Thoughts on the limits of a mutual technique*

Ferenczi’s appreciation of the inherently mutual nature of the analytic encounter led him, and many who followed, to explore the value of mutual openness between patient and analyst. Specifically, Ferenczi saw the analyst’s openness as an antidote to his earlier defensive denial of his failings and ambivalence toward the patient, which had undermined his patient’s trust. My own view is that, while the analyst’s openness with the patient can indeed help reestablish trust and restore a productive analytic process in the short term, it also poses long-term dangers. In certain treatments it may encourage “malignant regression”, where the patient primarily seeks gratification from the analyst, resulting in an unmanageable “unending spiral of demands or needs” (Balint, 1968, p. 146). I suggest that an analyst’s “confessions”, in response to the patient’s demand for accountability, can sometimes reinforce the patient’s fantasy that healing comes from what the analyst gives or from turning the tables on his own sense of helplessness and shame by punishing or dominating the analyst. In such situations, the patient’s fantasy may dovetail with the analyst’s implicit theory that healing includes absorbing the patient’s pain and even accepting his hostility, thus confirming the patient’s fantasies, intensifying his malignant regression and dooming the treatment to failure. When malignant regression threatens, the analyst must set firmer boundaries, including limits on her openness, in order to help the patient shift his focus away from expectations of the analyst and toward greater self-reflection. This requires the analyst to resist the roles of rescuer, failure, or victim—roles rooted in the analyst’s own unconscious fantasies.     

“In the Face,a Right Is There”: Arendt,Levinas and the Phenomenology of the Rights of Man

This paper examines the differences between the thought of Hannah Arendt and Emmanuel Levinas concerning the “Rights of Man”, in relation to stateless persons. In The Origins of Totalitarianism, Arendt evinces a profound scepticism towards this ideal, which for her was powerless without being tethered to citizenship. But Arendt’s own idea of the “Right to have Rights” is critiqued here as being inadequate to the ethical demand placed upon states by refugees, in failing to articulate just what states might be responsible for. I argue that the ethical philosophy of Levinas meets this lacuna in Arendt’s thought, via his concept of the Face as the locus of human dignity and to which states can be recalled to responsibility. Levinas wrote several papers on what he called “the phenomenology of the Rights of Man”, and in his phrase, which provides a summation of precisely what is lacking in Arendt’s arguments: “In the face – a right is there”.     

Maternal intrusion: Its roots and consequences

Abstract

Behind an intrusive mother’s view of her actual child lies a disproportionate, hidden desire to revive an ideal relationship with a perfect mother. The resulting image of an idealized child then becomes a strategic aspect of the mother’s own identity, representing an idealized figure from her own past. As the mother’s idealization is disturbed by the reality of the child, the mother experiences the situation between herself and the baby as “pathological,” that is, disruptive to her. She then attempts to repair the idealization by resisting any change in the status of her relationship to her child, even as the child grows older. Her rigidity in this regard necessarily excludes a paternal presence that could challenge or change the mother–infant idealized dyad. The mother’s orientation is also contradictory to, and acts as a resistance to, psychoanalytic therapeutic interventions, which aim at any “change.”     

Political Divide in the Consulting Room*

This paper addresses a treatment relationship that tests the analyst’s capacity for empathy within an impinging political context. It involves a Ferenczian “relaxation of technique” within the analytic frame, while the analytic couple attempts to negotiate a polarized transference and countertransference. Specifically, within a long-term treatment imbued with positive transference, my patient becomes openly outraged by my insensitive anti-Trump remarks. Increasing confrontations around the expression of political views illuminate our otherness. He complains of psychic ostracism within a liberal cultural context, which tolerates no divergence from mainstream liberal ideas or discourse. I come to embody the oppressive other: the liberal “thought police”, “silencing” him for his perspective. Empathic breaches between us take center stage: how I don’t see the world as he does, and don’t see or hear him.     

The Impact of Insecure Attachment on Mothering: A New Mother’s Story

This article describes the treatment of a first-time mother and her daughter. The mother’s impoverished primary relationships and the fragility of her early attachments contribute to her challenges with motherhood. Through parent-infant treatment she is gradually developing the capacity to reflect upon her experience and beginning to make discoveries about her attitudes toward herself and others. My work with Leslie has deepened my appreciation for Daniel Stern’s notion of “the motherhood constellation” and for the power of insecure attachment to destabilize the parent and consequently the parent-child relationship. During the treatment, I used the Newborn Behavioral Observations system as an adjunct to therapy to help demonstrate to this distressed new mother her infant’s competencies. Later, I also used the Adult Attachment Interview to enhance her curiosity about her own childhood, and in particular her relationship to her mother and the impact of that relationship on her own mothering.     

Dignity in Context,and Out: Discussion of Lynne Jacobs’ “On Dignity,a Sense of Dignity,and Inspirational Shame”

ABSTRACT

Dr. Lynne Jacobs’ “On Dignity, a Sense of Dignity, and Inspirational Shame” is an interdisciplinary integration of a priori ethics and a phenomenology of dignity. She contends that the human person’s engagement with other people—writ large in the therapeutic encounter—is inherently ethically situated. Moreover, she avers an inherent content to this ethics, namely, mutual respect for distinctively human value—dignity—between and among people. Her ethics of dignity informs her psychoanalytic exploration of experiences of dignity, indignity, and her notion of inspirational shame, among others. I join in Jacobs’ advocacy for therapeutic facilitation of a person’s sense of inherent worth, as well as her opposition to relational contexts of devaluation and degradation. However, the primordiality Jacobs grants to her ethics of dignity often obscures the constitutively cultural, familial, and personal contextuality of, first, her—and in my view, any—ethical conviction; second, what she describes as the experience of being human; third, the alleged indignity of human vulnerability; and finally, the claim that shame is the natural reaction to one’s failure to live up to personal ideals. In the end, and subject to certain clinical concerns, Jacobs’ article integrates into psychoanalysis primordial ethical duties that she and others claim inhere in us as human beings.     

Kierkegaard on Imitation and Ethics: Toward a Secular Project?

This essay demonstrates the prominence of imitation in Kierkegaard’s ethics. I move beyond his idea of authentic existence modeled on Christ and explore the secular dimension of Kierkegaard’s insights about human nature and imitation. I start with presenting imitation as key to understanding the ethical dimension of the relationship between the universal and individual aspects of the human self in Kierkegaard. I then show that Kierkegaard’s moral concepts of “primitivity” and “comparison” are a response to his sociological and psychological observations about imitation from an ethical point of view. In the final section of this paper, I briefly engage Friedrich Schleiermacher’s “ethics of individuality” and Gabriel Tarde’s “laws of imitation” to explore Kierkegaard’s consideration of ethics and imitation as situated within the context of a broader conversation on imitation.     

How a Kleinian Analysis Also Tells a Relational and Intersubjective Story Commentary on Paper by Meira Likierman

Dr. Likierman narrates her case in ways that differ dramatically from the usual discourse of relational analysts, and she frames her work with constructs that derive primarily from contemporary Kleinian theory. Yet I believe that if we listen closely to her clinical material, we can see how she and her patient live out a deeply relational/intersubjective process—intersubjective in both Stolorow, Brandchaft, and Atwood's (1987) broad sense and Benjamin's (1995) more developmental point of view.

I suggest is that there is real mutuality in their relationship, a reciprocal, unconscious, taking in of the mind and role of the other—a mutual change in which, paradoxically, both parties seem more real and, more deeply than ever, to express themselves. Ultimately, I think we can see that analyst and patient have “enacted” a slightly subversive, yet vital, mutual dance into and through precisely the paradoxes that Likierman recognizes as “forbidden” territory in the therapeutic relationship.     

A Procedural,Contextual, Action-Focused Understanding: Response to Renn and Westerman

In this reply to comments by Paul Renn and Michael Westerman, I discuss the nature of relational discourse and the various meanings of multiplicity in the relational literature. In further discussing Mitchell’s (2000) case of Connie, cited also by Renn, I highlight the ways in which Mitchell understood that Connie’s sadness was perpetuated by the ways she communicated her feelings and needs in the present. I discuss Westerman’s participatory perspective in relation to Schafer’s action language, Shapiro’s emphasis on action and responsibility, and Dollard and Miller’s conceptualizations of repression as the active behavior of not-thinking certain thoughts. I examine as well Westerman’s distinction between “self and context” and “self-in-context” formulations in relation both to the cyclical psychodynamic point of view and his own case example.     

Cognitive-Behavioral Conjoint Therapy for PTSD: A Case Study of a Transgender Male Co-Parenting With Former Spouse and Perpetrator of Domestic Violence

Posttraumatic Stress Disorder (PTSD) symptoms have shown to contribute to intimate relationship discord (Taft et al., 2011). Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012) is an evidence-based treatment for PTSD effective at significantly decreasing PTSD symptoms and increasing relationship satisfaction among dyads (Macdonald et al., 2016). To date, there has only been one case study examining the effectiveness of CBCT for PTSD with a sexual minority couple, (same-sex female couple) leaving uncertainty of the effectiveness of this treatment for other sexual minority couples. This case study examined a married couple’s response to treatment, in which the patient identified as a transgender male and his spouse identified as a cisgender female. The patient was diagnosed with PTSD per a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total score of 45 (of a maximum of 80). On the CAPS-5, the patient reported a first sexual encounter rape at age 15, from his first marriage with his ex-husband, whom he was dating at the time, as his index trauma. Of note, the patient and his wife currently co-parent two children with the patient’s ex-husband, who perpetrated daily sexual assaults for years during their marriage. Pre-treatment relationship happiness for the couple was “a little unhappy” on the Dyadic Adjustment Scale (DAS) Relationship Happiness Scale. Patient was also diagnosed with Dysthymia and responded well to continued Bupropion for depression. Following completion of the 15-session CBCT for PTSD protocol, the patient’s diagnosis of PTSD was determined to be in remission as evidenced by a post-treatment CAPS-5 total score of 7. At post-treatment the patient rated his relationship happiness as “happy” and his partner “very happy” on the DAS. The couple demonstrated clinically meaningful changes in areas of PTSD and relationship happiness. Functional improvements were also reported in the patient pursuing new employment and hobbies, improved co-parenting between the patient and his wife, improved sexual functioning, and decreased depression symptoms. Treatment gains were maintained at a 1-month and 3-month follow-up. These results demonstrate the effective use of CBCT for PTSD with a sexual minority couple that has continued co-parenting contact with a perpetrator of domestic violence.     

Who is the Hero in the Life of the Traumatized Patient? Reflections on Bodansky’s Work with Mrs. E

The vexed question of how to explain analytic success with traumatized patients like Bodansky’s Mrs. E is considered from a perspective on psychoanalytic history and the specific theory-buttressed assumptions and practices of earlier generations of analysts that led them to conclude that traumatized patients couldn’t be helped via psychoanalytic work. I then consider Mrs. E’s life with an organizing question, Who is its hero?, applying perspectives from Charles Dickens and from Fraiberg and colleagues’ work, and use these perspectives to question the theory-based assumption that Mrs. E must have somewhere had a good object experience to have a life. These perspectives allow contemplation of a saving forceful agency at Mrs. E’s core (perhaps one experienced by her as “animal”) that seems essential to understanding her successes in living. The success of her treatment in assisting her with building a life suggests that her analyst’s helping her with mirroring and, even more important, with mentalizing, contribute importantly to her life improvement. Some potential limitations of his approach to her are also implied in his account; in particular, his limited work with her intimate desires and feelings, both libidinal and aggressive.     

No explanation of persons,no explanation of resurrection: on Lynne Baker’s constitution view and the resurrection of human persons

I don’t think Lynne Rudder Baker’s constitution view can account for personal identity problems of a synchronic or diachronic nature. As such, it cannot accommodate the Christian’s claim of eschatological bodily resurrection-a principle reason for which she gives this account. In light of this, I press objections against her constitution view in the following ways: First, I critique an analogy she draws between Aristotle’s “accidental sameness” and constitution. Second, I address three problems for Baker’s constitution view [‘Constitution Problems’ (CP)], each more problematic than the next: CP1: Her definition of constitution lacks explanatory power; CP2: If there is a plausible definition of constitution, constitution implies either too many persons or no human persons at all; CP3: Constitution yields no essential distinction between human and divine persons. If my argument(s) go through, her constitution view has neither an explanation for diachronic personal identity nor personal identity through resurrection.     

What Are We Doing There? A Therapeutic Tale

In this paper I try to portray our interpsychic work as reflective of an infinite conversation: an intersubjective dreaming of one’s life, moving between multiple positions/self-states, those of the patient and our own; becoming involved while pondering the movement we are part of, sometimes in our hearts and minds, many times aloud and openly with our patient; recognizing her experience and enabling her to see us, and sometimes not reflecting at all—“the “moving talk.” The dilemma of the therapist’s positioning, internally and interpersonally, is further postulated, especially in regard to the posttraumatic patient who suffered severe childhood abuse.     

Euthanasia in psychiatry can never be justified. A reply to Wijsbek

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future.     

Adorno’s View of Life

The aim of this article is to reflect on the dialectic of the individual’s life and death in terms of Adorno’s moral philosophy, specifically through a thorough reading of his Negative Dialectics and other key works on the subject. I hold that there are two aspects of the dialectic of life within the context of Adorno’s “nonidentity”: one involves exploring the false identification, due to the reification of modern society, of the individual’s life experience with her or his death experience, while the other involves preserving the dialectical and irreducible tension between the theoretical contemplation of life and of historical conditions, as well as specific social systems. Heidegger’s ontological philosophy concerning Dasein and Kant’s categorical imperative will also be discussed in order to fully understand Adorno’s moral philosophy and his idea of nonidentity. From my point of view, Adorno’s moral philosophy is the prime motivator of his unique concept of nonidentity, and has influenced contemporary political philosophical concepts such as biopolitics (cf. G. Agamben).     

The Strangeness of Passing: Commentary on Paper by Christopher Bonovitz

Christopher Bonovitz gives us a rich landscape of the theoretical, historical, and relational aspects of his work with his mixed-race patient. In my response I explore what seems missing: a stronger sense of the patient as a person, more of her own history in her family, more of the clinical back and forth with her therapist, a sense of what is being played out in the transference, and particularly what “passing” is for her. I show how his choices about how to think about her story and how to tell it are oversaturated with awareness of identity and race at the expense of the basic human relationship. In the face of such racial anxiety, there is a pull to rely too strongly on countertransference as a way to gain privileged access to knowledge about the other. I attribute many of these problems to the inescapable power of race in our culture. Furthermore, I address the themes of hatred, silence, secrecy and transgression as they relate to the history of transgenerational trauma for this patient and invite our broadening our awareness about how they play out in the therapeutic process. We are faced with the difficult, yet the essential task of holding and living out the patient's anger and outrage at the racial hatred that has been endured.     

Vitalizing Enactment: A Relational Exploration

Drawing from her extensive work with deeply disturbed children Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst actively reaches out to contact and “reclaim” her most inaccessible patients, engaging them in the world of emotions and relationships. In this paper I consider Alvarez’s ideas through the lens of Relational thought, reconceptualizing vitalization as a unique form of enactment that can draw the analytic dyad from deadened impasse into enlivened contact. In vitalizing enactment embryonic affects, hopes, and longings find expression and are potentiated for patient and analyst alike. This is a view of enactment as a progressive and creative lived experience, rather than an unconscious collision to be survived and symbolized. I contextualize vitalizing enactment in relation to Alvarez’s original formulations as well as relevant contemporary theories and present a clinical vignette to illustrate this paper’s themes.     

Reply to Janine de Peyer’s “Traversing the Ineffable: Commentary on Sharon Farber’s ‘Becoming a Telepathic Tuning Fork’”

Janine de Peyer’s thoughtful and stimulating response to my paper evoked a good deal of thinking about playfulness and creativity in doing psychotherapy, what part intuition and empathy play in promoting telepathic communication, the distinction between thoughts and feelings unconsciously transmitted between people within close proximity and those transmitted across geographical distance, where there is no reliance on sensory clues involving sight, sound, smell, touch, and taste. De Peyer’s summary of research on telepathy tells us that most of the research tries to rule out the variable of unconscious sensory exchange by physically separating the “sender” from the “receiver.”

In her discussion of my paper, Janine de Peyer raises some very interesting questions about how telepathy is to be defined. I recall reading years ago about someone who had gone to a medium and heard some startling information about herself and those in her circle. As I wondered how the medium could know so much about someone she had never before met, it occurred to me that there was a lot of knowledge about a person conveyed by the brain-to-brain sensory cues, and this was not telepathic but more a function of intuition and empathy. I think that was true about the relationship I had with my patient. but as with the medium there was a lot of other information I received about her that did not depend on sensory cues, and that information was, I believe, conveyed telepathically. So yes, I say, to de Peyer’s (this issue) question, “Is it not worth differentiating between in-session heightened intuitive receptiveness, and unexplainable transmissions of affect/thoughts/information that traverse time and geographical space?” (p. 736, italics in the original). In considering the time spent in my patient’s physical presence, much of my empathic attunement originated from the intuitive response that was induced in me by her physical presence. I think the increasing empathic attunement laid the foundation for subsequent telepathic communication.     

Dignity in Three Acts

The author develops three distinct senses of “dignity” that materialize in Drozek’s paper. Dignity as intrinsic worth invites the question of whether the implicit notion of dignity in contemporary psychoanalysis is best viewed as Kantian and, if so, how we are to accommodate the rationalism that inheres in it. Dignity as a state of mind leads the author to sketch the view that dignity is imperiled by absence (of vitality, of realness), contrasting it with Drozek’s emphasis on badness. Dignity as a relational provision summons inquiry into the distinction between “valuing” and “recognizing” in the encounter between subjectivities. Recognition, it is suggested, not only begets love, but also serves as the most compelling analytic instantiation of the Kantian Formula for Humanity—to treat the other as an end. By spelling out these interrelated significations, we not only discern our debts to the concept of dignity but also reveal potential psychoanalytic contributions to the broader conversation about dignity’s essence.