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.

https://www.psychologytoday.com/blog/psychologically-minded/201503/the-therapy-relationship-in-psychodynamic-therapy-versus-cbt

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).

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.

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.

 

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Obviously this fits an egoist vs. altruist binary.

 

 

To think analytically vs. to practice analytically

I'm not a fan of Anna Freud. I'd much rather read Klein, and I find that Anna has too much common sense.

 

So, in the passage below I appreciate he common sense on how to think analytically, but then, in regards to technique, I find her thoughts very trite:

TO THINK ANALYTICALLY AUTOMATICALLY IMPLIES A DISSECTION of psychic material into its constituent elements, to treat each of these elements as a factor in its own right, and to trace it back to its first appearance within the psychic processes. In the technique of psychoanalytic treatment, it is the analyst's main endeavor to spotlight such items in the patient's unconscious mind, to expose them to consciousness, and then to leave it to the individual concerned to integrate what has been discovered with the rest of his personality. The analyst's task ends where synthesis begins, the latter being one of the most important functions of the ego—a function, moreover, which, according to analytic experience, proceeds best without interference from external influence (The Concept of Developmental Lines, 1981)

 

I think it's too easy to take refuge in ideas of the person having to do the work themselves; if they don't get better than it is their fault.

 

Also, tracing something back to its first appearance is valuable in regards to phantasy, but that's where Klein is valuable and not Anna:

 

A patient had a falling out with a friend because she had got into another power struggle with a room-mate, and the friend was tired of hearing about these struggles. The friend confronts her and says that she should consider how she might keep putting herself in these situations again and again instead of saying the room-mate is all bad. She takes this as a huge betrayal. We explore this for a while and she eventually decides that she will go see the friend. She goes and said it was good to see him but something felt 'broken' and like it can't be repaired. I ask her to associate to this. She says a mug that's thrown to the ground. It can be glued back together but "microscopically" it's not the same mug. She associates it to Persian tea inside, and she loves the smell. She associates this to boyfriends who she loves the smell of. She also associates her mother, always drinking tea and trying diet but keeps saying that she's not fat. Then a phantasy emerges of the fat mother who has all the liquid from the cup inside of her while the patient has none. I interpret the broken cup as her attacking the mother's breast because she has all the good liquid inside of her and is fat while the patient is hungry. This leads to her describing her parents love as something special in which they could finish each other's sentences and almost read each others minds. It didn't feel triangulated or like there was envy. 

So, from a connection with a close friend being lost we go back to an 'ur' moment in which she felt the connection to her mother was lost, with the mug. liquid, and indications pointing to the breast. This led to the interpretation of the mother withholding the breast and being fat while the patient was hungry and the patients aggression. Then this led to the appearance of the father and mother together and some relief for her.

 

 

Also, Anna neglects to mention 'the first appearance' of the problem in the patient's recent history. What happened with the parental-substitutes? Anyone with halfways decent judgment can see friends and acquaintances change, harden, die a little, or lose their former health and vibrancy. Problems in work and love are also important moments that have to be recovered.

 

These aren't the only ways to work with others, but they are better ways than blaming the person for not getting well.

wish to be both sexes- correction

Up til now I've been identifying the wish to be both sexes, and specifically the relationship in which there is there is the "everything" person who does the jobs of both man and woman and the "nothing" person who does the jobs of neither and is depressed, as volar.

My thinking has been that it's a defense against the sexual difference that is introduced at that stage. However, I've seen been with a patient who used the phrase "she is my whole world" in this relation and made me realize that it's better classified as auto-erotic.

In contrast, I can mention several volar stage relations.

There is the person who is so possessive and jealous that the other person can't even have a pet they are close to.

There is the relation in which one person is the other's will and commands him or her to do things, but without the commands the person doesn't do anything for the other on his or her own.

The nymphomaniac in which sexuality is felt for men or women in general is volar.

There's also a relation in which a person wants to keep the other person, seemingly as a pet, to be beautiful, be clever, or do something impressive. One works and pays for the other to live.

This is also the stage, as I've mentioned before, in which sexual difference exists and so you have the phenomenon of a man who only has female friends and distrusts other men, or vice versa with women.

An interesting idea from Bergler

It's sometimes nice to read Edmund Bergler because he's one of the last heroic analysts. To be more precise, he's a bit of a showboat, like Bill Murray in The Life Aquatic. The systematic thought in his writing always seems a little absurd, but from some of his examples, one can't doubt that he found something. It may not be the jaguar shark that he thinks it is, but it is something...

I was really bowled over by his idea of malignant masochism coming from a "schizoid" defense against anxiety.  (Schizoid, narcissism, and sexuality- are there any more overused words in psychoanalysis?) A person may get off on castration anxiety, like being caught in an affair, being laughed at by others, falling while climbing mountains, losing a loved one, etc. but not have the feared injury or death take place. Bergler adds that a schizoid defense that blocks the anxiety signal may be what results in the game of getting off actually turning into the injuries and death occurring. He cites those who commit suicide as examples. I'll have to think more about this... It might be a crayon ponyfish but it's the most interesting thing I've read lately.