Self-examination in Psychoanalysis and Psychotherapy

Countertransference and Subjectivity in Clinical Practice

William F. Cornell

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429886775
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Self-examination in Psychoanalysis and Psychotherapy provides open and intimate accounts of the experience of being in psychotherapy. The internal life of the therapist is as much at the heart of the stories told as those of the clients. William F. Cornell here writes in a more personal and literary voice, avoiding as much as possible, the dense theoretical language that often typifies analytic writing.

Central to the thesis elaborated in this book is that of how the therapist's own personal history and unconscious motivations can deepen or distort the therapist's understanding of the client. One chapter is devoted to the frank discussion of the author's work with a client that was not only unhelpful but in fact harmful. Cornell emphasizes the capacity to call one's self into question as a fundamental outcome of psychotherapy and psychoanalysis. Attention is paid to the conscious and unconscious forces that create profound dynamic tensions between the enlivening desire for a fuller life and the defenses that deaden one's capacity to think and to engage more fully in one's life and relationships. The dynamics of transgenerational transmission of grief, loss, and trauma are also examined closely.

The psychotherapist as person and professional, rather than the clients, is at the heart of this book. Self-examination in Psychoanalysis and Psychotherapy will appeal to all psychoanalysts and psychoanalytic psychotherapists who will find an exceptionally open discussion of the challenges, learning, and meanings of being a psychotherapist.

Chapter 1

What am I getting myself into?

We are not born knowing how to live the lives that we are about to enter. When we are reasonably fortunate, our earliest years teach us that people can care for one another, that our relationships help us feel more secure as we grow and develop, and that we are welcome in this life. As we grow and if we remain reasonably fortunate, our childhood and adolescence years are opportunities for tremendous learning and skill development. A satisfying life is a skilled life, the product of a lot of learning fostered by the interest and support of those who care for us. We need to learn many skills – skills for the forming and keeping of social and loving bonds, skills for separation and differentiation, skills for healthy aggression and conflict resolution, skills for work, skills for play, skills to think and create meaning in life, skills to deal with frustration, failure, and personal misdeeds, and skills for sexuality and intimacy. Most of us are fortunate enough in our family and school environments to arrive at adult life with a reasonable range of these skills for living. When we are this fortunate, we most likely had a growing-up environment that helped us accept and integrate differing, and sometimes conflicting, aspects of the self.

But, in fact, most of us have significant gaps, or downright gaping holes, in our abilities to grapple with all that life brings our way. These gaps in our emotional and psychological competencies can undermine our sense of what is possible for us in life. Most of us try to rely on our familiar skills to cover or compensate for the blank or damaged spaces. But it is these gaps in our abilities to live life at its fullest that bring most people into psychotherapy, seeking a place to learn to mind and mend the holes within ourselves.

People rarely enter psychotherapy in a happy and contented state of mind. Far more often than not, people come into psychotherapy with troubles in mind. In the background of the presenting problem, people are often distressed with their internal relationship to themselves. People all too often start therapy with a deeply held belief that there is something wrong with them (or with everyone else). As people enter psychotherapy, many are plagued by self-perceptions of character flaws, sinfulness, stupidity, failure, shame, or unlovableness. Some attribute these flaws of character onto those around them, blaming others for their own unhappiness. Whatever the case for a particular individual, few enter psychotherapy with hope and optimism.

It was more than 30 years ago when Suzanne first entered my office. I was still, one might say, learning my trade. I had had the good fortune of several years on practice in an extraordinary community mental health center where I was able to work with a broad variety of clients in individual, family, and group treatment models with a wonderful group of creative colleagues. I was now in full time private practice. My formal trainings were behind me, and I was beginning to formulate a more personal frame for how I understood what it meant to be a psychotherapist.

Suzanne, having just passed her 50th birthday and considering retirement from her position at a university, was neither happy nor content in her life. Our work over the next several years was pivotal to my maturation as a psychotherapist. We sat for our first session together, me busy gathering the basic facts of her life and her reasons for considering psychotherapy. For me, this first meeting was routine. Then she abruptly asked, “So, what am I getting myself into here?” My routine was upset. I responded, rather awkwardly, that I did not really understand the intent of her question. She explained that she wanted to know how psychotherapy actually worked. She wanted to be reasonably sure that she was spending her limited time and money well. She said she knew people who had really changed in psychotherapy, “but I don’t understand what psychotherapy is or how it works.” An informed and brilliant answer did not roll readily out of my brain and off my tongue. How does it work? I wondered silently to myself. Should I recite my favorite theories to her? What am I getting myself into as a therapist to this very bright and unhappy woman? I wondered to myself. I knew what the textbooks said about the mechanisms of psychotherapy, what Freud suggested, and what my various theoretical models had taught me to think, but this was not quite what Suzanne was looking for in her question.

When Suzanne asked me what she was getting into? I ventured forth, improvising on the spot: “We’ll be looking at the parts of your life that aren’t working effectively and see if we can understand why they aren’t working and what you might do differently. We’ll also be working actively with what emerges between us as our relationship develops. Either of us, at any time, can address our relationship directly – conflicts, appreciations, surprises, mistakes, deceptions, impatience, excitement, misunderstandings – whatever may affect the quality and effectiveness of our working together. We tend to create in the therapy whatever we tend to exclude or distort in daily life. We need to identify, understand, and change those patterns. It’s not always comfortable to do this, but this is a place to practice.” My comments were based in some of the basic tenets of transactional analysis, which include the use of the actual interactions as they occurred between client and therapist to explore and understand the client’s difficulties. “Not a bad improvisation,” I thought to myself at the time, although I knew there was probably much more that could be said.

No one had ever before asked me this rather obvious question in such a direct way at the start of therapy. I have since learned that many clients enter therapy with this question in mind but do not feel free to ask it. It was in this initial encounter with Suzanne that I began to realize that such an initial discussion provides an important foundation for the therapeutic work that follows. Psychotherapy is a difficult and exciting endeavor. It is work, rewarding work much of the time. Like all work, it can be difficult and frustrating. The therapeutic relationship can at times be gentle and supportive at times but challenging, conflictual, and even disorganizing at other times. Beliefs and ways of being that one may have taken for granted about one’s self, life, and other people will be opened to question. Psychotherapy offers the opportunity to examine ways of relating to one’s self internally and with others interpersonally. Psychotherapy examines present-day relationships, on the one hand, while looking at the lingering influences of historical, childhood relationships on the formation of current beliefs, feelings, and behaviors. The relationship between the therapist and the client, in the here and now, is one of the most important relationships to be examined as a means of personal understanding and change.

Suzanne had led quite an interesting life up to the point at which she decided to consider psychotherapy. Now as she considered retirement from her post as a university professor and campus minister, her life looked – from the outside – to be filled with accomplishments and, one might readily imagine, personal satisfaction. Suzanne was one of a handful of women to gain admission to a certain theological seminary and eventually to become an ordained minister and professor of theology. But she did not experience much pride or satisfaction in her professional accomplishments.

Suzanne was the only one of her siblings to leave the poor, rural area where she grew up, the only one to go to university, the only one to win any visible public and professional acclaim. And yet she was the “black sheep” of her family. Now, as she approached retirement, she was alienated from her family. Throughout a lifetime of professional struggle, she lived alone, could not sustain close personal relationships, and suffered recurrent bouts of depression. She was terrified that her retirement would be marked by relentless loneliness and depression. Suzanne decided to enter psychotherapy to see if she could understand and change her depressive and isolating tendencies and thus create a different sort of retirement.

Suzanne, like many people who enter psychotherapy, was extremely successful in certain realms of her life, while lost and ineffective in others. She consciously chose transactional analysis psychotherapy because she had read a number of transactional analysis books (Berne, 1961; Steiner, 1974; Erskine, 2016) and found them sensible and somewhat helpful. She had done enough reading and talking with colleagues to know that many of the transactional analysis authors and organizational leaders were women. Some had made contributions to the feminist literature, which had great value to her. Suzanne said she understood herself better from the reading but still could not significantly change her way of living.

Suzanne thought that she needed to be in long-term, psychodynamic therapy, even though she didn’t actually know what it entailed. She knew that in some way she needed the help of a professional in order to examine and change the way she had been living her life. In that first session, she told me she would rather be dead than live the rest of her life in the way she had been living. She felt like she had been enduring a living death, a half-dead life. This was not a suicide threat, but neither was it exactly an enthusiastic embracing of life and its possibilities. She wanted to know what it was we would be doing. The nature of long-term psychotherapy is a mystery to many people. It is not a normal and familiar way of relating to someone else. Images of “shrinks,” “mind readers,” saviors, and gurus often come to mind. Psychotherapy begins as the meeting of two strangers, each with initial impressions and fantasies about the other. In our first meeting, I found myself conflicted in my first reactions to her: admiring her (and a bit intimidated) on the one hand, and fearful that I might not be able to offer any real help. I felt an intense pressure as I imagined that the relationship that we developed with each other could afford Suzanne with a living example of what was possible between people and open new possibilities for her life. At the same time, I was worried that if I “failed,” she might passively or actively end her life. If we continued past this first session, she was entrusting me with her life. I wasn’t sure I wanted that responsibility.

It is part of human nature to try to make sense of life, of others, and of ourselves. We constantly create and tell stories: As children we listen to stories, then we read them to ourselves, we may even write them, and we watch them on television and in the movies. Stories can excite, soothe, disturb, explain, or entertain, thus serving many important psychological and emotional functions. We all have favorite stories from and about childhood; we grow up with family stories and have our own recollections of important childhood events. Stories help us make sense of life, providing not only a chronicle of history but tales of meaning and expectation as well. Life stories can be lived like an historical novel, a great adventure, a fairy tale, science fiction, a romance, a whodunit, a thriller, a tragedy, or even as a bad joke. Suzanne would probably have described her life’s story as falling somewhere between tragedy and a bad joke.

We have an innate hunger for psychological structure, for creating and maintaining familiar and predictable ways of making sense of ourselves internally and of life around of us. This need for psychological structure fosters a tendency to create accounts of our lives, stories, which can provide psychological stability and meaning. But these stories can also limit how we see life’s possibilities for ourselves and others. The power of childhood stories can be such that we turn new experiences into the same old thing, not even noticing the newness of what just happened. The power of “the same old thing” can create patterns that can make the outcomes of life seem inevitable, and changes seem impossible.

For example, seen from the outside, Suzanne was typically praised as intelligent, independent, and highly principled. As her therapist, I would not quarrel with these characterizations. However, as I came to know her, I came to see that the story of Suzanne’s life, as she experienced it, was considerably more complicated and disappointing. She was cast as the “black sheep” of the family, the misfit, the unwanted daughter and sibling. She was the youngest (and unexpected) child, a burden to her mother who turned her over to the care of her older siblings. Little Suzanne’s sisters and brother were already adolescents, and they did not welcome a new baby. They did not want to be bothered with serving as babysitters or substitute parents. This relentless sense of never being really wanted, or enjoyed, formed the unconscious foundation of the stories that came to define Suzanne’s sense of her place and meaning among others. It also created a split within Suzanne’s way of thinking about herself, so that she developed a public self, marked by a pride in her independence that hid a self that longed to belong with others, a longing which she came to reject within herself.

Suzanne gradually came to conclude that depending on anyone was bad news. She had a multitude of storied memories that reinforced her conclusion. These were the stories that informed, shaped, and defined her. This was her lot in life, and she came to see herself as a secretly unwanted, but begrudgingly accepted burden to those around her even as she moved through her adult life. Suzanne did not leave home because she wanted to but because she was not wanted – no one wanted her to stay. Her siblings all stayed in the area and remained involved in each other’s lives and families. For Suzanne, leaving home for the university was a kind of banishment from her family. No one from her family came to visit while she was at university. In fact, they found her whole life at an urban university quite threatening.

As a girl, Suzanne had found church comforting and the privacy of prayer and religious fantasy very soothing to her lonely soul. She found some kindness with the parish minister. She came to identify with him and eventually set off for a theological seminary in a major city, hoping to be able to offer others the kind of solace that he had offered her. However, once at the seminary she found herself ripped from her family and the comfort of a small country parish. She landed in an academic community dominated by arrogant men who disliked, and probably feared, women. They were not the gentle, sensible parish minister with whom she had grown up. She found herself, again, a black sheep, unwelcomed and unwanted. Given Suzanne’s experience of life to this point, being a black sheep in the seminary seemed to her to be inevitable and somehow deserved, the same old story continued.

Transactional analysis therapists often refer to such stories about oneself and the world as life-long “scripts.” The term script, rather than story, captures the sense that we often feel as though these stories have been written for us within our families and then imposed upon us. Although we, at least in part, create these stories (often unconsciously) ourselves, we often feel as though we are following someone else’s wishes, as if we are speaking lines handed to us as in a script of a play or movie. It was with this aspect of her readings in transactional analysis that Suzanne most identified; she had a profound sense of continuing to be trapped in scripted roles imposed upon her by her family and reinforced at the university. As children, we create roles that seek to adapt to our families and cultures so as to have a sense of belonging and to avoid disapproval, punishment, or outright banishment. Gradually, but repeatedly, these early life experiences foster story lines that take deep roots in our developing psyches. It comes to feel as though we are being taught certain fundamental and unquestionable lessons about who we are to become and what life is going to be like. Some parts of our personal stories can be exciting, unpredictable, and open-ended. But the “script” aspects of the life story feel like the deep ruts in a well-worn road.

Are we the author of a story or a character in someone else’s design for us? One of the important ways that psychotherapy works is that therapist and client work together to identify the enduring and compelling stories of one’s life. This is another aspect of the answer to the question Suzanne asked me in our first meeting. In our initial hours of working together, I felt the impact of Suzanne’s life stories. I wondered if I would be able to help her find some freedom from her life-long sense of being unwanted. This, unconsciously, was also the beginning of my own experiencing her as a burden. There were many hours to come in which I did not look forward to seeing her and in which I would not feel welcoming to her.

Suzanne, as the designated black sheep of her family, was extremely sensitive to any sign of my not liking her or “wanting to be rid of her.” She anticipated from the beginning (even before meeting me) that being a psychotherapist I would be biased against her religious orientation, regarding it as childish or dumb. Suzanne expected me to want to get rid of her. If I forgot something from a previous session, she viewed this as evidence that “as soon as I’m out of sight, I’m out of your mind.” Our work together almost collapsed when I double-booked her session after a vacation. Even though I owned the mistake as mine, and the other client agreed to come back at another time, Suzanne felt that I had humiliated her and that this was clear evidence that I did not care and wanted to be rid of her. In Suzanne’s mind it seemed perfectly obvious that she had somehow become a bore or a burden to me. As it had always seemed within her family, she now felt herself to again be a burden on someone she had hoped she could depend on. So, it seemed better to her to leave treatment at the first sign of trouble than wait for my inevitable rejection of her.

This mistake on my part, and Suzanne’s reaction to it, became a pivotal moment in her therapy. It was clear to her that we were both extremely uncomfortable in the face of my error, but I did not get rid of her. She could see that I could tolerate my own discomfort and maintain an investment in her wellbeing. This provided her with an emotional space within which we could begin to examine her various reactions to my having forgotten her appointment. She was able to begin to see that the only way she could understand my mistake was as an indication of my desire to be rid of her. She could consider that this habitual explanation was an expression of her life stories that imposed a particular meaning on what had happened. If this attributed meaning were accurate, it made sense that she (as usual) should prepare to leave yet another important place of hope in her life and again go it alone.

Suzanne began, very tentatively, to see that this life-long, ready-made explanation did not always fit the case. As she was able to see the power of her compelling expectations – those well-worn psychological ruts – with me, she was increasingly able to gain insight into herself. She began standing apart from the power of the stories of her past and saw how these assumptions played out in other relationships as well as ours. She realized that there were other times when she presumed she had become undesirable or a burden to someone and left the relationship. She began to see that there could be other reasons for difficulties in relationships and that solutions could be found to allow her to stay rather than leave. For Suzanne, as for most of us, these life stories, drenched in histories of failure and disappointment, are at one and the same time achingly familiar in our minds and compelling in their power and automaticity.

The unconscious enactment of one’s life stories within the therapeutic environment is most commonly called transference. This example of Suzanne’s transference reactions to me underscores one of the most important tasks of the psychotherapist and a crucial aspect of how psychotherapy works through the transference. In this instance, her transference reaction reflected her early childhood experiences of being an unwanted burden to those around her. When transference is not examined and understood, it has the power to reduce any new relationship into the same old and predictable story. The analysis of transference is an invaluable means of insight and pattern recognition, a crucial mechanism in how psychotherapy works. Often in work relationships, friendships, and our most intimate relations, we live out elements of our “scripted” stories without ever being aware of them, feeling instead resigned to predictable ways of relating, inevitable disappointments, with little that ever seems new or creative. Therapy allows us to engage in a mutual, respectful scrutiny of how and why we do what we do. Part of the therapist’s job is to stand simultaneously inside and outside this relationship as it develops. Therapy provides a space within which to reflect together and experiment with new meanings and possible ways of relating.

Of course, the therapist is also a human being with a past. In working with Suzanne, I was bringing my own past unconsciously into play between us. As for myself, while I did acknowledge and take responsibility for my mistake, I did not examine the reasons for this mistake within myself in the way that Suzanne and I had examined her reactions....

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• Introduction: Trouble in mind
• 1 What am I getting myself into?
• 2 Stumbling in the shadows
• 3 Calling one’s self into question
• 4 Failure
• 5 Finding a mind of one’s own
• 6 The therapist’s body at work
• 7 The disappeared self
• 8 Haunted
• 9 When life and death hold hands
• 10 Staying alive until the end
• References
• Index