Perhaps in some measure due to Freud's fascination with archeology, clinical psychoanalysis has tended to embrace an image of two people on a “quest”—a journey to reach an unknown destination to recover a buried past. Despite the fact that I rather like the image, in my day-to-day work as a practicing therapist, I seem to find my reality shaped more by Gertrude Stein than by Indiana Jones. Stein, commenting about the nature of life and the pursuit of goals, wrote that when you finally get there, “there is no there there.” My patients frequently make the same comment. The direct experience of “self-change” seems to be gobbled up by the reality of “who you are” at a given moment, and evades the linear experience of beginning, middle, and end. But linear time does indeed have a presence of its own—like the background ticking of a clock that cannot be ignored for too long without great cost—and it is this paradox that seems to make psychoanalysis feel like a relationship between two people, each trying to keep one foot in the here and now and the other in the linear reality of past, present, and future. Described this way, it sounds like a totally impossible process. If, indeed, “everyone knows that every day has no future to it” (Stein, 1937, p. 271), then what sustains a person's motivation for analytic treatment? How do we account for the fact that a patient remains in a relationship with another person for the express purpose of dismantling his own self-image for a presumedly “better” version that he cannot even imagine until after it has arrived? The answer, as I see it, touches what may be the essence of human nature—the fact that the human personality possesses the extraordinary capacity to negotiate continuity and change simultaneously, and will do so under the right relational conditions. I believe that this attribute is what we rely on to make clinical psychoanalysis, or any form of psychodynamic psychotherapy, possible. How we understand this remarkable capability of the mind, and what we see as the optimal therapeutic environment for it to flourish, are, I suggest, the fundamental questions that shape psychoanalytic theory and practice. What I talk about here is an outcome of this way of experiencing and thinking about the human relationship we call “psychoanalysis.”
For example, a patient is engaged in a passionate sexual moment that she refers to, in session, as “coming in diamonds.” She and her lover are “lost” in each other, and she, a woman who had entered analysis with “gender confusion,” has a visual experience that her lover's penis, moving in and out, might be his or might be hers. She can't tell “whose penis it is, who is fucking whom,” and “it doesn't matter.” How does the analyst hear and process this “loss of reality testing” at that moment?
Another patient reports having been reading a book in bed, looking down at the book, and noticing that it was wet. She realized she had been crying. What allows the analyst to comfortably conceptualize the fact that she didn't know she had been crying when it was happening? Does he think of such a mundane event as even interesting, analytically?
A patient, a woman with an eating disorder, is asked by her analyst to describe the details of last night's binge. She cannot do it. She insists, in a voice without affect, that she has no memory of the step-by-step experience of what she ate, how she ate it, and what she thought or felt as she was eating it. Resistance?
A new referral, perhaps an unanticipated dissociative identity disorder (formerly known as multiple personality), enters a trance state during an analytic session and, seemingly spontaneously, enacts a vivid portrayal of a child in the midst of a horrifying event, and then has no memory of that part of the session. How does the analyst perceive the “trance” phenomenon and his patient's subsequent report of amnesia for the event that had taken place before the analyst's eyes just a few moments before? From what stance shall the analyst attempt to engage the patient about any or all of this?
And now to the analyst himself. It is 7:45 a.m. Steaming coffee container in hand, standing at my window looking down at the street below, I am waiting for the “buzz” announcing my first patient, the cue that launches me into my chair—my haven, my “nest.” But my gaze is pulled as if by a will of its own, and inevitably submits as it does each morning. There he is! Just as he has been every day for months—in the same doorway next to my Greek luncheonette, half sitting, half sprawling, clutching an empty coffee container holding a few coins, some of them mine. Why must we share the same coffee container? I focus on the blue and white sketch of the Greek amphora and the “personal” greeting in simulated classic lettering: “It's A Pleasure To Serve You.” I think, somewhat irritably, “Get Lost! It's bad enough to see you when I'm buying my coffee—do I have to also see you while I'm drinking it? I need this time to relax! I have to get ready to help people!”
I hear a voice: “Why don't you just stop looking out of the window?”
A second voice replies, petulantly: “But its my window!”
The first is heard again: “Then why don't you give him something every day instead of just once in a while? Maybe you won't feel so angry at having to see him when you get upstairs.”
“But if I do that, he'll expect it every day,” the second voice argues. “He'll tell his friends, and then everyone will expect it. I'll have to give to all of them.”
“So what!” the first voice proclaims.
“But his needs are insatiable,” complains the second voice. “There's one of him on every corner.”
“Have you ever met someone with insatiable needs?” asks the first voice.
“I don't think so,” the second voice mutters defeatedly.
“I don't think so either,” says the first. “Do you think your patients have insatiable needs? Are you afraid of releasing a demon that will never go back into the bottle and will enslave you?”
That did it! I “woke up” and saw myself standing at the window, staring at the man in the doorway across the street. “Do I feel that way with my patients and deny it?” I wondered. “It's a pleasure to serve you, but stay in your bottle? It's a pleasure to serve you for fifty minutes but not to know you personally?” Oh, God, what a way to start the day. Ah, saved by the buzz!
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