A Parallel Journey Into Self

Antonia Noble Ludwig, Psy.D. MFT.

August 27, 2015

IFPE presentation

© 2015 Do not quote or reproduce without permission

antonianoble@gmail.com

             My intention in this paper is to take you with me on a journey into the essential interplay of two subjectivities, and to convey a “felt sense” of how truly difficult this work is.

I just saw Esther, an 18 year old young woman who amazes me–so young and yet so old, too old for her own good.  She speeds through our work together so fast that I wonder, ‘How is it possible?’  We are at the top of the rollercoaster again and about to go down screaming with pain.  I am not sure how far down we are going to go this time, before she takes a detour into binging and purging or cutting, or sex that is abusive to her, or getting high.  These are the most painful times for me, as I know I can only be with her, and I can’t stop her unless she is able to connect with me. Still, that sometimes brings her too much pain as well.

In a review of Neville Symington’s, The Making Of A Therapist, Judy Vida (1996) observed, “Emotional healing for Symington is an extremely complex matter, requiring for the severely traumatized the facing of extreme pain (which, if daunting for the therapist, may be unbearable for the patient)” (p. 417).

In my work with Esther and her parents,  (in my practice, when I am working with a client who has an Eating Disorder, if possible, I usually include the family when it is appropriate) I start to realize that I have very high expectations of parents in general.  I have the expectation that, as a parent, if your child is telling you that she wants to die and has made previous attempts, you would be willing to do whatever it takes to find out how to keep her safe, even if it is inconvenient or painful for you.  I know this is naive and I am seeing my own unconscious expectations peek through in my countertransference.

In my private thoughts, I am appalled that her parents are so selfish. I don’t even know how to address those thoughts, and I find myself pulling at my brain.  I am torn in two directions.  The first is the direction of pure disgust: their daughter is practically killing herself for their acceptance.  But all they can see is that she is harming their good name in the community.  I can feel myself shutting down. I don’t want to know this about them. I want them to be loving.  I want them to be like the Jesus they say they represent.  I cannot hold it that they are so selfish, and now I feel myself being pulled to understand them and their sense of being betrayed by this daughter.  I am holding on by my fingernails. My internal chant is “Don’t Accommodate, Don’t Acclimate, Don’t Accommodate.”  I am lost.

At last I can see my dilemma, and with extreme effort, I tell them that their daughter is not doing this to them. She does not mean to harm them. She is in a traumatized state and she is doing the best she can to stay alive.  The father does not have any empathy. They are angry at me for not making their daughter back into the Vestal Virgin that they wish for.  They don’t trust me, but they also don’t know what else to do.

I think of Ferenczi’s words in “The Unwelcome Child and His

Death Instinct (1929):”

“I only wish to point to the probability that children who are received in a harsh and unloving way die easily and willingly.  Either they use one of the many proffered organic possibilities for a quick exit, or if they escape this fate, they retain a streak of pessimism and aversion to life” (p. 105).

These words of Bernard Brandchaft’s are also crucial as I see myself being pulled into accommodating Esther’s parents because of my own childhood:  “The ensuing pathological accommodation continues to operate as an entrenched system beyond awareness, to preserve life by imprisoning it in archaic bonds (2007, p. 668).”

As I become more aware of my pull, I am finally able to make sense of Esther’s pull. Here are the words of Brandchaft (2007) again:

“At its center, the traumatized child has come to feel itself as bad… this child carries the stigma of badness driven into his selfhood and will never able to put the torment to rest” (p. 674).

In my private thoughts I realize “badness” is what Esther feels every day, and it is resonating inside of me as well.  I struggle to know I am sturdy, and then my anxiety takes over and I lose my footing.  It feels like whiplash.  I am very worried about Esther. Then I start to think about myself, and have a sinking feeling that I am going to be in trouble with her parents.  As I explore this feeling in my own therapy and supervision, I realize that her parents have dumped her on me and are giving me too much responsibility to keep her safe and alive.  I have taken on that responsibility as my own, and it is dawning on me that Esther is not safe, and that I can’t protect her.  Esther thinks that she is supposed to be strong; that she is supposed to be able to handle everything.  I also think that I am supposed to be strong and able to handle everything.  But I am relieved to discover that Samoan Barish and Judy Vida (1998) were here before me when they wrote:

“We were only able to learn what it was costing us when our reserve was exhausted.  An essential function that theory serves is to afford us protective coloration in the clinical jungle.  It contributes immeasurably to our clinical persona: ‘I’m not necessarily this, but my theory makes me so.  I am not a vulnerable person in the consulting room, I am the embodiment of the theory; I am the instrument of the theory.’  Theory buffers the ‘narcissism’ or basic vulnerability of the analyst and creates a ‘not me’ straw person that in principle both patient and analyst can batter” (p. 91).

Again, in my private thoughts, I am aware that coming home and leaving school would feel like a failure for Esther, yet she is suicidal and I cannot help her unless she is physically in my office.  Analysis is an intimate process.  Being in the room together is so important.  So much is said with body language.  Trust is not in the words but in the eyes.  Being on the phone is very different than Skyping or sitting with each other in person. 

I am going to tell her that I can’t work with her unless she comes home.  As I admit to myself, and to my supervisor, that I have limitations, I start to feel stronger.  As I stop accommodating, I am finding my way again. 

My supervisor says she is envious of Esther because she wishes she had someone like me when she was young; who knows what could have been different for her? This comment scares me.  Why?  I feel responsible now; do I have to take care of my supervisor?  Esther is in danger.  I am in danger. In danger of being found out. But found out for what?  Maybe I am good at what I am doing.  If I am, someone is going to try to destroy me, to take what I have.  I’ve got to hide.  My psychological skeletons are

coming out.  This is such an important moment for me: if I allow my supervisor to penetrate the dark depths of where I hide myself, might I be able to help Esther?  If I can start to see myself through my supervisor’s eyes, will there be hope for me and for all the clients, including Esther, who will come to me?  I am not allowed to know myself here.  I will be breaking all of my family’s rules, and worse, I will have to feel the pain of owning the light that my family tried to take, in the name of love.  No more excuses, no more hiding, no more self-destructive behaviors for me. I will have to show up. All of me will have to show up.  Now I understand: I too wish I had someone like me when I was Esther’s age. Who knows what could have been different for me?  This is so painful to understand in this very moment.

As we continue to work, it becomes clear to me that I have to keep looking at my own belief systems.  I understand wanting to kill yourself when you realize they are not going to accept your aliveness.  I am preparing her for the discovery that if she allows herself to know she is traumatized, there will be a cost, and that if she does not, there will also be a cost. What are the consequences? Everything has a cost. It is just a matter of what currency you want to use. (Pause)

We are in session. Christians are supposed to be different from other people: better.   She should be seeking closeness to God.  She offers the analogy of Harry Potter and the Horcrux[1], of Voldemort splitting himself into seven objects in order to survive.  The Horcrux is dark magic; what you do with your body affects your soul even if you are split.  This is what George Atwood (2012) refers to in The Abyss of Madness:

“Something happens in someone’s life.  It is too much for the person to bear, so it is not borne.  It is too much to be put into words, so nothing is said.  It is too much to be aware of, so awareness vanishes.  The person has become someone for whom it did not occur.  Of course, the person is nevertheless affected by the incident, whether or not he or she knows of its existence.  The events of our lives have all kinds of effects on us, regardless of whether those events are accessible to our conscious recollections” (p. 110).

I see that leading a double life is getting to her. She hates lying about where she is going, but when she spends the night with a boy, she has to create an excuse.  She copes with this duplicity by binging and purging and hating her body.  She is also not sleeping well.  I offer insight: when she feels the split in herself, she has to harm herself in either action or thought.  She likes to think that she does not feel pain when she splits, but of course it still hurts somewhere.  This is a new concept for her but one that I have made friends with long ago, and it is this internal relationship that helps me to know what she is dealing with and that I am on target.

In Conclusion…

This paper is meant to illustrate two journeys, Esther’s and my own, our separate yet connected experiences, from within our individual perspectives, both phenomenologically and contextualized. Robert Stolorow (2007) writes: “I have contended that the essence of emotional trauma lay in the experience of unbearable affect and that, developmentally, such intolerability is constituted within an intersubjective system characterized by massive malattunement to the child’s emotional pain” (p. 14).

Actually, he is describing the delivery of Esther’s trauma by the relentless failures of an intersubjective system of malattunement embedded in her family of origin.   Together Esther and I struggle with her “unbearable affect,” the consequence of never having emotional needs understood. Separately, I carry my own version. Sometimes my life, my autobiography, provides invaluable illumination of Esther’s; at other times, Esther, unaware, pushes me to a deeper grasp of my own unbearable pain. This is what Judy Vida and Gersh Molad say is the basic mutual work of psychoanalysis (2004, ,59:349).

Now a final comment: Writing this paper was exhilarating.  Writing this paper was unbearable.  I had to find myself as I was writing this paper just as I have to find myself as I tell it to you.  I have to look at my own traumas.  I have to realize that I understand Esther at a deep level but that she is not me and cannot directly or immediately use what I offer her.  I imagine that if someone had been there for me at 18, 19, and 20 (as I am with her), I would have devoured everything on that intersubjective, relational table.  I have to understand that in some ways I was stronger than she is and that my experience of malattunement is different from hers.  I also have to struggle not to turn away when she does to me what her parents do to her.  I have to show up for her; I cannot stay safe in my invisible hiding places when her pain and my pain merge and I want to hide.  I have to use all the resources available to me (my supervisor, analyst, and thesis advisor) to understand my own frozen, traumatized state; to feel in my gut and acknowledge how afraid I have been that Esther would kill herself; to not tell myself lies, like, “she will get through this” or “maybe I can’t help her; maybe she would be better off without me, because, after all, I am a bad therapist.”  This is a big theme for me. I find it difficult to acknowledge that I can be good at what I do.  I am so allergic to grandiosity that if I find myself sounding that way I have to immediately make myself small.

            I am a survivor. I am beginning to understand that I have that survivor’s guilt that makes me feel responsible for taking care of everyone who is wounded. Through this process, I am actually starting to understand that this is not my responsibility.

            I sit with Esther as she strives to come out of her shell and then watch her retreat.  She struggles to this day with wanting to be seen until fear drives her back into hiding.  One of the main issues for Esther and for many women is the experienced pressure to fit into that category, “Good Girl” or “Bad Girl.”  What happens when you don’t fit into either?  There seems to be so little room for a third category: “Both” or “N/A (not applicable)”.  Esther’s solution so far is to split herself into different parts depending on who she is with.  In each situation she does not know what she is doing or why she is doing it.  This is when she starts to self-implode.  She starts to destroy herself when she does not feel there is any safe enough relational space.  Everyone seems to want something from her, and depending on whom she is with, it is always different, and she cannot hold on to herself.  Being told she is special only makes her feel more threatened. She does not know if she is supposed to be special or to be small.  In the end, no one is safe, not even herself.

            We are continuing to work to develop a sense of who she wants to be when she grows up and to keep her safe enough to explore her identity. I am in a different place in my life, but I think I am doing the same thing.   I hope Esther’s parents don’t pull the plug on the treatment, but I don’t have any control over that.

            As for myself, coming out of the shadows is both scary and freeing.  Writing this paper is an acknowledgement that I have a mind. (When I am alone, I am allowed to think, but in public that is very different. This paper is “public.”)

            I don’t know how to end, but it does not matter, because, really, there is no end.

This is an extract of a larger paper with the same title.

 References

Atwood, G. (2012). The Abyss of Madness. New York: Taylor & Francis Group, LLC.

Barish, S. & Vida, J.E. (1998). “As Far As Possible”: Discovering our Limits and

Finding Ourselves. American Journal of Psychoanalysis, 58 (1): 83-97.

Brandchaft, B. (2007). Systems of Pathological Accommodation and Change in Analysis. Psychoanal. Psychol. 24:667-687.

Ferenczi, S. (1929,1980).  The Unwelcome Child and his Death Instinct. Final Contributions to the Problems and Methods of Psycho-Analysis. M. Balint, ed. London: Maresfield Reprints, 1012-107.

Stolorow, R.  (2007) Trauma and Human Existence. New York: Taylor & Francis Group, LLC.

Symington, N. (1996).  The Making of a Psychotherapist. Madison, CT: International

Universities Press.

Vida, J. E. (1998). Book Review: The Making of a Psychotherapist by Neville

Symington. Psychoanalytic Books, 9: 415-419.

Annotated Bibliography

Atwood, G. (2012). The Abyss of Madness. New York: Taylor & Francis Group, LLC.

“Madness is not an illness, and it is not a disorder.  Madness is the abyss; it is the experience of utter annihilation (p. 41).”  George Atwood’s works are very important to me.  Esther is always talking about feeling crazy. When someone looks at her out of context, she is certain she looks crazy and stupid.  George Atwood reminds me that there is a reason for everything we do, even if we don’t understand it.  He has a way of understanding what others see as weird or crazy, and when he lets you into his world, the secret language of pain becomes so clear.  I really enjoy his insights into the connections he has made with the people he has worked with.  I use his work on intersubjective systems as a way of finding another context in which Esther’s psychological conflict take form.

Barish, S. & Vida, J.E. (1998). “As Far As Possible”: Discovering our Limits and

Finding Ourselves. American Journal of Psychoanalysis, 58 (1): 83-97.

This paper is about clinical work with a client but is also about my own journey.  It       is good to read these senior analysts struggling with their own clients and their own sensibility, as well as with conflict about what is a “Good Analyst,” and to see them coming to their own solutions.  There are a lot of theories to choose from in the world of psychoanalysis.  I think about how I have used these theories to build me up and protect me, and yet sometimes I have put too much faith in theory, and I need to trust my instincts more.  I also think about the balance between self-protection and client-protection.  I want to do both.  In my paper I am struggling with the messiness of countertransference, the discovery of my own ongoing development as an analyst and Esther’s ongoing discovery of her personhood.

Brandchaft, B. (2007). Systems of Pathological Accommodation and Change in Analysis. Psychoanal. Psychol. 24:667-687.

This is a paper I have read many times. Each time I come away with more insights into my patients (and myself, especially) how creative survivors of trauma really are.  I am reminded, and increasingly aware, of how much of themselves children can be required to give up, when the adults are not able to help their children to be themselves.  Once children have given themselves away, the struggle begins not to be annihilated.  Esther has been asked to accommodate to the point that she becomes suicidal in an attempt to save a small sector of her nuclear self.

Ferenczi, S. (1929/1980).  The Unwelcome Child and his Death Instinct. Final Contributions to the Problems and Methods of Psycho-Analysis. M. Balint, ed. London: Maresfield Reprints, 1012-107.

This very short paper points to the child’s intuitive awareness at birth of not being wanted in the human environment. Such a child demonstrates an aversion to life and searches for ways to disappear.  It is striking to me to see that we have been struggling with the issue of love and loss probably from the beginning of our development.  Esther struggled with this aspect of her existence throughout the treatment. It seemed to be on the edge of her consciousness, “on the tip of her tongue.” Ferenczi gives language and a breadth of understanding to that impulse of Esther’s to “disappear” in all her self-destructive behaviors. He does so from a psychological understanding that goes beyond the notion of psychic defense.

Stolorow, R.  (2007) Trauma and Human Existence. New York: Taylor & Francis Group,             LLC.

Robert Stolorow’s work presents trauma as a frozen affect state.  Esther’s trauma is difficult in itself, but what is even more devastating is the absence of attunement in her family.  Stolorow helps me to keep in mind Esther’s constant struggle with the threat of annihilation.  I have used his work to help me better understand the sudden derailments that occur when Esther is faced with her inability to regulate unmanageable affective states.  I help her to have greater awareness of how she disavows segments of her emotional life so as not to feel the threat annihilation and the loss of her ties to her family.

Symington, N. (1996).  The Making of a Psychotherapist. Madison, CT: International

Universities Press.

Symington explores not just the pain of the client to look at his/her trauma but also of the therapist, who has to face his/her own trauma, and to hold on to both of them.  Holding on to the trauma of the analysist and the patient is the essence of my paper and what I think is one of the main difficulties of being an analyst.

Vida, J. E. (1998). Book Review: The Making of a Psychotherapist by Neville

Symington. Psychoanalytic Books, 9: 415-419.

This is relating to the imperfections of being a psychotherapist/human being, and     how we are vulnerable to all of the same feelings and conditions our clients are struggling with.  When my clients are terrified, I am also terrified, but it is my job to try not to get lost in the terror, and also not to get rid of the terror but to be with them in it.   As I have had to do so many times with Esther.

Vida, J.E. & Molad, G. J. (2005).  The Autobiographical Dialogue in the Dialogue Between Analysis: Introductory Notes on the Use of Relational and Intersubjective Perspectives in Conference Space. In: Relational and Intersubjective Perspectives in Psychoanalysis: A Critique, J. Mills, ed.  Lanham, MD: Jason Aronson, pp. 255-278.

This article addresses our presentation as analysts with one another.  I was very concerned with how I sounded in writing about this case.  I thought I needed to sound “professional,” but realized it was not so much a matter of “professional” but more about not giving the reader ammunition to rip my work apart.  This paper supports our being more real in our presentations because only in our vulnerability can we really understand what we are doing, and only in the audience’s vulnerability can be found the feedback and responsiveness needed by us all.

Antonia Ludwig Noble can be contacted at: antonianoble@gmail.com

[1] Voldemort (the villain, of the Harry Potter book series), in order to stay alive, uses a forbidden spell “ the Horcrux spell” to separate himself into 7 different parts and puts those parts into 7 objects.  That way he can hide himself from anyone who would try to harm him. However, he cannot be whole as long as he is split.

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