The Analyst's Vulnerability

Impact on Theory and Practice

Karen J. Maroda

• Editorial: Routledge
• Año: 2021
• ISBN:
  9781000411454
• Edición: 1
• Categoría: Psicología
• Categoría: Psicoanálisis

This book closely examines the analyst's early experiences and charactertraits, demonstrating the impact they have on theory building and technique. Arguing that choice of theory and interventions are unconsciously shaped by clinicians' early experiences, this book argues for greater self-awareness, self-acceptance, and open dialogue as a corrective.

Linking the analyst's early childhood experiences to ongoing vulnerabilities reflected in theory and practice, this book favors an approach that focuses on feedback and confrontation, as well as empathic understanding and acceptance. Essential to this task, and a thesis that runs through the book, are analysts' motivations for doing treatment and the gratifications they naturally seek. Maroda asserts that an enduring blind spot arises from clinicians' ongoing need to deny what they are personally seeking from the analytic process, including the need to rescue and be rescued. She equallyseeks to remove the guilt and shame associated with these motivations, encouraging clinicians to embrace both their own humanity and their patients', rather than seeking to transcend them. Providing a new perspective on how analysts work, this book explores the topics of enactment, mirror neurons, and therapeutic action through the lens of the analyst's early experiences and resulting personality structure. Maroda confronts the analyst's tendencies to favor harmony over conflict, passivity over active interventions, and viewing the patient as an infant rather than an adult.

Exploring heretofore unexamined issues of the psychology of the analyst or therapist offers the opportunity to generate new theoretical and technical perspectives. As such, this book will be invaluable to experienced psychodynamic therapists and students and trainees alike, as well as teachers of theory and practice.

Part I

The analyst as a person

Chapter 1

The analyst’s early experiences

Anyone who has chosen to become an analytic clinician is keenly aware that there is something deep and primitive about that decision that eludes understanding. We readily acknowledge the positive and obvious reasons for our choice, like wanting to help others and have meaningful work. Yet, most of us are aware of deeper needs being met by doing therapy. The same is true for our theories and the ways in which we prefer to work with patients. The purpose of this chapter is to orient the reader to the idea that everything about why we became therapists, how we build our theories, and how we practice, is significantly shaped by our own early experiences. I want to begin by looking at some of the early experiences that contribute to our vocational choice. I will then explore the numerous related issues that include our fear of doing harm; our tendency toward passivity rather than action; our ambivalence about technique; our need to see ourselves in an overly-positive light; the personal nature of our theories; and the impact of gender within the transition from classical to relational analysis.

In A Curious Calling, Michael Sussman (1992) speaks openly and extensively about both our motivations for doing treatment and the ongoing gratification for the therapist that is essential, albeit largely unconscious. He notes that if you ask therapists why they chose their profession, you will get generic answers about wanting to help people, doing something to change the world, wanting to solve problems, and making money. The point of his work and my own (Maroda, 1991, 2010) is that our true reasons for being therapists are mostly unconscious (although capable of being brought into awareness) and have historically been ignored as a subject for scrutiny—even in personal analysis. Some of the finest minds in psychoanalysis have addressed this subject, but somehow it has never gained traction.

Jacobs (1993) acknowledges that our reasons for becoming therapists have much to do with our early childhood experiences, particularly being the sensitive, empathic child who provides comfort to a depressed mother (Olinick, 1980, Sussman, 1992). Searles (1979) reflects on the common therapist experience of guilt, questioning its origins.

Thus, it may not be so much that our doing of analysis tends to promote guilt in us, but rather that we originally entered this profession in an unconscious effort to assuage our guilt, and that the practice of analysis fails to relieve our underlying guilt. For example, we may have chosen this profession on the basis of unconscious guilt over having failed to cure our parents. (p. 28)

More important for our ongoing work as clinicians is that we, just like our patients, carry these early experiences and motivations with us for a lifetime. The goal for us, and for them, is not to rewrite history but rather bring it into awareness in the interests of greater conscious control and less internal conflict. As we treat other people, we are necessarily working through our own issues and attempting to overcome our guilt and become the best people we can be. As Kite (2016) insightfully observes,

I will go on to suggest that the personal history of the analyst, known or not, understood or not, has everything to do with how we live our version of analysis, and a great deal to do with how our patients experience us. I will also suggest that we may become analysts in the first place in order to clarify who we are ethically to ourselves. (p. 1160)

In this way, we attempt to redeem and save ourselves. In some sense, this is our greatest strength—our need to help others. We were rewarded early in our lives for being unusually sensitive and empathic; over time, we naturally extended this skill set into a career choice. But this embedded need to relieve others of their pain can also be our greatest weakness, in that we are prone to taking too much responsibility for their distress. Doing so produces excessive guilt in response to our patients not doing well, particularly if they are blaming us for their suffering—as they often will. Making things more complicated is our potential guilt for what Brenner (1985) referred to as our “wish to see another suffer” (p. 158).

We become analysts to prove, in part, that we are not destructive—that the pain in our families was not our fault. We survive and assuage our guilt in doing so by spending our days attempting to emotionally connect with others. As Celenza (2010) says, “The skill of using ourselves to help others find themselves coincides with our own pressing need to heal ourselves and to do so by finding ourselves in the other” (p. 60).

A supervisee of mine, who had the benefit of being well into middle age, surprised me at the onset of our work together by simply stating that her new patient’s history of being unloved and rejected by her mother resonated deeply with her own similar experience. She added that feeling her patient’s pain took her to an even deeper experience of her own pain, even though she had explored this thoroughly in her personal analysis. She said this in a matter-of-fact way with no guilt or shame—something I have rarely seen. We agreed that we never lose the ability to revisit our own painful experiences, and she felt hopeful about helping this very difficult patient achieve some of what she had achieved in life. She wanted more for her. She readily admitted to feeling guilty that she had a husband and children, plus an analysis early in her life, unlike her occasionally homeless patient. She also had no illusions of being able to save her, focusing instead on simply helping her to improve the quality of her inner and outer existence.

Her frank admission and acceptance of the gratification she experienced in working with this patient, combined with an equally deep understanding of the potential for this identification to go awry, made for a potentially compelling experience for me as well. Working with therapists who understand their own countertransference repetitions, and who are eager to explore them in their work, makes for both a better therapeutic outcome and a better supervisory experience.

A personal story

In the interests of transparency, I will disclose some of my own motivations for becoming an analyst. My mother came to the United States from Australia, having married my father there during World War II. To put it mildly, she never adjusted to being here. My father’s parents came over from Hungary and spoke little English. His sisters did not care for my mother and resented her for coming from a significantly higher socioeconomic class. They thought her “haughty” with her highbrow British-sounding accent. When people called the house, they thought we had a maid. My mother became wearily accustomed to jokes about kangaroos and questions about whether or not her family was descended from criminals (they weren’t).

My mother was naturally quite playful and charming. She loved music and laughed easily. She was warm and nurturing. I loved her deeply. But she was also incredibly sad and lonely. My father was a workaholic, and she depended on her three children for company. My older sister resented her neediness; my twin brother felt overwhelmed by it. I anguished over her pain and worked daily to take it away. When she was terribly upset with us for misbehaving, she would emptily threaten to go back to Australia, then apologize later for speaking out of frustration and anger. Looking back, I think I took on the job of making sure she didn’t ever really want to leave.

My story is not just about fear of loss and excessive responsibility for my mother’s feelings; it is also implicitly a story of ambivalence. As much as I loved my mother, I also hated her passivity, her seeming unwillingness to make a genuine effort to assimilate and build a life for herself, and her expectations that I would be a consistent soothing presence. As I write this, I am aware of my own warnings about the possible idiosyncratic nature of theory-building. Nonetheless, I think it reasonable to suggest that to the extent that therapists were their mother’s keepers, they also would share this ambivalence. (I will leave it to the reader to decide.) During my childhood, I was not aware of these feelings, of course. But I did become aware of them in adolescence, especially in the face of my older sister’s rage at my mother.

This is only a keyhole into my childhood experiences, and I have observed myself confronting many aspects of my relationships in my family, including with my siblings, in the course of doing treatment. I will also add that my early interest in countertransference came both from my own intense feelings toward my patients (and desire to rescue them) and also from experiencing my analyst’s intense countertransference to me. The Power of Countertransference (Maroda, 1991) is, in part, my account of that struggle.

I want to insert the caveat that I do not think it necessary for analysts to describe details of their early childhood experiences when they present or publish, since no one is entitled to this very personal information. And many would question this practice, given that patients would potentially have access to this material. I think we could do justice to our early contributions simply by weaving this idea into the narrative of what we believe and how we practice. When describing a particular encounter with a patient, we might simply make reference to some general aspect of our own personalities or early life that contributed to what was going on, be it positive or negative. Accepting that our own motivations and needs play a major role in our professional identity and daily clinical work has the potential for changing the narrative in a profound way.

The fear of doing harm

From Freud’s early admonitions to act like a surgeon to current controversies regarding any systematic use of self-disclosure, the theme that consistently arises is that of potential harm. From my perspective, this fear of doing harm exceeds the expectable caution born out of legitimate professional concern for doing right by the patient.

Since most analysts are very decent, hard-working, dedicated professionals, why would such a fear be so pervasive? I think Searles’ argument about our shared guilt goes a long way in understanding these edicts. Even if it is suppressed, at some level, we all know that we are getting some personal needs met in our relationships with our patients. Is the hidden knowledge of this personal benefit producing so much guilt and shame that we need to overemphasize our role as not only “good enough” caregivers but also as self-sacrificing humanitarians (Orange, 2016)? Moreover, to what extent is this fear of harming patients a reaction formation in response to the repressed anger that arises from our internal mandate to put others first? Although it is quite evident from reading the literature that our fear of doing harm is substantial, there is little discussion of why this is so.

On this topic, Prodgers (1991) cites Storr (1979), saying,

Storr (1979) makes similar points about the personality of the therapist. Anecdotal evidence points to a high incidence of depressed mothers amongst trainee psychotherapists who acquired a sensitivity through judging her moods. They also learn to put their own feeling secondary to hers—another prerequisite for the therapist. Making demands often then leads to guilt and fears of damaging others in relationships. Putting others first is the safe option but inevitably means repression of aggression. (pp. 146–147)

Thus, our unfailing preoccupation with being good can be seen as a reaction formation—an irrational defense against our own guilt and anger about having precociously surrendered our own well-being (Miller, 1997). Focusing on the needs of others, and developing a finely tuned ability to instantly read another’s moods, necessarily produces a degree of resentment. What child wants to be his/her mother’s or family’s keeper? Yet expressing this resentment runs counter to the role of soother and peacemaker, and therein lies the problem. I think that therapists of all persuasions have an aversion to expressing anger toward their patients or even feeling it, because it stimulates this irrational fear of not only failing to soothe but also to harm. This is the conundrum that we need to break free from.

Accepting our inevitable ambivalence toward both the work itself (Kravis, 2013), and often toward our patients as individuals, could provide the necessary momentum to advance both our theoretical formulations and our clinical interventions. Even more important is the acceptance that we are not without memory or desire. As poetic and appealing as Bion’s famous line is, I think it is not a realistic approach to doing treatment. I appreciate that his prescription was meant to encourage receptivity rather than deny our personal biases and needs. Nonetheless, his words are often taken more literally, denying the considerable realities that prevent such a state from truly existing.

Even as an aspirational concept, it does more harm than good, in that it sends the analyst’s thinking in the wrong direction. Rather than seeking to have no needs or desires, we would benefit from expecting to have them and working to bring those needs into awareness. One might argue that Bion’s words are meant to counterbalance the realities of the states of mind and biases that we naturally bring to each session. Just as with all countertransference, there will be needs of ours that arise with most patients and those that arise less frequently and more specifically with certain people. In any event, we all bring our own personal desires, needs, and wishes for the patient into each new treatment relationship, and we may begin a session with needs or desires that have little to do with the patient sitting before us. And even with our work ego in place, striving to minimize the impact on our patients, success is highly dependent on our own self-awareness.

Striving to transcend primitive feelings of resentment, fear, despair, hopelessness, and rage only results in the need to deny these feelings or try to inhibit them when they occur. We are much more comfortable, of course, with deep experiences of joy, exhilaration, pathos, and love. Furthermore, this volume pursues the concept that unconditional acceptance of the patient’s negative feelings and behaviors, though easier than accepting our own, represents an unrealistic wish to both have and to be the idealized, loving mother. As Searles (1966) said,

I surmise that wholehearted acceptance of the patient is another unrealizable goal. We could unambivalently love and approve of and accept our patient only if he were somehow able to personify our own ego ideal—and in that impossible eventuality, we would of course feel murderously envious of him anyway. (p. 35)

Miller (1997) has elegantly detailed our...