Newsletter of the Chicago Psychoanalytic Society
VOLUME 4, NUMBER 2 JUNE 1, 1996 ______________________________________________________
The Beat Goes On, by Bob Fajardo, M.
Frankly Speaking, by Ron Moline, M.D.
Highlights of the Executive Council Meeting of the A.Psa.A. - May 2, 1996, by Judith Davis, M.D.
From Your President, by Harvey, Strauss, M.D.
Meet Your Colleague, by Richard Herron, M.D.
Reconsidering Mark Gehrie's "Empathy in Broader Perspective," by Jeff Stern, Ph.D
The Institute/Society Public Relations Committee has stayed fully involved while also accomplishing a significant change in membership. Dave Edelstein, Bob Gordon, Art Nielsen, Sheila Nielsen (Institute Board of Trustees), and Brenda Solomon have each shifted into other activities, after having provided us with important assistance in building our foundation. The committee is presently composed of Bob Fajardo (Chair), Marty Fine, Paula Fuqua, Alyce Gorsky (Institute Development Office), Mark Smaller, and Annette Yonke (Research Candidate).
We have appreciated the Institute and the Society's budgeted commitment to a three year continuation of our efforts, and we have attempted with the assistance of our PR firm, Janet Diederichs and Assoc., Inc., to develop realizable goals for each year. This year we had two major goals: (1) to evolve a media spokesperson program, and (2) to develop an annual participation in the City of Chicago Humanities Council, Fall Program.
To work on the first goal, the PR firm conducted a Saturday morning media training program that was attended by approximately 15 Society members. Since that time we have had 3 newspaper telephone interviews. Two of these interviews were major components of articles written by prominent column writers in the Chicago Tribune and the Chicago Sun-Times. The articles each dealt with aspects of genius and violence. The Institute/Society members interviewed were Barry Childress, Bob Fajardo, and Bob Galatzer-Levy. Additionally, three Society members (Barry Childress, Bob Galatzer-Levy, and Mark Smaller) participated in a half-hour long radio interview on "Chicago Up Close," with Lee Ann Trotter, 99.5 FM. The topic of discussion, "Parental Responsibility," followed upon the unfortunate death of the 7-year-old girl presumed to be the pilot in a plane crash. Meanwhile, the PR firm is searching out other media opportunities for Society members. A number of members have actively volunteered participation in programs. The opportunities seem to present themselves with either eruptive immediacy, wherein member accessibility is crucial, or through a slowly-evolving consideration of program format. Just such a consideration is underway to present a program on violence.
The Chicago Humanities Council involves a large array of presentations to a large Chicago audience over a number of days. This year's theme will be "Birth and Death." We have made participation in this acclaimed Chicago activity our second major PR effort. Mark Smaller and the PR firm have discussed a number of possible topics that our committee could help to field. Presently the Humanities Council Director, Eileen Mackevich, is considering an Institute/ Society presentation utilizing the film "Ordinary People." This presentation is still in the early talking phase.
Our committee additionally facilitated two other activities. Arnold Tobin was interviewed on the topic of "Crimes of Passion and American Justice," to be broadcast on the Cable Arts and Entertainment channel (#57) sometimes during the late summer. Also, on June 20th, Charles Jaffe will make a presentation on "Short Term Psychotherapy" at the Great Lakes Naval Hospital on the North Shore.
Our committee greatly appreciates everyone's assistance.
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WE JOIN THE PERSONALLY BEREAVED IN MOURNING THE LOSS AND HONORING THE MEMORY OF TWO RESPECTED COLLEAGUES, WHO CONTRIBUTED SO MUCH TO SO MANY
CHARLES KLIGERMAN, M.D.
HELMUT BAUM, M.D.
Requiem for an Era
It is not my intention to become a mavin of melancholia. I strongly suspect, however, that those of you of a certain age and beyond share my proclivity these days for a kind of somber reflectiveness, in reaction to the many losses we have experienced within the psychoanalytic community. Personally, I would not call what I am experiencing depression. (Richard Nixon: "I am not a crook.") Yes, I feel the losses, mourn them, and feel quite keenly my own mortality; but I am also sharply aware of the processes of growth, and positive change. Our field demonstrates that whole unbroken circle, in my opinion; along with our losses and our struggles there exists creativity and health. I want to address both polarities in these remarks today.
First, I want to give my own brief eulogy for Dr. Helmut Baum, who passed away around the same time that Dr. Kligerman died. Helmut had been my second and last analyst. He was, I be-lieve, among the first of his generation to grasp the meaning of Heinz Kohut's new ideas, and to incorporate them - effortlessly, from the point of view of an analysand - into his analytic work. He gave me much of what I needed, in the way of an analytic experience, and my life would have been both different and more im-poverished without his efforts. I shall always be grateful.
Dr. Kligerman was a presence my entire professional life, until his death; this contributed to my tendency to view him as epitomizing the psychoanalysis I "grew up" with. I do not intend to eulogize him, here; that has been and will be done better and more meaningfully by others, elsewhere. Neither do I wish to deal simplistically with his life's work nor casually with his memory; but I am wanting to talk about Dr. Kligerman in the ways that he symbolized certain things for me, and the ways in which those conceptualizations changed for me, over the years.
Dr. Kligerman and Dr. Herman Serota were the first two psychoanalysts to whom I was exposed, as a first year psychiatric resident at the University of Chi-cago in 1963. They alternated case conferences on a weekly basis--doing live interviews of both inpatients and outpatients. I was powerfully impressed by two aspects of those interviews, as they were conducted both by Dr. Kligerman and Dr. Serota. One was the nature of the relationship they established with the patients. I was struck by how comfortable they were, and how comfortable they consequently were able to make the patient. The interviews seemed to flow, effortlessly; there was very little sense of "taking a history" or making an assessment. They were trying to listen to the patient.
The other aspect, while equally impressive, was less congenial, for this tenderfoot. This was the formulation which these experienced analysts subsequently made of the data they had elicited in the interview. Many of my fellow residents were awestruck by the ability these men exhibited in formulating the unconscious conflicts, the interweaving of oedipal and pre-oedipal elements, the defensive structures--and after all that, delineating the implications for treatment approach and outcome. I was not awestruck in quite the same way, however. While I too was impressed at the erudition, I was less convinced that these formulations were true. Unlike the atmosphere, perhaps, of their formative years in psychoanalysis, these analysts - particularly Dr. Kligerman - did not prohibit skepticism or debate. We were deferential, no question - students still were, in those final years of American respect for authority - but skeptical questions were raised. The responses, however, were partly satisfying and partly not. One answer was essentially a shrug: "After a while you can see these things." More satisfyingly: "If the data later reveals other dynamics or trends, one's formulation changes accordingly." Still: these formulations were highly complex and seemingly tightly interwoven. Was it possible, I wondered, to change much, without the whole edifice becoming unraveled? I had not yet heard of Popper, but the thought also occurred to me: can this formulation be disproven? Is there any way to refute it?
The approach to psychoanalytic knowledge so skillfully demonstrated by Drs. Serota and Kligerman was in fact the norm for that era. Analysts observed; they gently but insightfully probed; and then, from the distance of a medical expert, made their dynamic diagnosis and treatment plan. There was data to be elicited - real facts, not of course primarily of life events or behavior, but of psychological reality - and then woven together in a satisfying understanding.
Fast forward. Over a decade later (Maria Kramer and Helmut had their hands full trying to shape me into a sufficiently coherent self to warrant analytic training), I am in classes at the Institute. One is a case conference run by Dr. Kligerman. He still has the same enthusiasm, the same almost competitive intensity to bring to a case conference-- competitive not with us, the students, but with the challenge posed by the patient by the data, seemingly inchoate and unconnected, but subject to the mastery of understanding, with enough effort. One got the impression that he couldn't wait to get going--that there was nothing on earth he'd rather be doing than trying to make sense of the case about to be presented.
By then, the understandings had changed. Kohut had shaken the foundations, and the best and the brightest had either imposed upon themselves the task of reinterpreting psychoanalytic understanding in the terms of self psychology, or of incorporating his insights into what they felt was already solidly established psychoanalytic knowledge. Dr. Kligerman seemed to me to be in the latter group. What had not changed, however, was the aim, the point of it all. There were us experts, and then there was the patient. The analyst's contribution was still either good technique, or countertransference. There were new and illuminating understandings of the patient: breaks in empathy, which in years past hadn't even been part of the analytic discussion, assumed new importance, and contributed to our formulation of what lay at the base of the patient's disturbance. The amount of time spent on discussing the therapist's experience in the analytic situation, however - much less on the dance which both participants were creating - was negligible.
Times had changed, but the bottom line remained that analysts knew what they knew. There was a confidence, even a kind of serenity, in the sure knowledge that years of analytic experience led to a wisdom and unerring capacity to see to the heart of psychological matters that we trainees could only dream of attaining. I was struck dumb to be told by a senior analyst some time late in my training, "You know, Ron, you really need more analysis." It took me some years to realize that my deepest reaction had been, "Compared to whom? You?"
About a week before he died, Dr. Kligerman made the first referral to me he had ever made. He told me on the phone that he was seeing this woman in psychotherapy, and that he was referring her to me for couple therapy with her husband. He told me that he had had her on Prozac for some time, which seemed to be helping. I thanked him, and thought about the remarkable changes that have taken place in and out of our field in the past ten to fifteen years. Today, we are more likely to know that we don't know everything, to be more humble about our work and more open to all the therapeutic resources we can muster, not least psychopharmacology. We treat more patients who in previous eras would have been judged out of hand as unsuitable for psychoanalytic therapy, much less psychoanalysis. They are more demanding of us - of authenticity, of our attentiveness, of help - than used to be true of typical analysands. These are not people by and large who, in reaction to an unempathic comment by the analyst respond, as most of us did a decade or more ago on various couches, with: "Of course-- I needed that (...I guess)."
Another contribution has been our personal life experiences over the course of years. Analyzed though we were, knowledgeable as we thought ourselves to be, our marriages still went through rocky times and often broke apart on those rocks; our kids acted out, got depressed, had tough sledding. Many of our patients didn't get better. More analysis - for ourselves - sometimes helped, but sometimes didn't. If we knew so much, how come these things kept happening? Of course, no one ever promised us a rose garden; but more often than was admitted in the Institute corridors, analysts were still in pain, still struggling, at times barely successfully. (I got my comeuppance fairly early on; after terminating my analysis, during which time I had gotten married, Barbara in essence said: "This is it? This is as good as it gets? No, no, no, no!" We were shortly in couple therapy, and much the better off for it by a couple of years later.)
Finally - and more positively - we learned more. We did gain wisdom, but even more than the ability to formlulate people's problems more persuasively, the wisdom to understand the analytic process as a joint endeavor--as an exploration of ourselves in relation to the other as much as an exploration of the other's psychology. We came to understand the inevitability of enactments, of the importance but relativity of the narratives we constructed with our patients. We shared more of ourselves--not so much about our own lives, but about our experience in the room, with the patient. We became secure enough to accept our insecurity, even to expect it as inevitable.
So I start with the losses, the deaths. People who were important to us, and who will be sorely missed. But I end with what I can only experience as hopefulness and optimism. We are surely on the right track. It shows in my work with patients, and in yours. Certainly most of us will be doing much less four-times-a-week psychoanalysis, much less at the fees to which we had grown accustomed. But we have learned things that make virtually all of our encounters with patients more authentic, more vital, and more truly therapeutic. The requiem ends in a major key.
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The American has been studying the feasibility of proceeding with a CD-ROM project, in which all issues of five major psychoanalytic journals (JAPA, IJP, IJR, PSC and PQ) will be contained on a CD-ROM, with a search function for locating desired references. The cost will be $595 for individuals (less $100 if ordered early), and $955 for libraries (less $200 if ordered early). It will be formatted for both IBM and Macintosh. At our Business Meeting on April 23, I was instructed (by unanimous vote) to vote against this project in its present form. Our membership felt that it would not be useful to have only five journals rather than a more complete collection. We were also concerned as to whether adequate market research had been done, as the American will be committing 20% of its assets to this project. I presented our opinion in Council, but all other societies were in favor of this project, and it was passed with only one (Chicago's) negative vote. Some Council members pointed out that certain journals declined to participate because they needed the revenue they receive by selling back issues. Other Council members described having elicited great interest among candidates and Europeans (two groups who do not already have a full library of English language journals).
The proposals for restructuring the American, which had been presented by the Committee on By-laws and the Task Force on Board-Council Structure and Function have been put on hold for the moment. A new Select ad hoc Committee , chaired by Jon Meyer of Milwaukee, has presented a very different proposal, suggesting that the Executive Council can indeed function effectively as the Board of Directors of the Amer-ican, if Councilors are clearly informed about their responsibilities and are provided with the information they need in order to discharge their fiduciary responsibilities. It also recommends changing the name from "Executive Council" to "Board of Directors" or "Council of Trustees," to clarify this body's role. Regarding Council-Board of Professional Standards relations, the report describes the very different functions that these bodies perform, acknowledges the strife that occurs over certain issues that concern both bodies, and recommends measures to facilitate a full airing of views on these issues for Council's consideration. Discussion of this proposal will be conducted by e-mail among members of Council and all interested members of the American.
The Committee on Membership recommended that progression from affiliate (candidate) membership in the American to active membership should be made automatic upon graduation, and that a simple application form should suffice for graduates who have not previously joined. The Council approved both recommendations.
The Committee on Homosexuality reported that although five years have passed since the American publicized its non-discriminatory position on homosexuality, this position has not become widely known; and there are potential candidates who do not yet know that sexual orientation will not be a consideration in their application. It was suggested that the confusion may be due, in part, to the fact that not all analysts agree with the new position. In fact, a group of analysts (led by Dr. Charles Socarides) has formed the National Association for Research and Treatment of Homosexuality (NARTH). The American's newsletter, The American Psychoanalyst , has been publishing NARTH's announcements of meetings because of concern about abridgement of free speech. After extensive discussion, the Council recommended that TAP continue to publish NARTH's announcements, but also place the American's position statement on the same page.
The Budget and Finance Committee recommended that research be funded directly as a budget item, rather than through voluntary contributions on the dues statement; and that the officers of the American receive small stipends as partial reimbursement for the many out-of-pocket expenses they incur as they perform their duties. The Council approved both recommendations.
The American's Committee on Government Relations and Insurance (CGRI) and the Coalition for Patients' Rights (CPR) are now working cooperatively together. They are actively lobbying in regard to two bills:for the Kassebaum-Kennedy "portability" bill (which mandates continuity of insurance coverage for employees who change jobs), and against the Bennett bill (which, if passed in its present form, would require that all patient-therapist contacts be reported to a national data bank!).
The Peer Review's Subcommittee on Notes provided two clarifications to the practice guideline on charts which had been previously adopted. This guideline states that no notes are necessary beyond the initial evaluation and recommendation for psychoanalysis, as note-taking can "degrade" the treatment by intruding on the free-floating attention of the analyst. The clarifications state that 1) it is inimical to the psychoanalytic process to chart (for insurance reimbursement purposes) how many minutes late a patient may be for appointments, as this fails to acknowledge that the treatment is an on-going process; and 2) it also degrades the treatment to perform "negative charting" (i.e. to state that the patient is not suicidal, etc.). The Council was in agreement with these clarifications.
Jorge Schneider was elected Councilor-at-Large by the Council to complete the term vacated by Bob Pyles when he was elected President-Elect. The Council voted for the following slate of nominees for office in the American, to be voted on by the membership in the fall: For Secretary: Jon Meyer of Milwaukee and Paul Mosher of Albany; for Councilor-at-Large (two to be elected): Peggy Hutson of Miami, Donald Meyers of New York, Warren Procci of Pasadena, and Jorge. If Jorge is elected from this slate, and if he prefers to serve this term rather than the remainder of Bob Pyles' term, the Council will elect another Councilor-at-Large to fill that slot.
It is becoming increasingly important for psychoanalysts to have e-mail. Discussions of the important issues that face us will increasingly be conducted through this medium because of its inherent utility for this purpose. In addition, much money can be saved by the American as expensive mailings are replaced by e-mail communication.
My term as your Councilor ended at the conclusion of this meeting of the American. During the four years that I have served on the Council, I have seen it change from a passive, ill-informed group to an increasingly vigorous and demonstrably competent body. I have found it to be a very interesting and gratifying experience, both in terms of the work and of the new friends I have made. I would like to extend my best wishes to your new Councilor and Alternate, Drs. Mark Levey and Ron Krasner, and hope that they will find this experience as rewarding as I have.
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The first of my two years as President of the Society is drawing to a close. It's my impression that the two-year term is proving to be a good idea--giving the President the opportunity to oversee larger Society projects, providing follow- through, sustained efforts, and evaluation. Two major activities of the Society this past year have been: 1) to ask the membership to make a major commitment to the Public Relations Committee, both through a substantial dues increase and by participation in the activities it generates; and 2) to create a basis for the Society to offer much more to candidates and recent graduates that could be helpful to them both clinically and in their own progress towards gaining a solid identity as psychoanalysts.
There are several other projects at the planning stage that I will discuss in the fall. I hope that you all feel free to call me with any comments or suggestions about Society activities. I look forward to our next year together as professional colleagues. Have an enjoyable summer.
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Question: What psychoanalyst and Society member has her own
Answer: May Weber.
May Weber, at the age of seven, made a significant decision: having been given fifty cents for ice cream by her father, she elected to spend thirtyfive of the fifty cents on the purchase of an intriguing piece of Indian pottery, while on a family trip to the Southwest. May, a graduate of the Chicago Institute for Psychoanalysis in 1977 and a member of the Society since 1982, could hardly have imagined that this was the inception of a life-long interest in collecting art objects, which has grown in scope and extent over the past 20 years. As an ardent collector, May describes her collection as "living arts"--that is to say, forms of art which have a functional use in day to day life. These objects may range from altar pieces to mixing bowls.
Many Society members are collectors, of course, many with deserved reputations. May's collecting, however, is distinguished by her interest in sharing her collection with others. She has been unique in her effort to combine her collection with a passion for teaching, and the belief that mutual tolerance among humankind would be enhanced by increasing everyone's knowledge of world cultures through their art.
To promote her philosophy, she opened the May Weber Museum of Cultural Arts, and directed the museum for six years. It was a showcase of changing exhibitions of objects made for use in daily life, but clearly recognizable as well as works of art. May placed eight easy chairs throughout her museum to better provide a comfortable setting for her patrons, or for those wishing to do more intensive research. Exhibits ranged from "The Ritual Art of Papua, New Guinea," to "Containers of Spirit and Substance."
May has a special passion for educating youth, and through numerous outreach programs to children through the schools, hoped to promote the message of the oneness of all humankind. She regards this value as a heritage from her family of origin; she has a vivid sense that her parents treated all people with equal respect and regard, both in attitudes and behavior. The museum, through the exhibits, provided the children with opportunities to discuss and learn how the particular artifacts were used, how they were discovered, and the story of how they came to be in Chicago. In the best tradition of an art museum, her enterprise combined history, anthropology, geography, and economics, together with the aesthetic sensibility.
Alas, after approximately six years, the museum could no longer sustain itself financially, and in 1994 closed its doors to the public. May is in the process of negotiating with one of the Chicago area universities to house and promote her collection in a manner which would enhance college undergraduate as well as children's education in the Chicago area.
Who came first: May Weber the psychoanalyst, or May Weber the collector? Both obviously have their roots in childhood, but May adds that it was her study of history which led her eventually to psychoanalytic training. Serious collecting became an outgrowth of her interests in both history and psychoanalysis. Interestingly, May has earned masters degrees in both music and history; medicine was only a peripheral interest in her undergraduate days.
Within that group of unique and talented individuals which comprise the Chicago Psychoanalytic Society, May Weber stands out as an exceptional member. She has combined seemingly disparate interests into a coherent whole, and through passion and will, created something of rare substance, which she has generously shared with the community.
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In his January address to the Society ("Empathy in Broader Perspective: A Technical Approach to the Consequences of the Negative Selfobject in Early Character Formation"), Mark Gehrie described a class of patients profoundly traumatized in early childhood. In Gehrie's view the early negative experience of these patients forms a preverbal psychic structure or "template" which shapes all of their later affective experience. Gehrie implies - at least as I read him - that such patients are at the outset of treatment beyond empathy, transference, and interpretation: empathy (at least as usually understood) because it inevitably fails to reach them at the template's diacritical level of affect; transference, because it is the template-driven nearly biological compulsion to repeat that shapes these patients' responses, not a relationship to a narcissistically or libidinally significant other; and interpretation, because the experience which the template organizes is not verbally encoded. The patient learns of this lost experience only when the analyst (re?)constructs it. Only what Gehrie thinks of as the "dynamite" of the therapist's appropriately intense (often negative) affect is able to engage these patients at their emotional core and make egress from their archaic state possible. Thereafter Gehrie believes they may be analyzed along conventional lines. His point is that interactions or enactments which elicit the therapist's "level-appropriate emotionality" may be considered empathy of a newly-defined sort.
Dr. Goldberg responded by arguing that Dr. Gehrie's views of empathy, transference, enactment, and interpretation are unnecessarily restrictive. He believes that to empathize with patients who experienced constant and traumatic ruptures in the attunement of their early idealized selfobjects is precisely to understand that such patients will inevitably experience their analysts as constantly and traumatically failing to be empathically attuned to them. For Goldberg these ruptures and the negativity and rage that follow before reconnection can be fleetingly restored are not about a template-driven compulsion to repeat, but are transference par excellence: the result of the patient's shattered idealization of the analyst. For Goldberg the analyst's empathy consists not in understanding the patient so well that such ruptures can be avoided, but rather in understanding that such sequences are inevitable. Goldberg sees no reason to regard certain affectively charged interactions as privileged material for reaching the patient at the template's core level of affect because he believes enactments are ubiquitous in treatment and will unavoidably engage the therapist at the appropriate affective level. He dismisses Gehrie's concern that the analyst may iatrogenically pacify negative patients and thereby fail ever to reach them at the level of their core emotional reality because he believes that patients who need to see the analyst in a particular way will find him so and indeed make him so. Finally, Dr. Goldberg denies that such patients - even in their most archaic states - are beyond interpretation. He believes that even preverbal experience is ultimately verbally inscribed and psychologized when language acquisition reorganizes the self. Gehrie's undestanding of empathy in a broader perspective strikes Goldberg finally as leading toward the slippery slope down which therapists may justify any sort of non-interpretive intervention in the name of the need to reach the patient.
I would like to think that Dr. Gehrie is right about the value of the therapist's negative affects in certain cases, because his position - as I understand it - seems to justify much that I found myself thinking and doing in such cases. Nevertheless, I believe that my most representative patient has taught me to think that Dr. Goldberg's is the better understanding. It is with a view to adding her voice to this rich exchange that I write.
J., a 32-year-old professional woman, was almost unendurably negative. I found that my efforts to be empathic had little or no effect in mitigating her pervasive angry gloom, or in resolving derailments in the of-fice. It generally seemed that nothing I said or did ever pleased her or seemed in any way to lessen her suffering. Like Dr. Gehrie, I found myself embroiled with her in angry enact ments when I could bear no more of her depreciating rage. At times her tirades would threaten the peace of neighboring offices and I would declare sessions to be over. When she insisted that I was stupid and sadistic (often for refusing to see her outside the office) I suggested she seek treatment from someone whose ideas about therapy more closely accorded with her own. Despite my inability to manage the treatment in a way that didn't seem to me impossible she seemed to progress remarkably outside the office. As a result I wondered if my countertransference hadn't somehow unerringly guided me to the level of affect she required to experience me as caring and real, as Dr. Gehrie argued was the case with some of his patients. But J. wouldn't have agreed. She would have insisted rather that enduring my angry distress was what she had to put up with in order to have a relationship with me -- just as had been the case growing up with her parents. She would have cheered Dr. Goldberg for saying that when I enacted in an angry and retaliatory way it was to help me calm down and reorganize myself. It wasn't for her. J. would have said that when she felt hopeful it was in response to the moments I saw through her bitter complaints and cruel depreciation of me and found a way to speak to the wounded and fragile soul she was in her heart. These were the pearls with which she strung the treatment together.
Such a moment occurred during a memorable sequence of sessions in which her gloom, hopelessness, and stinging criticism of me became almost too much for me to bear. I somehow thought to ask her if she had ever been read to as a child. I said it seemed to me that when she was distressed it was terribly hard for her to calm down. I wondered how she'd been able as a little girl to get to sleep. She said she'd never been able to sleep when things had been stormy. Her mother had never read to her. I asked if she'd like it if I would. It was instantly clear that the spell we'd been under had been broken. We read fairy tales together for several months. I thought we had come through. Then my summer vacation interrupted us and shattered the fragile glass of our connection. The relentless intensity of her hostility and self loathing and my total inability to reconnect with her made me wonder again along Dr. Gehrie's lines if somehow empathy and transference hadn't been entirely beside the point. Perhaps I'd been deluding myself and what was happening was driven by some such mechanism as the template rather than any recognizable transference relation to me. My efforts to be empathic seemed only to enrage her.
J. insisted that I was utterly incapable of understanding her pain. After weeks of getting nowhere either by attempting to soothe her or by expressing my frustration with her I decided she was right. I agreed that my own experience in no way prepared me to understand hers. I decided to give up trying to be empathic entirely and to think of her as if she were from another planet. I'd simply try to learn the language of her affects and struggle to speak it. I would accept her hopelessness and gloom, her rages and pervasive paranoia, as if I were the curious but emotionless Spock from Star Trek. Her experience wasn't for me to question or understand, merely to witness and record. I was surprised to find this position liberating. I stopped expecting we would get beyond sequences of traumatic derailment followed by slow and painful reconnection, and tense and gloomy ceasefires. I expected these sequences as I might the phases of the moon. What was striking during the derailments was her absolute certainty that I wanted only to be rid of her. I began to regard this conviction as the heart of the sequence and then (perhaps because it was becoming less and less true of my feelings) the heart of the transference. Her mother had left her father and J. when J. was 11. She'd explained to J. that she wasn't going to take J. with her because J. was so "impossible." J. begged her to stay and threatened to kill herself if she wouldn't. Nonetheless her mother left.
Our sequence was similar. When I failed her J. would become enraged and "impossible." Eventually I'd suggest she see someone else. At this moment of truth she would become desperate to stay with me. For a very long time she insisted that our interactions had no relation at all to her history. But as the benevolent circle of calm in the office more and more came to replace the viciously traumatic one we had struggled in, she began to find linking our experience in the office to her life interesting and convincing. Her gloom became less pervasive, her depreciation of me less constant; she began to suffer my questions and occasion conjectures with curiosity rather than vexation. She began sensitively to observe herself. It seemed that in spite of myself she had taught me to be empathic with her. My emotions changed from angry and bitter to hopeful calm and curiosity. Increasingly I was able to use my feelings not with a view toward touching her directly at a core affective level but rather as a window to her own unspoken feelings and those of her earliest selfobjects. Enactment had been the means between us to ends (perhaps as Dr. Goldberg would have had it) first of misunderstanding, then to negotiation, and thence painstakingly toward understandings she experienced as empathic and attuned. Where actions had been, interpretation came to be.
I have come to believe that even in the early phases of treatment, J. was never beyond empathy, transference, or interpretation. When I allowed her to teach me the language of her affects, I learned to read her empathically. After a very long time I was able to follow her down the yellow brick road of the transference. Increasingly she began to tolerate what I believe were structuralizing interpretations. It was precisely the transformation of my strong negative affects, not their expression, that made possible this gradual process of understanding . What made her feel hopeful was my ability to withstand her destructiveness without retaliating. My experience with J. seems then to justify Dr. Goldberg's conviction that we do best even with very negative patients to rely on self psychology's classic paradigm of em-pathy, understanding, and interpretation.
For Dr. Gehrie the enacted expression of the analyst's emotion was itself an expression of empathy in a broader perspective because it reached the patient at the split-off level of core emotionality and opened a pathway to ongoing analytic work. In my experience with J. it was not the expression of emotion that was important per se - neither the positive enactment of the fairy tales nor the expressions of anger - but rather my understanding of my strong affective responses as an expression of something felt but unrecognized in J. herself (or in her early selfobjects), and my ability eventually to allow this understanding, like Freud's hysterical symptoms, to join in the conversation.
For me empathy in a broader perspective came to be about privileging the authority of J.'s knowledge and affects rather than my own--and this is the issue which I think is at the core of the Gehrie-Goldberg discussion. If I had insisted that she accept my assurance that her impossible behavior was based on a mechanism - an influencing machine - that she could only know about through my instruction, she would have left, as she had left many previous therapists with similar ideas of privileged knowledge. I feel certain that insisting, even if only initially, that J. idealize my authority to know her better than she knew herself would have foreclosed the transference revelation of her enormously fragile grandiose self. The effect of such a foreclosure I believe might have been the foreclosure of the very mirror transference whose truth I believe has begun to set her free.
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