Psychoanalytic Psychotherapy in the Independent Tradition

Stanley Ruszczynski, Sue Johnson, Sue Johnson

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429918025
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is a collection of papers to which seven senior members of the British Association of Psychotherapists have contributed. Each essay discusses a problem or impasse the author has encountered in the course of her clinical work with mainly borderline and severely traumatized patients. In this context the writers have all chosen those psychoanalytic concepts, mainly from the Independent psychoanalytic theories but also when appropriate those from Kleinian, Post-Kleinian, Contemporary Freudian and American contributions, that they found useful for the understanding of their patients' often painful psychic states they have brought to therapy. The implications for the transference and countertransference as they have evolved during the treatment process and their technical handling of them are discussed.

CHAPTER ONE

Who and whose I am: the emergence of the true self

Sue Johnson

The title of this chapter is derived from a question posed to me at the beginning of a session recently by a woman whom I have been seeing for intensive psychoanalytic psychotherapy for just under a decade. Without her being aware of it at the time, the search for her “true self” (Winnicott, 1960b) was what had originally prompted her to seek treatment. Her desire to find conditions in the outside world that will allow for its expression is at the core of our continuing work together.

In this account I shall try to show how my attempt to maintain a stance of analytic neutrality occasionally resulted in false-self behaviour on my part and how my momentary movements away from that position both paralleled and facilitated the emergence of the true self of my patient.

Before introducing the reader to Janet, it is perhaps worth first introducing myself.

At the time that Janet was referred to me, I was newly qualified as a psychoanalytic psychotherapist, and I had been practising for approximately a year. I was working in an agency with adolescents and their families, and I had a small private practice. In my previous work settings I had been required to make practical arrangements for clients, thereby involving me in more “real” contact, but I was keen to work in a more analytical way.

One dictionary definition of the word “neutrality”—the stance meant to be taken by a psychoanalytic psychotherapist—is: “absence of decided views, feeling, or expression, indifference; impartiality, dispassionateness” (Brown, 1993, p. 1911). My understanding of the phrase “analytic neutrality” came from Freud’s statement, “The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him” (Freud, 1912e, p. 118). At that time I took this to mean that I was to withhold anything personal about myself from my patients.

Looking back, I think it is fair to say that I took into the consulting-room something of a false self—what I then believed to be an analytically neutral one, but one that was, in fact, a false one. For the most part, I attempted to leave myself outside the consulting-room. It was the way in which, I believed, I would then not intrude into the analytic space that I provided for my patients. My experience was, I imagine, akin to that of Symington, who writes about how his narcissism as a beginning psychotherapist contributed to something of a “self-annihilation” when he was practising (Symington, 1996).

At this juncture the reader can probably see that this search for the true self was the point at which my patient and I met—she, searching to find her true self, I looking to find a way of expressing mine as a practising psychotherapist.

JANET

I will now introduce the reader to Janet.

Janet was 57 when she was referred to me by a consultant psychiatrist/psychotherapist at a therapeutic community. She had been a patient there for over three years following a breakdown several years previously, and she had recently made contact with him when she again found herself in difficulties. He recommended that she have intensive psychotherapy (minimum three times a week), and she readily accepted his suggestion. He told me that she came from the provinces and that she had grown up in a closely knit, intact family. Both of her parents had been dead for some years, as had her elder brother. She had two elder sisters, both of whom lived near her childhood home. She and her husband were both retired. She had been a teacher, and he a businessman. They had two grown-up sons. The referrer said that Janet’s memory was extraordinarily vivid and that when she spoke of any past happening, it was as though it had only just happened. The detail of each remembered event was as clear as a bell.

Janet arrived on time for her initial consultation with me. I opened the door, to be greeted by an attractive woman with beautiful silver-blonde hair. She was well dressed and immaculately groomed. Her hair and appearance were striking because her face was youthful but her hair denoted age. Her voice was that of a sweet little girl.

I remember little of the content of my initial consultation with Janet, but my memory of the atmosphere and of her sense of urgency is vivid. She spoke quickly and was worried that I would not take her into treatment but would, instead, send her away. She told me she had had three breakdowns—the first being after her mother had died 20 years previously. She described the events surrounding her mother’s death, just as my colleague had told me she would; it was as though no time had passed and she continued to be in deep grief.

Janet recalled being in her bedroom upstairs weeping when she and her family returned home after the funeral. Her husband came upstairs and reminded her that she had two little boys downstairs who needed her. At that moment she got up, put on a mask, and just carried on with life for the sake of her family. Since the year following her mother’s death, she had had various forms of psychiatric treatment for depression, including hospitalization, medication, ECT, and three years in a psychoanalytically oriented therapeutic community, where she had experienced various forms of treatment. One statement she said to me forcefully was that I would have to push her out when the time came—she would not be able to go.

My experience of Janet was that she was studying my face to find something; her look was a plaintive, searching one, which, at the time, I experienced as intrusive in that it seemed to allow no thought to take place, either in her or in me. In Diary of a Baby Stern says, when referring to 4½-month-old Joey: “After all, it is mainly in the face that we feel we can read one another’s feelings and intentions. And we start becoming experts at the very beginning of our lives” (Stern, 1990, p. 48).

In addition to scrutinizing me, Janet also talked non-stop. At the same time, she appeared to be wanting something from me that I felt unable to give while she was controlling me through her gaze and her speech. My experience was that she wanted to relate to me in a very real way, which left me feeling unable to occupy my therapeutic space, and I think because she was so anxious to please me, she compliantly agreed to use the couch. I believe it is true to say that it was my need for some distance—for some “neutral territory”—that dictated my need for her to use the couch (Winnicott, 1950).

Janet had been referred to me in June. As there were only six weeks before the summer break, I offered, as is my usual practice in such a circumstance, to see her once a week until the break and to begin then seeing her three times a week when we resumed in September. Janet readily accepted this, but after the second week of treatment she asked whether I could see her twice a week or even three times a week until the break. At the time I sensed a desperation in her, so I agreed to it. The reason she gave was that her eldest son was to marry in October. He wanted the reception to be at the family home, and Janet had agreed, but she was very anxious about her ability to cope. She did not want to begin intensive treatment just before the wedding.

My memory of those first six weeks of treatment is dim, other than to say that Janet continued to talk rapidly, anxiously filling up the space. She seemed unable to pause for thought. I listened and seldom interpreted. I had little idea why she had been referred to me but relied on my colleague’s assessment that intensive psychotherapy was the treatment of choice.

I have a distinct memory of being puzzled by one particular phrase Janet used. She talked in detail about individuals with whom she had grown up and, in describing people to me, she would occasionally say that the person was a “love-child”. Each time she used the expression, she would anxiously sit up, turn around, and look directly at me, then resume her position lying down. I remember feeling perplexed as well as somewhat irritated by this. Clearly she was looking for something, but I had no idea what it was. I believe she probably sensed my irritation and then resumed her position to please me. Her sitting up appeared to have a defensive quality to it—it was as though she no longer wanted to think but wanted instead to relate. I, in my “neutral mode”, tried to appear as unresponsive as possible in turn.

Janet returned from the summer break looking strained and tense. She sat on the couch and looked me straight in the eye. She said, “I have had a shock, and I knew I just had to hold on until you got back.” I was briefly left in suspense while she lay down and began recounting the events of the break.

She had great difficulty in telling me what had happened. Her account was as follows. She and her husband had gone down to the village where she had grown up to see her eldest sister, who still lived there. In conversation she had asked her sister why it was that at times she had been called by her middle name.

Her sister had retorted, “Well, that’s your name—that’s what is on your birth certificate.” Janet said she had never seen her real birth certificate—it had been lost—and the only one she had was the one that illegitimate children had. Her sister said, “Well, that’s what you are!” At this point her sister angrily got up, left the room, and returned with Janet’s birth certificate, which she thrust at her, saying, “There—read it!” Janet looked at the certificate and saw that the names given as her parents were not those of the people who had brought her up.

Janet was shocked and disbelieving. When she said this to her sister, her sister angrily told her that she had known about this—a childhood friend had told her when she was a little girl. Janet insisted she had never known that her parents were not her “real” parents. She then learned from her sister that she had been adopted at seven weeks. The person she had known as her father had been her uncle, her natural father’s brother. When Janet read the name of her natural mother, she did not recognize the name. Her sister told her that she was the woman Janet knew as “Auntie Margaret”. (In order to avoid confusion, from this point on I will refer to Janet’s adoptive mother as her “mother” and to her natural mother as “Auntie Margaret”.)

At that point Janet’s sister realized that Janet had not consciously known about her birth. She became frightened about what she had done by telling Janet and told Janet’s husband that she had thought she had known. She later acknowledged, however, that she had always believed that Janet should be told the truth; she felt that the deception had been at the root of Janet’s problems when she was a child and young woman, and was the reason for her repeated breakdowns following her mother’s death. Her parents had given Janet’s birth certificate to her elder sister’s husband, but he had been unable to tell her the truth about her birth, and, as her sister angrily said, “I was left to do it!”

Traumatized as she was when she related this to me, Janet said that when she saw the birth certificate, something clicked into place, and she suddenly discovered who she was.

I felt stunned by what I was being told.

Events in Janet’s life gradually began to make sense to her. She recalled having been terrified when her mother once threatened to send her to the “cottage homes” if she didn’t behave herself. She remembered asking her mother why it was that she, but not her sisters, went on weekly outings with Auntie Margaret, and being told that Margaret was lonely. She also recalled Auntie Margaret telling her to remember that two children she played with when she visited her were her cousins. As Janet couldn’t make sense of this communication, she thought one of them must be mad. Now she saw that Auntie Margaret had been trying to tell her that she was her mother.

She knew that as a young child she had often experienced acute confusion and had then always curled up in the foetal position in a chair in the kitchen and gone to sleep. She remembered the first time she had experienced despair. It had occurred when she was 13 years old, and she had been unable to understand what was going on around her and had concluded that she must be mad. She remembered comforting herself with the thought that if she could not stand it any longer and could not carry on, she could always kill herself.

In “Adopted Children in Adolescence”, Winnicott writes:

The adolescent needs to find out about the real world, and that important part of the real world which revolves about the general enrichment of relationships by instinct. Adopted children need this especially, because they feel insecure about their own origin. . . . Almost anything is of value if it is factual, and by the time a child gets near to a breakdown the need is so urgent that even unpleasant facts can be a relief. The trouble is mystery, and the consequent admixture of fantasy and fact, and the child’s burden of the potential emotion of love, anger, horror, disgust, which is always in the offing but which can never be experienced. If the emotion is not experienced it can never be left behind. [Winnicott, 1955a, pp. 141–142]

Later in the paper, he says:

Children have an uncanny way of getting to know the facts eventually, and if they find that the person they have trusted has misled them, that matters to them far more than what they have discovered. [Winnicott, 1955a, p. 146]

Not surprisingly, for many months following this revelation from her sister, Janet was traumatized. Not only were her parents not her parents, but she was also illegitimate. In addition, she became alienated from her sisters. She felt furious, rejected, confused, and frightened, and in the therapy she regressed dramatically. She was brought to and collected from her sessions by her husband— she had handed over her “caretaker function” to him and to me (Winnicott, 1960b). After some months we agreed to increase her sessions to four times a week and later to five times. Whereas previously she had been immaculately dressed and made up (wearing the uniform and mask she had donned following her mother’s death), she now came to sessions in sports shoes and socks and what she began calling “my rompers”. These were pastel-coloured velour suits that did, in fact, resemble romper suits.

For a long time she and I occupied what Winnicott, writing about transitional phenonema, refers to as “neutral territory” (Winnicott, 1950, p. 143), “neutral area of experience” (Winnicott, 1951, p. 239) and “neutral zone” (Winnicott, 1971a, p. 64). In “Playing, Creative Activity and the Search for the Self”, he writes,

The searching can come only from desultory formless functioning, or perhaps from rudimentary playing, as if in a neutral zone. It is only here, in this unintegrated state of the personality, that that which we describe as creative can appear. This if reflected back, but only if reflected back, becomes part of the organized individual personality, and eventually this in summation makes the individual to be, to be found; and eventually enables himself or herself to postulate the existence of the self. [Winnicott, 1971a, p. 64]

Janet required me to be there, not as an interpreting therapist, but instead as a provider of a setting in which she could retrace the path of her life given the new understanding she now had.

Once she had begun to recover from her shock, she began a search to find out the details of her early life.

As all four of her parents had been dead for some years, Janet had no direct access to a parental figure who could tell her about herself. She resumed contact with her sisters and learned from them that her mother had lost a little girl infant shortly before she herself was born. Janet had been described as “almost dead” when she had entered their family at the age of seven weeks, and the milk of one particular cow had been saved for feeding her. As for her natural father, she learned that he had made regular financial contributions to her parents for her keep and that he had ended his days in a mental institution. Her natural mother, Auntie Margaret, had moved in with her own sister and her family when her sister was ill and, following her sister’s death, had married her husband and raised his children. These children were the ones she had tried to tell Janet were her cousins.

Janet’s sister reminded her that, when she had been at the point of leaving the therapeutic community, she had planned to go to what was then Somerset House to look up their family tree. At that time her sisters were very frightened of her finding out the truth about her origins. When her elder sister told her of her birth, she believed Janet was pretending not to know and thought she had learned the truth when she went to Somerset House.

While Janet was engaged in her conscious search to find out about her roots, she was also unconsciously motivated to learn details about my life. I was a live human being—not dead, like her parents—but the details of my life were a mystery to her. Her curiosity about me was exceptional, and was unconsciously motivated by her desperation for me not to be a mysterious figure to her. At the time I experienced her behaviour as exceedingly intrusive.

The post sometimes arrived during Janet’s sessions and was lying on the mat when she left. By scrutinizing the post, she discovered a number of things about my life. I frequently received post from abroad from a woman with an unsteady handwriting and a surname that was the same as the middle name that appeared on some of my letters. Janet rightly deduced that this person must be my mother. On one occasion she asked me whether she could have a magazine contained in a piece of post. On another occasion, when another middle name appeared on a letter, she became furious and demanded to know just how many names I had!

At this point Janet was beginning to be able to be angry in the present, and my middle name enabled her to express anger she had been unable to express in relation to her own middle name— the very thing that had provided the occasion for her to learn about her birth.

As I have already said, for a very long time Janet was brought to and collected from her sessions by her husband. One morning they arrived very early and were waiting outside when my husband and I returned from our morning walk. I recognized the car from some distance as we approached it and felt very awkward and embarrassed to be seen outside my house in my grubby clothes (as opposed to...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Acknowledgements
• Contents
• Contributors
• Introduction
• 1 Who and whose I am: the emergence of the true self
• 2 The concept of internal cohabitation
• 3 How far is transference interpretation essential to psychic change?
• 4 The absent mother: splitting as a narcissistic attempt to find a solution
• 5 The move from object-relating to object-usage: a clinical example
• 6 The potential for trauma in the transference and countertransference
• 7 Erotic transference and its vicissitudes in the countertransference
• 8 Dreaming and day-dreaming
• References and Bibliography
• Index