Thinking About Clothes

October 15, 2011 10:00 am

By Samoan Barish

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“Clothes are inevitable.  They are nothing less than the furniture of the mind made visible.”  James Laver, Style in Costume

One is only poor, only if you choose to be
Although we had no money, I was rich as I could be
In my coat of Many Colors my mama made for me.” Song by Dolly Parton

From the adornment of the fig leaf to modern times, covering the body has been fraught with symbolic significance.  Early psychoanalysts talked about the genital meaning represented by different items of clothing. Although acknowledging that clothes served as a protection from the cold and the range of natural elements, their focus of interest was upon the conflictual and symbolic nature of clothes.  They talked about the struggle between modesty and primitive exhibitionism; addressing the wide span of possible sublimations and displacements on to beautiful clothes.

Surely, like Jacob’s many colored jacket, looking at clothes for its idiosyncratic meanings to us as well as its reflections upon the times and culture we live in, is indeed a many splendored thing.

Flugel, as long ago as 1929 summarizing the literature of the time, wrote in his  article “Clothes Symbolism and Clothes Ambivalence” that the object most frequently symbolized by clothes is the phallus, and  goes on to list some specific items of clothes, e.g. the hat, the shoe, the tie and even the humble button”.  It all sounds a little laughable now; however, he concludes with the following statement which is many ways is the organizing principle of my paper. “Fully to understand the dynamic relations involved in a man’s attitudes to the garments he wears would carry us far towards knowledge of his Whole Psychological Development.”  Indeed, Ilene Beckerman’s (1995), little illustrated book,  Love, Loss, and What We Wore (recently made into a play by the Ephron sisters) is in fact her life story told and drawn through the prism of her clothes. We follow her life starting at seven years old when she wore her Brownie uniform, the clothes her mother made for her before she died when Ilene was not yet 13 years old, her prom and wedding dresses and so forth. She concludes her monograph after she’s become a grandmother and watches her first granddaughter play dress up with her old clothes. Undoubtedly, many of us can remember events by what we wore. And each of us carries our own storehouse of symbolic meanings these clothes held for us. Recently a 31 year old patient of mine, in trying to recall how old she was  when her maternal grandmother died, identified her age by the dress she wore (“It was white dress with hard yellow buttons”).

I will consider women’s/men’s development in light of their relationship to clothes. In the spirit of the 2011 IFPE conference, at which this paper was presented, “Psychoanalysis: Not the Same Old Song and Dance?” we will play with clothes. Let’s go to the store, let’s go to the closet. Let’s go to your closets, let’s go to mine.   What do clothes mean to us, how do we feel about them how do we choose them, and what do our choices in clothes say about us and our sense of our selves? Do our choices and sense of style change over time and so on and on?

I also will look at clothes in the context of the clinical situation. For example. do we think about specific patients we’re going to see when we choose our clothes for our work day? How do we decide what to wear? How much do the patients we’re going to see influence our choices? In addition, we will elaborate upon some of our reactions to what our patients wear, and if and when we talk about it with patients.

Further, I will explore how and when the topic of clothes comes up in therapy, including considering some different illustrations of patients talking about clothes and the ways and the therapists’ response to them.  What resonates for us as we reflect with our patients upon the meaning of clothes for them?

In a sense, I invite you to sing along and play together as we enter the world of clothes.

“I have nothing to wear” and “What should I wear?” are oft repeated refrains for most of us.

What do we think about when we think about clothes? Or, do we even think about them?  Indeed, I do, lots of people do, and many of our patients do, and thus I invite you to open up this arena and cast eyes and mind about. What conscious and unconscious thoughts fly through our heads, like  buzzing bees, as we stand before our closet making up our minds about what to wear? How do we develop our unique style Or, do we? And, what does that even mean? What is each of our particular relation to clothes? What does it say about us who we are, how we are in the world, how we wish to be seen, and the time and place we live in?

I grew up in NYC in a middle class Jewish family and neighborhood.  How you looked and what you wore were very important to my family and to most of the people I knew, if not all.  Critiquing other peoples clothes and style was an ongoing activity; almost a pastime in its own right in my family.  My mother positioned herself as the authority, the expert. My father wasn’t far behind. And my uncle was in the garment industry as were many of my parent’s friends and relatives.  It was quite routine and normal for my sister and mother and I to go downtown to the wholesale houses and choose our clothes among people who “knew” what was best and best for you. They appeared and acted as if they were “in the know”.  Indeed, they were in the forefront of perceiving what was in fashion and the latest styles….  Going shopping was fun for me; an adventure, never knowing what you might find; in many ways, our family’s form of an expedition to new and old territories.

I only began to realize as I got older, what little say I had in the matter of choosing my clothes.  That was my mother’s job and I thought she did it very well.  I never doubted her choices for a moment.  (Obviously I was a pretty naive child). I can remember a  particular time after the rigors of my mother’s, my sister’s and my shopping tour, relaxing in the comfort of my father’s car, after he came to pick us up at the store.  My mother said to my father “It’s always such a pleasure to go shopping with Samoan”. That made me feels very on top of already being so pleased with our purchases. It was only many years and analyses later that I came to realize what my mother really meant by that statement.  In short, essentially that I happily agreed with everything she picked out for me, never disagreed or fought with her and consequently never exercised any decision making or inclinations of my own.  That process was to take years and years until I could feel both the right, wherewithal, and confidence to figure out for myself what I liked and what looked good on me.  To develop that kind of confidence has truly been a developmental achievement for me.  Notably different, my five year old granddaughter seems to have very strong opinions about what clothes she likes, what looks good on her, what combinations to put together for herself and what she will wear and what she won’t.  She seems to know her likes and dislikes in a way I had no concept of earlier.   I do now…………….

Claiming myself, discovering my own taste and rights to my own taste, occurred quietly throughout the course of my lifetime. I remember all those early years of shopping with my mother; her choosing the clothes and me agreeing and seeming to like them.  I have a memory of some specific clothes I especially liked. A yellow dress with a cape collar piped in white. I wore it to mysixth grade graduation and I remember feeling so good in it. The cotton felt so soft and good on my body, the lemony shade of the yellow felt so happy without being too bright; just right, the soft flare of the skirt had the perfect degree of twirl.  I especially loved the cape-like collar, so unusual; I’d never had a dress like that.  All so pleasing to me.  I’m sure everyone reading this essay have your own storehouse of memories of clothes you wore for special occasions or just clothes you loved and were especially attached to. I remember my Sweet 16 dress I picked out with my mother and my mother’s friend and her daughter who was older than me but who also fell in love with the dress too and bought it too! All I can remember of it now was that it had a lot of pink in it and ruffles. I just felt so special in that dress, like a Sweet 16 girl should feel! And, then in the earlier years of flying, when flying was a big deal and people got dressed up even to go to the airport, I had this checkered shirtwaist dress that I wore quite regularly when we flew. My husband and I came to call it “my airplane dress”. It was very comfortable, suited me and looked good on me to boot. I literally wore it until it just frayed and essentially fell apart. I bet most of you have your memory equivalences; something you loved and literally fell apart. . And maybe are associating to them right now!

I know that I must have gone with my mother to buy both my sixth grade graduation dress and my Sweet 16 dress,  both of which I so loved and felt so special to me; although I only remember she and I  and her friend and her friend’s daughter going to buy the Sweet 16 dress. What I don’t remember at all is whether my mother made the choices unilaterally, or whether I participated in the choice. All I can remember is that I loved them and remember them fondly to this day.

It’s interesting to consider a paradox here. The fabrics that clothes are made from are generally not long lasting, nor are the styles, and yet, the memory of the clothes and their requisite meanings linger perhaps forever in our minds and psyches. What does this say about the meaning of clothes and our attitude towards clothes and what they represent? There’s a certain nostalgia in considering clothes we wore at earlier times in our lives. .Nostalgia is often considered an aspect of mourning. Impart and Rubin (in press) talk about nostalgia’s unique capacity to both facilitate and impede the mourning process, reminding us that it has both an affective and sensory component…

In many ways, some of our tender feelings about our clothes, our attachment to our clothes, whether from the distant past , more recent past, or present,  may well serve as “evocative objects” (Bollas, 2009). Bollas informs us that these evocative objects tell a story about our lives, calling forth a time that has vanished; that is, much was changing in my life as a result of my sixth grade graduation and the summer that followed. I was having to give up all my attachments to my old school, the neighborhood where the school was, my familiar walk t o get there, passing my best friend’s house en route, my favorite candy store that I habitually frequented, my teachers, classmates and friends, some of whom I would be separating from and perhaps never to see again. Indeed, my familiar and comfortable surrounds changing before my eyes. My sense of growing up and my decided ambivalence about that state of affairs was palpable… Would my mother still be there to go shopping with me and either pick out my clothes or help me pick them out?    Clearly I was one of the kids who felt she needed her mother and couldn’t manage very well on her own, and now I was being thrust into the growing up world of junior high school!  However, loss and anxiety were not the only feelings I felt. I also felt great excitement about the novelty of the prospect of a new school, new friends, new environment; really a new world. Accompanying my sadness was also a sense of adventure, exploration, curiosity and optimism.

Consider, when Bollas was taking about object-as-thing, he tells us that “we need the object to release our self into expression” (Bollas, 2009. P.87). There are a myriad different functions clothes serve for us (“releasing our self {through our choice of clothes} into expression”).

As I write this, I find myself suddenly remembering the summer right after I graduated and wore my yellow and white dress.   My whole family went away to Rockaway Beach for the summer. There were family friends around, which was always fun; and I loved the novelty of this very different physical environment outside the city. I loved the air, the light, the beach, the smell of the ocean, and especially the relaxation that the grownups seemed to feel, which in turn made me feel more relaxed.   I think it may be the summer I learned how to ride a two-wheel bike, and the sense of mastery and freedom were powerful.  I could ride my bike all around Rockaway by myself using my own pedal power! Yet I distinctly remember feeling sad, very sad.  I thought a lot about leaving my grammar school, never to return and the loss of all my connections. I had had a particularly goodsixth grade. Things had jelled for me, and I didn’t want to give it up.

I thought wistfully about the physical school, the places I knew in it, my friends, some of my teachers. I played through in my mind any number of times the particular events that had occurred in my classroom and in that school the past year.  The replayed experiences were vivid….  I had the painful realization that that was all over, never to return. I missed it and them and the prospect of it all being gone made me feel very sad. I remember some yearning to be able to go back again, but I knew it was not to be. It was over and never to be repeated in the same way again. I keenly remember how it hurt to think about it. I had a real sense of loss (Viorst ,”Necessary Losses”). My sixth grade was over and now irretrievable.

I guess I was beginning to understand the concept of endings, and the cycle of endings, loss and new beginnings in a way I had never gleaned before.  Yet another memory comes to me about that summer. I made a very big decision to break myself of my habit of putting U –Bet chocolate syrup in my milk. I hated the taste of milk and somehow had come up with the idea of putting syrup in my milk to make it palatable. Had that been my mother’s idea? I made a concentrated effort to wean myself of this habit. I figured out, that I could drink my milk straight without the syrup, if I had a cookie or something else sweet to eat with it. Now, of course in retrospect that was hardly a great solution, since I now changed my dependence from U-Bet chocolate syrup to other sweets. (Which unfortunately I still have!) But, I guess it was the best I could do at the time. Clearly I was trying to get more grown up. My family was rather bemused and indifferent to the whole matter and, knowing my mother, she was probably happy to supply the cookies.

Now I see how these memories of the summer after I graduated were all condensed and symbolized by my yellow dress.

Clothes were like a talisman in many ways. Growing up in NYC, they ushered in the seasons and in a sense recorded the passing of time. We went shopping for new clothes every season. Came late August/early September we went shopping for school clothes, cooler and colder months ahead, and the holidays. I seem to remember always having sad feelings when each season was over, although also having excited feelings about the season ahead. Because we lived in a small apt with precious few closets, there were rituals around each season with our clothes. We removed our clothes from the last season, packed them up and put them in the building’s basement storage, clearing the way and the space for the next season’s clothes. We usually had some clothes we carried over from the last year’s season, would unpack those and then go shopping for new ones. I especially liked spring and summer clothes. They were lighter not just in weight, but in spirit; brighter colors, lighter fabrics, more playful and fun. Less serious. I think in those days my whole family was pretty much driven by what was in style that year.  There was not that much room or emotional space for free expression, experimentation and creativity.

During my adolescent years I went shopping with my friends, especially my best friend. During that period, I distinctly remember wanting to dress the way all the other girls did. I specifically did NOT want to stand out. Fitting in with all of them felt just right to me.

I don’t remember much about clothes during my young adulthood one way or the other, although I’m quite sure I also continued to shop at the wholesale manufacturers with my mother, and possibly my sister.  Being in style was a serious and important matter for the whole family.

I always liked clothes, was interested in them. I was quite inhibited and somewhat cautious and uncertain. I did not think I had any particular knack or gift for being creative around clothes. I would often look at other woman’s clothes and admire how well put together they were, but I didn’t think I could quite do that for myself.

Before I went off to graduate school in social work, leaving the city and moving 3000 miles away to Berkeley CA, which was a gigantic move for me, an uncle who worked in the garment industry gave me a talking to, his form of a goodbye lecture. In effect, he talked about clothes and how I should dress and how important that was.  By then, being a kind of snobbish and somewhat intellectual young woman, I was appalled. How superficial! Really! Even insulting!  Why would anybody be thinking about clothes at a time like that? I certainly wasn’t. Although in fairness to my uncle, my mother and I had gone shopping in preparation for this new phase of my life. And I felt quite prepared, clothes-wise anyway.  I remembered recalling Polonius’ soliloquy to his son, Laertes, as he strikes off on his own and heads for Paris.  “Buy as costly clothes, as can pay for, But not made fancy, rich, and certainly not gaudy. For the clothes often tell what kind of man you are, the apparel oft proclaims the man….”  In my graduate school years, and my early motherhood years, clothes were not very central in my life, although I cared about how I looked and what I wore. All the while, my mother was ever present in her pronouncements about what looked good on me and what I should wear. Even so, I was gradually finding my own path regarding clothes choices for myself. It probably helped that my mother was 3,000 miles away much of the time. I found small stores that I liked, and salespeople who got to know me and we’d work together on finding clothes the seemed to suit me. I was in the process of discovering what colors most suited me, what cuts more flattering to my body and shape, and so on.  I have always had fun shopping with a sense of positive anticipation, albeit accompanied by worrying that I was spending too much money. And I was — and do.

I became friendly with a woman whose life revolved around clothes, particularly high style. She had a great eye, a lot of money, and had come from a family where clothes were central to their lives. Since she never worked, and had access to considerable funds, once her child care and family duties were fulfilled, she could devote the rest of her time to shopping and buying, and shop and buy she did!..  She was, and is, a phenomenon to be reckoned with. She would come alive as soon as she entered a store. I think it was with her and our many shopping expeditions that I came to develop my own sense of taste, style and finally figured out what suited me best. We especially preferred artisanal clothes, and went to many artists’ designs shows, got to know some of the artists, and worked with them. It was all very exciting and a lot of fun. I like wearing art; I appreciate the time, imagination, knowledge, creativity and work connected with each item I buy and I feel proud supporting their work and wearing their clothes.

Quietly, moving in like soft south sea island breezes, my pleasure around clothes with all its attendant meanings evolved for me into a “conflict free area zone” (Hartmann, 1964).

Throughout all these years, some of my clothes my mother liked, some she didn’t. She was the eternal critic until the day she died. And, until the day she died some three and a half years ago, she cared very much how she looked, what she wore, how she put it together, just as her mother had done before her, until the day she died, both dying in their mid-late 90’s.

For a period in her life, my sister was very much in the jet set life scene. To that effect she had a personal shopper choose her very expensive designer couture clothes. My mother would quite regularly critique this professional woman’s taste, letting me know, and whoever else would listen, how that woman put my sister in the wrong cut, wrong color, wrong print, wrong, wrong, wrong. My mother TRULY believed she knew best. And, for many years I too thought she knew best.

In many ways, it’s taken me a lifetime to grow into my views about clothes and to have confidence and not be too hard on myself, when I made some mistakes (which I do).  In a sense it’s a telescoped story of my growing into myself . In short, my life’s development.  Imperceptively, like a quiet south sea breeze, my relation to clothes has evolved into “a conflict free zone” (Hartmann, 1964).  I can now enjoy clothes and be less inhibited. I am far from consumed by them or needing to buy a lot all the time. I truly have come to see them as a form of self expression, different costumes to put on, as it were, conveying different aspects of myself and my mood. I have grown to see clothes as a means by which I can express myself and happily present myself to the world…. This is who I am and I finally feel good enough about myself and my presentation

Clothes are how we interface with the world. They cover our nakedness, protect us from the world and the world from us, but they also reveal who we are, how we see ourselves, our social class and the times we live in.  Thus, simultaneously, clothes both cover us up and reveal us.  In the novel Clothes on Their Backs by Linda Grant, the heroine tell us, “The clothes you wear are a metamorphosis. They change you from the outside in.”  (Think of Bollas here, of the object releasing our selves into expression)…. “A new dress. Is that all it takes to make a new beginning? This shred of dyed cloth, shaped in the form of a woman’s body? My clothes acted as a kind of carapace, armour with which I protected my inner softness….. And if life took you to uncertain, strange margins, to the places where people struggled to express their whole being, through dress, whatever forms such individuality took, that that’s where I would go.”..

Through the years I‘ve come to appreciate the artistry, imaginativeness and craftsmanship that are involved in designing and making fine clothes. At any given time of the year, in U.S. and abroad, one can see museum shows devoted to clothes and high fashion, in different ways, all the styles in the shows reflect social, political, economic circumstances of the times.   The shows portray the archetypes created by mass media and hardly represent any of us ordinary folk. None the less, in reviewing  the shows, The New Yorker tells us, “The archetypes do suggest the way that each ideal makes subtle alterations to the notion of a woman’s place, and to the code that determines who is worthy of respect and who isn’t.” (September 20, 2010)  To be sure, most people don’t wear couture, having neither the body nor especially the finances that these shows are highlighting. But, one of the many fascinating aspects of the shows, is how they do reflect larger historical trends in taste, mores and of course wealth, while at the same time capturing the technical innovations, artistic sensibilities and fantasies that trickle down to more practical designs that are available to most women and men . In line with my heightened appreciation of the artistic aspects of clothes, one can also consider some designs as art;  fiber art combining features of painting, sculpture, architecture, body art, and theatre and exquisite craft”(The New York Times, May 7, 2010.  Consider for a moment another kind of art show.  It was entitled “No Man’s Land”. The artist was Christian Boltanski and it was at the Park Avenue Armory, New York City, in May 2010.  The show consists of a five-story crane claw and a 25 foot-high mound of salvaged clothes. Every few minutes the crane picks up a random assortment of shirts, pants and dresses from the mound and releases them to flap back down haphazardly.  Clothes here are certainly not about high fashion.  A deeper, darker aspect of clothes and their meaning are represented here.  The artist tells us they are meant to represent survival and death and the randomness of life”.

Turning for a moment to the matter of the centrality of social class and its relationship to clothes, I want to share with you a powerful book Landscapes for a Good Woman, by Carolyn Kay Steedman, a sociologist who writes of her growing up as a daughter of a working class mother in South London during the 1950’s (2003). Steedman, graphically and poignantly, writes about the social world she and her mother knew about, and their place within it.  She tells us “My mother did what powerless women have always done and do still, she worked on her body, the only bargaining power she ended up with, given the economic times and the culture in which she grew.” Appearance was connected to her choice of clothes.  She goes on to tell us what her mother learned by the 1960’s. She learned through magazines and anecdotes  “how the goods of that world of privilege might be appropriated, with the cut and fall of a skirt, a good winter coat, with leather shoes , a certain voice, but above all with CLOTHES, the best boundary between you and a  cold world.”

I think we can all agree that clothes carry a vast and deep panoply of meanings; symbolic and metaphoric in nature. Thinking about clothes and their meaning to each of our patients and to us, may shed light on deep, dare I say closeted, pockets of our psyches. Way back in 1977 I wrote a paper about listening and metaphor in the clinical situation, and I cited as one example a patients whose oft repeated refrain was the difficulty she had finding suitable clothes to buy.  She’d go to stores and look and look, but almost always come home empty handed. Her explanation for such frustrating experiences was the following: “Others had gotten there first and had picked out the newest and best clothes and left the junk behind.” Somehow, in her way of thinking, there was a very limited amount of the good stuff, to which she could never get assess to it. Invariably she came too late. I think you can all play with some of the metaphoric meanings of her beliefs around clothes. She was in treatment for many years, and eventually she began to find clothes she liked and took great pleasure in her purchases; a felicitous indicator of deeper psychic changes.

So, lets look some more at the clinical situation, and start by answering a question I posed earlier. Do we think about patients when we get dressed for our work day?   I do think about the patients I’m going to see on any specific day and choose my wardrobe accordingly. Some patients don’t seem to ever notice ever what I am wearing, and with them I am less thoughtful about what I choose to wear. With other patients who comment about my clothes, or whom appearance and clothes are important to them, I dress more carefully and perhaps take a bit more effort… With certain patients it’s fun to wear something new and different… I like to feel good in what I’m wearing and try not to wear the same thing I wore the last time I saw the same patient. Some patients I feel I can be more casually dressed than others… In short, overall I like to look nice and well put together. I enjoy the novelty of deciding what to wear each day, based on the weather, the degree of comfort and the patients I’m seeing that day, although sometimes I’m lazy and just don’t put out much energy around what I wear. And, that’s okay too.  How I dress, including clothes, shoes, jewelry, is but one of several ways I bring myself into the consulting room.    Although I’ve moved very far from my original training and its prohibitions against expressing too much of your personality in your clothes, I. have some mindfulness about what might be inappropriate dress: e.g. I’m reminded of a male supervisee whom I had many years ago. He wore jeans with an eye catching fly; thereby making it inevitable that your eyes would be drawn to his nether region. That felt inappropriate and I remember how uncomfortable it was to talk to him about it as all the staff was urging me to do. In regards to patient’s attire; with some patients I might well comment about something they were wearing, particularly if it seems to have some relevance to our work. With other patients I would never comment on their clothes. In all of these areas around clothes; mine or my patients, I feel much freer to comment upon, talk about and discuss than I did formerly.

In general, I would say that throughout therapy, most of my female patients and many male patients invariably talk about clothes in a variety of different contexts.  With some frequency, patients share memories of going shopping with their mothers.

Rhoda D. is now a woman in her mid 50’s whom I have seen for over 25 years. Rhoda is a very smart, extremely thoughtful, somewhat proper and conservatively dressed professional woman married with no children. She comes from a very wealthy family stemming from a family business started by her maternal grandfather. Her grandparents, especially her grandmother were very important to her. Rhoda is the oldest of four siblings and the only daughter. Much was expected of Rhoda, growing up. Perfectionism was the name of the game in the family. Her mother was obsessive and demanding and was frequently volatile.  Clothes, dressing well and in high style was  her mother’s credo.  Rhoda has early memories of hiding in one particular closet. The closet she chose was a storage closet, so all of the clothes, many of which were coats and other outer garments, were encased in plastic, so she couldn’t cuddle next to the fur coats and feel cozy. None the less, being surrounded by those clothes served as an oasis for her.  In this closet she could feel at peace. She also could hear her mother. When her mother’s voice got to a certain pitch, Rhoda knew it was time to come out. In all the years she used this closet as her temporary safe base, her mother never knew it.  Rhoda was an extremely vigilant child, forever on guard and on the lookout. She actively problem solved her way through childhood, anticipating her mother’s moods and positioning herself accordingly. Rhoda’s mother was a shopper par excellence. She went to the finest stores, knew the salespeople, managers and buyers. She was up on the latest fashions. Dressing herself and her daughter well was a serious manner, nothing frivolous or light about it. Certainly not much fun. To this day, she knows ahead of time when a sale is and what will be on sale, and it’s a matter of urgency that her daughter drops whatever to accompany her, then and there, to the store. There was a rather rigid ritual around clothes. Clothes had to be reviewed at the end and at the beginning of the season. Nothing must be kept that was deemed out of style.  From Rhoda’s point of view, her mother could be absolutely ruthless when it came time to getting rid of the old things.. Out with the old, In with the new. But, Rhoda had her attachments to her clothes and other things, and it was very painful to her to let them go. Her mother simply couldn’t fathom that attitude. It appeared to be almost Rhoda’s duty to keep up the high style that both her grandmother and mother maintained. In a manner of speaking, Rhoda had to uphold her family’s social reputation by her deportment and dress. Quite a burden to be sure.

Rhoda’s conflicts were indeed fraught with anguish.  Choosing clothes and her whole relation to clothes is fraught with pain that is blatantly alive. One of the major topics through all our years of work, has been about her closet, sorting through clothes, deciding which ones to get rid of and which to keep, and purchasing new clothes.  As she goes through sorting out her clothes, her mother’s words from when she was a child still ring in her ears.  “These have to go, they don’t fit you…or they don’t look good on you anymore, etc.” Rhoda says, “I have a hard time making decisions, what should I choose, what should I save, what should I let go”? Rhoda’s sense of deprivation. sense of loss and abandonment and identification with the items given away are palpable. “It pains me to think of the old clothes in the bag.” She frets that if she lets things go, she may not find the equivalent quality again. We have had many, many discussions through all these years, about her attachment to the past and her associations to each article of clothing. She feels it also says something about the future.  In a very profound sense, she has come to see that so many of her feelings around clothes say something to her about the “meaning of life”. Once again, Bollas’s notion of “evocative object” inevitably comes to my mind.  Rhoda says she grew up hearing, “Your mother is so attractive, and she dresses so beautifully”. Rhoda never felt she was as attractive as her mother nor could she dress as beautifully. Self contempt and despair have been constant companions for Rhoda every step of the way, although the depth and extent of her despair has been considerably mitigated through the years of our work.

Shopping with her mother was fraught with utter anguish from childhood on. Her mother would pick something out and even if Rhoda didn’t like it, she’d end up getting it, because “Otherwise I’d leave empty handed”.  Using her analytic way of thinking she has thought and thought about what happens around clothes for her with her mother and with herself. She says, “My mother is intuitive and I’m not. I have to think things through more carefully.” As she’s gotten older, she likes some of her mother’s choices for her, but certainly not all. She’s come to see that her mother doesn’t pay attention to details the way Rhoda does and often chooses thing for her now middle aged daughter that may be good looking, but not really right for her figure, her life style, etc. With time, Rhoda has become more in touch with her ability to know what she likes, and feels more comfortable with her choices.  Parting with things is still a struggle. In many ways, one could say that her lengthy treatment has been conducted around the crucible of clothes.

Another middle-aged patient who has had life long struggles around accepting her body self recalls how hellish it was going shopping with her mother. She distinctly recalls her mother picking something off the rack and saying “That would be the cutest thing on you.” Whereupon her daughter would think, “Who do you think I am. All those frilly clothes. They’re just what I don’t like”. Invariably they’d end up having a huge fight.

Another patient in her late 30’s talks about how she doesn’t know what to wear for the many groups she participates in as a volunteer. She bemoans the fact that she feels she “can’t get it right”. She’s come to think that the women in these groups wear a kind of uniform that she has yet to fully decipher. She says “I worry before an event. I don’t like to call attention to myself. I like clothes that have plain, classic lines; I don’t think the others do. She recalls her times shopping with her mother and their fights… Reared in the Catholic faith, she recounts the very last time she went to confession. She and her mother had gotten in to a terrible fight at the department store and she had screamed at her, “I hate you!” She says with some pride, “when I  finally turned 16 I got my driving license, got a job, bought my own clothes and never went shopping with my mother again!”

Talking about mothers and daughters shopping and yelling at each other at the store, puts me in mind of a painful scene from the recent movie “Please Give”. The mother and teenage daughter are shopping for jeans. The daughter wants a special designer brand; the mother says it’s too expensive. The daughter tries on a number of other less expensive jeans and feels miserable.  The mother says they look good, the daughter feels they look horrid, and end up yelling in the store at the mother “I hate you!”…

I end with a quote from Oscar Wilde:

“One should either be a work of art, or wear a work of art.”

REFERENCES

Bollas, C.  1992.  The Evocative Object.  New York: Hill and Wang.

Flugel, J.  1929.  Clothes symbolism and clothes ambivalence.  The International Journal of Psychoanalysis, 10:205-217.

Grant, L.  2008.  Clothes on Their Back.  New York: Little Brown and Company.

Hartmann, H.  1964.  Ego Psychology and the Problem of Adaptation.  New York, NY:   International Universities Press.

Steedman, C.  2003.  Landscape for a Good Woman.  New Brunswick, N.J.: Rutgers University Press.

Wilde, O.  1894.  Epigrams: Phrases and Philosophies for the Use of the Young.  Oxford:  Chameleon, December 1894.


Samoan Barish  has a MSW and DSW in Clinical Social Work and a Ph.D in Psychoanalysis.  She is past president of AAPCSW, and former Dean and current faculty of The Sanville Institute.  She is on the faculty of the New Center for Psychoanalysis and is a member of the IFPE Board, where she serves as Awards Chair.  She is in private practice in Santa Monica, California.


Ancient and Indigenous Roots of Psychoanalysis

October 15, 2011 10:00 am

A Psycho-Anthropological-Shamanic Treatise

by Farrell R. Silverberg, Ph.D., N.C.Psy.A.

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Supervising and Training Psychoanalyst, Philadelphia School of Psychoanalysis and Member, Society of Shamanistic Practitioners

A preliminary version of this paper was presented at the International Forum for Psychoanalytic Education Annual Conference Friday, October 28, 2010, Nashville, Tennessee

In the cave of the Trois Frères in southwestern France, there is a painting of a shamanic healer that dates back to approximately 13,000 B.C. (about 15,000 years before Sigmund Freud and Josef Breuer published their 1895 Studies in Hysteria). As psychoanalysts, we are accustomed to dating our legacy back to Freud, or to the important psychoanalysts who followed in the ensuing century. But this may be a bit short-sighted since we hold much in common with our prehistoric forbears, medicine men and women, and subscribe to theories and methods that are consistent with ancient wisdom. Rather than a relatively recent arrival on the healing scene, psychoanalysis may have roots that stretch back tens of thousand years or more.

In 1939 Freud’s ashes were placed in an urn at Golders Green Crematorium in London. Around 12,000 years earlier, at a burial site in Israel, an elderly woman, thought to be a shaman, had been laid to rest on her side, her legs folded at the knee with ten large stones placed on her body (Grosman, Munro & Belfer-Cohen, p. 105). The grave was located in a cave in Galilee and contained 50 tortoise shells, a human foot, body parts from animals such as a cow tails, eagle wings and parts from a boar, leopard, and two martens. These animal parts indicated that the woman was seen as being in a close relationship with the animal spirits (Grossman et al., 2008, p. 105).

Upon first glance, indigenous healers and psychoanalysts may seem as far apart as the 12,000-year interval between the two graves I just mentioned. However, psychoanalysts and indigenous healers share the very important common belief that forces beyond our control and phenomena that are not generally observed, or observable, in our ordinary daily awareness affect our health. These forces have been identified by a variety of names depending upon the metaphor that one employs: factors in our unconscious minds, the Tao, transpersonal fields, the effects of our core energies, the life force, our chakras, God’s will, grace, Buddha-nature, the interconnectedness-of-all-things, synchronicity, the collective unconscious, fate, the remnants of past lives, or, as healers in indigenous cultures view it, the spirit world. Whatever label is put on these unseen phenomena, most practitioners of a healing art acknowledge that matters of sickness and healing always involve more than meets the eye.

A key contribution of indigenous medical thinking is the conviction that not only is the etiology of a patient’s illness caused by happenings in non-ordinary reality but that, in order to cure the patient, the practitioner must gain access to that dimension of reality to help free the patient of the adverse effects resulting from happenings therein.

This treatment philosophy may sound familiar to us as psychoanalysts since psychoanalysts also hold that emotional and relationship health is indeed mediated in another dimension: the non-ordinary reality of the unconscious mind with its psychodynamics. This extremely important similarity with indigenous medicine is often missed in our profession, since the commonality tends to be overshadowed by the metaphors that are used by traditional shamans – these metaphors distract us from noticing the shamanic roots of our work.

Roots of Illness in Another Dimension

Indigenous medicine and psychoanalysis share the key perspective that, in order to obtain a cure for certain maladies, something within non-ordinary reality (a realm of experience inaccessible in daily life) be adjusted. Since non-ordinary reality is not readily available for direct observation and medical manipulation, such elements must be understood through metaphor. And, in each of these metaphors for non-ordinary reality, there are theories about how things operate and systems of rules for this other dimension.

In the Pima culture of Northern Mexico, for instance, trespassing against the “way” (or rules) of a powerful object in the spirit world will lead the lingering “strengths” of that object to cause problems within the patient (Bahr, Gregorio, Lopez, & Alvarez, 1974, p. 21).  The object is usually an animal spirit, and each class of animal spirit has rules. For instance, according to Donald Bahr, Juan Gregorio, David Lopez, and Albert Alvarez (1974), violating the “jackrabbit way” might make a patient suffer impulsive and out-of-control behavior while violating the “owl way” might make the patient become lethargic (p. 28).  Such afflictions, with roots in non-ordinary reality, cannot be reversed without taking the world of spirits and strengths into account.

Likewise, in the culture of psychoanalytic psychotherapy, afflictions that have their roots in the “unconscious mind”––cannot be understood or remedied without taking into account the theories or rules of that realm. In our metaphor, powerful objects and forces in the unconscious realm come about by introjecting or moving certain reactions and energies into this non-ordinary realm. Once relocated, introjected objects create an internal parallel universe in that typically invisible realm––which, if you step outside of the psychoanalytic worldview for a moment and think about what our theories portend, is a rather mystical sounding process.

Of course we have our own rationales for the development of the non-ordinary world of the unconscious mind, such as our motive for introjection that is based, according to Otto Weininger (1992) on the fantasy that: “If I have it inside me, I can control it effectively, it will not be on the outside where it can threaten me and destroy me” (p. 27).  It is a false fantasy, however, because these powerful internalized objects could, when trespassed against, cause toxic effects in the unconscious, thereby sickening the patient with emotional illness—and even cause such extreme effects as suicide.

In both metaphors, the shamanic and the psychoanalytic, it is thought that the patient’s transgression or the patient’s parents’ transgression (albeit usually unwitting and accidental in either case) have effects in non-ordinary reality that lead to the patient’s illness. In both the explanatory stories told by shamans and in the case of historical stories told by psychoanalysts, the interactions responsible for the current symptoms are thought to have occurred long before the patient developed the illness. Among the Pima, such interactions took place, “so long before that the patient has forgotten what he [or she] did and, therefore, he [or she] required the services of a shaman to diagnose the sickness” (Bahr et al., 1974, p. 21). Bahr et al. also point out that, in the shaman’s system of medicine, “Sickness comes from failure to follow the commandments of the way: failure to be careful, to remember, to believe, or to defer to things” (pg. 42).

According to Mariko Walter and Jane Neumann-Fridman (2004), shamans of the Numic culture (including the Native American Shoshone, Comanche and Ute tribes) are called in when an unremembered dream is thought to be causing an illness in the patient:

In the curing ceremony, the shaman discovers the dream and the person who dreamed it.  The dreamer must confess the dream and relate its content publicly.  Not until the dreamer confesses the content of the dream to the shaman can a cure be made (p. 293).

Sharing the indigenous medical idea, psychoanalysts also believe that the etiology of an illness often occurred so far in the past that the patient has forgotten, potentially in the patient’s formative childhood years – and that the etiology may reveal itself to people through their access to the unconscious realm in dreams. So, we can note that both in psychoanalytic psychology and in indigenous medicine, dreams are a  “royal road” (Freud, 1980, p. 647) to non-ordinary knowledge. In the indigenous medicine practiced in Borneo, “Dreams are believed to be what the soul sees when it travels outside the body during sleep. Dreams are the only way in which normal people [as opposed to shamans]… have contact with the spirit world” (Bernstein, 1977, p. 59).

In the Piman system of diagnosis, taboo events such as having stepped on a bear track, may have brought about symptoms. In this case , symptoms are thought to be due to the infiltrating and lingering punitiveness of the bear strength. In psychoanalysis, violating the tacit rules of one’s family of origin, and the introjects that are reflective thereof, that operate in the unconscious realm, can lead to similar infiltration and lingering punitive symptoms.

For example, I have a patient who was raised to have a very undignified existence. Most of her family members live victimized and self-destructive lives, including drug and alcohol abuse, brushes with the law and promiscuity. Whenever this patient violates that family legacy (e.g., chooses not to get drunk and refuses to have a one night stand with a stranger) she feels the compelling urge to, and often carries out, self-mutilating behavior such as cutting her legs with a razor knife.  In other words, it could be said that these symptoms came from a violation of the family “way” and the punishment for this trespass is the family “strength” in her body or mind that makes her cut herself.

In the case of the emotional suffering of babies and young children, shamans and psychoanalysts both agree that the patient is innocent of committing any violation, but suffers nonetheless. Another similarity between the two metaphors of etiology, is that there is often, a separation in time between the causative factors and the appearance of symptoms. For instance, if the patient has a symptom picture known to the Pima as “whirlwind sickness,” the shaman assumes that as a child, the patient ran inside of a whirlwind and the consequences of that trespass took several years to “reach” and sicken the victim (Bahr et al., 1974, p. 74).  Likewise in psychology traumatizing events in childhood (being caught in a different kind of whirlwind, an emotional one, so to speak) may take years to “reach” and sicken the patient. And just as in the uncovering work of psychoanalysis, in shamanic healing work the wrongful past transgressions of a parent are sometimes only discovered through the analysis of the symptoms and history of the child (Bahr et al., 1974, p.76).

Shamanic Trances and Ogden’s Reverie

Shamans may access non-ordinary reality through the use of plant-based mind-altering substances and/or through a spiritual practice that allows them to enter into a trance-like state of consciousness. In the shamanic metaphor, the altered consciousness allows the healer to journey into the “spirit world” associated with the patient; wherein the contents affect the patient’s inner balance and health. Having experientially “walked in the patient’s shoes,” and even having transacted with non-ordinary reality entities and spirits affecting the patient, the shaman returns to ordinary reality with important knowledge. As psychoanalysts we glean similar experiential knowledge when our countertransferences transact with the patient’s transferences and introjects — all of which originate in the non-ordinary reality we call “the unconscious mind.”

According to Barbara Tedlock (2005), Essie Parish (a California Kashaya Pomo indigenous healer) describes her experience of the shamanic trance as follows:

“While the disease is coming to me, I’m in a trance. It speaks to me firmly saying, ‘This is the way it is. It is such and such kind of disease. This is why the person is sick.’ But when I come out of the trance I no longer remember what the disease told me” (p. 19).

In indigenous cultures, such trances are not considered autistic or out of touch with the person who is ill, but are viewed as a method that allows the shaman to immerse himself or herself more deeply into an understanding the patient’s illness.

When a psychotherapist engages in a close empathic connection with a patient to the point of exchanging his or her own reality for the patient’s unconscious-realm reality, a similar curative element is added to the treatment. This is not an uncommon occurrence in forms of psychoanalysis wherein the therapist is trained to cultivate the ability to become open to experiencing a many-textured countertransference and therapeutic relation in order to experience a better empathic “grasp” (Kohut, 1984, p. 210).

According to Indian psychoanalyst Sudhir Kakar (2003), “Empathy, and the meditative state that underlies it, may well be the sluice through which the spiritual enters the consulting room and where it flows together with the art and science of psychoanalysis in the practice of psychotherapy” (p. 674). In our psychoanalytic shaman’s shift, rather than subscribing to mind altering drugs, we employ free-floating attention, or what Thomas Ogden (1997) describes as a “reverie” within the analyst’s mind during the session—a process that could be viewed as a form of healing trance (p. 719-732).

It is particularly hard to deny the similarity between our work and that of indigenous medicine when noting a shamanic technique among the Navajo medicine men and women called “listening.” According to Walter and Neumann-Fridman (2004), such listening has similarities to the kind of open attention many of us practice during our psychoanalytic work and was carried out:

…in a similar way to stargazing. The listener would bless his ears and those of his patient with powder made from dried badger eardrums: he would then go outside away from the patient and chant and the listen for telltale sounds in the environment.  Based upon the pattern of what he heard (lightning, a rattlesnake, a coyote howling, whatever it might be), he would render a diagnosis (p. 322).

Becoming the Patient: A Common Thread

Michael Harner (1990) describes an indigenous healing ritual that is striking in its similarity with the experience we have as psychotherapists when understanding our patients through our empathy and compassion for their history and suffering. In the “becoming the patient” technique used by Coast Salish shamans of British Columbia, the shaman takes upon himself the harmful effects of the spirit world that are making the patient ill (p. 132).  The shaman interviews the afflicted person to learn about the experience of the patient and about what it is like to be the patient. This interview process is similar to the process of interview in psychoanalytic psychotherapy except that it lasts only a few days while the psychoanalytic version takes more time.

When the Salish shaman knows enough about the patient that he or she feels capable of identifying with the inner experience of the patient they both go to the wilderness to perform the ritual. During this ritual the shaman and the patient slowly exchange clothes, and with each article of clothing borrowed and put on, the shaman contemplates taking upon himself more of the patient’s hurts and symptoms. Then the patient and shaman perform a dance in which the patient moves and the shaman imitates each movement and gesture of the patient. At first the movements are just empty imitation but eventually, the shaman feels his consciousness changing and would feel “waves of sickness, or pain, passing over him” (Harner, 1990, p. 133)

Like the shaman, the psychotherapist who is open to non-ordinary elements welcomes, even cultivates, the transfer of psychological toxins such as despair, helplessness, aggression and self-punitiveness. If the therapist has discovered what it may be like to be the patient through touching the non-ordinary realm of the unconscious, a small trace of that knowledge inhabiting the tone of voice or infusing the supportive words being spoken reinforces that the patient is being understood and makes intervention more meaningful. As I’ve stated in a recent paper:

Without the analyst’s sustained ability to experience the resonant empathic connection as the ground from which the hope is expressed, and to calmly abide the concomitant tension, there is more risk of the empathic breach about which Kohut warned us (Silverberg, 2011).

Shamanism Without Drama

Psychoanalysts and psychotherapists need not carry a rattle, beat a drum, chant, lay hands upon, lie down on the floor beside the patient, take mind-altering botanical formulae, or enter into a trance in order to access a patient’s unconscious realm and affect elements therein for the sake of helping that person. These are the rituals of indigenous healers and although they bring the shaman into the limelight, such drama is not the only way to have access to the patient’s deeper world. In our work with non-ordinary reality as psychoanalysts, our lack of these overt displays does not vitiate the fact that we may be accessing a hidden dimension in our work. In our version of the healing rituals, we are more subtle in our empathic pyrotechnics than our shamanic forebears, who might, for instance, enhance the impact of the encounter by rubbing an egg over the patient to absorb all the toxins and then throwing that egg at the door of one of the patient’s enemies..

But, despite the reputation of shamans for chants and rituals, drama was not always a required element of healing. According to Walter and Neumann-Fridman (2004), in some indigenous cultures, shamanic healings were often performed simply through “a conversation between the sick person and the shaman in which the shaman would induce hope of recovery in the patient by referring to similar cases where the ill person became well again or by narrating the happiness in the Otherworld” (p. 301).

As a matter of fact, a smooth and non-jarring accessing of non-ordinary reality of the unconscious and the hidden dimension of the intersubjective without disrupting normal discourse and without entering a trance state, and in the absence of elaborate rituals, is key to our work. Our psychoanalytic empathic in-touchness via a non-ordinary connection can also be seen as a form of shamanism without the drama of the rituals.  Non-ordinary reality can be integrated quietly, and with a smooth interface into psychoanalysis, psychotherapy or other healing procedures. In our work we prove that, extraordinary levels of experience can be accessed without telegraphing to the patient or anyone else who might see the transaction that an extraordinary experience is occurring – although the outcomes of treatment and the profound experiences that occur on the way will give testImony to this fact.

In Conclusion: Sharing the Tradition of Eyes that See in the Dark

According to Tedlock (2005), the Inuit and Innu peoples who reside close to the Arctic Circle refer to shamans as “those with eyes that see in the dark” (p. 25). Clearly the metaphors used by indigenous shamans and those used by psychoanalysts differ, but if one takes an overview that encompasses both, indigenous medicine and psychoanalysis, it is also clear that the two metaphors share common underlying assumptions about what can be seen in the dark.

According to James Grotstein (1981), Wilfred Bion (in poetically confabulating a line from one of Freud’s letters to Lou Andreas Salome with a line from the Nobel prize acceptance speech from the inventor of the CAT scan) stated that analysts need to send  “a beam of intense darkness” (p. 507) in order to obscure the distractions of ordinary reality.  Sending such a beam allows one to become more receptive to messages from the unconscious world, which in contrast to the darkness, would be illuminated. This idea is not at all dissimilar from the idea expressed in the Inuit expression about a shaman’s eyes.

The two metaphors that have been discussed in this paper (that of shamanic healing and that of psychoanalysis) may ultimately be pointing to the same notion–the concept that health is mediated in a non-ordinary reality.  Through conjecturing this common thread, we can say that the legacy of psychoanalysis extends thousands of years into the past, and could well be a continuation of ancient and indigenous healing practices.  Just as the indigenous healers had methods of facilitating a shaman’s trance or healing interaction, we have been seeing a shamanic lineage within psychoanalysis without having realized how far back the association goes. By such standards, our lineage of psychoanalytic shamans includes Bion, Ogden, Kohut and Mitchell, to name just a few whose work entailed cultivating a state of being wherein the analyst can more easily access the non-ordinary/unconscious dimension in the service of helping another person. The extraordinary knowledge gleaned from the elusive, and for the most part invisible, non-ordinary reality, whether considered the stuff of the spirit world or of the unconscious and intersubjective word, is never far from us when we are working with “eyes that can see in the dark.”

References

Bahr, D., Gregorio, J., Lopez, D.I., & Alvarez, A. (1974). Piman shamanism and staying sickness. Tucson, AZ: University of Arizona Press.

Bernstein, J.H. (1997). Spirits captured in stone: Shamanism and traditional medicine among the Taman of Bomeo. London, UK: Lynne Rienner.

Freud, S. (1980). The interpretation of dreams. New York City, NY: Avon.

Grosman, L., Munro N., & Belfer-Cohen A. (2008). A 12,000-year-old Shaman burial from the southern Levant (Israel). Proceedings of the National Academy of    Sciences, 105 (46):17665-17669.

Grotstein, J. S. (1981). Wilfred R. Bion: The man, the psychoanalyst, the mystic: A perspective on his life and work. Contemporary Psychoanalysis, 17:501-536.

Harner, M. (1990). The way of the shaman. San Francisco, CA: Harper.

Kakar, S. (2003). Psychoanalysis and Eastern spiritual healing traditions.  Journal of Analytical Psychology, 48: 659-678.

Kohut, H. (1984) How Does Analysis Cure?. Ed. A. Goldberg., Chicago, IL: Chicago  Press.

Ogden, T. (1997). Reverie and metaphor. International Journal of Psycho-Analysis, 78:719-732.

Silverberg, F. (2011). The Tao of Self Psychology: Was Heinz Kohut a Taoist Sage?, Psychoanalytic Inquiry, 31(5).

Tedlock B. (2005). The woman in the shaman’s body. New York City, NY: Bantam.

Walter, M., & Neumann-Fridman, J. (2004). Shamanism: An encyclopedia of world beliefs, practices, and culture. Santa Barbara, CA: ABC-Cleo Publishers.

Weininger, O. (1992). Melanie Klein: From theory to reality. London, UK: Karnac Books.


Author Bio:

Farrell Silverberg, PhD, NCPsyA is a clinical psychologist, a certified psychoanalyst, a member of the Society for Shamanic Practitioners and the first Western student of Taopsychotherapy master Rhee Dong Shik in Seoul, Korea. Silverberg has lectured internationally and has published in journals in the United States and in Asia. He began integrating psychoanalysis, Buddhist-Taoist philosophy and Shamanic thought thirty years ago, and his papers on the combined technique include Therapeutic Resonance (1988), Resonance and Exchange in Contemplative Psychotherapy (2008), and, recently, The Tao of Self Psychology: Was Heinz Kohut a Taoist Sage? (2011). Having served in hospitals and clinics over the years, Silverberg is currently a Supervising and Training psychoanalyst at the Philadelphia School of Psychoanalysis. His 2005 book, entitled Make the Leap, distills professional concepts into accessible language, is currently being used as a treatment manual in randomized and controlled design research to prove the efficacy of psychoanalytic psychotherapy.

Contact: drsilverberg@drsilverberg.com


Through the Lens of Quantum Theory

October 15, 2011 10:00 am

A Mother/Daughter Dialogue About Creativity in Art and Psychoanalysis

by Rachel Paula Shapiro, artist, and Leanne Domash, psychoanalyst

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Introduction

LD: First, let’s introduce ourselves. I’m Leanne Domash, psychologist and psychoanalyst, and the mother of Rachel Paula Shapiro, artist. I am very interested in the creative process and in the intersection of various fields as an inspiration and breeding ground for creative ideas. This article will hopefully be an enlightening mix of art, quantum theory and psychoanalysis. I’m so excited that we can dialogue about how creativity manifests itself in our life and work.

RPS: I’m Rachel Paula Shapiro, artist and teacher, and I share similar interests. I am fascinated by the symbolic life surrounding us and the language of the psyche. This conversation touches on themes that are relevant to each of us in a unique and intersected way.

LD: In a way, we are also introducing ourselves to each other, as adult colleagues. Although I’ve assisted you some in your growing jewelry business, this is the first time we have formally discussed our work together.  I hope this dialogue helps create the birth of this new collegial relationship as well as deepen us as mother and daughter.

RPS: Absolutely. This forum also helps me formulate ideas that are sometimes abstract and elusive. I appreciate the space to focus and discuss these issues that are so important to me.

How do new ideas come into being?

LD: One of the most intriguing questions for me is: how does creativity happen? How do new ideas come into being?  As therapists, we want new insights about our work and our patients. As an artist, how do new ideas come to you?

RPS: Sometimes it’s as if the idea is already there and that it comes into being when my senses open up and I am able to notice it.

LD: This makes me think of our recent IFPE conference Psychoanalysis: Not the Same Old Song and Dance where I was inspired by Ken Silvestro’s discussion of quantum theory as a paradigm for psychoanalysis (Silvestro, 2010). This led me to begin to explore these ideas further in relation to art and psychoanalysis.

The Quantum World

As background, based on both Silvestro and Al-Kahali (2003), I’ll discuss several key concepts in the quantum world before we begin our dialogue.

According to quantum theory, the universe is comprised of waves of energy.  These waves are like energy clouds of sorts, without a beginning or an end.  They contain possibilities that begin to exist in the real world only when they are measured, a process called decoherence.  This is when possibilities pop into being.

Analogously, in the case of your creativity,  Rachel, you are the measurer. You notice the idea or image and then you gradually bring it into being as you develop it.

Silvestro and others have made the analogy of the quantum world to the unconscious realm and the Newtonian or material world to the conscious. The quantum universe is nonlogical, acausal, counter-intuitive and bizarre. Silvestro likens it to Alice’s Wonderland. I liken it to unconscious dream life.

It is by reaching this unconscious realm that meaningful work occurs, both for the patient/therapist dyad in psychotherapy and for the artist and her creative product. Using the analogy of quantum theory, we can explore the implicit self from a new perspective and better understand our elusive, emotional and “illogical” unconscious.

An example of the illogical nature of the quantum world is that a quantum particle can be in two or more places or states at the same time, a concept called superposition.  For a quantum object a single position of a particle within a waveform is impossible. Since they are only potential particles, many potential particles simultaneously exist within the wavefunction and simultaneously don’t exist. Potentialities can exist in many places at the same time.

As Silvestro explains, pointing to the location of a quantum particle in a waveform is similar to attempting to grasp the elusive rabbit in Alice’s Wonderland. One quickly discovers the rabbit exists in many places at the same time. By analogy, this captures the elusive, shifting, multi textured, and multi determined quality of working with unconscious material.

Perhaps an analogy in the physical world is that in dialoguing together, you and I are each in two states at the same time.  You are both an artist and a daughter and I, psychoanalyst and mother.

Silvestro writes that the unconscious cannot be directly known but as soon as an unconscious waveform interacts with a Newtonian measuring device (in this discussion, the “measuring device” is the artist or the psychoanalyst), the unconscious content becomes a conscious physical or psychic object. In our therapeutic language, this is when the unconscious becomes conscious.

Ideally, in our work, the psychic object that pops out may be a memory or association that leads to a new perspective or reflection; this can help the patient move in productive directions.

This can be experienced as an “aha” moment when clarity is suddenly achieved, a process I have written about elsewhere (Domash, 2010). For this to occur, both patient and therapist need to be receptive and open, to be comfortable with paradox and ambiguity. Similarly, the artist creates a physical work of meaning and passion which too seems to pop out of her unconscious as she embraces surprise and ambiguity.

As artists or as psychoanalysts, we have to tolerate the indeterminate nature of our process and our knowledge.  Similarly quantum theory stresses the indeterminacy of knowledge of the quantum world which is only a world of possibilities, not of realities. Therefore we can never know with precision what will happen or where a particular “particle” will emerge from the infinite length of the waveform. Similarly, therapy is an unpredictable process. It is an environment of possibilities; insights come and guide the patient but do not follow a set pattern.

Uncannily, quantum particles are known to pop in and out of existence. Bohm (1983) describes this “in and out movement ” from waveform to Newtonian reality as a dynamic between the implicate and explicate orders, much like an unconscious thought can become conscious and then recede back into unconsciousness.

RPS:  Sometimes in therapy I have come across “blind spots” where after the session I actually forgot what I had spoken about. When trying to recall the content of what had surfaced, I am only able to remember the context, but not what was actually said. My therapist is able to then guide me and bring light to this dark area. This is an example of material surfacing from the unconscious that is difficult to face, and when out of the therapy space, recedes back into unconsciousness.  This in and out movement also occurs when remembering dreams, the memory is present and then often vanishes and recedes.

LD:  Another concept is called entanglement: once two quantum particles intersect, they remain connected and will behave in the same manner no matter how far apart they are in space and time.  This is because, according to one interpretation by quantum physicists, they remain as part of a unified waveform which can extend indefinitely and stretch throughout space. The unified waveform contains the shared information about their quantum states so when one potential particle changes in any way, the other potential particle simultaneously changes as well.

To help us understand nonlocal reality– this connection regardless of time or space due to an earlier entanglement– the following example is sometimes given.  Picture two dice that, when thrown, alway register doubles, that is two threes, two sixes, and so on, no matter how far apart they are.  One die could be on earth and the other on Pluto.

As I understand it, this is because in the quantum world the waveform for each die entangled and then separated but stayed connected.  Then each waveform, with all the potentials simultaneously present, was measured. These measurements cause the waveform potentials to decohere to particles in our reality, Newtonian reality. (When measured, potentialities come out of the waveform and appear as real objects.)  In our case, the two die in the example appear in the real world.  Therefore, when one die is thrown and results in a number, the other die, wherever it may be in Newtonian reality, will suddenly display the same number due to the one time entanglement at the quantum level. Because of the original entanglement, when one particle changes in some way, the other will as well.

This strange concept of entanglement has been related to Jung’s concept of synchronicity (1972). Synchronicity is the co-incidence of a psychic state in the observer and an objective, external event. In other words, synchronicities are highly meaningful, symbolic, acausal connections made between one’s interior subjectivity and the events of everyday reality. It is the psychological connection between the inner state and outer event that makes it synchronistic. These are experienced as extra-ordinary co-occurrences. (Hopcke, 2009; Sylvester, 2010).

I have written about how we and our patients have to be alert for synchronicities, that is when an outside event seems to “hit” us as uncannily coincidental and gives power to the moment.  I termed this “psychoanalytic luck” (Domash, 2009). Moments of synchronicity can alert us to exceptional and meaningful opportunities and reveal an underlying pattern or framework, otherwise unknown or hidden from us. These moments can be thought of as an unconscious entanglement suddenly erupting into conscious reality.  These are connections that we can productively and creatively use.

Ironically (or not, considering quantum theory), the same day as I attended the presentation on quantum theory, Rachel sent me a poem she wrote titled “Footprint” which both by its content and timing illustrates these ideas. This poem “hit” me as important and as a possible avenue to begin exploring these important themes.

Creativity pops into the Newtonian world

RPS:

Footprint

Last winter
I began to find
peculiar silences imprinted everywhere.
Silence, in dust gathered,
silence, after a closed book,
around an empty glass of water,
after a switched off light.

The quiet that resided
in the folds of my sheets,
the blankets piled up
to get through winter,
the caves they formed around me.
The quiet that lurked in the morning
in those caves
is the silence that I speak of.

In this soundless state
I found myself
seated at my worn wooden desk
in a diagonal beam of light,
coffee cold
and a canvas before me.

LD: It seems as if this poem is about your emergent creativity and how it arose from stillness.

RPS: Yes, it is. This poem speaks about creating from a place of sad silence. Last year, recently separated, I found myself with more time to myself than I had had in years. I actively chose not to fill that time with distracting noise and activities to take me away from my feelings. Sometimes I would just sit in my house. Over time, I began to listen, to myself, to what was around me, and I heard a calling. In the poem the calling comes as a beam of light across my desk, me dazed, and my coffee cold. As I settled into this silence, I began to see more intricacies to my world, and was able to dive into my own self, slowly and gently peeling back the layers. It was in this void, this void that was both a gift and a theft, that I was to create.

It is only now as I write this that I can give thanks for this separation, for the clean and lonely hole it created in my life. It is through that hole, that I began to cultivate my artist.

LD: It sounds like you were able to tolerate the silences and allow something profound to emerge from your unconscious and work with it.

RPS: Absolutely. This emptiness was necessary for me to cultivate the land and wait for the seeds to come. Cleaning the creative space, watering it lovingly, is as important as the actual flowering process.

LD: You also used the beam of light (which behaves like a wave) as the symbol for the “calling” of your creativity, perhaps an unconscious analogy to the quantum waveform in the world of possibilities. Clarissa Pinkola Estes (1992), whose work you introduced me to, uses surges of water as the metaphor for female creativity.  She writes,  “The creative force flows over the terrain of our psyches looking for natural hollows, the arroyos, the channels that exist in us.  We become its tributaries, its basins; we are its pools, ponds, streams, and sanctuaries. The wild creative force flows into whatever beds we have, those we are born with as well as those we dig with our own hands. We don’t have to fill them, we only have to build them.” (p. 299)

This is analogous to a forceful emergence of particles from the quantum wave into consciousness. Estes (1992, p. 299) writes that the creative force is not a “matter of wanting to, not a singular act of will; one solely must.”

How is this for you? Are artists beings who are called to bring “the quantum into the material world”, to continuously reach the unconscious and bring it forth?

RPS:  I agree that my creativity comes from a place below and I think that the water images powerfully speak to the ways this energy can flow in a river or a stream, and often I experience it like a great wave. Sometimes it is  still water in a basin, and sometimes a dry riverbed. This terrain is always present and I do believe that my work as an artist is a conversation, sometimes aware and sometimes not, with my unconscious psyche.  It’s when the boundary between the two worlds blur that I am able to create most abundantly and freely. When patterns in randomness become clear, these two realms have connected. I try to feed this unconscious, illogical and intuitive part of myself as part of nourishing my artist.

How do we nurture our creative self?

LD: Estes talks about the importance of caring for our creative life. The “river beneath the river” which nourishes us can get polluted and seal off the creative. As she states it, then the river of life becomes the river of death.

Many myths have this theme of how negative forces can rob us of our life force. One of many examples she gives is one in which two men seal off a well owned by a man and his family so trees and flowers can’t grow; another in which a noxious fog spreads over an island so the gods cannot continue to create the story of life. These myths serve as warnings for us to escape, at all costs, negativity in our surroundings.

The above examples are of negativity coming from the outside.  The negativity can also come from within in the form of denigrating one’s own work and/or succumbing to procrastination, disorganization, or distraction. In women, the most common symptom of this pollution is a loss of vitality, to be distinguished from a natural ebbing and flowing of the creative process.

What thoughts do you have about our protecting our creative life, whether as therapists or artists?  Would you feel comfortable discussing your recent meditation retreat and if you feel it helped deepen your creative life?

RPS:  As I mentioned above, there are ways in which I actively nourish my creativity. I think protecting it is crucial. Julia Cameron, in The Artist’s Way, refers to our artist as a child. A child needs to be fed, taken care of, spoiled, loved, and protected in order to blossom. I think we are our worst enemies when it comes to our own art. The self-critical voice in the mind is often so developed, sometimes overpowering. Part of protecting my artist, is quieting and reasoning with that voice of self doubt, of comparison, of negativity. I do this in the same way that I would try to protect a child from violence or anger, from harmful things in life.

I do feel the meditation course signaled an initiation of sorts that had been building in the months prior to it. Before I left for this course I had begun to float so freely in the unconscious realm that I got scared. I had a dream that came true. I also started falling asleep while I was dreaming and having deeper dreams inside my dreams. What really scared me though, is that I started having experiences in reality that felt like “waking dreams.” My dreams started feeling more “real” than certain moments or scenes from my waking life. This completely threw me off balance and I didn’t know how to navigate this dissolution.

LD: It sounds like you were so in touch with the unconscious realm, or metaphorically the quantum realm, that you were beginning to feel like an Alice in Wonderland. How did the “initiation” of the meditation course affect this?

RPS: I went to a 10 day Vipassana meditation course in absolute silence, where one tries to observe “reality” as it really is, without any distractions.  As I observed self during this immersion into the mind, I experienced a certain internal death. Various patterns and ways of living began to dissolve as it became clear that they were outdated. Maybe with this ‘death’ I will be able to let go of the need for a specific structure in reality in order to feel safe.  Maybe developing as a artist means deepening my experience in both the conscious and the unconscious realms. Sometimes getting lost is part of the journey. I could see that the fear that came up in the period before the meditation course was because I had reached a level of acute awareness that was new to me. Once I became familiar with this level of unconscious awareness, the fear began to retreat.

During the meditation course, my senses on an earthly level also became fine tuned.  My visual eye began to focus on light in ways I don’t recognize in normal life. Shadows, rays through clouds, reflections bouncing off my glasses, circular light particles, the early morning winter light before the sunrise- blue grey and misty.  I ate an orange at 5 PM with the sun low over the mountains and was able to observe every little bubble particle that made up such a luscious fruit. Holding that same fruit up to the light, I saw a warm tender glow.

LD: Wow, that’s an endorsement of the Newtonian world!

Jewelry As Symbolic Expression

LD: You are a jewelry designer as well as a fine artist.  From a psychological perspective, could one of the functions of your jewelry be to help us evolve, both to more fully express who we are and also to try out new and future selves. Can jewelry, with its fanciful and playful aspects, help us create a self that is “truer” than the real self, maybe the self we want to become.

I have been reading the work of Doniger (2005), a Hindu scholar, who discusses the use of “masquerade” and “pretend” in finding an identity. She writes in “The Woman Who Pretended to Be Who She Was” that a masquerade can help one find out who one really is. The mask reveals rather than conceals the self beneath the mask.

In this sense, the mask may be more authentic than the real self, the surface “deeper” than the depth. There can be a dialectic between the idea that the meaning is hidden beneath the surface and the idea that the meaning is on the surface, or still a third position, that meaning is in the space between the two.

She also discusses how symbolic jewelry was, especially rings, in ancient Hindu myths. One of the many possible symbols for the ring is of identity and the loss of it.  A signet ring was one’s particular seal or stamp, similar to credit cards of today. Credit card theft is termed identity theft. In some of these ancient myths the ring was also actually used to establish identity, usually of a male child by identifying his father. For example, the woman takes the ring of her lover while he is sleeping and then returns years later to prove he is the father of her child.

Can you say something about jewelry as a symbolic expression?

RPS: Jewelry is functional art.  It is meant to be worn, touched, and it ages with time. A special piece of jewelry can also become an extension of the body and a symbol reflecting one’s life experience. If the jewel is timeless enough to be passed down in a family, it holds in it memory and story and through the identification with that memory, a shared family identity.

I am wearing a ring right now that illustrates this symbology. Before I was born, you gifted your mother with a trip to Israel. The trip was meant to help my grandmother reclaim aspects of her emotional and spiritual identity after her husband, my grandfather, had passed away. In Israel, my grandmother bought a gift of a raw ruby for you. You then had that stone made into a ring and wore it for many years. Now that ring sits on my hand and connects me with my matrilineal line and is a symbol for reciprocity between generations. The story it holds is invaluable to me, and it’s the only artifact I have that my grandmother held in her hands.

LD:  Powerful. I didn’t realize until now how important this ring is to you and how it is a thread through the generations of our family, establishing a strong sense of female identity and the value of sharing resources. I wish my mother could know this and could have known you. I’m reminded again of my sadness that you two never met, yet the ring does link us all.

Let’s go from talking about symbolic expression to self expression. Can you say more about how your jewelry might speak to this?

RPS:  I think jewelry has the power to set a mood for the wearer and express different sides of personality. For example the movement in a pair of slinky earrings can be wispy and feather-like evocative of the feminine or of the forest. The wearer might choose these earrings to express that energy on a given day.  On another day, she might choose a pair of heavy hoop earrings that express a tougher, more urban aspect of self.

However, when I create, the small sculptures come to being without thought about what their essences will reflect. My own emotions and experiences come into play when I am doing art. It is more when I wear the jewelry or see it glowing on another person that the language it speaks becomes clear. It is to say, the wearer gives the object life and voice.

LD: The pieces of jewelry are expressions from the implicit world that can assist us in shaping ourselves psychologically.

Doniger writes that many myths have as their message the fact that you cannot escape your fate. However, myths provide “loopholes” as well. For example, as you travel through life, you may not become a completely different person but you can learn and evolve; you can find valuable aspects of yourself with the help of others and in that way experience a transformation.

Jewelry may help us find some of these “loopholes”, that is, it can help us to continue to discover ourselves and evolve.

Dreamwork

LD: In psychoanalysis one of our main goals is to reach the implicit or unconscious self to access and potentially change early dysfunctional patterns that are repetitive and self destructive. One key method of reaching this implicit self is through dreamwork. The psychoanalytic literature has described  many possible functions of dreams. Some intriguing new research from neuroscience suggests that dream can change the brain both by helping us form new memories as well as reworking old memories. In this process, dreams can help us solve problems (Stickgold, 2005). On a neuronal level, this happens because our usual censors are turned off during dreaming so neurons are freer to roam about and make new connections (Limb and Baum, 2008; Beeman, et al, 2004). Relating to the quantum field, dreams are examples of images from the unconscious decohering and becoming manifest. Bion said it well: dreams are alpha functions by which he means the dreamer takes amorphous feelings and turns them into meaningful symbols (Bion, 1962).

Does dreaming help you come up with new ideas?  Can you give us an example?

RPS: I have definitely dreamt ideas for jewelry and images have come to me in dreams that inspire my collage work. When creative energy is flowing in my life, my dreams are vibrant and alive, which adds a symbolic and inspiring tone to my life. I don’t always strive to create actual dream images, but rather, to operate in a space where the active dream world allows me to enter deeper into myself. There have also been instances where I have dreamed about a piece of work and have literally tried to copy the dream.

LD: Can you tell us a dream that helped you solve a creative problem?

RPS: Yes I can, I have been working on a large collage of a volcano. The entire collage was completed except I needed to finish the lava. I didn’t know how I wanted to do this. I got frustrated, even proposed the idea to myself that it was an inactive volcano. Then I had a dream where I was observing a real view of this volcano erupting from a floating room inside myself. There were intense flashes of orange, yellow, and purple glowing behind the image and yes, there was lava flowing. But instead of what I was thinking and imaging lava to be in the conscious realm, in the dream world the lava consisted of black silhouettes of people, animals, objects all fleeing the mouth of the volcano. They were black paper cut out silhouettes on the horizon. I understood this eruption as an illusion to my past memory, to the people and events that have shaped my life and a purging that is happening right now for me.

I think this dream was advising me to not think of lava so literally in regards to my painting. I photocopied photographs, reduced them, darkened them and cut out the silhouettes of my family members and placed them on the horizon of my collage. However, it was impossible to achieve the grandeur of the image experienced in the dream. I was unsatisfied with the real image of the lava I had created in the collage, and after many hours of work, ripped it off layer by layer. This destruction was an echo of my own internal active eruption. Now the piece is finished, and it depicts the smoke settling post explosion. This collage was part of a group exhibition in March 2011 in Barcelona.

LD: Wow, the collage is electric and is such a good example of the force of the quantum popping into existence. Knowing your journey with the images makes it even more meaningful.

I am intrigued by this concept–the way that dreams can help us solve problems. I sometimes dream about patients, especially when I am puzzled by them. Reflecting on the dream can help me understand the treatment more deeply and may even suggest a direction I need to take, or be careful not to take, with the patient.

The following is an example, reported elsewhere (Domash, 2010), of a chilling image from a dream and my subsequent emotional insight about a patient. This insight may have prevented an enactment.

I awoke from a dream in which all I remembered was the chilling and dreadful image of a seductive mermaid in the water but with the face of Joan Crawford (whom I associate with cruelty from the biography Mommie Dearest). On awakening I thought of my patient who the day before had been discussing her mother as a seductive, yet periodically cruel woman. Although she had been discussing this a great deal in these first few months of therapy, I had been unable to feel it. Whether I was mirroring her detachment or it was my own defensiveness, or possibly both, I don’t know. However, when I woke up from the dream, I was very shaken and felt a sense of dread about the image. I felt I then knew on a very visceral level what the patient felt.

I began to think of what could develop in the treatment, that is, how we could get into an enactment where either she or I could become the seductive mermaid and have a sadomasochistic interaction. Instead, I was forearmed by the dream image and could move forward with more awareness of both her unconscious and mine. Of course, my feeling of detachment in the treatment was already the beginning of this enactment.

This unconscious insight (the image of the mermaid) helped me understand the patient from “the inside out” (Bromberg, 1998) and be more free of the possibility of unconsciously acting this out.

RPS: Very interesting, so your dream also helped you develop true empathy for the patient.

LD: Yes, I felt more alive with her and understood more deeply her experience of her mother.

Collage

LD:  You do collage which is literally creating a new composite from existing pieces, perhaps something like we do in dreams. At times you may be representing artistically what exists now; at other times, you may be grappling with what

could be, or an imagined reality you may want to create, something beyond what exists now? Can you comment?

RPS: I love collage as a medium because it is so open. Almost anything can be used and incorporated into a collage. This freedom allows me to descend into internal terrain and create images that are sometimes evocative of my irrational dreamscape. This world has particular color palettes that I identify with this descent.

I recall talking to you (my mother) about a dream I had where there was an underwater basketball game going on, and in a fit of rage one player threw the basketball to the surface of the water and hit a swimmer who was doing her laps in an enormous pool. While analyzing this rage, you pointed out to me that in the subconscious, emotions are raw; they exist without judgement. It is when the ball breaks the surface that we tag opinions and criticisms onto emotions. Some of my work  in collage is a meditation on a particular raw emotion. During this process I try to create from this raw place that is alive only “under water.” This is a collage exploring raw rage.

LD: So the viewer of your work can experience this too and get a sense of his/her own unconscious for a moment without all of the usual censors operating. You give us an opportunity to go deep below the surface to know ourselves more deeply. As therapists, of course, we are trying to help patients contact their deep emotions. It is only in this way that change is possible.

Synchronicity

LD: As mentioned, an intriguing concept in quantum theory is entanglement, that is when two quanta meet and touch, they are eternally connected. This is analogous to Jung’s concept of synchronicity (1972), when a psychic element meets an element in the real world evoking strong meaning for the person.  This can be viewed as an expression in the real world of an entanglement that existed in the unconscious before the real event occurred.

I encourage my patients to welcome synchronicity, to notice and seize these moments as they may lead to new opportunities.. That uncanny feeling of “aha” when a synchronistic event occurs can alert us to something meaningful to pursue, perhaps a “forgotten” but important path.

Does synchronicity play a role in your art? Can you give us an example?

RPS: Synchronicity plays a huge role in my life.  When I am aligned with my creativity the more synchronicity and magical things happen in my daily life. My senses are more open and fine tuned so I notice these things more- perhaps they are always actually there, just like the ideas floating around, present only when we capture them. These events and this way of interacting with the world in turn inspires my art. I recently made a collage on top of a city grid of the gothic neighborhood in Barcelona. This collage was inspired by various synchronistic events that occurred along this street during the month of December.

LD: To answer the question at the start of our dialogue, “How do new ideas come into being?” it seems that creativity happens when we allow ourselves to notice it, when we can “measure” our unconscious. Many things can facilitate this: meditation, dreaming, psychotherapy.  I’d say a general attitude of welcoming surprise, of letting oneself be “struck”.

The Entrance of the Unconscious into the Physical World

LD: Let’s bring these ideas into the very physical world by presenting one of your collages which suggest some of these themes as we bring our dialogue to conclusion. We are going to ask you to be both artist and commentator on your own artistic work!

LD:  As you reflect on your work, what would you say are some of the feelings and ideas you are conveying?

RPS: In this collage a young girl is scribbling on a chalk board. She just woke up and is desperately painting a dream she just had. She is in a trance, a creative spell, a hypnagogic state wherein everything else falls away. There is fear in her eyes. She is scared the creative spell will end and the inspiration will slip away. Her time is limited. She fears she will be judged. She fears the sensations; she is out of sorts.

The bottom part of the image is the surreal, subconscious world.  Trees from the subconscious are growing up towards waking life, connecting the two arenas. The collage illustrates a moment where the subconscious or dreamworld overlaps with the Newtonian world and is expressed through art. This young girl represents a primal necessity to release the quantum energy into the real world, to express her dreams with a mass of scribbles on the wall. The river running horizontally separates the two realms; the creative life bridges the two.

In the girl’s hand, growing from the chalk is a gear from a clock. It is with this gear and a piece of chalk, the artist’s instruments, that she navigates through her psyche. She is able to turn the hands of time back and access the past dream world and lost memories. This is new territory for her, and she is young. She is intrigued but navigates cautiously.

LD:  Despite her fear, it seems she is capable of traveling between the two worlds. Like the quantum popping in and out of existence.

Psychoanalyst/Mother, Artist/Daughter

LD: A toast! As mother and daughter, may we be an example of “metaphorical entanglement”, forever psychically connected regardless of time and space.

By this I mean a deep meaningful connection that is inspiring. The term entanglement should not be confused with the negative concept of enmeshment. Enmeshment suggests a crippling, overdependent connection whereas entanglement evokes freedom and individuation while never losing a primal sense of being related and part of the other.

In this dialogue I hope we have succeeded in our experiment in superposition, that we have been able to exist as artist/daughter and psychoanalyst/mother at the same time! I am so grateful to have this special opportunity.

RPS:  Bringing these words into being, artist and psychoanalyst as the “measurers”, I too hope that we have been able to connect both the quantum world with the conscious world, and then back again, the Newtonian world with the unconscious realm. And, I hope we have shown how creativity helps us navigate the space between the two.

Glossary

waveform:  an energy cloud, of sorts, without a beginning or end that inherently ‘contains’ the possibility of transforming into a Newtonian particle  (Silvestro, 2010).

quantum particle: a possibility in the wave function

superposition: a quantum particle or possibility can be in two or more places or states at the same time

entanglement: once two quantum particles intersect, they remain connected and will behave in the same manner no matter how far apart they are in space and time. We are using the term “entanglement” in a psychological sense to mean connected in a meaningful, growth promoting manner. This is to be distinguished from the psychological term “enmeshment” which connotes a crippling, suffocating connection that impedes individuation and freedom.

decoherence:  when the quantum particle is measured, it comes into the real world as a material object and is no longer just a possibility. Then it loses the capability of superposition.

synchronicity: a meaningful, acausal, connection between a psychic object, event or element, and its manifestation in everyday reality

Acknowledgement: We both wish to thank Dr. Ken Silvestro for his generous and thoughtful help with this article.

Bibliography

Al-Khalili, J. (2003). Quantum: A guide for the perplexed. London: Weidenfield & Nicolson.

Beeman, M.J., Bowden E.M., Haberman J., Frymiare J.L., Arambel-Liu S., Greenblatt, R.,  Reber, P.J., & Kounios, J. (2004) Neural activity when people solve verbal problems with insight.  PLoS Biol 2, (4),  e97. doi: 10.1371/journal.pbio.

Bion, W.R. (1962). Learning from experience. London: Heinemann Medical Books.

Bion, W. (1967). Notes on memory and desire. Psychoanalytic Forum, 2, 271-280.

Bohm, D. (1983). Wholeness and the implicate order. London: Ark Paperback.

Bromberg, P. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: Analytic Press.

Cameron, J. (1992). The Artist’s Way: A spiritual path to higher creativity.  New York:Tarcher/Putnam.

Domash, L. (2010). Unconscious freedom and the insight of the analyst: Exploring neuropsychological processes underlying “aha” moments. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry,  38(2), 315-340.

Domash, L. (2009). The emergence of hope: Implicit spirituality in the treatment situation and  the occurrence of psychoanalytic luck. Psychoanalytic Review. 96, 35-54.

Doniger , W. (2005). The woman who pretended to be who she was: Myths of self-imitation. New York: Oxford University Press.

Estes, C.P. (1992).  Women who run with the wolves: Myths and stories of the wild woman archetype. New York: Ballantine Books.

Hopcke, R.H. (2009). Synchronicity and psychotherapy: Jung’s concept and its use in clinical work. Psychiatric Annals, 39(5), 287-296.

Jung, C. G. (1972). Synchronicity: An acausal connecting principle. London: Routledge and Kegan.

Kandel, E. R. (2006). In search of memory: The emergence of a new science of mind. New York: Norton.

Limb, C.J., & Baum, A.R. (2008). Neural substrates of spontaneous musical performance: An fMRI study of jazz improvisation. PLoS ONE, 3(2), e1679. doi: 10. 1371/ journal.pone.

Silvestro, K. (2010). Newton meets the Mad Hatter: Introducing psychoanalysis to quantum physics.  IFPE Annual Conference: “Psychoanalysis: Not the Same Old Song and Dance.” Nashville, TN.

Stickgold, (2005).  Sleep-dependent memory consolidation. Nature,  437, 27.


Rachel Shapiro, an artist, jeweler and teacher living in Barcelona Spain, is fascinated by the intersection of the language of the psyche and the creative process in art. Her collage work was recently exhibited at Gallery Maxó in Barcelona. Her jewelry line, Rachel Paula, is for sale in New York City and Barcelona as well as on the web, on Etsy and Amazon.
rachelpaula@gmail.com
www.rachelpaula.com

Leanne Domash, psychoanalyst and supervisor in New York City, is intensely interested in how both patient and analyst can become more innovative and creative in the psychoanalytic process. Dr. Domash maintains a private practice in Manhattan. She is a Supervisor in the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis and Consulting Psychologist, Beth Israel Medical Center and Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine.
leanne.domash@gmail.com

Leanne and Rachel are mother and daughter. This is their first collaboration as colleagues.


Death Drive Through the Lens of Melanie Klein

October 15, 2011 10:00 am

by Melanie Zarabi

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From the day I first met Frankie, I was drawn to him like a moth drawn to a flame.  He stood out at the VA by his unusual appearance, dressed in a paint-splashed over-shirt, jeans and sneakers and not in the usual military garb typically worn by Vietnam War veterans. I saw him as the liveliest and deadliest member of the group, and most consistently unpredictable. Although he was short and stocky, he filled the room with his loud voice and hearty laugh. He had a full head of thick silver hair down to his shoulders that bounced around with the rest of his exaggerated gestures which enhanced his tan rugged face, intense dark eyes, bushy silver eyebrows, and thick silver mustache.

We made positive contact through our mutual interest in art and creativity. I was compelled to work with him initially because of his immense desire to drink in as much treatment as possible. He enthusiastically engaged himself in the voluntary psychosocial program that I direct, including my art and psychotherapy groups.

Referral History:

Frankie was referred to the program in March 2006, as part of the discharge plan that concluded an intensive stay in a VA day hospital program (July 2005 – March 2006), where he was diagnosed with Post-traumatic Stress Disorder.  He began attending my program in July 2006 and started once weekly individual therapy with me in September 2006, which was increased to twice weekly individual therapy from January 2008 – April 2009.

Prior to the Day Hospital program, Frankie had been hospitalized on a VA inpatient psychiatric unit (June 2005 – July 2005), where he was treated for a severe vegetative depression with suicidal ideation and diagnosed with “Major Depression”. He had attempted suicide five years earlier (April 2003) by trying to suffocate himself by placing a plastic bag over his head, but did not go through with it. He removed the bag when he could no longer breathe.  After he caught his breath he took himself to the nearest VA Emergency Room.  After being evaluated, he walked out of the ER and did not follow up with recommended psychiatric care. Until his suicide attempt, he had not sought out any medical or dental care since he left Vietnam. After he was hospitalized he realized the seriousness of his depression and embraced all the psychiatric, medical, and dental treatment that was available to him.

Cast of Characters and Symbols:

Frankie: Adult patient

Frankie the Bull: Imago/shadow aspect of patient as an adult bully character

Annihilating Black Square of Thanatos: Patient’s death instinct

Lucy: Lucille Ball character in “I Love Lucy” TV show

Psychoanalytic Matador: Analyst as “I Love Lucy” TV character

Italian Bull: Patient’s mother

Bull Breast: Representation of Frankie’s first part-object & object relation

Frankie the Bull-et: Patient as an infant

Ferdinand the Bull: Story book character as child & libidinal self

Good Looking Horse: Patient’s ex-wife

Rooster: Patient’s first representation for new girlfriend

Cow: Patient’s second representation for new girlfriend

Oscar-Patient’s adopted male kitten/replacement for son

Lucy Kitten: Patient’s adopted kitten/replacement object for analyst

Bull Ring: Analyst’s office

Bad Breast Collage: Symbolic image of condensed and merged self & object representations

“Annihilating Black Square of Thanatos Mural”

Two years after his abrupt termination from his analysis (April 2009) Frankie re-appeared in the program and executed a very large (168” x 50”) abstract mural for the patient lounge bulletin board.  As I contemplated the mural, it appeared to capture who he is symbolically.  At its center was a large black square, surrounded by brilliant colors. I perceived the black square as the “Annihilating Black Square of Thanatos” – a symbol of Frankie’s powerful death instinct  in the depths of his being.

“Bad Breast Collage”

Several days later he reappeared in my art therapy group with his humble and compliant self, and created a little (5’’ x 5”) square collage, which I refer to as the “Bad Breast Collage”.  I view it as a symbol for his condensed and merged self and object representations. When I looked at his immense mural in juxtaposition with his tiny collage, it appeared to me that a process of “reversal” had occurred. In contrast to the large black square at the center of his mural, there was a modulated burnt orange, decaying breast-like form surrounded by a ring of brown (fecal) patches at the center of his collage.  The brilliant multi-colored ground of the mural had been replaced by the brilliant yellow ground with patches of red (aggression and anger). I view the luminous colored grounds of both images as symbolizing his idealized self representation. The large black square (condensed annihilating self and object representations) at the center of the mural appeared to reverse and is transformed into the decaying, fecalized, burnt-out Bad Breast (condensed self and object representations) at the center of his tiny collage. The large black square at the center of the mural appeared to have fragmented, diminished, and almost disappeared; and was replaced by the breast-like form.  It seemed to re-appear and transform itself into the little dark blue corners of his tiny collage.  My contemplation and analysis of the symbolism found in the content and juxtaposition of these two artworks demonstrated to me, just how volatile and unstable Frankie’s self and object representations are; and how quickly they shift into each other’s opposite in such extreme ways. It appeared to me that they even condensed and collapsed into each other. As Eigen (1993) writes:

Freud suggested that the operation of reversal is so basic that it seems to antedate the development of usual defenses. He gave, as an example, the tendency of an impulse directed toward another object to turn upon the self (and vice versa). It would appear that a double-headed arrow joins self and other. However, not only may an impulse shift directions, it may also change in valence as well, as when an impulse turns into its opposite (love-hate). As defenses develop, they exploit the minds capacity to reverse directions and change valence. Typical styles of reversing areas of experience develop and gradually become part of one’s character. In psychosis, the capacity to reverse spirals and hardens. Reversal tends to become a steady state, which turns any experience into what it is not. The Individual may so place himself on one side of duality that the excluded   opposite assumes demonic proportions. The capacity to reverse may accelerate to the point at which the individual spins himself out of existence, or decelerate until what remains of existence falls in upon itself. At the same time, this capacity helps build our sense of self and other and contributes to our creative life. (p. 35)

Before we processed Frankie’s collage in the art therapy group and prior to my contemplation and analysis of the two images, I had imagined that his little collage might be a symbolic representation of his libidinal self. My reverie about his returning to the program and his creation of the mural; and his joining my art therapy group and creating the collage, was that they served as transitional experiences for him to reconnect with me.  This represents just how strong my countertransference need was to see and find his libidinal self. But he looked at his collage and exclaimed, “I can’t get enough sex and money”.  I thought of this as an expression of his free-floating greed which seemed to come from nowhere.

After the art therapy group session, Frankie and I were standing in front of his large abstract mural and I asked him, “So, what is in that Black Square”?” He glanced at it and it and said, “Hell if I know!” Frankie resists acknowledging symbolic process, yet his language expressed the hell it represented, even if he could not acknowledge it.  Frankie had crafted a colorful personality from early childhood as camouflage to divert attention away from his “dark side” and to keep others engaged only with the surface presentation of himself.  The brilliant multi-colored ground which the large black square appears to float in, appeared to symbolize this aspect of his personality.

Frankie presents himself as bigger than he is, and I experienced him as enormous. Compared to him I see myself as rather fearful, and I admired and envied his apparent fearlessness. What initially appeared to me as a luminous and libidinal center of the little collage began to appear as a decaying process at the core – a kind of fecalization of both self and object.

I relied heavily on my intuition and my many years of experience of working with traumatized war veterans until I developed greater confidence in my newly acquired psychoanalytic skills and technique.  We enjoyed laughing together as he charmed and seduced me with his entertaining stories and witty, off-beat humor.

Initially Frankie accepted the frame without any resistance to it.  As the analysis progressed, he began to identify with me as an artist and started selling his artwork.  Eventually he began to gently push and pull on the frame with humble requests for changes in appointment times to accommodate the sale of his artwork. The requests seemed reasonable since he was one step away from homelessness and he desperately needed the money. I took pleasure in witnessing his newfound desire to romp around a larger bull ring with his newly developed libidinal life force, and I bent the frame to accommodate his needs when I could work it out with my own schedule.

After he terminated his twice weekly analysis with me, he would drop by occasionally to ask me for a “few minutes of my time”.  I was happy to see him and hoped that he would ask me if he could resume his analysis, but he never did. Each time I felt disappointed.  He would stand at the threshold of my office with one foot in the door and the other one out.  He always talked with me while he was standing up, even though I invited him to sit down.  Mostly he talked about what was going on at the artists’ cooperative, his art, or news about his trips and his daughter. After he was asked to join the board of the artists’ cooperative, he came by in his self-appointed role as ambassador and recruiter to encourage me and other veterans to join.  My fantasy was that he wanted me to join him on his terms and on his territory so that he could maintain his fantasy of omnipotent magical control over the object.  He asked me if I would write a letter, as he put it, “in your official VA capacity” to obtain grant money for the artists’ cooperative, since several veterans had now joined it.  It was on one of these visits in January 2011, that I was identified as “Lucy”, the psychoanalytic matador, based on “Lucy”, the character in “I Love Lucy”. I can see myself as Lucy as I resemble her physically and characterologically. I was the blonde ditzy, hysterical, curious kitten.

Although Lucy pretended she was not afraid, she dangled her little red psychoanalytic cape ever so gingerly – just enough to get the bull’s attention and to allow “Ferdinand the Bull” to charge at it playfully so that he could safely project his deadly substances into it. The analysis became a safe intercourse in which he could discharge his aggression. I had seen with my own eyes how Frankie could switch from his endearing self to his raging self in an instant. I knew the kind of destruction he was capable of, if I made one wrong move. One death charge from Frankie the Bull, and Lucy and her red cape would be splattered about the ring with the rest of its  tattered creative contents. At the depths  of his existence was Thanatos, his “Killer Self”, saturated with excess death drive, primordial  anxiety, envy, greed, aggression, boredom, loneliness, and emptiness.

I enjoyed going into the bullring.  Of course this was no ordinary bullring.  It looked like a creative war zone with art products scattered everywhere.  A cluttered desk, equipped with a large screen computer anchored us in reality.  A comfy chair on wheels allowed the bull to position himself at a comfortable distance from the matador.

We were joined in primary process and for a large part of the treatment I managed to perceive “Frankie the Bull” as an endearing little bull-et, or as the famous storybook character, “Ferdinand the Bull”. I had difficulty seeing “Frankie the Bull” as the bully he truly was. I identified with his embittered victim introject, which he continuously projected into me. Both of us split off from the “Italian Bull”, Frankie’s phallic breast mother introject. Neither of us wanted her savage and suffocating breast in the room. His idealization of me protected me from its mental corollary; his hatred and unconscious destructive impulses. Frankie’s transference was deeply split, as I was also the stand-in representation for his all-powerful Italian Bull Breast. He always spoke about his mother with deep hatred and resentment and frequently told me that he refuses to visit her grave. My counter-transference was split. I enjoyed the gratification of Frankie’s idealization of me and I split off the hated, greedy, withholding, denigrated, despised and aggressive pieces of both of us. As I gained more insight about the split off annihilating pieces of Frankie and myself, I went from idealizing to devaluing him, before a more realistic picture began to emerge towards the end of treatment.

His well-polished mix of smoke and mirrors and over-the-top humorous antics disarmed me, erasing my memories of his unexpected deadly attacks.  When we were in the magic bullring together he was dear little Ferdinand with flowers entwined around his baby horns.

HOW TREATMENT BEGAN:

After several months of working with Frankie in group, I offered to work with him as my control case. I explained to him that I was a psychoanalytic candidate at a psychoanalytic institute and I asked him if he was interested in seeing me for twice-weekly individual therapy. I laid out the conditions of the therapy and explained that I needed to work with a patient who was able to commit to being in twice weekly therapy for at least one year; that I would be supervised by a training analyst from my psychoanalytic institute; that we would need to meet when I was in a non-pay status and no fee was involved. He asked appropriate questions about vacations and missed sessions.  He was given the choice of seeing me at the Institute’s office or my office at the VA and he chose the VA because it was “more familiar” to him. It was intuitively evident to me that the only way of working with him was face to face as Frankie had demonstrated his distrust and paranoia on numerous occasions. He had mentioned before how he hated talking on the phone because he cannot see the person’s face. I did not explore why he needs to see the person’s face, I just accepted his basic need to keep me in sight. Frankie appeared to have no resistance to the new plan and was eager to begin treatment with me.

Frankie began therapy by telling me about his most recent depression. It was so severe that he could no longer force himself out of his apartment for days at a time. He stopped showing up for work at the car service where he had worked as a driver for the past fifteen years; was seven months in arrears on his rent; and he could no longer forage for junk food that he and his son were subsisting on. When his disintegration anxiety evoked thoughts of suicide and he was about to become homeless, he called his daughter who lived 3000 miles away to help him get hospitalized.

Frankie was a 60 year-old, divorced, first-generation Italian American Vietnam veteran, and was estranged from all his family, other than his daughter, whom he absolutely adored and idealized.  She was his best friend and she could do no wrong. Although he and his son lived together in a one-bedroom apartment, they did not speak for months at a time and occasionally each threatened to call the cops when physical altercations occurred. Frankie’s son could do no right and was devalued and demonized. Frankie was completely estranged from his three older siblings whom he had not spoken to for years. He did not have any relationships to speak of other than his recent acquaintances at the VA and the “Mob-owned” car service where he drove seven days a week, taking overtime and every holiday to fill the void of loneliness and emptiness which enveloped him.

Frankie had not had a relationship with a woman, sexual or otherwise, for over sixteen years. He told me he left his drug and alcohol addicted girlfriend in order to achieve what is now his sixteen years of sobriety. He said that from the time he left Vietnam until he left his girlfriend, “I was always stoned on something – I did every kind of drug except for heroin until I quit cold turkey.”  He maintained a split between sex and intimacy. Throughout his twenty years of marriage he continued to have sex with prostitutes, but when his wife finally took a lover, he felt betrayed, and so he divorced her. Throughout his tour in Vietnam he only had sex when he went to Thailand.  My fantasy about this is that he would not sleep with the enemy. He had shared this piece of information early on in his analysis and in retrospect I wish I would have explored this with him.  I consider this one of those missed opportunities due to a lack of experience as a beginning analyst.  I held back because I feared that he might experience my inquiry about this as intrusive.

For the first four months of treatment Frankie was always prompt and never missed a session. He was compliant with maintaining the frame inside the session time, and he was acting out as if he were the law outside the session time as he often described vignettes which depicted his  assaultive behavior towards anyone who offended him.   He mostly talked about his life outside the session time – about his frequent verbal and physical altercations with strangers or anyone who did not agree with him or his views. Frankie felt he was always right in serving justice in this way.  Initially he acted out his need for omnipotent control outside the analytic hours, but as the transference developed and I became less idealized, he shifted to acting in during the analytic hours..    He went from acting out to acting in mostly around the analytic frame. Towards the end of treatment he went about destroying the analytic frame altogether with missed appointments and not bothering to call me to reschedule or to let me know why he missed his appointments.He used therapy to reflect on his assaultive and aggressive  behavior and modified his aggressive impulses outside the analytic hours so that he eventually was able to work within society’s systems.

Frankie identified with me as an artist and after several months of analysis he began to paint all day and into the wee hours of the night.  He discovered that his newfound creativity helped him sleep better so he did not have to “pop all that toxic sleep medication” that he finally flushed down the toilet. It also gave him a respite from those two haunting nightmares: “Being chased on a path”; and “looking down on a circle of Asians from above”.  He was not able to articulate what his art or dreams symbolized and was highly resistant to “exploring their meaning” with me.

Ferdinand the Bull discovered that he enjoyed selling his paintings in a city park where artists and performers gathered daily to sell their wares. Later he developed enough artistic confidence to join a local artists’ cooperative. The park and the artists’ cooperative became his newly created families and provided him with support apart from Lucy, the psychoanalytic matador, on whom he did not want to become too dependent. The money he made from selling his art kept food on the table and obviated homelessness while he awaited approval for his disability benefits from VA. He charmed his fans and customers with his amusing stories and comic antics that enhanced the marketing of his artwork (Frankie had abandoned his education over 30 years ago when he was just a few courses short of a Bachelors Degree in Marketing).

Suddenly one day, his beloved park turned on him, and as he put it, “lost its tranquility.”  His park with its flowing milk turned toxic in an instant and became the persecuting “Italian Bull Breast.” This happened when a city cop threatened, as he put it, “To give a Vietnam War Veteran a ticket on Memorial Day Weekend, just because his art was displayed on a three-legged illegal table.”  I wholeheartedly empathized with Frankie’s victim introject.  After this humiliating experience, Frankie could not bring himself to return to the park until a year later. He blamed his delayed return on the carpenter he had hired to construct a new display table. Now his sessions were flooded by the persecuting carpenter, who was the new phallic Bull Breast, which was keeping all the milk for itself, by not completing his table. Several months later, Frankie stopped by his tailor for the third time pick up his blazer he had dropped off to have the sleeves shortened, and when the tailor told him it was not ready, Frankie went into a rage and threatened to cut off the tailor’s arms. Now the tailor had become the persecuting Italian Bull Breast. He displaced the rage he felt towards the Italian Bull Breast onto the cop, carpenter and tailor who were all stand-ins for it.

As therapy progressed Frankie brought in more of his Vietnam War self and survivor’s guilt into the room. He talked about the death of his replacement with deep sadness and guilt. He spoke about how “every day was Father’s Day and that he cries himself to sleep wondering about how many children he left fatherless and unborn in Vietnam because of his killing.” He countered this with stories about his own greatness as a father to his own children.  Frankie prided himself on dispelling all their childhood myths so that they would be prepared for the real truth about life.  Santa Claus was not real.

BACKGROUND:

Frankie knew he was in his early sixties but not sure exactly how old he was or the ages or birth-dates of his son and daughter, who were now adult children in their late-twenties-early thirties. He had to ask his daughter for this information. He described his daughter as his “best friend”, and for many years, she has served as an alternative ego for him.

Frankie referred to his mother as the “Italian Bull”. He was not sure how old she was when she gave birth to him. He told me, “She had me very late in life, after she had a back alley abortion with the pregnancy before she became pregnant with me”. His mother could not speak English and he could not speak Italian. My reverie about why he never learned to speak Italian is that he could not take in his “mother tongue” as it became a symbol of his mother’s toxic milk. The Italian language itself was experienced as a bad breast in the same way that the Asian language was experienced as a bad breast.  Frankie was the youngest of four children. His oldest sister and brother were both adults when he was born and his sister “closest to him” was a teenager.

Frankie recalled a few of his childhood memories: His mother taking him to Coney Island to purchase the bamboo canes she used to beat him with; and her bashing his head into the window casing so hard she gave him a concussion; hiding under the kitchen table when his brother and father threw punches and furniture at each other, as his mother stood by and screamed in Italian; and waving good-bye to his parents on the pier as they left for Italy, where his father suddenly died.  Frankie described his father as passive and not protecting him from the “Italian Bull”.  His childhood provided sadistic grooming and anticipation of fear when relating with others.

Memories of Vietnam include: his savage checkpoint behavior – poking his fingers into their eyes, dragging them out and bashing their head repeatedly into the vehicle; witnessing an interrogation and torture of a prisoner whose head was bashed with a gun so many times that his brains spilled out; watching his commander shoot a teenage girl whose chest had been half blown off by helicopter fire; and getting wounded.

His father’s funeral was the most devastating trauma of his life. Frankie hated his mother for hosting such an extravagant funeral in Italy, which, as he put it, “drove the family into debt and robbed me of my childhood. It forced me to work summers and after school just to pay down the family debt”. He brought in his father’s funeral album to show me the evidence. He confided, “Ordinarily I would not show this to anyone outside the family, but I wanted you to see this because of the special relationship we have”.  Frankie pointed to the photo of his mother leaning over his father’s corpse on his deathbed to give him her final farewell kiss of death.  He cynically exclaimed, “After that one shot, she never appears in any of the other photos.  She never even attended the funeral or the burial. It was all for the camera”. Klein (1975 a) noted:

The fear of being devoured by the father derives from the projection of the infant’s impulses to devour his objects. In this way, first the mother’s breast (and the mother) becomes in the infant’s mind a devouring object   and these fears soon extend to the father’s penis and to the father. At the same time, since devouring implies from the beginning the internalization of the devoured object, the ego is felt to contain devoured and devouring objects. Thus the super-ego is built up from the devouring breast (mother) to which is added the devouring penis (father). These cruel and dangerous internal figures become the representatives of the death instinct…The fear of being annihilated includes the anxiety lest the   internal good breast be destroyed, for the object is felt to be indispensable for the preservation of life. The threat to the self from the death instinct working within is bound up with the dangers apprehended from the internalized devouring mother and father, and amounts to fear of death. (p. 30)

Now Frankie devoted his sessions to comparing the way bodies were disposed of in Vietnam with the way his father’s body was “wastefully disposed of.”  He told me, “Over there, bodies were bagged or thrown into mass graves or just left to rot. There was no respect for death”.  His father’s corpse was paraded around in a glass carriage drawn by a team of black horses adorned with black feather head-plumes, followed by a procession of two hundred paid mourners.  Frankie asked me several times if I wanted to purchase his cemetery plots that he had purchased for himself and his ex-wife upon his return from Vietnam. His implied death wishes left me speechless. I felt assaulted by Frankie’s ideation about my own death and it frightened me. Underneath his idealizing transference, I experienced myself condensed with his hated mother and his ex-wife, both of whom he very much wanted to kill. Now that I have more experience and confidence in my analytic skills and the analytic process, I might have said, if I were to use that grave, how might I die? Or if I died before you would you visit my grave?

Frankie’s phantasies about his father’s funeral is a re-transcription of his phantasies as an infant when he imagined that his phallic Italian Bull Breast had devoured and incorporated his father’s penis inside itself. These phantasies were fueled by his excessive envy and oedipal jealousy towards both parents.  As Klein (1975 a) suggests,

The development of the Oedipus complex is strongly influenced by the vicissitudes of the first exclusive relation with the mother, and when this relation is disturbed too soon, the rivalry with the father enters prematurely. Phantasies of the penis inside the mother, or inside her breast, turn the father into a hostile intruder. This phantasy is particularly strong when the infant has not had the full enjoyment and happiness that the early relation to the mother can afford him and has not taken in the first good object with some security. Such failure partly depends on the strength of envy…The influence of the combined parent figure on the infant’s ability to differentiate between the parents, and to establish good relations with each of them is affected by the strength of envy and the intensity of his oedipal jealousy. For the suspicion that the parents are always getting sexual gratification from one another reinforces the phantasy–derived from various sources-that they are always combined. If these anxieties are strongly operative, and therefore unduly prolonged, the consequence may be a lasting disturbance in relation to both parents. In very ill individuals, the inability to disentangle the relation to the father from the one to the mother, because of their being inextricably interlinked in the patient’s mind, plays an important role in severe states of confusion. (p. 197-198)

Frankie’s projection of his cannibalistic attacks on his Italian Bull Breast and fears of its retaliation were exacerbated by his mother’s hostility and death wishes towards him. His hatred towards his mother, “The Italian Bull” extended to his relationship with his father and all other object relations as well.

Klein (1975 a) writes:

The flight from the mother to other people, who are admired and idealized in order to avoid hostile feelings towards that most important envied (and therefore hated) object, the breast, becomes a means of preserving the breast-which means also preserving the mother…The way in which the turning from the first to the second object, the father, is carried out is of major importance. If envy and hatred are predominate, these emotions are to some degree transferred to the father or to siblings, and later to other people, and thereafter the flight mechanism fails. (p. 217)

Frankie experienced his father as abandoning whereas his mother was always raging, annihilating, devouring and suffocating. That male/female Italian Bull Breast that greedily kept all of Frankie’s milk for itself was now symbolized by his father’s funeral and funeral album. This vicious projective and introjective cycle of his death instinct increased his hatred, greed, and envy, and left him feeling depleted and in a paranoid state.  The combination of his mother’s abusive behavior and lack of nurturing; the traumatic loss of his father at a young age; his financial deprivation and the Vietnam War prevented him from building up enough libido or life instinct to develop his ego and stifled his capacity for love and gratitude. He never was able to develop basic trust. From the day he was born until now, his external “facilitating environment” was lacking, violent and hostile.

Winnicott (1989) writes:

In the area of psychoneurosis it is castration anxiety that lies behind the defenses, in more psychotic phenomena that we are examining it is a breakdown of the establishment of the unit self that is indicated. The ego organizes defenses against breakdown of the ego organization, and it is the ego-organization that is threatened. But the ego cannot organize against environmental failure in so far as dependence is a living fact…

The individual inherits a maturational process. This carries the individual along in so far as there exists a facilitating environment, and only in so far as this exists. The facilitating environment is itself a complex phenomenon and needs special study in its own right; the essential feature is that it has a kind of growth of its own, being adapted to the changing needs of the growing individual…The facilitating environment can be described as holding, developing into handling, to which is added object-presenting. In such a facilitating environment the individual undergoes development which can be classified as integrating, to which is added indwelling (or psycho-somatic collusion) and then object-relating. (p. 88-89)

Six months into treatment Frankie discovered a donation cadaver program at a local university. His cadaver contract and the disposal of his remains became a major focus. He enjoyed entertaining me with his morbid jokes, which served  as a defense against his unconscious painful and anxious feelings; and I enjoyed the jokes as they protected me from my own fear and anxiety about death. His self-hatred and denigration was revealed when he told me that his body was of more value to society dead than alive, and as he put it, “At least then it will be put to good use – for scientific research rather than for killing.” By donating his body to the cadaver program he is making reparation for his existential guilt for all his killing. Frankie talked about all the benefits of the cadaver program. “They pick up the body and dispose of all the unused parts for free! This way the family doesn’t have to squabble over the debt”. He asked his daughter if she wanted to keep his skeleton as a conversation piece. Even in death he fantasized that he could remain with his daughter. His excitement about the cadaver program was at such a peak that I imagined that he was trying to sell me on buying into the cadaver program. In my reverie about this I wondered if he wanted us to be joined in death. I imagined that he might be fantasizing that we could be dissected together and that our unused body parts could be thrown together in a garbage heap for eternity. He joked, “I told my daughter to make sure to dress up my stiff and put me on a plane and have the cadaver program meet the body at the airport. They only pick up the body for free if you die in the state.” Against his daughter’s wishes, he arranged to leave everything to her and nothing to his son. When his kids were little, he told them, “If I should die, just put me out on the curb with the rest of the garbage.”

Frankie hated the government and the media and he was very bitter about being drafted. He often wondered out loud, “If the army knew I was a killer.”  He resented his mother for trying to stop his deployment to Vietnam, as it only delayed his deployment and resulted in his assignment to “funeral detail.” This was truly hell on earth as he had to assist with the funerals and burials of deceased soldiers killed in Vietnam. He wondered how his family would feel if he was in the box. When he got his orders for Vietnam, he refused to do any more funeral detail and suggested they put him in the brig instead.

When Frankie returned from Vietnam, he moved back into his mother’s house, where she continued to treat him as a child, and not as a man who had returned from war. She suffocated him with her screaming and insisted he be home by 10:30 PM.  He exclaimed, “I told her at that time in Vietnam I was killing someone or that they were trying to kill me.” After he almost strangled her twice, he moved out. He employed a massive reaction formation defense against being like his mother, yet he is just like how he described her – explosive and assaultive.

Frankie’s immense masochism and guilt is demonstrated by the fact that he currently lives in a neighborhood with a lot of Asians. Memories of Vietnam are triggered by seeing Asians, particularly if they look at him in a certain way or when he smells their cooking. To avoid becoming assaultive, he has to exit a bus or train when he hears Asians speaking. He exclaims, “It’s the cadence of their voice that bothers me.” The cadence of their voice not only triggers memories of Vietnam, it may also trigger unconscious traumatic phantasies of his infancy and childhood of his mother’s screaming at him in a language he could not understand.

Awakening of Libido

About five months into his analysis, Frankie began to actively experience libidinal strivings, and therefore began to allow himself access to his sexuality.  He embarked on a new relationship with an “on-line” girlfriend. He told me that his new girlfriend sent him a “hot and steamy e-mail”. When I asked him about what was in it, I became the phallic Bull Breast. With a dead serious look in his eyes, and in a cutting tone, he asked, “What are you lacking”?  In that hazardous moment, Frankie the Bull no longer saw me as Lucy, the playful matador. For him, it appeared that I lost the maternal gleam in my eyes.  At that moment he phantasized that I had turned into a giant devouring, castrating, and vagina Bull Breast. He left me frightened and speechless, as I raced through my own thoughts and feelings of how I was lacking. Perhaps if I had more confidence in my analytic skills and  technique, I could have explored with him how it made him feel to think of me as lacking. In retrospect I could have worked more with the relationship, but at that point in time, I did not have enough trust in my analytic expertise and I was too frightened. My instincts prevented me from engaging with him at this level of relatedness. What happened between us around the “hot and steamy e-mail” captures the essence of the transference and countertransference manifestations between us. Neither of us were developed enough to deal with unleashing “The Annihilating Black Square of Thanatos” into the bullring.  In that moment of my inquiry into the hot and steamy e-mail, Frankie projected his sexual impotence into me, which I introjected and reflected back to him, leaving us both “lacking”.  Now his “I Love Lucy Breast” had become the Italian Bull Breast that was lacking – an impotent scooped out phallus with no milk. Mother and all women are experienced as castrating and devouring. The Italian Bull has no breast, it only has a phallus. It has no milk and no nurturing capacity. His phallic breast is too confusing, demanding and unpredictable. It embodies persecuting annihilating aggression. I needed the master matador, my supervisor, to help me realize that he had projected his own sexual impotence into me. Both of us were now that impotent scooped out Breast face to face in the bullring. Again I asked him about what was in the hot and steamy e-mail, and so he told me: “I imagine myself taking a sip of scotch from my glass and as I lean over to kiss you, a drop of alcohol drops from my lips onto yours”.   I avoided the sexually laden erotic transference implications of his comment and asked him how this e-mail impacted on him. He laughed as he replied, “She got me all worked up – I was so horny I couldn’t sleep for the rest of the night”. I asked him if he thought this fantasy might impact adversely on his sobriety. He minimized its malignant impact and said, “Oh, that doesn’t bother me”.

In the ensuing sessions Frankie took delight in entertaining me with the romantic details of their courtship, such as when his girlfriend told him about purchasing a little red negligee for their first night together; and how he brought the candles and music for the hotel room. When they finally did have intercourse, he complained, “It took me hours to ejaculate.” Frankie’s castration anxiety was the result of his unconscious phantasies as an infant, when he imagined he had destroyed his good breast by tearing it to bits with his excessive greed and envy.  Now he feared his breast would retaliate by castrating and devouring him. Sexual intercourse with his girlfriend evoked these infant phantasies, which now caused his difficulties in releasing his sexual products.  Frankie phantasized that he had contaminated her good breast by projecting his own oral, anal and urethral products into it.

Klein (1975a) claimed:

The capacity for full oral gratification, which is rooted in a satisfactory relation to the mother, is the basis for experiencing full genital orgas (Freud). In men, the envy of the mother’s breast is also a very important factor. If it is strong and oral gratification thereby impaired, hatred and anxieties are transferred to the vagina. Whereas normally the genital development enables the boy to retain his mother as a love-object, a deep disturbance in the oral relation opens the way for severe difficulties in the genital attitude towards women. The consequence of a disturbed relation first to the breast and then to the vagina are manifold, such as impairment of genital potency, compulsive need for genital gratification, promiscuity, and homosexuality. (p. 201a)

The relationship with his girlfriend is a representation of his phantasized relationship with me and my idealized “I Love Lucy Breast”.  All went well with his girlfriend until he began to notice that she no longer thought exactly as he did or could not do everything he wanted to do. Her increased demands for sex and intimacy suffocated him, and he had to flee from her. He could not tolerate being with her or me, when we ceased to just gratify his needs and hold his idealized projections.

Barnyard Animals

Once Frankie had referred to his ex-wife as “A good looking horse”, so I asked him, what kind of barnyard animal is your new girlfriend?  He laughed and said, “She’s a rooster”. When I asked him why she was a rooster, he replied, “Because her hair is dark with one orange strip down the middle.” As his analysis with me and his relationship with his girlfriend continued, Frankie introjected more nurturing, gratifying, female breasts creating more available libido and ego.  His “Rooster Breast” was gradually transformed from a phallic male image into a female representation as he began to refer to his girlfriend as a cow.  His transformation of the Italian Bull Breast into the Rooster Breast; and then into the “Cow Breast, represents a gradual transition in his object relations. The all powerful phallic Italian Bull Breast representation is diminished in size and is less destructive as it is transformed into the male Rooster Breast.

The vicissitudes of Frankie’s bestiary of symbolization can be summarized thusly: as Frankie’s relationship with his girlfriend and their courtship developed, and his sexual fantasies increased, he transformed his “Rooster Breast” into an idealized “Cow Breast”- a large nourishing female representation with an abundance of milk. After they had sexual intercourse it began to turn toxic and contaminated as he projected more of his own toxic substances into it. Frankie’s girlfriend and I were all the barnyard animals and the I Love Lucy Breast but he did not know it. As these female breasts became more developed, female, and differentiated, he experienced them as more demanding, suffocating and devouring. They turned on him, like all the other barnyard animal breasts had done before. The transformations of his barnyard animals reflect the gradual modifications in Frankie’s self and object representations as his analysis progressed. At first we see a gradual softening and modification of his object representations and relations; and how Thanatos is diminished as the result of his increased libido from introjecting idealized “needs gratifying” breasts.  When I asked him why his girlfriend turned from a rooster into a cow, he laughed and replied, “Because she’s overweight.” When I asked him, “What kind of a barnyard animal am I?  He spontaneously replied, “You’re a cat.” I asked him why I was a cat and he said, “Because cats are curious and intelligent.” He quickly told me, “I only like dark women.” This is opposite to me. I am fair with blue eyes and blonde hair. I asked him why he only likes dark women and he said, “Because they are sexually less inhibited; more direct, more sensual and easier to relate to.”

Frankie projected his sexual inhibitions and his unconscious split in his sexuality into me. He is not able to tolerate seeing Lucy, his maternal breast, as a sexual breast. His self-state in the transference was so young that I did not experience him as a sexual object. We were both much younger part objects. At that point in Frankie’s analysis, and my development as an analyst, we had to be. I did not address his transference to me as a sexually inhibited woman because I felt it  was too dangerous to be in the bullring with Frankie the Bull as a giant sexual, castrating vagina Breast.

Thanatos

Although the vignettes he shared about Vietnam were tragic and deadly, Frankie talked about them with bravado and humor. When we touched on his feelings of existential guilt and sadness, he quickly placed us dead center in a MASH episode. He was a gifted storyteller and it felt like we there “in country” sharing and reliving all his extraordinary existential moments together. He laughed as he told me, “I volunteered to Walk Point (the most forward and dangerous position) in my unit.” I asked why he volunteered for the most dangerous position, and he replied, “Because I was a little guy and I couldn’t carry all that heavy equipment and ammo in that 120 degree heat.” My fantasy about this is that consciously he volunteered to Walk Point because he did not trust his life with anyone else in that position (Frankie’s need for omnipotent control was established very early in life) but unconsciously it was an expression of his Death Wish. He spoke about his guilt about the death of his replacement, which he had trained, with sadness in his voice. Two weeks before Frankie left Vietnam, his replacement stepped on a mine, lost both his legs and died several days later. When Frankie began to feel his unbearable guilt and depressive anxiety, he fled further into his “paranoid-schizoid” defenses of omnipotence, splitting and denial.

Frankie confided in me, “Some veterans enjoyed the killing,” and I replied, “Yes, some vets do.” This allowed him to bring his killer self into the room.  Soon after this, he brought in one of his poems entitled, “First Kill”, which begins, “Who died that night, was it him or was it me?”  He then told me about a painting he had hanging on his wall that haunted him, entitled, “Blood on the Leaves”.

The painting was a primitively rendered image of an American and a Viet Cong soldier, both peering out from bloodied leaves.  He told me, “The American soldier and the enemy were just the same, only one had a helmet and the other had slanted eyes. Other than that they were just the same.”  For Frankie, there was very little differentiation between him and the enemy, or between him and me, or between him and anyone else for that matter.  We were all the persecuting Italian Bull Breast and we could annihilate each other at any moment.  He wanted me to keep the painting in my office, so I did.

Dreams

Frankie only brought in two recurring dreams throughout his analysis. Both dreams represent traumas in infancy and childhood. In one dream he is being chased on a path. He connects this dream with an incident in Vietnam, when he chased down the enemy after an ambush, shot him in the back, and then discovered that he was lost and separated from his unit. Getting lost and separated from his unit in Vietnam evoked his earlier phantasies of separation and annihilation anxiety from the trauma of his own birth. His Italian Bull Breast, the military, and the Vietnam War, were all violent and deadly environments which exacerbated his primordial anxiety. Being dependent on such a hostile and violent breast must have produced unfathomable amounts of primordial anxiety, but without it there was nothing.

In his other dream, Frankie is “up above looking down on a circle of Asians.” This dream represents his original dissociative splitting defenses – out of body phantasies he employed as an infant to protect his self from his Italian Bull Breast. The Asians represent his Italian Bull Breast in bits and pieces that he looks down on from above who are going to turn around and attack him from every direction. His projections and re-introjections of his raging attacks on it (the Asians/his Italian Bull Breast) weaken his ego, and flood him with disintegration anxiety. Frankie’s inner and outer world is in bits and pieces. He is always being attacked from within by his own unconscious phantasies and from without by his predominately hostile, violent, rejecting and abandoning environment.

Good Breast vs. Bull Breast

To Frankie, I was a curious and intelligent two-dimensional TV character and a neutered cat/kitten. Perhaps his relationship with me may be the highest level of relatedness to a female breast or to anyone he has ever had.  As I learned more about Frankie’s traumatic childhood, and his life of trauma and failures, I came to understand through supervision, that Frankie the soldier may have been his highest level of functioning; and that the military may have been the best Breast he had ever had until he found mine.

Frankie the Bull-et must have wondered if his Thanatos Breast was a breast or a penis or if it was both. It must have been very confusing.  In order to survive on that empty phallic breast he had to resort to cannibalism, as he sucked and scooped it out, along with the rest of the “Italian Bull’s” body. He must have believed himself to be a Thanatos baby and that he had created that Italian Bull Breast with his own omnipotent demonic powers. Who knows what Frankie’s pre-natal life was like?

Klein (1975 b) believed:

In the oral-sadistic stage which follows upon the oral-sucking one, the small child goes through a cannibalistic phase with which are associated a wealth of cannibalistic phantasies. These phantasies, although they are still centered on eating up the mother’s breast or her whole person, are not solely concerned with the gratification of a primitive desire for nourishment. They also serve to gratify the child’s destructive impulses. The sadistic phase which succeeds this – the anal sadistic phase – is characterized by a dominating interest in excretory processes – in feces and the anus; and this interest, too, is closely allied to extremely strong destructive tendencies…between the oral-sadistic and anal sadistic stages there exists another stage in which urethral-sadistic tendencies make themselves felt, and that the anal and urethral tendencies are a direct continuation of the oral sadistic ones as regards the specific aim and object of attack. In its oral-sadistic phantasies the child attacks its mother’s breast, and the means it employs are its teeth and jaws. In its urethral and anal phantasies it seeks to destroy the inside of the mother’s body, and uses its urine and faeces for this purpose. In this second group of phantasies the excrements are regarded as burning and corroding substances, wild animals, weapons of all kinds, etc.; and the child enters a phase in which it directs every instrument of its sadism to the purpose of destroying its mother’s body and what is contained in it. (p. 253 b)

After Frankie had projected enough of his death instinct into his “I Love Lucy Breast”, it too became toxic like all the other barnyard breasts before it, poisoned by his own excrement and death wishes. It became too demanding and suffocating. Thanatos always overpowered Eros. Frankie never knew when that breast would turn on him. Frankie never had a “good enough” breast before.

A Good Object

For months Frankie talked about wanting to get rid of his son. When he finally drove him out by tearing up the apartment, he adopted “Oscar”, a male kitten. He told me, “I had to adopt Oscar when I noticed him in the litter trying to lick his birth-defected sister back to health.”  Frankie replaced his son with Oscar, a diminished male Eros representation that he could now project his idealized self into. Frankie also identified with the sick kitten that Oscar tried to lick back to life.

Approximately nine months after he had fled treatment and “abandoned” me, he returned to the psychosocial program at the VA and  revealed that he was feeling bored and lonely.  He told me that he had adopted a female kitten a few months after he had adopted Oscar to keep Oscar company. I asked him what he named his female kitten and he told me that he named her Lucy . Frankie could tell me this, and bring in his more vulnerable self only after a significant amount of time had passed since he stopped his analysis.  ”I asked him about Lucy, and Frankie replied, “I found Lucy in a boat (a vehicle that travels the unconscious waters) among an abandoned litter.” He laughed as he told me, “I named her Lucy, after Lucille Ball. Lucy was the first female star to have her own TV show.  She was way before Oprah. I have fun with Lucy.  She is curious and intelligent. Lucy likes to play throw and catch with me.”  Frankie loves Lucy because she is playful and right where he wants all women to be – at his feet and ready to gratify him. Lucy, a neutered female kitten and younger mammalian self-object, replaced my “I Love Lucy Breast”.

As my analytic capacity increased and he became more dependent on my good breast, and as I became more real, his envy of me increased.  As he approached the “depressive position”, his depressive anxiety and guilt overwhelmed him, precipitating his regression further into the paranoid-schizoid position. In the end, the barnyard animals had become much smaller and younger, representing Frankie’s flight into regression.

I asked Frankie jokingly, “So, who wears the pants in the family, you or the cats?” Frankie laughed and said, “They do – I’m always in my underwear and I’m always cleaning up after them.”  Frankie invites me in to watch him play with his male and female kitten breasts in his underwear, but he does not want me to notice that his sexual apparatus does not work. Frankie is arrested very early in his psychosexual development. He is a 60 year-old man with childlike passions, the impulses and instincts of a very young child, who is expected to live his life as an adult man. Lucy the Kitty Breast appears to be a younger self-object who appears to be more oral than genital.

From the beginning I was a female object representation. Frankie is able to tolerate me being female but we do not know at what level of relatedness to female. Frankie’s mother, the “Italian Bull” remained an aggressive male representation, rather than even a phallic female representation. Frankie’s phantasies of his actual mother could not be transformed into a nurturing female representation. He enjoys playing with his Lucy Kitty/Pussy Breast and Oscar Penis Breast because they just gratify his needs, and this is all he can tolerate. The cat is a female representation but we do not know who this “pussy” is that he has taken home with him. Frankie had to leave me before I became toxic, devouring, suffocating and abandoning like all the other male/female breasts he has created and destroyed.

As Frankie drank in my mirroring of his idealized self; and introjected my good, libidinal, needs-gratifying breast, “The phallic Italian Bull Breast” was gradually transformed from male to female representations. Gradually the animals became tamer, smaller, more female and nurturing, less intimidating and domesticated.

Holding and Ego Development

I instinctively employed what Winnicott (1989), refers to as, a good enough holding or facilitating environment with primary maternal preoccupation.

I transformed my matador’s cape into a baby blanket, providing him with the warmth, nurturing and understanding he never had before.  I held him gently and creatively for as long as he could tolerate it. Frankie took delight in the admiring gleam in my eye, as I enjoyed being part of his newly discovered creative enjoyment of life. My holding and his identification with me as an artist were the primary healing forces. Our joint humor and creativity served to keep Thanatos at bay; and to wake up Eros enough to transform the Minotaur into a slightly more integrated, flexible, and reflective individual who could join the human community, at least on its creative fringes.  At least now “Ferdinand the Bull” could play with some of the other bohemians who also dance around the surface of human existence. He is more related and can now work marginally within the system when he has a personal grievance.

Winnicott, (1989) notes:

For babies there is a basic ration of “good breast” without which the early stages of the individual’s emotional development do not get initiated. Various authors have attempted to formulate this. Balint in his concept of primary love, myself in my terms “good enough mothering” and “primary maternal preoccupation”.  The “good breast” proves to be a jargon term for (a) “good-enough mothering” and (b) “satisfactory feeding” and (c) the joining together of (a) and (b) first in the environment and then in the mind of the baby. (p. 453).

With just a taste of a “good enough” breast, Frankie developed enough libido to gradually modify his destructive impulses. As a result of his analysis with me, he re-connected with his family; traveled across the country to visit relatives and friends; expanded his psychosocial support system to include two artist’s communities; successfully obtained his 70% Service Connected Disability Pension from VA; paid off his back child support and other debts; obtained his American and Italian passports; attended his daughter’s wedding in Italy; opened a checking account and obviated homelessness. When Frankie left treatment he was able to work within society’s legal and financial systems.

End of Treatment:

Toward the end of treatment, when I decided to focus more on everyday reality as well as symbolic and unconscious process, and I gently questioned how his renewed use of marijuana would affect his treatment, the word treatment must have shattered his delusional transference. My sudden differentiation by my difference of thought about his marijuana use, and the word “treatment” shocked him.  When I asked him if he wanted to continue treatment with me, it made him realize that his “I Love Lucy Breast” could suddenly be taken away. The momentary recognition of his own dependency needs and fears of abandonment; while simultaneously feeling suffocated by the relationship and the frame, led to his abrupt termination.

In this initial phase of Frankie’s treatment, I believe he would have fled much earlier if I had used even a “modified” or expressive approach of the sort  suggested by Kernberg.  I don’t think he could have tolerated a more active focus on our relationship by interpreting his defenses and underlying negative transference.  In Kernberg’s (1985) review of the literature, he noted that Stone felt that patients with a borderline personality organization might need preparatory psychotherapy. (p. 76).

Kernberg noted:

That authors dealing with the problem of the treatment of borderline conditions may be placed on a continuum ranging from those who recommend psychoanalysis, to those who believe that psychotherapy rather than psychoanalysis, and especially a supportive form of psychotherapy, is the treatment of choice”…in my opinion, in most patients presenting borderline personality organization a modified analytic procedure or special form of expressive psychoanalytic psychotherapy rather than classical psychoanalysis is indicated. This expressive approach should involve consistent interpretive work with those defensive operations reflecting the negative transference and contributing directly or indirectly to maintaining the patient’s ego weakness. (p. 75-77)

At this point in Frankie’s analysis, Frankie and I did not have the capacity for a modified or expressive approach. My analytic skills and technique were not developed enough, and Frankie had experienced too much trauma.  He had never before had a supportive relationship.  I believe a “holding” approach was a necessary “preparatory” phase of treatment before we could safely and successfully embark on a more expressive psychoanalytic psychotherapy approach.  First he needed an experience of a supportive relationship, in contrast to his predominately traumatic relationships, to simply build capacity for being in a relationship at all. Frankie was psychically too young for a more interpretive approach.

Many factors contributed to my reticence about using more of my countertransference in session and working more directly with the transferential and actual therapeutic relationship.  I had witnessed Frankie’s assaultive behavior and I imagined if he tried to strangle his mother twice, he might do the same thing to me. Other contraindications included his non-differentiated delusional idealized transference with its implied hatred and demonization of me. Interpreting Frankie’s negative transference was just too dangerous at that point in his analysis and my development as a psychoanalytic candidate in training.  If Frankie’s ego and my analytic skills were more developed, maybe I could have shared more what it was like to sit with him.

In the end, Frankie walked into the bullring defeated.  He shrugged his shoulders as he told me, “I am talked out.” I asked him if we could sit in silence together, and he laughed and said, “Well this would be okay if were both stoned and sitting on top of a mountain overlooking a beautiful landscape together.”

“Girl in the Garden Collage” here

As he parted (April 2009), Frankie gave me two little gifts of reparation – an appointment book and a collage that he had made  of a young woman in a garden. The inner painting of the younga woman is framed by aprotective string perimeter Vietnam War veterans have been known to create perimeters as a measure of safety.Perhaps this represents an unconscious wish to protect me from his own aggression and negative transference.

In March 2011, Frankie physically assaulted his wife’s former lover of over 30 years ago in the VA cafeteria. He called me for a session.  He cried. Perhaps this is a new beginning for Frankie and me.  He drops by to say hi, but he has not resumed his analysis.

Frankie falls within the lower end of the borderline personality disorder spectrum with narcissistic features.  In addition, he has an Axis I diagnoses of Post-traumatic Stress Disorder and Major Depression.  Since Frankie’s abrupt termination of treatment in April of 2009, we both have grown. I have two more years of psychoanalytic experience and supervision under my belt and Frankie has returned with his more vulnerable self.  I have developed more confidence in my psychoanalytic skills and technique and in the analytic process. The patient has developed more capacity and trust in his relationship with me. I feel both of us are ready for me to try a more expressive psychoanalytic approach.

References

Eigen, M. (1993). The Psychotic Core. Northvale, NJ: Jason Aronson Inc.

Kernberg, O. (1985). Borderline Conditions and Pathological Narcissism. Northvale, NJ: Jason Aronson Inc.

Klein, M. (1975 a). Envy and Gratitude And Other Works 1946-1963. Money-Kryle, R, Joseph, B. O’Shaughnessy, E, & Segal, H. Eds. New York, NY: The Free Press.

Klein, M. (1975 b). Love, Guilt and Reparation And other Works 1921-1945. Money-Kryle, R, Joseph, B. O’Shaughnessy, E, & Segal, H. Eds. New York, NY: The Free Press.

Winnicott, D., (1989). Psychoanalytic Explorations. Winnicott, C., Shepherd, R. & Davis, M., Eds. Cambridge, Massachusetts: Harvard University Press.


Biography

Melanie Zarabi, MPS, ATR-BC, LCAT, NCPsyA is a NAAP Certified Psychoanalyst and a Licensed, Board Certified, Creative Arts Therapist. She is a graduate of the Institute for Expressive Analysis; a graduate of Pratt Institute, with a Master of Professional Studies degree in Art Therapy and Creativity Development. She serves on the NAAP Board of Directors. Melanie has a private practice in NYC and is a painter and photographer.

Currently, Melanie is the Coordinator, Creative Arts Therapy and Clubhouse Programs at the VA New York Harbor Healthcare System. In 2008, she coordinated the First National Veterans Poster Project on the Afghanistan and Iraq War, sponsored by the National Office of Psychosocial Rehabilitation and Veterans Hospital Association. The original mural “Chaos of War-2008” is currently on exhibition at Deloitte.


Bedroom Door

April 15, 2011 7:00 am

By Vanessa Bezbrozh

The image of the bedroom door
Imprinted in my eyes
And any moment I will see
The one who heard my cries

Alone, and hopeful that you know
How urgently I need
But…I’ve been calling you a while
And anxiously I plead

Will you return? Are you aware
That I’ve been calling out?
Will you be angry, or concerned?
Will you relieve my doubts?

More minutes slowly going by
And still I watch the door
It seems unfair, but I don’t know
What I’ve been punished for.

Alone and aching for her care
I’m trapped, a helpless pose
And when so many minutes pass
I only hope she knows…

 

Vanessa Bezbrozh is a NYS licensed acupuncturist running a community acupuncture clinic in Bensonhurst, Brooklyn. She has found that using poetry and other creative arts as part of her own analysis is an immensely healing and satisfying means of expression. Many of her poems such as the one above were written on the basis of subtle memories and feelings from a preverbal stage in her life. She plans to study psychoanalysis formally in the near future to add to her practice as an acupuncturist, intending to create a therapy that deeply addresses both body and mind.


A Therapist’s Report

April 15, 2010 12:01 am

By Arleen Levine

Sometimes the emptiness of a single soul
in the universe
Brings breath-stopping fear to her.
A gasp is heard
As she seeks warmth and lively energy
A deep look into my face,
iris to iris, seeking
Can return her to even breathing.

A cigarette,
smoke filling the interior with cloudy gray
And forcing the breath
to return to
inhale, exhale
Like a mantra
Is used to stabilize angst.

Cocaine is effective
Making time stop
A room becomes a container
for the body
And the soul goes elsewhere
Floating, as if in a pool of water
Relieving the psyche. A respite
Until alas the return
to uneven breathing.

Medicine with a long name
Jiggles in a clear plastic vial
assuring safety to escape
By the FDA, MD, and journal of medicine.
This time blood is ejected
to test damage
And the dirty danger of street drugs is eliminated.

Except when
Uppers, downers and stayputs
collide in her vessels
And never consult
the soul, heart and mind
To ask about
love, irises and mantras.


Arleen Levine, Board Certified Art Therapist, Licensed Psychoanalyst, Licensed Professional Counselor in private practice, is Clinical Coordinator, Center School, working with emotionally disturbed/neurologically impaired young people. She has lectured internationally.


Psychic Fallout from Breach of Confidentiality: A Patient / Analyst’s Perspective

April 15, 2010 12:00 am

Download

Jane B. Burka, Ph.D.

I never expected to confront my analyst in a court of law. I thought we had a beneficial, profound, mutually respectful relationship. Yet, the unimaginable occurred. I filed a lawsuit against my analyst for breach of confidentiality, asserting that he had revealed privileged information about me to another patient, a woman with whom he had engaged in sexual misconduct. A few years after their relationship ended, that patient, whom I’ll call Ann, could remember many personal things our analyst had said about me, and the list of her recollections became the evidence on which my lawsuit was based. After depositions and failed mediation, my analyst and I faced each other before judge and jury. The jury found him liable for negligence and for breach of fiduciary duty. They determined that his conduct was a substantial factor in causing me emotional harm.

At the end of the trial, my former analyst agreed not to file an appeal of the verdict against him. I agreed to a confidentiality clause that requires

me, in my published paper, to omit identifying information, including  his name, office location, professional association, and the status of his license to practice.

Glen Gabbard has said, “If we are to prevent destructive enactments of boundary violations…we must enrich our understanding of the impact these violations have on our patients” (Gabbard, 1995, p.1134). Yet there are few accounts of the psychological impact of boundary violations on the patient. (One account is Yahav, R. & Oz, S. (2006). Perhaps this is because a therapist working with a patient who has experienced boundary violations in a previous treatment is understandably reluctant to publish a detailed case report. You don’t want to risk exposing the patient again and perhaps jeopardize the new therapeutic relationship. So I’m in a unique position as both the patient whose confidentiality was broken and as a psychoanalyst reflecting on the emotional damage that resulted from my analyst’s crossing of boundaries. My decision to share my personal experience comes with the hope of speaking for others whose stories can’t be told.

The literature on boundary violations has focused primarily on attempts to understand analysts who engage in sexual misconduct. (Celenza, 1991; Gabbard & Lester, 1995; Celenza & Gabbard, 2003; Celenza, 2006). Papers also address organizational denial and ambivalence, as professional groups and training programs struggle to deal with members who commit boundary violations. ((Margolis, 1997; Gabbard & Peltz, 2001; Sandler & Godly, 2004). Recently, a few reports are coming out from analysts whose own analysts were censured for sexual misconduct, exploring the painful effects of being “collateral damage” (Wallace, 2007).

When breach of confidentiality is addressed in the literature, it has been described along a continuum from casual social conversations to actively gossiping about patients, but always with the assumption, as a given, that identifying information is withheld (Olinick, 1980; Caruth, 1985; Guthiel & Gabbard, 1993; Lander, 2003; Goldberg, 2004). Therefore, my experience of breach of confidentiality, which identified me by name and revealed details about my analysis, is both unusual and extreme in the literature. However, this kind of conduct may be under-reported. The expert witness who testified in court on my behalf told me it is “not unusual” for analysts who engage in sexual misconduct to break patient confidentiality in that illicit relationship (personal communication).

I will now give a chronology of my unexpected adventure, interweaving events in the real world with experiences in my psychic world, including reflections, dreams, and dream-associations. I will focus on the emotional issues of traumatic de-idealization and dis-identification; the intensified collision of loving and hating feelings toward my analyst; my feelings mistrust and shame; disturbed professional identity; permeable psychic boundaries, and death anxiety.

The Discovery

I had been engaged in a helpful analysis for several years when I decided to apply to become a psychoanalyst. I was in my late forties and had been in private practice for fifteen years. My analysis continued during the five years of my analytic training from 1994-1999. Two years after I graduated, that is, in 2001, my analyst told me that he was taking a “forced sabbatical” from his responsibilities at his institute, which was not my institute, because he had a “legal problem.” I inquired, and he said he had been advised not to discuss it, adding softly, “You’ll never know.” I felt shut out but also tantalized by this declaration, and I asked a few colleagues if they’d heard anything about his “sabbatical” or his “legal problem.”

Within days, I heard that my analyst had engaged in an “ongoing sexual relationship with a patient.” (His assumption that I would never know was the first of many illusions I discovered he held about this experience.) I was terribly upset by the possibility of his sexual misconduct, but I didn’t know if the rumor was true. I then had a dream that I was on vacation with a friend in a park on the edge of a huge ice floe in Alaska or Antarctica. We had a map, and there was a lot to see all over the park. We were at outdoor picnic tables, and at the next table was a psychoanalyst I recognized. He was old; he was alone. He was asleep with his head down on his arms, snoring. He woke up, looked around, and got up to see where he was. He said, “They have professional meetings at places like this.” Though confused at first about where he was, he decided he was at a professional meeting. Then he sat down and went back to sleep. He seemed ridiculous to me: he didn’t get it. He woke up and got ready to leave. He never did see me. When he walked away, I said to my friend, “Of all the places on earth, he ends up at a table next to me on a glacier.” And my friend replied, “Well, you two like to travel to the same places.”

I’m going to limit my discussion of my dreams to associations that are related to the disrupted relationship with my former analyst. Of course, I also had associations to other relationships and to my history.

This dream seems to reflect my complicated reaction on hearing the rumor of my analyst’s sexual misconduct. The landscape in the dream is cold, as I was suddenly in a cold, unfamiliar place in my analysis. The nourishing environment is no longer inside in the containing enclosure of the consulting room but outside with no protective boundaries.

In the dream, I know the difference between work and play, but the analyst doesn’t. He is old and ridiculous, confused and disoriented. In my dream, I have characterized him as demented, not exploitative—it’s aggressive on my part, but it still offers a more benign explanation for his conduct: “He didn’t get it” because he is confused rather than immoral. My mistrust in the authenticity of my analysis is expressed here too: had he slept through my analysis while he was sleeping with his patient? Did he ever see me?

The comment that we “travel to the same places” I take to be a reference to the analysis, a psychological journey that analyst and patient travel together. It also reflects my identification with him. There is no suggestion in the dream of his sexual interest in another; instead he seems asexual. But my erotized attachment comes through in the paraphrasing of Humphrey Bogart’s line in Casablanca: —“of all the gin joints in all the world, she had to walk into mine.”

This dream suggests that perhaps I already know unconsciously that I am going to leave my analysis and survive. I’m in unknown territory, but unlike my analyst, I am not lost.  I have a map, and there is a lot to see. I will go forward on my journey without him.

Back to my chronology:

After hearing that I would “never know,” I felt a compelling need to seek out facts, so I asked a few people if they’d heard anything about my analyst’s sabbatical or his legal problem. One colleague, who had not heard the rumor, speculated that if it were true, it could involve Ann, a psychotherapist I did not know. My colleague was a friend of Ann’s and knew that Ann had seen my analyst. She recalled that Ann had mentioned an occasion when the analyst had significantly broken the analytic boundary in her treatment. And, my friend added, Ann was strikingly beautiful.

I confronted my analyst with my idea that he’d had a sexual relationship with Ann, whose involvement, at that point, was just conjecture on my part. He responded, “I guess it’s a small town.” Confirmation. I was not left hanging in a state of not-knowing, but my faith in my analyst was abruptly shattered at that moment.

I ended my analysis that week. I was convinced that not only had his behavior been unethical, but his thinking was impaired, and his acceptance of personal responsibility was lacking. He referred to his sexual misconduct as “a mistake” and claimed, “It happened a long time ago.” (Anything that happened during my analysis was not a long time ago to me!)  He said, “What does my relationship with one patient have to do with my work with you?” I recognized a capacity for minimization, rationalization, and compartmentalization that could allow someone to be sexually involved with a patient while holding a position of authority in our field. At the same time, I was crushed that my analyst was blocking out my psychic reality.  He urged me to stay in treatment to deal with my reactions, but I felt that I no longer had a psychoanalyst.

I was reassured that although he had transgressed with another patient, at least he had always been ethical with me. Nevertheless, I felt tainted. I was ashamed of choosing the wrong analyst, of being fooled, of having an unethical analyst as my model of a psychoanalyst, of having loved him and now of also hating him.

My faith in my own intuition—perhaps my most dearly held professional quality—was profoundly shaken. How could I not have known? My trust in psychoanalysis as a profession and in psychoanalysts as practitioners had also been severely damaged. Who are these people, really? I am one of these people. Would I be capable, under extreme circumstances, of committing a serious ethical violation? If I were, would I be able to accept the gravity of my actions and the destructive consequences to myself and to others? Would I “get it?”

The complaint

I wondered if Ann had submitted a complaint against him with his professional licensing board. I searched online and discovered that indeed, a complaint had been registered. When the document arrived in the mail, I knew it had been filed by Ann, because the complainant was identified by her initials.

I did not want to believe the multiple allegations in the lengthy complaint. Among them was the assertion that my analyst had broken the confidentiality of many patients and talked frequently with her about intimate things patients had revealed in their analyses. This seemed impossible. I didn’t believe my analyst could be cavalier about confidentiality.

But doubts plagued me. He had crossed one professional boundary; could he have broken another? If he had breached confidentiality, could he have talked to Ann about me? Assuming that the timeline put forth in the complaint was accurate, the alleged year- and- a- half sexual involvement with Ann overlapped my early years as a psychoanalytic candidate. If Ann’s allegations were true, I felt there would be a stigma on the analytic hours that were required for my training and on my entire analytic education.

Two months after reading the complaint against his license to practice, I contacted Ann to ask if my confidentiality had been breached. She was guarded and reluctant, but she confirmed that my confidentiality had been broken, and we agreed to meet in person.

Our conversation was awkward but polite. The previous evening, Ann had written a list of things she remembered our former analyst saying about me, using my name. Ann read aloud the thirteen items on her list. Each one was about me; there was no misinformation. Each item reflected something I’d said during my analysis or expressed my analyst’s feelings about me. In some cases, I heard the very words I had spoken in my sessions. I was in shock. I muttered, “That’s me.” I couldn’t believe it, but I knew it was true.

As the initial shock yielded to outrage, I decided to file a complaint with the state licensing board, and an investigator soon called to set up a meeting. The night before my appointment with the investigator, I had the following dream:

I come home and several men with guns are ransacking my house; one is unplugging the computer. Another man shoots me several times, and as I fall, I say, “That’s it; it’s done.” I expect to die. But there is not a lot of pain, and I don’t die. Then the men are gone, and I can walk, even though my right leg has been reduced to pulp. I see that they did not take my computer. The protective window coverings that I had put on the windows were no help at all. There is a lion on the roof and large antelopes on the lawn. Anyone and anything can get in and out.

The act of filing the complaint, taking a public stand against my former analyst, stirred up intense paranoid anxieties. My internal world has been turned upside down, and the board investigation is going to rummage through my personal things. The invader is unplugging my computer, retaliation against the instrument I’d used to locate Ann’s complaint and an attempt to disconnect my thinking capacities. “That’s it, it’s done”—by filing my complaint with the licensing board, I felt I had killed my intimate, loving relationship with my former analyst, and the dream reveals my anxiety and guilt over my aggressive action.

The partition between inside and outside, my skin ego (Anzieu, 1989), was permeable, so that my psychic contents were unprotected. The lion and antelopes that may come and go are beautiful animals, though they have the potential to become enemies to each other and to me.

In this dream, there is primitive confusion of life and death. I am attacked so severely that I expect to die, though I don’t die. Great damage has been done, but I don’t feel pain. As in many of my dreams about this trauma, there is a part of me that is devastated and feels deadened, and at the same time, a part of me remains alive and is able to move forward.

The Lawsuit

Because the breach of confidentiality was so egregious, I considered filing a lawsuit, but I was very ambivalent. I wanted to take a stand against my analyst’s breach of confidentiality, but I knew that a lawsuit would compound my exposure and humiliation. I consulted with family and close friends, and I met with the Chairman of the Ethics Committee at my institute. Thinking about my patients was the tipping point. Our psychoanalytic community is a small, complex matrix of relationships. I could not tolerate the possibility that any of my patients might somehow learn that my confidentiality had been breached and I had done nothing about it.

I filed the lawsuit about a year and a half after I left my analysis, asking my former analyst to compensate me for the emotional damage caused by his negligence. His case was handled by an attorney representing his malpractice insurance company.

After filing the lawsuit, I felt isolated from institute colleagues, who had no idea about what I was going through. Outwardly, I maintained minimal involvement with my institute, but internally, my trust in myself, my analysis, and my field was broken.

The first depositions took place about two and a half years after I ended my analysis. I was allowed to be present at his deposition, but I was not allowed to speak. Although he looked the same, he no longer felt familiar, and he gave the impression of being relaxed and nonchalant, sitting with his legs stretched out under the conference table and his hands laced behind his head. While he acknowledged that he had talked to Ann about me a few times after she was no longer his patient, he justified these conversations as “informal consultation with a colleague” and insisted he had not used my name. He acknowledged no wrongdoing.  I became confused: Could I be falsely accusing him, as he claimed? Was there some other explanation for how Ann could quote the words I had spoken in my analysis? What was real?

Because my former analyst refused to consider a settlement for something he maintained he hadn’t done, the case went forward to trial. Another woman, whom I’ll call Mary, had also learned from Ann that her confidentiality had been broken, and we were co-plaintiffs using the same lawyer. We attended court together.

The Trial

Three years after I filed the lawsuit and four and a half years after I ended my analysis, the case came to trial before a jury. In his opening statement, my lawyer read Ann’s list of the 13 items my analyst had said about me. Although I felt humiliated as my lawyer read each statement slowly and deliberately, I soon discovered an unanticipated benefit. I went to my office after the first day of testimony to sort through my mail, and when I entered my consulting room, I noticed a new feeling…my office suddenly felt clean, and the analytic couch seemed to fully belong to me. Having separated myself from my former analyst on the record, having taken myself out of his lineage in a public act, I began to reclaim my analytic identity.

The trial lasted two weeks. I testified for several hours, but I don’t remember most of what I said. I answered my lawyer’s questions succinctly while looking at the jury; some were listening and some were barely awake. As the trial developed, I felt more comfortable about my decision to file the lawsuit and more confident in the outcome. But I continued to be dismayed by my former analyst’s stance. His testimony contradicted Ann’s testimony, and I believed Ann. I kept hoping that as the evidence against him was mounting, he would agree to settle, to put an end to the ordeal, but he did not. The jury deliberated for two days. They found him guilty of negligence and breach of fiduciary duty. They determined that his behavior was a substantial factor in causing me emotional harm. The jury awarded me financial damages. But, after deducting my lawyer’s percentage and paying the expenses of mounting the trial, the amount did not equal the cost of my long-term analysis. This award was covered by malpractice insurance.

The lawyers interviewed some jurors after the trial. The jury’s logic was not psychological logic. They determined that since some of my hours of analysis had occurred during my training and counted toward my becoming a psychoanalyst, the analyst had fulfilled part of his “contract” with me, so they did not grant the full amount I had paid for my analysis. They also didn’t grant the amount I had requested for future psychoanalysis, because, as one juror said, “These people are in therapy all the time anyway.”

Recovery

The guilty verdict reached by the jury felt like a confirmation of my psychic reality of being betrayed and seriously harmed. In addition, once the trial was over, my ex-analyst stopped being part of my everyday life, and I no longer had to be affected by his behavior or keep confronting our clashing views of reality. Freed from the combative relationship of being opponents in a lawsuit, I was able to recapture my gratitude for the help I had received early in my analysis.

As time went on, I made progress regaining my faith in myself as an analyst, further separating myself from my ex-analyst. Six months after the trial, I dreamed:

I was at a psychoanalytic conference, and I came out of a large session and saw my former analyst sitting on a sofa in the corridor, outside of the session room.

In this dream, I am entitled to participate in the psychoanalytic world, while my ex-analyst is on the outside. Seeing him “outside of the session room” meant to me that he is now outside of my sessions, no longer infiltrating every minute of my analytic work. At the same time, there is a way that I still feel on the outside, unable to share the experience of the majority of analysts who have ended analysis feeling respect for their psychoanalyst.

Conclusion

In this talk, I have selected a few dreams representative of unconscious issues that demanded my attention as I careened from learning about my analyst’s sexual exploitation of a patient, to knowing that he breached my confidentiality, to filing a lawsuit, to facing him before a jury that found him guilty. I believe that my dreams saved my psychic life. I mean this in both senses: the dreams preserved the pain that registered in my unconscious until a dream story could be created and remembered; and also, working with my dreams exercised my psychoanalytic capacities when my analytic identity was in greatest jeopardy. Through the dream work, I regained faith in my intuition, conscious and unconscious.

Breach of confidentiality is an exploitation of the patient’s psyche, using analytic communication to satisfy personal needs of the analyst rather than to benefit the patient’s psychic development.  Even if the patient does not learn the details of the breach, as I did, the analyst who talks too freely about a patient breaks the protective perimeter of the analytic container, and the patient’s analytic safety leaks through the cracks. Perhaps my experience will help clinicians understand the destructive consequences of this boundary violation on a patient’s psychic life, so that we may practice caution at the beginning of the “slippery slope”—in order to do no harm.

References

  • Anzieu, D. (1989) The Skin Ego. New Haven, CT: Yale University Press.
  • Caruth, E. (1985). Secret bearer or secret barer?—Countertransference and the gossiping therapist. Contemporary Psychoanalysis, 21: 548-561.
  • Celenza, A. (1991). The misuse of countertransference love in sexual intimacies between therapists and patients. Psychoanalytic Psychology, 8: 501-509.
  • Celenza, A. (2006). Sexual boundary violations in the office: When is a couch just a couch? Psychoanalytic Dialogues, 16: 113-128.
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  • Margolis, M. (1997). Analyst-patient sexual involvement: Clinical experiences and institutional responses. Psychoanalytic Inquiry, 17: 349-70.
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  • Wallace, E. (in press). Losing a training analyst for ethical violations: A candidate’s perspective. International Journal of Psycho-Analysis.
  • Yahav, R. & Oz, S. (2006). The relevance of psychodynamic psychotherapy to understanding therapist-patient sexual abuse and treatment of survivors. Journal of the American Academy of Psychoanalysis and Psychiatry, 34: 303-331.

Dr. Jane Burka is a psychologist and psychoanalyst in Oakland, California. She is Personal and Supervising Analyst and on the faculty at the Psychoanalytic Institute of Northern California and teaches widely in the San Francisco Bay Area. Dr. Burka has written articles on the therapist’s body in fantasy and reality, group dynamics in teaching, learning styles in supervision, as well as breach of confidentiality. Dr. Burka is also co-author of a book written for the general public, “Procrastination: Why You Do It; What To Do About It NOW.”


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