Theoretical and Clinical Perspectives on Narrative in Psychoanalysis

The Creation of Intimate Fictions

Joye Weisel-Barth

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000287554
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

This book is of and about psychoanalytic stories. It describes the personal, theoretical, and cultural stories that patients and analysts bring, create, and modify in analytic work. It shows how the joint creation of new life narratives over time results in transformed senses of self and relationship.

Flowing from the tradition of narrative theory, these stories seek to recast the creation of analytic narratives in social contexts and contemporary relational theories. They depict ongoing therapeutic process and heightened interactive events and moments that together expand personal scope and change life directions for both partners in the analytic dyad. Its stories illuminate sometimes difficult and arcane analytic theory, bringing the meanings and utility of theory into living action. They also show how familiar emotions such as love, hate, envy, and loneliness, and active human values such as empathy, generosity, and good faith function in psychoanalytic interaction. In short, these analytic stories are useful teaching tools.

The narrative tales in this book address a wide range of history and emotions in both patients and analyst. The patients, fictionalized characters from a lifetime of analytic practice, are protagonists with backgrounds of trauma, loss, relational and geographical dislocation, but also successful adaptations and struggle toward self-development. Some of their stories describe intense short-term work and others long-term analytic relationships. The subjective experience and responses of the analyst are also central parts of the analytic fictions.

The book will be invaluable to readers curious about psychoanalysis, for therapists, and especially for teachers of therapeutic issues and process.

1 On my becoming an analyst

An overview of the contemporary analytic world

This story is about my patient Lara and me, placed in the context of my becoming a psychoanalyst. I hope the story not only traces my learning and growth process, but also illuminates the many worlds of psychoanalysis that I discovered in my training: the theoretical, clinical, and political worlds it inhabits. This is a rather long piece because in it I want to capture the maze of personal, cultural, theoretical, and associational paths that touch every psychoanalytic couple. These paths are dense, circuitous, and often lead to unexpected and surprising places.

Lara, a fascinating woman, trauma survivor, and long-term psychotherapy patient, agreed to be one of my control cases when I was in psychoanalytic training. I invited Lara to psychoanalysis because in our early therapy it was difficult for us to develop a working rhythm. Everything about Lara was rapid, darting, and hard for me to capture: her speech, her decisions, her mood shifts, etc. It was like trying to catch a grasshopper in a meadow full of grasshopper delights. Our once or twice weekly therapy did not allow sufficient time to hold her, to grasp each other, or to explore her inner world. I hoped things would change with the increased time and space that psychoanalysis provides. I felt lucky when she agreed to the analysis because Lara was a complex and challenging person from whom I expected to learn a lot. This turned out to be the case.

Shortly after the analysis began, I was invited to present Lara’s and my work at a self psychology conference in Chicago. Robert Stolorow and Lewis Aron, two analytic luminaries, would respond to my paper. Estelle Shane, my supervisor, would moderate the panel. With Lara’s approval and lots of trepidation, I accepted the invitation, and here is the case I shared:

Patient: Lara

Lara came to see me in distress about violence. She was in a destructive relationship with an alcoholic and compulsively unfaithful man. Her encounters with this man had become increasingly violent, violence in which she participated by baiting him and hitting him in their drunken rages.

Lara is a middle-aged beauty with patrician features, dark, well-cut hair, and hazel eyes. Her dress is either casual urban chic—good slacks and Armani jackets with the sleeves rolled—or else raggedy blue jeans and boots, her “cowgirls-get-the-blues” look. She brings her big old dog to sessions, a loving yellow lab. A year ago Lara agreed to be an analytic control case and come to treatment four hours per week.

Lara grew up on an isolated farm with her intact family: parents, an older sister, and two younger siblings, a boy and a girl. Her father, charming and charismatic, was also an alcoholic womanizer. Many people from political, literary, and theatrical circles visited the farm. Lara says, “There were two different groups of people at our home: interesting artists and intellectuals and vicious alcoholics. The same people belonged to both groups depending on the amount of alcohol consumed.” In the grip of alcoholic states the father and mother physically battered each other, violent encounters that Lara and her siblings witnessed. The father also beat the children in unregulated rages.

Her mother, the daughter of a socially prominent family, suffers from schizophrenia. Lara remembers her childhood mother as drunk, ineffective, violent, and not much involved in childrearing. Once, during Lara’s adolescence the mother went on a rampage and trashed Lara’s bedroom. Her father was kinder to her, and as a child Lara identified with her father’s strength. When she was a teenager, the parents divorced. Mother now lives in a transient motel.

Lara’s childhood was socially isolated and largely unsupervised. In addition to the domestic violence, she suffered from many early traumatic experiences. These include several sexual molestations—by her uncle, neighbor boys, and drunken family friends; an automobile accident that sent her—alone at 4 years old—to a hospital for several weeks; and a public school tenure in which her classmates, poor rural farm children, treated her as a social pariah. Lara wandered the farm to comfort herself and found an imaginary friend. Set into the stone wall bounding the farm was a medallion of a little deer. Lara imagined that the faun would come alive to play with her and protect her. She believes she saw it move and look at her on several occasions. This faun has been a kind of talisman for Lara in her life, a balm for her loneliness.

Lara left home early, left college early, and became a model and actress. She also became a jet setter, involving herself sexually with a roster of fast, famous, and powerful men. She participated in orgies. The history she describes is one of sexual exploitation, heavy drug and alcohol use, and occasional physical violence. Initially, she defined her life as moments of intense drama and of narrow escapes. Now she identifies her sexual experiences as “spaced-out,” devoid of feeling, episodes of dissociation.

When Lara was in her mid-twenties, her younger brother committed suicide, an act she blames on her father’s brutal treatment but for which she also carries deep grief and feelings of guilt.

At 28, Lara married a man known equally for artistic genius, destructive drug use, and reckless behavior. During the marriage he beat and sexually abused her. She fought back. Although divorced now, they still maintain close personal and business ties.

The treatment

During the first stage of our psychotherapy work, the transference was negative and testing, Lara often angry with and critical of me. How could I say so many stupid things? How shocked was I by graphic depictions of her sexual exploits? Could she seduce me with her tales? Sometimes! Could I stand her impulsive behavior, temper tantrums, and sometimes foul mouth? She would watch me, head cocked to the side with the smile of a naughty child, as she narrated some outrageous incident. She was surprised and touched when I commented at every opportunity on her strengths: her generosity, her senses of justice and loyalty and humor, her street smarts, her kindness to animals, and her ultimate self-restraint—the ways in which she played at its edges but never let herself fall into the abyss. In fact, our closest therapeutic moments have occurred when I have surprised her expectations; when instead of criticizing her, I have gotten beneath her narrative to find tender meanings.

Shortly into the psychotherapy, Lara tried to please me by becoming “a good girl.” She would proudly report holding her temper or saying “No” to some powerful man. She even broke off her relationship with the alcoholic for a while. In return, she expected perfect therapeutic behavior from me, and was enraged when I came up short. She became even more sensitive to and critical of my every word, frequently accusing me of clumsiness and obtuseness in dealing with her. For example, with respect to her alcoholic lover, she felt I disapproved of the relationship and did not respect the depth of their mutual feelings. She scolded me for weeks “for not getting it right.” I acknowledged that she read my concern about the relationship correctly.

When I presented her the offer of an analysis, she accepted immediately. (Parenthetically, Lara had left a classical analysis with a male analyst in early adulthood.) Later she wanted assurance that I would not become cold and clinical. She also insisted on my choosing a woman supervisor and liked my supervisor’s name: Estelle. She called her Star. Lara argued that no man would comprehend her story. In her view, even if a woman supervisor missed something or was mistaken about something, at least a woman can admit a mistake and rectify an error.

Once Lara and I began analytic work, the clinical focus softened and mellowed. The difference between our psychotherapy and the analysis was like the difference between a spotlight or laser beam, on the one hand, and the wash of indirect ambient lighting, on the other. In the time-constrained weekly therapy, our attention had been sharp and concrete, concentrated on current life and relational events, on immediate problems in need of immediate solutions. Like a track hurdler, Lara talked fast and leapt from topic to topic. At the end of our weekly sessions, I often felt tired as after a race, my powers of concentration taxed and exhausted.

With increased time, Lara’s pace slowed, and the contents of the hour changed. She began thinking more reflectively, formulating and making sense of dominant life patterns. Her attention and the clinical material became more diffuse and the connections between topics more associative. She began to time-travel seamlessly between the present and past; she brought in more dreams; and painful sequestered memories emerged. And there were increasing silences between us, silences that were filled with emotion and reflections and that seemed to move the process between us along. The expansion of therapeutic space enabled Lara to elaborate her narrative of early deprivation, neglect, and abuse. Telling the story slowly allowed the emergence not only of long-buried incidents but also of long-buried sorrow. Particularly in relation to her dead brother, Lara has expressed profound grief.

Like Lara, I experienced diffuse attentional states as the analysis deepened. While these states stimulated imaginative associations, they affected my immediate memory. For example, as I reviewed each session, my recall was fuzzy. Then I realized that I had joined Lara in softening the therapeutic focus and, in doing so, had somewhat relaxed my rational faculties. The relaxation of focus afforded me a different experience of Lara, afforded me a chance to access her in the aesthetic/subjective/affective way that people like Marion Milner describe. Milner, for example, posits a two-stage aesthetic process that begins with being present with the object in attentive tranquility. In this state there is a continual oscillation between unconscious and associative activity relating to the object on one side, and more objective “surface mind” activity on the other. The second stage of the process involves state sharing with the other in an intersubjective dialogue in both verbal and non-verbal modes.

In such a state I attended to non-verbal as well as verbal emotional exchanges that took place between Lara and me. I also developed a deep caring for “Little Lara,” the child as I imaged her: an eager and lonely little girl. For example, a vision took shape in my imagination of her roaming the family farm, her childhood home. In the vision she is about 4 years old, spunky, joyful, and curious, but also unsupervised and imperiled by the natural dangers of the rural terrain: hills, gullies, a running stream, and a storm culvert where, she told me, she sometimes used to hide. This image vibrates with some feelings I have about my own unsupervised childhood. It provided me with one of many points of emotional identification with Lara.

With respect to the non-verbal in the analytic relationship, then, contemporary inquiry has many interests. As in the above example of “Little Lara,” it focuses on the analyst’s personal images and associations, which a patient’s presence may evoke. In addition, analytic interest is tuned to subtle changes in the physical features of the analytic interaction: in facial and vocal expression, in body posture and demeanor, and in the rhythm and tone of dialogue. Finally, contemporary analysts concern themselves with more overt, non-verbal actions and strategies called “enactments.” Enactments represent the meeting of psychologically meaningful unconscious and unarticulated patterns in both patient and analyst. Both partners express these patterns behaviorally in the therapeutic relationship. Meaning-makers by inclination and training, analysts explore with patients the meanings, personal and relational, which underlay enactments.

An example of an enactment happened eight months into Lara’s analysis. It was my first day back at work after a two-week vacation and fifteen minutes before our scheduled appointment. I was looking forward to seeing Lara, anticipating a happy reunion without considering any negative possibilities. This emphasis on the positive—with some might say a disavowal of the negative—is a characteristic, and sometimes problematic, pattern of mine. My front doorbell rang—my office adjoins my home. There stood Lara, looking forlorn and stricken. “You forgot me,” she said in an accusatory but pitiful wail. Because I was glad to see Lara, and because her distressed demeanor seemed so out of place, for a second I thought she was joking. But I quickly saw she was genuinely upset, on the brink of moving from sadness and panic to rage. “I waited for you, and now I’m leaving. I can’t talk to you now.” She turned to go, her voice scaling in anger.

I paused a moment to catch my breath before pursuing her. I must have looked some combination of shocked, confused, and stricken myself because, when she turned back and saw me, Lara stopped, stared, and said with concern, “Are you O.K?” In response to her concern, I recovered sufficiently to recognize that Lara had mistakenly arrived early to our session. Thinking I had forgotten and abandoned her, she had become distressed and panicky. When I said something to acknowledge these feelings, she softened, her eyes tearing. We went into the office and teased out the meanings of the enactment.

The transaction indelibly reinforced my image of Lara as a little, abandoned, and emotionally disorganized child. Behind her angry withdrawal, I felt she had allowed me a glimpse of her early fragmented emotional life. The enactment also lent itself to a traditional transference interpretation—something to the effect that, based on early family experience, she expected me to desert her. The incident also revealed how flat-footed I can be when unforeseen circumstances upend my positive expectations.

Reviewing the enactment, however, I was most interested in how, together and wordlessly, we had negotiated our mismatched emotional states. Her sadness and my happy anticipation, her anger and my confusion, my distress and her concern, my empathy and her tears—these shifts expressed themselves in facial expressions, vocal intonations, and muscular and postural tension to a greater degree than they did in words. This was a non-verbal emotional dance, the choreography of which rested on habits of mutual observation and previously established trust and goodwill.

One way to speak of the dance is as an event happening on the level of procedural memory. In contrast to declarative memory, which has to do with symbolically mediated and verbally articulated recall, procedural memory relates to non-verbally mediated memory. Procedural memory, in effect, is embodied emotion expressed in action, emotion made manifest in sequences of behaviors occurring wordlessly and out of awareness.

Feeling pain is difficult for Lara, and she has a number of avoidant and protective strategies to distance herself from emotion. For example, she often cancels the session following an intense analytic hour. At times she wants a phone session from her bed. Then, Lara brings her dog to analysis to guard her. Together we have observed that the animal does, in fact, regulate and modulate her feelings. If she is angry, distressed, or crying, the dog lumbers over and nuzzles her or licks her hand. Lara also relieves intense feeling by changing the subject. For example, she might abruptly shift from a painful memory to some superficial observation about my hair or clothing. I sometimes feel annoyed at the resulting choppiness in the flow of our sessions.

In addition to these strategies, Lara protects herself from painful emotion by isolating narrative content from feeling. To illustrate: Lara has horrible dreams in which demonic men pursue, threaten or sexually attack her. In different dreams these men assume different guises: “Machete Man,” “Gangster Man,” “Murderous Men of Color,” menacing men, faceless or masked, and sexual predators, unknown and renowned, wielding all kinds of lethal weapons. In these dreams her places of refug...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Credits
• Preface
• Introduction I: Stories, imagination, language, and the development of mind
• Introduction II: Sample stories
• 1 On my becoming an analyst: An overview of the contemporary analytic world
• 2 On analytic certainty and delinquent dissembling: The case of Sharon
• 3 Analyst envy in working with an artist: Four scenes
• 4 Thinking and writing about complexity theory in the clinical setting
• 5 Waking sleeping beauty in the case of Emily: Mutual dissociation from a systems perspective
• 6 Stuck: Choice and agency in psychoanalysis
• 7 Malignant loneliness and its clinical implications
• 8 Bad faith and analytic failure
• 9 Temporal disturbance in the case of Maya: Musical dissonance, and the failure of future vision
• 10 Courting the “real” and stumbling in “reality”: Confusions and hazards of relational practice
• 11 Katherine: A long, hard case
• Index