discussing Claire Allphin’s An Ethical Attitude in the Analytic Relationship (Journal Analytical Psychology, 50:451-468) in which she reminds us that “the source of ethical capacity is the ability to accommodate conflicting needs…” a plea for intersubjectivity if I ever heard one. She cites John Beebe’s obligation of the ethical attitude to protect (the patient’s) self esteem, or, as Hessel might say, each person’s dignity. I was reminded of a 20th century Christian hymn which sang “guard each [one’s] dignity and save each [one’s] pride” as the class, later, discussed interpretation and the exhortation to avoid shaming a patient by the meaning we may bring to their narrative or behavior.

Sunday Morning Musings

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 16 Oct 2011 20:29:00 +0000

This morning I had the unexpected pleasure of hearing a hospital chaplain friend of mine give a sermon at his church. He shared with us his personal story of loss and darkness woven masterfully with the readings of the day from Exodus 33:17 (where God says to Moses “…I know thee by name”) and from Revelations 2:17 (where the those who “overcome”—did my friend know that the Martin Luther King, Jr Memorial was dedicated today?—will be given “a white stone, and in the stone a new name written”) and with the birth and naming of his first son. He thought perhaps the name at time’s end written for him in the white stone might be ‘the carrier of sorrows’ but should one turn over the stone, one might find also the name of joyousness.

After service, my friend reminded me of the psychiatrist (Peter Wilkins, see blog post of 9-9-11) who was asked how he could bear listening all day to the sorrows of others. Then I thought of my answer to the many times I have been asked such a question: I do not bear others’ sorrows as some burden, but rather I embrace them, with joy of communion, and with the recognition of the privilege that is bestowed when others share them with me. Then I thought of a person I see, a Buddhist who lessened her burden, not by bearing her sadness, but by giving it a name, by making it a companion always beside her, recognized and acknowledged, both sides of a coin, or of a stone.

Rimbaud: “Je est un autre” the constructed self

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 20 Oct 2011 09:36:00 +0000

Parents who fear for the future of their rebellious teens might take heart from the life of Arthur Rimbaud who, born in Charleville on this date in 1854, wrote his renowned and iconoclastic poetry before the age of majority and lived, a runaway, his wild, debauched, drugging (to derange his senses) days in Paris, London, and Brussels while still a teen. Rimbaud then put poetry and rebellion behind him to become, for the remainder of his short life (he died in 1891 at the age of thirty-seven), a lucrative coffee and guns trader in colonial East Africa for a French trading company. Not unlike teenagers today, Jean-Nicolas-Arthur Rimbaud, before running off to Paris, scrawled graffiti (“Shit on God”) on town walls, smoked, grew his hair long, and mocked a town priest with an homage to his holy bowel movements (the poem “Squattings”).

Teens have been discovering and held anthem the revolutionary works of precocious, adolescent Rimbaud ever since. Marcel Proust, Jim Morrison, Bob Dylan (who refers in one of his songs to Rimbaud’s tumultuous experiment with homosexuality and Verlaine); singer-songwriter Patti Smith (who wrote Rimbaud’s Illuminations “became the Bible of my life.”) have all, in some way, cited Rimbaud’s influence. Even the film Eddie and the Cruisers (with its nod to the poetic lyrics of Bruce Springsteen) referenced Rimbaud, with Eddie’s lost album entitled Seasons in Hell.

Rimbaud wrote to his friend and former teacher Georges Izambard: “I'm working to turn myself into a seer: … It has to do with making your way toward the unknown by a derangement of all the senses.” And “It's wrong to say I think: one should say I am thought.” and “I is someone else”. Rimbaud was perhaps the most avant garde in this statement “JE est un autre” ( I am an other) intimating, like Hegel before him, that the subjective self, the “I”, is constructed, the other, constitutive. A useful construct, yes, but within it are multiple components, opposing sameness, what today we call multiple selves.

And with nothing merely as its constructed façade, Rimbaud saw the value of writing not only of internal things but also of ordinary things as experienced through the unique subjective self. This required a new way of constructing poetry, including synesthesia (as Baudelaire had done), such that chaos was captured in correct form (Oh, that my keel might rend and give me to the sea!). Soon after, he contacted the Symbolist poet Verlaine.

Mothers of prodigal sons might also appreciate that Rimbaud returned again and again, after many escapes, to the home of his own stern mother, his father having abandoned them when he was five. At fifteen, Rimbaud sought his fortune in Paris, for the Franco-Prussian war had led to closure of his school and he was too young to be allowed to be a soldier. This runaway, homeless in Paris, arrested, destitute, was, most likely, also raped. His suffering and early losses are reflected in his poetry. (See, e.g., The Drunken Boat below.)

In Enid Starkie's biography, she writes that Rimbaud gave up poetry when he realized it would not bring enlightenment. His mother’s influence, when she wrote to encourage the suicidal Verlaine: “..each of us has a wound in his heart, more or less deep...true happiness consists solely in fulfilling of one's duty, however painful it may be. …you'll see that misfortune will grow weary of pursuing you, and you'll become happy once more”, may be evident in Rimbaud’s choice to become an industrious trader of goods. In a twist of fate, his capitalististic endings perhaps mock his earlier work, just as his poems had earlier mocked French conventional verse, liberating it from its 19th century themes and form.

Rimmbaud's suffering is evident in this excerpt from Oliver Bernard’s translation of The Drunken Boat

But, truly, I have wept too much! The Dawns are heartbreaking.
Every moon is atrocious and every sun bitter:
Sharp love has swollen me up with heady langours.
O let my keel split! O let me sink to the bottom!
If there is one water in Europe I want, it is the
Black cold pool where into the scented twilight
A child squatting full of sadness, launches
A boat as fragile as a butterfly in May.

Shaddock Shares Systems Theory Approach to Couples

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 23 Oct 2011 11:23:00 +0000

The Tampa Bay Institute for Psychoanalytic Studies, Inc (TBIPS) was delighted to have as guest lecturer on October 19, 2011 David Shaddock, author of Contexts and Connections: an interubjective systems approach to couples therapy, apply systems theory to his work with couples. Intersubjective Systems theory recognizes that people are inherently connected. Moment to moment an individual’s psychological life is embedded in relational context. One advantage of a Systems approach is that everything is inherently contextual, everything potentially important. Likewise, the therapist does not have to be the one who knows (everything), as the goal instead is to bring about a shift in the dynamic system. The therapist asks herself in the moment ‘What triggered this shift?’

Shaddock says that a Systems approach, with its tenet that the whole is more than the sum of its parts, is optimistic, for systems can rearrange unpredictably after perturbation. Phase shifts are always possible. Perturb the system and the chance that it will reorganize itself in a new way becomes possible. Systems theory recognizes that the self is organized and reorganized spontaneously, not predictably predetermined. The therapist ‘catches’ these phase shifts. The couples therapist can, by making explicit a shift in the system, empower a couple with the experience that it does not take much to induce change. For example, when an angry couple suddenly softens because of something implicit, Shaddock will, to bring it under conscious control of the couple, point out the shift (e.g. ‘What just happened here? Your face just softened with concern and then your wife became calmer.’)

The therapist may view the couple through the frames of the repetitive selfobject dimension (ala Stolorow ), and the self/interactive regulation of affect dimension (ala infant research). In the former, one member of the couple may, in the therapy situation, have her/his worst fears confirmed. Couples therapist Carla Leone will watch the faces of each member of the couple to discern any hint of this retraumatization. The therapist can then intervene to shift from the repetitive pole to the more hopeful, regulatory one.

Recognizing two important ways to organize the world: defensively, and engaged toward relatedness, the therapist focuses on ‘toward relatedness.’ Couples therapists want both members of the couple to feel understood. (This decreases defensiveness, engenders hope, and increases the chance that each feels safer to state which needs each would like met.) A history, taken in front of the other partner, helps both the therapist to elucidate for herself a partner’s repetitive pole, and invites a new relational dynamic between the couple (by allowing the other partner to witness that it is historical factors, not the witnessing partner, which trigger fearful responses) and this may lead to a reparation of empathy.

In the affect regulatory dimension, each partner sometimes needs attunement from the other (interactive regulation) and sometimes needs time apart or alone for self regulation. Problems arise when there is a mismatch between how much a partner prefers one type of regulation. Because how we regulate and organize ourselves becomes who we are, the mismatch can suddenly shift to a ‘do or die’ level when denial of a preference threatens the self and feels like annihilation. Shaddock will make the shift explicit (e.g. Five seconds ago you were just talking about who does the dishes and now we are talking about divorce. How do we understand such a shift?).

Shaddock’s presentation was so illuminating that we look eagerly forward to his return to TBIPS in January 2012 to lecture again in our Couples Treatment course.

Birthday: RFK

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 20 Nov 2011 10:26:00 +0000

Had he lived, Robert Francis Kennedy would be 86 years old today. Perhaps like his brother before him, would also have been a U.S. President and an Elusive Hero. Robert Kennedy, on April 4,1968 in Indianapolis on the campaign trail, upon learning of the assassination of Martin Luther King, Jr, spoke to the crowd gathered before him, and, like a good enough therapist or parent, put himself in the shoes of an other when he said, “For those of you who are black and are tempted to be filled with hatred and distrust at the injustice of such an act, against all white people, I can only say that I feel in my own heart the same kind of feeling.”

As many that night had shown up with intent to avenge the murder of their beloved spokesperson, it was this empathic attunement which, I believe, circumvented in Indianapolis the violence that erupted in other U.S. cities. By acknowledging, understanding, and accepting such a feeling for himself, noting that he, too, had had a family member killed, the crowd knew that it had been heard and so action as attempt to be understood was not necessary. More than mere empathy, Kennedy, offering himself in communion with their sorrow, offered an alternative that might be shared by all “people who love peace all over the world.” That alternative was “love and wisdom, and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or they be black,” claiming that “the vast majority of white people and the vast majority of black people in this country want to live together, want to improve the quality of our life, and want justice for all human beings who abide in our land.”

In this same address, Robert Kennedy said,
“My favorite poet was Aeschylus. He wrote:

‘In our sleep, pain which cannot forget falls drop by drop upon the heart until, in our own despair, against our will, comes wisdom through the awful grace of God.’ ”

Sometimes I find the work that we do is also through awful grace.

Pathological Accommodation

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Fri, 16 Dec 2011 21:49:00 +0000

Last month at our Tampa Bay Psychoanalytic Society, Inc meeting, I found myself literally jolted by a concept. Many of our speakers have left indelible ideas and memories within me, but this notion explored on a November Saturday morning struck me as profound and clear and pervasive. Dr. Shelley Doctors elucidated the psychological process called "pathological accommodation," in which a person, likely from infancy onward, learns essentially to erase him- or herself in order to have a relationship with an important other. In other words, a child grows up knowing that in order to maintain a relationship with a caregiver, he or she must deny longings, feelings, and opinions that reside authentically within: "I will accommodate to you, my mother, so that I can have a relationship with you and thereby survive, but I do so at the cost of my very self and its development. I will do this because to be rejected by you, I fear, will be the very end of me. So, this is my choice, the lesser of two evils, between having no self and having nothing at all."

The Impact of Pathological Accommodation

It was not the idea of pathological accommodation per se that rocked me, but rather, the developmental course that this may take in one's life. Authors Brandchaft, Doctors, and Sorter1 describe these possible trajectories:

The child may attempt to preserve and protect this core of individualized vitality at the expense of object ties by determined non-conformism or rebellion. That is a path of isolation and ultimate estrangement. Alternatively, the child may abandon or fatally compromise his central strivings in order to maintain indispensable ties. That is the path of submission. Or the child may oscillate
between these two . . . Depression becomes the dominant affect in a person whom such a conflict has become chronic and internalized. It signals the loss of hope where no synthesis can be found between intimate connectedness with important others and the pursuit of a program of individualized selfhood. (p. 56)

It is deep within this quandary where I see many precious people. Those who disconnect relationally may do so because they have come to the conclusion that the price tag surrounding personal connections, especially intimate ones, is simply too high: it requires a submission of self-ness, authentic personhood. Those who remain in unhappy intimate situations may do so because they have concluded that it is better to have a relationship that is smothering and controlling (or abusive), than to disconnect from it and risk alienation or worse. And the third group: those who cannot be at peace in isolation or stultifying relationship. These try one approach until the pain of their current dynamic overwhelms them and then they flee---either into nonconformity in a brave attempt to find and hold onto their own voice, or into a painful intimacy in an attempt to feel less alien, less disconnected from.

Perhaps as you read about this process, you might identify with it, if only to some degree; perhaps you have noticed themes in your life not altogether different than the process of pathological accommodation. Coming to a point in life where you dare to believe that you can indeed have relationships that are mutual and reciprocal, that do not require a forfeiture of self, is not only a life-changing moment, but a life-giving one.

Steve Graham, PhD

1. Brandchaft, B., Doctors, S., & Sorter, D. (2010), Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision. London: Routledge.

TBIPS COURSE REGISTRATION Form Spring 2012

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Tue, 03 Jan 2012 13:19:00 +0000

Program Offerings First and Third Year
2011-2012

About our Program:
TBIPS is a professional community which embraces pluralism and a comprehensive contemporary view of psychoanalysis within the context of a mutually respectful and open learning atmosphere.

We invite you to:
• Deepen and develop your clinical skills
• Join colleagues to network and share practical issues
• Enroll in an individual class, or
• Enroll in a training program
Two year certificate program in Psychoanalytic psychotherapy
Four year certificate program in Psychoanalysis

Courses:
Classes are open to mental health professionals with an interest in psychoanalytic ideas. The courses may be taken independently, but, in order to optimally elaborate concepts, we suggest that you enroll in the full semester.

Distance Learning:
Long distance learning options available through use of phone conferencing or Skype video conferencing.

Please be aware that the TBIPS Board has recently decided that all tuition scholarships (for Semester II and after) will be 'work study' where the student or candidate will volunteer for one hour per semester to TBIPS (nothing strenuous: typing, attending planning meetings, errands) for every $50 of scholarship monies the student receives (eg, if you receive $100 off of your tuition, then you will volunteer for two hours in that semester).
Spring Semester 2012

First Year Courses Semester II

Introduction to Psychoanalytic Concepts Part II (16 weeks)
The second part of this course will provide a strong foundation in theory. Contributions from major theoretical predecessors from Ego/Structural and Drive, Objects Relations, Interpersonal, and Self Psychology, and how these influence Relational, and Intersubjectivity clinical engagement will be discussed, as well as Affect Regulation, and Attachment Theory.
Instructor: Lycia Alexander-Guerra, MD, with guest faculty.

Meets Wednesdays 700pm-830pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Clinical Case Conference (16weeks)
This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material.

Meets Wednesdays 345pm-515pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Human Development (16 weeks)
Participants will supplement and re-configure Freudian and Mahler's ideas with infant research, attachment theory, contributions from Benjamin, Stern, Bowlby, WInnicott, and others. Instructor: Lycia Alexander-Guerra

Meets Wednesdays 525pm-655pm at 14043 N Dale Mabry Hwy Tampa, FL 33618.
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Third Year Courses Semester II Spring 2012

Painful Repetitive States (16 weeks)
This course explores how early paradigms of self and self with others become encoded and then repeated in self injurious behaviors, addictions, and psychosomatic symptoms. We will discuss the therapist's frustration in working with people who have these particularly intransigent symptoms, as well as ways to engage this world of patients in an effort to co-create new ways of being together.

Meets Wednesdays 215pm-345pm at 300 S Hyde Park #240, Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012. (note, first year may conference call in from 14043 N Dale Mabry)
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Clinical Case Conference (16weeks)
This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material. Instructor: Susan Horky
Meets Wednesdays 345pm-515pm at 300 S Hyde Park #240 Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 28; April 4, 11, 18, 25; May 2, 9, 16, 2012.
Fee: $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take fourth course).

Trauma III (8 weeks) and Gender III (8 weeks) (must register for both)
The Trauma course revisits Freud's seduction theory and is contemporized by the works of Van der Kolk, Davies, Boulanger and others.
Instructor: Peter Rudnytsky
Meets Wednesdays 530pm-700pm at 300 S Hyde Park #240 Tampa, FL 33606
February 1, 8, 15, 22, 29; March 7, 14, 21, 2012
The Gender course looks at postmodern views of gender, its construction, and the loss and mourning of paths not taken.
Instructor: David Baker
Meets Wednesdays 530pm-700pm at 300 S Hyde Park #240 Tampa, FL 33606
March 28, April 4, 11, 18, 25; May 2, 9, 16, 2012
Fee for Trauma and Gender Course (taken together as one course): $250 for the single course; $200each if enrolled in full semester (all 3 courses $600; $750 if take a fourth course).

Registration for first year courses Spring Semester 20I2
Name________________________________________ Degree____
License #_______State___
Address________________________________City_______________State___Zip______
Email address________________________________
Request long distance learning ____(yes)

Spring Semester 2012: Registration deadline January 19, 2012

______ Intro to Psa Concepts II (16 weeks) Wednesdays 700-830pm
_______ Clinical Case Conference (16 weeks) Wednesdays 345-515pm
______ Human Development (16 weeks) Wednesdays 525-655pm

_______ Painful Repetive States (first year may add as option) Wednesdays 215-345pm

_______Total Payment Enclosed

Mail this copied registration form with check (and CV if first time registrant) to:
TBIPS, Inc 14043 N Dale Mabry, Tampa, FL 33618
refund policy (85% 7 days before classes begin)

Registration for third year courses Spring Semester 2012
Name________________________________________ Degree____
License #_______State___
Address________________________________City_______________State___Zip______
Email address________________________________
Request long distance learning ____(yes)
Spring Semester 2012: Registration deadline January 19, 2012
______ Repetitive Painful States (16 weeks) Wednesdays 215-345pm
______ Clinical Case Conference (16 weeks) Wednesdays 345-515pm
______ Trauma and Gender (each 8 weeks) Wednesdays 530-700pm
______Total Payment Enclosed

Mail this copied registration form with check (and CV if first time registrant) to:
TBIPS, Inc 14043 N Dale Mabry, Tampa, FL 33618
refund policy (85% 7 days before classes begin)

A Conversation With Bruce Herzog: Relational Templates

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 15 Jan 2012 11:34:00 +0000

When the Tampa Bay Psychoanalytic Society, Inc offers a day-long program with a guest psychoanalyst, one of my favorite parts of the day is the early morning, intimate, small group “Conversation” with the expert speaker. On January 14, 2012, Bruce Herzog discussed his very accessible ideas about relational templates.

Repeated behavior becomes a relational template, and becomes procedural. He defines relational template as “an internalized relational pattern that has been learned through repeated exposure and applied to interpersonal circumstances throughout life”[1] and may be “activated” by specific, contextually-driven interactions. (Unlike Stolorow’s ‘invariant organizing principles’ which implies cognitive, relational templates are behavioral. Herzog‘s “relational expectancies” are more akin to the former. A relational expectancy includes an automaticity that assumes a relationship to be a certain way.)

Multiple templates exist, each with its own variable unconscious, and are hierarchical, the most frequently activated ones being the most accessible. He notes “a stockpile of templates waiting to be mobilized when needed”[2] The analyst can track shifts in relational states (often accompanied by a shift in affect), e.g. when a negative transference appears. Clinically, the analytic relationship offers the opportunity to encode new ways of being in relationship, new templates. For example, when a patient, long holding the expectancy to be ignored or misunderstood, finds that the analyst does not meet her/his expectation, a new template is encoded and now joins the repertoire of multiple relational templates. Herzog notes that each of us has the capacity throughout life to continue to grow and change when our expectations are confounded in this way.

Herzog prefers the term ‘template’ for its simplicity; Preferring ‘relational template’ to the unwieldy 'projective identification,' Herzog nonetheless notes that Klein described something useful to the clinician. For example, where Kleinian analysts might say a patient had projected disavowed sadism into the analyst and so now the analyst is feeling angry at the patient, Herzog would say simply that a sadomasochistic template has been activated.

Like an attuned parent who gives words to experience, thereby adding to the child’s comfort, mastery, or joy, Herzog says “naming and explaining” helps a patient. But, he notes, it is not simply content which is mutative, but that we bother to say something at all, for, along with tone, prosody, etc, this is also a procedural interpretation, the non-symbolic part of the verbal interpretation. [See his 2001 paper]

Patients may activate templates in the therapist just as analysts’ behaviors also activate patients’ templates. The therapist has certain capacities (e.g. what s/he can give) while the patient has certain capacities too (e.g. what s/he can take). In template theory, provision might balance expectation; it is as if the analyst is saying, ‘Even though you ask something of me in a way that makes me want to withdraw from you, I know you need it and so I will provide it.’ Having in the past been accused of being a ‘provision-ist,’ Herzog retorts that the accuser might be a ‘frustration-ist’ and recalls how Kohut advocated “optimal frustration” and Bacall, “optimal responsiveness.”[3]

Herzog finds that perhaps his foremost goal in treatment is to enjoy his work, which means enjoying his patient, which means the patient, perhaps for the first time, is enjoyed (thereby creating a new relational template). Herzog also reminds us that each therapist must ‘survive’ (in Winnicottian terms). He also seeks to find something he can love in every patient. [It is perhaps these final sentiments with which I most agree.]

[3] Bacal and Herzog (2000). Optimal Responsiveness and the Use of Specificity Theory
in Clinical Practice, Presented at the 23rd Annual International Conference on The
Psychology of The Self, Chicago, Ill.

Herzog, B. (2001). Procedural Interpretation and Insight: The Art of Working Between
the Lines in the Non-Verbal Realm. Presented at the 24th Annual International
Conference on The Psychology of The Self, San Francisco, Ca.

[1,2] Herzog, B. (2004). Reconsidering the Unconscious: Shifting Relational States,
Activators, and the Variable Unconscious. Presented at the 27th Annual
International Conference on The Psychology of The Self, San Diego, Ca.

Happy Birthday Paul Cezanne

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 19 Jan 2012 10:47:00 +0000

Paul Cezanne (1839-1906)

The father of modern art, Paul Cezanne paved the way for Cubism, and both Matisse and Picasso credited Cezanne as “the father of us all." Born in a provincial, southern French town in Aix-en-Provence on January 19, 1839, Cezanne endured early maltreatment from, and rejection of his artistic endeavors by, his tyrannical father. Nonetheless, Cezanne defiantly chose his own way in painting with passionate colors, and eventually deliberately distorting his subjects by painting multiple perspectives in one painting (later to be exaggerated by Picasso in Cubism), deconstructing the laws of painting.

Cezanne’s early paintings depicted murder, rape, and nudity, conflicts about sexuality, entwined with violence (e.g. in “The Murder,”
where a woman holds down another woman who is being stabbed by a man. [Did Cezanne blame his own mother for not intervening or mitigating father’s dictatorial impingements?] Cezanne’s father remained contemptuous of Cezanne. A loner with many fears and phobias, Cezanne hid his private endeavors, his painting, and his mistress (later his wife) from his fearsome, cold father. Cezanne himself both feared intimacy and was easily enraged. Personally he could not stand to be touched and he was disturbed by the nudity of female models.

Eschewing the human body (nude), Cezanne would paint landscapes, still life with voluptuous fruit,
portraits, and bathers, the latter reminiscent of his youth with Zola. Frightened by women models, he tyrannically controlled his human subjects, like his son and wife. He fantasized about murdering his family of origin, upon whom he felt completely dependent, but often used them as models. Cezanne identified with Wagner’s struggles in “Tannhauser” (1861) between spirituality and sensuality. In an homage to Wagner, he painted his sister at the piano playing Wagner while his mother (darned), but his father was painted out of the picture.

Hiding his professional and private life from his father, upon whom he relied for financial support, Cezanne was encouraged by his childhood friend Emile Zola, whose boyhood bathing expeditions would later inspire portrayals on canvas (“The Bathers”--
misshapen nudes, ambiguous in their hermaphroditic bisexuality). Cezanne would follow Zola, the great French writer, to Paris. There he met Monet, Pissarro, and Renoir, and he discovered the Louvre. Finding at last, amongst great works of art, a relational home, he spent hours copying masters of the past, ancient sculptors, and Rubens. But Cezanne’s artistic talent, while supported by the Impressionists of his day, was ridiculed by Parisian haute culture and the press, and his work considered depressing and violent.

This rejection must have painfully resonated with his father’s disregard. Mocked by the critics, by the public, and even by Zola, who used Cezanne as the inspiration for the artist in his novel L'Oeuvre, which described the unsuccessful artist Claude Lantier and his ineptitude with women and painting, Cezanne felt betrayed, never spoke to Zola again, and retreated to Provence. Cezanne, an outsider when visiting Paris and his work artistically incoherent to his provincial neighbors, spent most of his life as a recluse there.

At the first Impressionists exhibit in 1874 he had not been well received. To the late 19th Century his works looked flat. Like contemporary psychoanalysts who strive to balance foreground and background, another characteristic of Cézanne's paintings is the equal treatment of every part of his canvas. Not only is a flattened space created by the integration of the foreground and the background, but neither dominates the other. Cezanne painted dozens of views of Mont Sainte-Victoire
from his family home Jas de Bouffan, the "Home of the Winds," with abstract sky-mountain-earth in a single solid structure, the tree in the foreground appears to merge with the image of the mountain in the background.

Repulsion in the analyst

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Sun, 22 Jan 2012 11:51:00 +0000

In the afternoon session of “A Day with Bruce Herzog” on January 14, 2012, Dr. Herzog presented to the Tampa Bay Psychoanalytic Society, Inc.: Repulsion in the Analyst and its Impact on Empathic Capacity, a paper that is remarkable for Herzog's willingness to discuss something many therapists are loathe to admit. His candor about times when he was disgusted or disdainful and how he traversed these therapeutic impasses was compelling.

Herzog believes “For an adequate therapeutic process to occur there must be islands of empathic contact, which requires some matching of relational premises [1] between the analyst and patient.” and that “greatest empathic connection takes place when the relational premises of patient and therapist are best aligned. [I think of how much easier it is to love a friend than an enemy.]

Patients may come to us expecting rejection or disdain while simultaneously hoping for something different. There are other times when revulsion is in accordance with the patient’s point of view [empathy?], and serves to collude with a patient so that neither discusses something they find unacceptable. Herzog encourages us: “As long as there are enough instances where there is a concordance of relational premises and behaviors in the dyad, sufficient areas of contact for a ‘good enough’ empathic connection can be established.” He emboldens us: “The therapist first needs to know that empathizing with the patient will not harm him [him the therapist].”

While this may be so, it is, of course, I think, incumbent upon the analyst to seek, to struggle, assiduously if need be, to find the point of view of the other. Sometimes there seems to be no common ground, sometimes empathy fails us, and we are left then to negotiate explicitly a way to be together without common ground. Sometimes this negotiation can only come to the table through the other side of an enactment.

[1]“ ‘Relational premises’ refer to the many innate relational assumptions that are applied by an individual to interpersonal circumstances. These assumptions amount to belief systems that we hold about the functioning of, and our place within, relationships. We often assume that others share our relational premises; this is not always the case and can be a cause of considerable conflict…”

Herzog and Shifting Relational States

noreply@blogger.com (Lycia Alexander-Guerra, M.D.) — Thu, 26 Jan 2012 09:06:00 +0000

On the morning of January 14, 2012, Dr. Bruce Herzog presented to the Tampa Bay Psychoanalytic Society, Inc his 2004 paper Reconsidering the Unconscious: Shifting Relational States, Activators, and the Variable Unconscious. “The unconscious is not a fixed structure, … thus what is conscious in one state of mind can become an unconscious entity in another… When an event is encoded into memory, it occurs within the specific relational state that is active at the time. …Hence, what I am conscious of at any particular moment has much to do with the relational state that I am in.” [When I read this paper a few years ago, these statements of Herzog’s were a kind of eureka moment for me: what he wrote had made profound sense (with a forehead slapping “Of course!’) and yet I had not heard it articulated that way before.]

Herzog continues: “… each relational state has its own particular consciousness and unconsciousness. …In any individual, the unconscious is in no way fixed, but is rather a continually changing phenomenon. I have chosen to name this the variable unconscious. … The notion of a variable unconscious proposes that people, when shifting from state to state, have a level of awareness and unawareness that shifts along with them. The unconscious is no longer considered a fixed phenomenon, but is something that moves and adjusts according to what state one is in. A shift to a new relational state can grant access to certain affects, memories, and relational behaviors that may have been previously unconscious [inaccessible].” Herzog calls his concept of shifting relational states, activators and the variable unconscious: template theory.

Herzog gracefully utilizes both traditional interpretation and relational theory: “…it is not only an interpretation’s content, but … the act of interpreting [italics added] can trigger a shift to a new state that can give rise to a different awareness.” [Here I like the integration of interpretation itself, its content making conscious what was heretofore unconscious, with the act itself having meaning separate from the meaning of the content. This deconstructs somewhat the privilege heretofore given to narrative interpretation, and insight, as a mutative power.] One aim of psychoanalytic treatment has always been to increase the capacity for self reflection, in Herzog’s terms, to activate a reflective state and increase the frequency of its activation. In treatment this can allow access to previously disavowed self states or to newly co-created (in therapy) self states.

I particularly liked finding new ways to consider transference, repression, interpretation, and the goals of treatment: “The transference might be seen as the activation of a particular relational state, and the interpretation could be seen as a means to help the patient organize the procedural (non-verbal) elements of the [that] state into symbolic thought (Herzog 2001; see previous post). The entire process serves to improve the reflective capacity of the individual, by allowing the current relational state to be consciously apprehended, understood, and modified - from within an overriding reflective state established in the analysis.” And where “repression comes in the form of disavowal of certain relational states …
What’s reported to the analyst is limited to what can be accessed in the state the patient is in when seeing the analyst.”

Herzog concludes: …”my patients [are] shifting through relational states, moving between the various possibilities within their relational repertoire, and having each state of mind containing its own unconscious elements… Pathology in the individual comprises rigid denial of the existence of parts of the self, whereas emotional health involves a general awareness of all parts of the self and controlled, flexible movement between them. …The analytic dyad’s growth-promoting behavior and ability to comment on the relational changes that are being fostered will lead to the development of a new repertoire of more functional relational behaviors, and a capacity to recognize and access them.”

I thoroughly enjoyed my day with Bruce Herzog, a presenter who embodies what he says, thereby providing the best educational experience: when procedural learning accompanies the symbolic or spoken lesson. I did regret that Dr. Herzog often chose to put aside for the day, leaving unexplored, the contribution the analyst makes to a shift in a relational template, and thereby, momentarily, eschewing elaboration of a two-person psychology.