Friday, April 17, 2015

counter-transference as re-enactment vs. using intellectual constructions

Shedler recently had an article about the psychoanalytic relationship being the true therapeutic relationship, while the CBT practitioner would just be friendly and warm like your dentist might be. He gives the example of a patient who has had problems with her therapists before and how he'd explore with her the feeling that he'd like to have her approval as past therapists did.

What he's bringing our attention to here is either a deutero adaptation in which the person takes some of the transference the father imago would get and has that extra confidence or wholeness that people find attractive, inviting, or connected to that isn't based upon their achievements, what they've done, (etc.). The other option, is that through projective identification that the patient has totally assumed the parental imago. As I've posted before, this has been the case for a lot of depression (i.e. not melancholic self-reproaches, but feeling empty or no motivation) and often has repetitions in the person's romantic life (i.e. he or she is "the nothing" and the other is "the everything").

Anyway, based upon our economies of libido there will be times in which we are induced to take on certain roles with patients because we share similar fixations, adaptations, and are on opposite sides of a defense. There was a patient I had the other day who had an egoistic 'I don't care attitude' because he felt like he should have got a raise by now and he hadn't, so he wasn't going to "make those assholes any money". I mocked him about being too good for the world because he hadn't talked to his boss about a raise and expected him to see his work and give it accordingly as if the boss should be giving him special attention like a parent and pat him on his head. Afterwards, I had the feeling that I might have acted on an inducement (that would could only have found purchase because it worked in my libidinal economy). At the time, I thought that his narcissistic bubble needed to be pierced, but afterwards I came to think that the bigger ingredient was his echoism and fear of asking his boss for a raise that was central.

Counter-transference that is caught in the act is important. I've written before that I had several patients who have messy lives with no structure and that when I feel like I want to give advice and organize them, I instead ask them 'Should I be feeling like I should leave with you and talk to x and y, be a life coach with you, etc.?'  However, we won't have a lot of counter-transference inducements when we don't have the relevant libidinal positions (horizontal, bisexuality) or levels of being (vertical, superego) functioning. In these situations, one needs intellectual constructions.

Kurtz's Hakomi has 'probes' in which you listen to what a missing experience was with the patient and then, try to offer it. If you have a patient who brings up that she was neglected and other sisters got more attention from father and, in her present situation, she has similar themes comes up, then you might ask her how it feels if you tell her "you are loveable" or "I want you to be my daughter". Kurtz says to stay away from probes that might commit the analyst to much (i.e. choose you are loveable, rather than I love you). So, when one begins to hear a theme in a patient it becomes possible to deepen it by asking questions in that area and bringing it to the past if it's in the present or vice versa. At the point where it feels weighty enough, it's possible to try a probe or to use a counter-transference construction in which you think about what the person needs in the moment and putting yourself in that place.

What Shedler has written about has been around for a while in the work of Spotnitz and others in psychoanalysis. It's nice to see that it might gain a wider appreciation. However, coming through a relational framework in which the unconscious is constructed in the moment between the analyst and patient, and the loss of the economics of libido, my worry is that they will neglect the importance of intellectual constructions. (Of course intellectual here is a reference to EQ and not IQ, but as Wittgenstein showed, judgment in these areas is based upon a logical operation and not just mimetic sympathy).

Wednesday, April 15, 2015

phallic symbols post from psyart

We had a previous thread on phallic symbols and I related them to the deep objects of perfection (egoism) and death (altruism). I thought I'd add a couple more examples that I've found.

When someone talks about their truck having 'balls' it's a reference to the power of the vehicle. This isn't the only form of power though.

In my book, The Economics of Libido, I argue for 4 basic libidinal positions along two poles. Along the egoistic pole, I point out that someone can be narcissistic or possess an attitude of superiority (arrogance, vanity) about their physical or intellectual potency (subject egoism) as well as about their beauty, aesthetic refinements, or judgement of the lack of virtues in others (object egoism). Power, perfection, and relating to others by competing with them is what's important here. 

Additionally, I point out that someone can masochistically put the desires of others before her own (subject altruism) or masochistically desire the approval of others or have the need to be liked or be seen as interesting by others (object altruism). The former is tied to “people-pleasing”, being “self-effacing” etc. and the latter is tied to being a “people person”, endearing, and wanting to be the centre of attention but not for admiration of one’s skills or potency but to share enthusiasm, or to be interesting. In the book I point out that there are also egoistic versions of masochism and so would be better to contrast narcissism with echoism. Belonging, death, and relating to others by restoring them to their idealized state or lifting their spirits or mood is what's important here.

I've had a couple female patients whose interest in shoes was a phallic symbol. There was a "displacement below from above" and feet were associated with being disgusting and ugly while the clean shoes they compulsively collected were attributed with clean, beautiful, and perfect properties. I want to be clear,  this isn't to say that every person who collects shoes has this motivation.

I've had some male and female patients who took the loss of belonging to their group of friends very hard and the death of that connection resulted in romanticizing the past and other cultures. I think it's often seen in Wes Anderson movies in which commodities from other times and places are given prominence and have an idealized and magical quality. For the object altruist this is in contrast to the dead present, the dead local scene.

The tattoo of the dead beloved, rituals erected to honor their memory, and in some cases, giving up one's life (expressing one's own desires) to carry on his or her legacy are examples of phallic symbols in subject altruism.

psychosexual stage- the face- small clinical report

I've written about the auto-erotic in the feminine position (object egoism and subject altruism). In my experience Fairbairn is right. There is an 'as if' quality to the object egoist who utilizes the impressions she has of others and there is whole sale adoption of something in the personality of the beloved with the subject altruist.

In both expressions the face has shown up in dreams or from associations. In my experience the face will also be paired with some kind of darkness. These self-other units are always important and to ask the person to describe the darkness and get adjectives like empty, cold, etc. to be used as I statements is important.

Fairbairn wasn't dynamic enough and what he was describing as "schizoid" phenomena is sometimes projective identification in which the person assumes the place of the parental imago. The parental imago of Death at this early stage is just emptiness and coldness.

I don't think the face is the deutero object of the auto-erotic stage, like hand, anus, or phallus is. I still have to point out that it seems wrong to use these stages since they are also the masculine and the feminine has its own zones.

Additionally, the face sometimes reveals its importance in relation to a mask.

Interestingly, masks, shoes, and hats and other things seem to often represent the phallus for the feminine. The importance of having many shoes often indicates the importance of the feet as a displacement of the penis in some women, for example.

It's a good rule to ask for thoughts about the body part that is covered up by an idiosyncratic item that appears in a dream or that is emphasized in stories.

Wednesday, April 8, 2015

be destroyed vs. destroy

I just sent this to Mike Eigen:
I wanted to tell you that I'm reading The Sensitive Self and that there are always great strings in your books for me to pull.

The idea of letting one's self be murdered in Bion and being able to be destructive to the object in Winnicott has been turning over in my head for days now.

For Bion's idea, I think of the criminals I work with who have idealized themselves at the expense of working jobs and competing with others in a fair way in society. Often times there is a fear of going to classes to get their GED with younger people and being judged or they find imperfections in their bosses or co-workers and will walk off a job. They feared normal competition and idealized the self and have to let that self be murdered so that they can have respect for others.

For Winnicott's I think of the people I see who are choking on the hate they have for a past boyfriend or girlfriend who treated them badly (sometimes its for God for letting things happen). They keep the other person idealized and highly responsible for what they did instead of being able to murder the idealized image and see them as more flawed, unfree, and weak.
Obviously this fits an egoist vs. altruist binary.