Category Archives: psychoanalytic theory

Balancing Act

April 25, 2013 By in psychotherapy, New therapists, psychoanalytic theory, branches of psychotherapy, Ecopsychology, Archetype, Depth psychology Tags: , , , , , ,

Objects fly through the air, stars wheel through the universe. All fall eventually. If we become obsessed with definitively mastering the decline, we are lost. If we achieve peace within the intervals of rising and falling, we find grace.

(Arthur Chandler, On the Symbolism of Juggling: The Moral and Aesthetic Implications of the Mastery of Falling Objects. http://www.juggling.org/papers/symbolism/)

In the minor arcana of the Rider Waite tarot deck, a juggler is depicted, in the act of balancing, exchanging, juggling the flow of energy between two large coins. In more ancient decks, The Juggler (now more commonly titled The Magician) was considered a symbolic entity important enough to be placed in the front of the archetypal gallery of Major Arcana.

The cards are said to represent balance, as a positive action. Reversed, the card implies imbalance, the need to recover the center and rhythms necessary to keep the balls steady and flowing movement through the air between human hands. The message of the Juggler is this:

Learn at first concentration without effort; transform work into play, make every yoke that you have accepted easy, and every burden that you carry light.
(Anonymous, Meditations on the Tarot: A Journey into Christian Hermeticism, p. 8)

The conception of medical, physiological homeostasis permeates psychological diagnosis. Traditional western psychology and psychiatry seek to identify and quantify the archetype of a perfectly balanced mind, as well as create diagnostic codes for all the ever multiplying transient or enduring ways that we can find ourselves out of balance. Even the Diagnostic Manual’s Global Assessment of Functioning Scale (which assigns all human functioning a number between 1 and 100 – 1 equaling imminent death and 100 representing The Perfectly Balanced Human) evokes the archetypal Master Juggler:

100-91 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. (DSM IV Global Assesment of Functioning Scale – emphasis mine)

And certainly, a preoccupation with the processes of balance, counterbalance and imbalance in all its forms: equivalence, compensation, correspondence, fairness, justice, homeostasis, equilibrium, equality, symmetry, evenness, centeredness, quid pro quo, and tit for tat have been woven into the very fabric of all psychotherapeutic contemplation.

In Freudian thought all dreams, slips and symptoms are potential solutions to states of internal imbalance. The uncoordinated triplet team of consciousness – Id, Ego, Superego – attempt to pass and juggle conflicting needs between each other. One member aggressive and full of appetite, another practical and concerned with working the crowd, and the third, the conscience of the troupe trying to keep the other two in check. A symptom, in this model, is merely one aspect of the self over-correcting for the wild toss of another. The analytic therapist’s job is to help the bickering internal troupe get their act together.

For Jung, dreams, and unconscious phenomena are acts of counterbalance and compensation for whichever stance we have consciously identified with. The Unconscious swings and tilts to balance out whatever it is we believe to be true about ourselves in our waking Conscious life.

In narrative, social and environmental therapies the circle widens. The individual is embedded in a system which is inherently out of balance. Personal imbalance is seen as an extension of and appropriately reactive to injustice, narrative burden, unsustainability, or unconscious guilt stemming from being the un-entitled beneficiary of or hoarding resources without true entitlement.

And each of these seem to me, as always, to be single facets of a still incomplete truth, all of them more incomplete without the others.

An overcommitment to consciously maintaining personal balance creates its own form of disease: A life that is seemingly, superficially never “out of hand” simply banishes chaos to its hidden depths.

A perfectly and consistently balanced human, if one were to exist, would be inert, fixed, stagnant, immobile, inanimate. How monstrously impervious this perfectly balanced human, would be, more of a “thing” than a “who.”

The existential therapies remind us that we are no thing, nothing at all, and that teetering on the brink of meaninglessness, discombobulation and existential dizziness are necessary to apprehend the brevity of our lives, and begin to take real responsibility for our choices and our effect upon each other.

Some ascetic Sadhus, Hindu holy men, spend many years standing on one foot, discovering the balance that can only emerge from negotiating an asymmetrical stance.

Life is inherently out of hand; death, illness, pain, loss, grief, war, disasters natural and man-made, trauma, heartbreak, abuse, cruelty, racism, sexism homophobia and heteronormativity, oppression and injustice in all its forms, including the depletion, exploitation, and hoarding of the earth’s resources. In the face of all that life can throw at you there are times when blatant mental imbalance is the sanest, healthiest most healing response.

We are all embedded in enormous systems, familial, social and planetary, which are also cycling, swinging wildly, falling in and out and passing through imbalance, equilibrium and back again. Living and breathing balance requires and contains imbalance within it.

We will all lose our footing.

No one is impervious. We will all drop the ball.

The universal deadly sin of every routine is The Drop. Dropping is so common in juggling that every performer must come to terms with the inevitable accident that breaks the rhythm of the routine and calls one’s skill into question.
Since drops are inevitable, and even the most accomplished professional jugglers drop in public performance of their routines, one might well ask why a drop should be considered such a disaster.

Part of the reason has to do with the psychological interaction between the audience and the performer….Admiration for the juggler becomes submerged in the more general feeling of wonder at what the human mind and body can accomplish together. It is the overcoming of gravity with style and grace, and produces the kind of internal affirmation that comes with any art or sport done supremely well.

The drop breaks the spell. The audience is reminded of human fallibility when the juggler has to stop and start all over again. Now the creeping doubt has entered everyone’s mind: will the juggler drop again? The second drop confirms this doubt, and the audience now sees only a struggling human being endeavoring to ward off disaster. After the third drop, even the memory of the magic is gone, as both performer and audience only wait for the ordeal to conclude.
(Arthur Chandler, On the Symbolism of Juggling: The Moral and Aesthetic Implications of the Mastery of Falling Objects. http://www.juggling.org/papers/symbolism/)

Extreme imbalance, too many too repetitive “drops” become destructive in their own way. They break down the faith that others have in us, along with our faith in ourselves, our resilience and the world around us.

One of the most common early by-products of imbalance in intimate personal relationships is resentment. If the spirit of quid pro quo is violated, exploited, or ignored, and the energetic, logistical and personal exchange becomes too chronically lopsided resentment compounds, festers and mutates into toxic contempt, hopelessness, and love-killing exhaustion.

Learning how to make necessary corrections and adjustments to preserve the loving core of intimacy is the work of couples and family therapists: Do I accept and try to accommodate the low ball, hold out for a higher toss, or stop trying to feed my partner the ball in just the way they demand it? Should I ask for more, settle for what I’m getting or give less?

When one member of a family or social system changes their rhythm or their stance – the entire network is thrown out of its precarious homeostasis, everyone reels and teeters. “Change back!!” they seem to cry, as their footholds crumble out from under them. A deeper equilibrium, a truer justice often requires that we mourn the loss of an unjust balance and pass through a period of disorienting imbalance before we find a stance that allows everyone to have some part of their need acknowledged and met.

Our relationships, and perhaps Love itself require some balancing component in order to thrive, and without it, we will too soon reach breaking points, beyond which the old center can never be recovered.

We hold many apparently imbalanced relationships as sacred in the service of growth and nurturance: Parent and child, teacher and student, sponsor and sponsee, therapist and client. There are vast power differentials, discrepancies in knowledge and experience and attention, the most obvious giving flows in one direction. Yet, there are symmetries, larger circles of justice exchange and evenhandedness at play: Someone gave this to me, so I now give it to you. In caring for you, I care for untended aspects of myself.

The mystic symbol of justice, that is equivalence and equation of guilt and punishment. …In its most common form two equal scales balanced symmetrically on either side of a central pivot. A Dictionary of Symbols, J. E. Cirlot

All of our theologies and most of our philosophies circle around cycles of cosmic balance and justice. We construct an evenhanded tit for tat, eye for an eye, the equivalence of opposites: Heaven and Hell, Good and Evil. Alternately we embrace the long view of cyclic karmic justice: what goes around comes around. Souls are weighed and balanced in the afterlife in the mythic psychostasis: in ancient Egyptian cosmology, the human heart is weighed on cosmic scales against the feather of Maat, the goddess of order and justice – while a monster “waits below the scale, ready to devour the unbalanced heart.” (The Book of Symbols The Archive for research in archetypal symbolism pp. 512)

Individual psychological equipoise and the ultimate cosmic balance intersect to complete the hermetic formulae and the Master Juggler’s circuit: As it is above, so it is below. As it is below so it is above, As it was in the beginning, so it will be at the end. As it is within, so it is without.

The therapist, is only supposedly, a skilled juggler and juggling teacher – able to keep many balls in the air, managing their own internal and external challenges to equanimity and flow while incorporating all that the client throws at them, and passing back the ball at the right speed, spin and rhythm so that the client can receive it, polish up their own act, and expand their bag of tricks. Therapists make split second assessments as to whether a client is trapped in sticky bullshit stasis, if they need to pushed off of a false-too-comfortable standpoint – or if they are reeling too near to dangerous overwhelming imbalance requiring all the therapist’s skills to help them stabilize. Young clinicians often wonder, when they have fallen on their asses, in life or in session, if they themselves are stable enough to go forward in the work.

I am no Master Juggler although in session I have learned to keep quite a few balls up in the air. Usually just one or two more than any given client, (although sometimes, admittedly, I must scramble to keep ahead).

Just as the Juggler or magician has had to train and work for along time before attaining the ability of concentration without effort, similarly, he who makes use of the method of analogy on the intellectual plane must have worked much, i.e. to have acquired long experience.
(Anonymous, Meditations on the Tarot: A Journey into Christian Hermeticism, p.10)

I’d better at least look like I’m good at it by now. I’ve been practicing almost everyday for nearly two decades – and perhaps for long stretches I can manage to appear as if it never gets out of hand.

But it does. Of course it does. I get knocked off my pins, blown off my center, lose my flow and rhythm and toss out ill-timed passes with humbling regularity.

The drop is inevitable.

And although I can still be shaken when my act has inadvertently slipped into an ordeal for the most part I have learned to enjoy the momentary peace within intervals of rising and falling.

copyright © 2013 All rights reserved Martha Crawford

Strange Dreams

February 9, 2013 By in Depth psychology, Dream work, Ecotherapy, psychoanalytic theory, Shadow Tags: , , , , , 2 Comments

You know those nights, when you’re sleeping, and it’s totally dark, and absolutely silent, and you don’t dream, and there’s only blackness, and this is the reason, it’s because on those nights you’ve gone away. On those nights, you’re in someone else’s dream, you’re busy in someone else’s dream.

Some things are just pictures, they’re scenes before your eyes.
Don’t look now, I’m right behind you.

~ Laurie Anderson, Someone Else’s Dream, lyrics

The first time it happened was early in my career, too early for me to know or understand the phenomenon well – and certainly too early to trust it.

I was working in milieu therapy, a day treatment unit, where several hundred “severely and persistently” mentally ill adults came each day to receive their medication and case management, group therapy, art therapy and rehabilitation.

I dreamed that I was wearing a police officer’s uniform, and one of my clients was begging me to spank him, while he masturbated.

I was startled by the dream, it felt different in tone and quality from my “usual dreams” whatever that meant.

I explored it in my own therapy extensively – looking at the countertransferential sadistic and aggressive impulses that emerge when working with clients who have difficulty containing their own aggression. I considered the power and class differentials between me and my stigmatized, disempowered clients, and tried to examine my privilege and the authority, authoritarian, and social control functions that I was expected to serve on the treatment unit. I explored my personal, familial and historical associations to the specific client, to police officers, to spanking, and to domination and submission.

I explored my own sexual fantasy life – but, the sexualized aspects of the dream somehow felt off: a dream could have shed light on power/authority issues without sexualizing it.

But, the sexual nature of the dream just didn’t feel like my kind of kink.

The next week, the dreamed of client came in for an awake, daytime session and confessed that he had been embarrassed to tell me that he had been having masturbatory fantasies about me for sometime. He imagined me, dressed up as a police woman spanking him.

I felt enormous relief. The strange bits of the dream weren’t mine. The dream was about my role on the unit, and also about the ways I had been subtly, unconsciously pulled by this specific client to “police” and monitor his compliance and program attendance in ways that were stimulating to him, perhaps over-stimulating to him, and which made perfect sense with the clients history of sexual and physical abuse.

That was when I began to understand, many years, before I began to study Jung, that my own dreams about clients were not merely about my individual psyche.

I told my therapist excitedly about my new realization and he responded:

“Be careful.”

Be careful of what, I wondered? It seemed to me that I was in greater “danger” or getting pulled more deeply into some destructive authoritarian enactment, scolding or punishing, or chastising a client who could feel too stimulated by it if I hadn’t had the dream.

The dream had clearly protected me, and the client. Surfaced a dynamic, an unconscious currency, an exchange that was already present, but unspoken, unacknowledged.

The dream itself wasn’t the danger.

“If a dream shows me what sort of mistake I am making, it gives me an opportunity to correct my attitude, which is always an advantage”
~ C. G. Jung, Dreams

I left a long message on my therapist’s answering machine after that session, certainly too long, trying to shake off the undermining caution, and the traditional psychoanalytic models of dream theory that we had both been indoctrinated into

The various psychoanalytic branches which grow off of Freud’s ego psychological tree view dreams as subjective and individualized experiences, as a portal to unconscious conflicts which are about the clients personal history – and the conflicts from the past which have been transferred onto the therapist or other loved ones. And an analyst’s dreams could only reveal something about the analyst’s individual, private psyche, and transferences. If an analyst were to dream about a client, it would speak to their countertransference, the aspects of their own historical conflicts, or perhaps a dangerous over-identification, activated and constellated in the treatment.

I don’t know about your dreams. But mine are sort of hackneyed. Same thing, night after night. Just…repetitive. And the color is really bad – And the themes are just – infantile. And you always get what you want – And that’s just not the way life is…
~ Laurie Anderson Talk Normal, lyrics

There was another, more minor dispute about dreams a year or so later. Another one of “those” dreams – this time a strange dream I had about my therapist:

I was in his home, sitting on the treatment couch. His wife, as I imagined her, was nearby. A daughter, a son, and five month old baby boy. I sat and played with the baby boy while others went about their business around me, not interacting with me. The dream itself had little emotion attached to it, I was neither happy, nor distressed, perhaps a little bored, but enjoying the baby enough. Yet, in the dream, and afterward, I wondered why I was there, and worried that I was intruding on the scene.

Again, of course, I explored the dream extensively: as a transferential wish to have siblings, to be a part of his family, to be parented by him. To be trusted and invaluable member of his inner circle. I considered whether or not this tiny baby was an extension of my self, perhaps my inner child, that I wanted to be responsible for, as I was seated, held by the sofa now in the middle of his living room.

Four months later, he informed me that he would be taking a leave for a few weeks. Shorter notice than his usual vacation at an odd time.

“Are you about to have a baby? Is this a parental leave?” I asked.

Yes, he admitted, a boy.

I expressed my happiness and congratulations. But, I had a question:

“Do you remember that dream I had a while back? About you having a new baby boy?”

Yes, he said.

“Was your wife, by any chance, 5 months pregnant at the time?”

Yes.

“Did you think about that then? Did my dream seem strange or uncanny to you? Because I remember saying that it felt like a weird dream for me to have – and I worked very hard to try to understand how it might have been about me! But, now I see, it was also about you – or about us both!

Yes. He had thought of that.

“Well it would be very helpful to me if the next time that happens that you just let me know so we can sort it out. Maybe in a previous session I was sensing that you were internally preparing for the birth of your son, I’ve known you through other parental leaves, and I – or maybe both of us – felt that I was intruding on that scene. And you sort of left me trying to take responsibility for the whole unconscious scenario by myself.”

Fair enough, he promised.

“Enlightening an interpretation on the subjective level…may be entirely worthless when a vitally important relationship is the content and cause of the conflict. Here the dream content must be related to the real object. ~ C.G. Jung, Dreams

Many many years later, following a weekend which involved a very emotional and excruciatingly painful crisis involving my family of origin, a client of mine reported this excerpted dream (with permission) which she had herself after the previous Thursday session:

“You were motioning me to wait – but this guy started to upset you.  I thought you’d tell him to stop going through your papers (they were certificates, I think, of your degrees or licenses or something). Instead, your emotions quickly escalated and you started yelling / pleading with him to stop – and you screamed ‘what are you doing! you’re ruining my life’ He was completely in control of upsetting you.

You sat down across from me, legs curled in and started crying out of control.  I couldn’t help but to cry as well – seeing you in so much pain. You were destroyed.  I think I tried to hug you but you were a broken, small, mangled version of yourself.

There was a pause in the dream. I’m telling you about the dream that I just had (above)- and how upsetting it was for me because it was so strange but midway through, it’s abundantly clear that you’re not listening.  You’re going through your papers.

I stopped talking mid-sentence and waited. You looked up at me and I asked you if you’re listening – if you’re with me.  but you weren’t. So I got up to leave, undramatically. but really very upset. And I said “I can’t do this.” you just watched and didn’t stop me.  I left without looking back.”

Her “strange” double dream not only anticipated my unexpressed concern with a crisis that was about to erupt, the distress I had been in – it showed me the ways in which I could re-injure the client, abandon her and damage our alliance if I chose to hide behind my professional papers, degrees and certificates.

We began by exploring her associations and history, her relationship with her wounded parent, and her personal subjective assumptions about the dream – I started slowly, as, frankly, I did not want to expose the details of a personal conflict that felt still vulnerable and I did not want to burden the client or require that she take care of a “small broken” version of myself. Neither did I want to abandon her behind a professional stance that exempted me from my responsibility for my own unconscious processes as they influenced the treatment relationship.

As we were about to move on, just as the subject was changing, I summoned my courage:

“So, listen, there may also be another component in the dream. You’ve been going through a very intense time, and I know that you have been really needing me lately, and whenever we feel we need someone, we watch them very closely. I am wondering if this dream may also be about me in someway… After our session on Thursday, I had a family emergency/crisis which flared up, and I think, I did, over the weekend feel quite small and broken and I did cry a great deal like in your dream. I wonder if you were reading the signs in me, maybe in the same way you learned to at home, to anticipate an upcoming crisis. And then, the second part of the dream expresses your fear that I could deny your astute perceptions of me, and just pretend that nothing ever happened. Kids learn to read their parents like the weather, and maybe you were reading me, and feeling my own storm coming on, and then expecting that I would just act like you hadn’t felt anything real about me.”

“Yes”, she said, breathing more deeply.
“I must have felt something coming on. I always had to do that at home, and my family would act like I was crazy.”

More deep, relieving breaths.

“Are you ok?” she asked.

“Yep.” I answered, “I take good care of myself.”

“It must be left to the analyst to decide how far he, himself, is the patient’s real problem” ~C.G. Jung, Dreams

In some therapeutic relationships, dreams become the transitional play-space where the patient and the therapists’ unconscious processes communicate and play with each other, telling us both about the aspects of the therapeutic relationship that we have consciously missed.

I’ve learned to trust my dream life, and my clients dream lives as they sense and sort through the unconscious processes that exist as a dynamic in relationship to others, to the systems we live in, to the culture and communities we embed ourselves in.

“That is to say, I take dreams as diagnostically valuable facts”
~ C.G. Jung, Dreams

I once dreamed about a client who was unable to tolerate weekly therapy and had terminated abruptly:

I walk down the streets of the city through various familiar neighborhoods and the client pops up randomly, here and there, as if they are making brief, cameo appearances -walking on the sidewalk next to me, coming out of a store, standing at the cross walk as I pass – in a movie that is about something else.

I realized upon waking that I needed to let the client come in as needed, pop up, pop-in, and not try to force them to into my story-board of weekly standing appointments.

Certainly there are many dreams that emerge entirely from our personal unconscious, our unprocessed conflicts alone, calling attention to our history of past traumas, losses and misattunements.

But in the past fifteen years of recording my own dreams, my dreams of clients, and my client’s dreams, it has become obvious to me that dreams serve many other functions as well.

Last night I had that dream again. I dreamed I had to take a test In a Dairy Queen on another planet. And then I looked around And there was this woman… She was writing it all down. And she was laughing. She was laughing her head off. And I said: Hey! Give me that pen! ~ Laurie Anderson Talk Normal, lyrics

I’ve come to think of dreaming as a natural, sensory and relational phenomenon, a means of digesting and incorporating our unconscious perceptions: dreams solve problems, anticipate transitions, highlight things we have overlooked, prepare us for dangers, help us communicate to each other, tell us what issues our psyche is working on in the background, reveal what lives and moves out of our awareness, point out imbalances in our relationships and environments, and extrapolate/project future outcomes from the current trends in the patterns we are embedded in personally, relationally, systemically, and globally.

All of nature talks to me. If I could just figure out what it was trying to tell me. Listen!
~ Laurie Anderson, Sharkey`s Day, lyrics

Many clients in the weeks before 9/11 reported dreams of the like that I have not experienced since. I had been enrolled in a Depth Psychology class studying Jung at an institute in the city, and everyone in the class was asked to keep a dream journal for ourselves, and for all our clients’ dreams. The week before the attack on the World Trade Center, we read aloud from our journals: Strangely, there were many dreams within dreams: of kamikaze jets flying down the streets of the city, of giant tornadoes coming “from the east” which destroyed tall buildings killing hundreds of people, dreams of four giant bombs dropped from the sky but the fourth one doesn’t explode. And those were just my clients. Other classmates’ journals contained surprisingly similar themes and images: lost pilots, building explosions and collapses, one classmate’s client dreamed of turning over the Tower card from the tarot deck.

We wondered together what violent shift was present in the environment that could be reflected in the community’s dreams.

Perhaps any random sample of dreams reported at any given time would contain similar imagery.

I don’t deny the statistical realities of probability or chance.

But I haven’t been privy to a similar thematic thread since.

And I would damn sure brace myself if I was.

Some say our empire is passing as all empires do. And others haven’t a clue what time it is or where it goes or even where the clock is.
And oh, the majesty of dreams, an unstoppable train, different colored woodlands. Freedom of speech and sex with strangers
~ Laurie Anderson, Another Day in America, lyrics

I’ve had dreams, for example, where one highly/overly intuitive client critiques my treatment of another client with a highly/overly developed thinking function: the dream itself offering me excellent insight and supervision into both of the clients undeveloped bits and the functions that I am called upon to strengthen in each of them.

Sometimes I share dreams that have been helpful to me in a case with the client.

Sometimes I don’t.

And another interesting “strange dream” phenomena, which I have experienced many times – A client and I dream a similar sounding dream, the day or two before session, from different vantage points: A dream of a terrible storm in a steep valley, me looking from the ridge of the hill, the client looking at the clouds coming over the high tree-line. A dream with the client swimming against the current, tiring in the water looking up at a woman in a small boat, and me, in a small canoe trying to figure out how to pull a drowing client safely on board.

The dual dream content itself is usually fairly obvious, and takes little work to interpret, but the synchronistic phenomena itself has come to represent to me a kind of alchemical consolidation of the therapeutic relationship itself.

Our unconscious lives have found themselves in the same place, in the same time, working on the same problems, from different perspectives.

I don’t claim that this is science.

Nor do I believe it to be magic.

I remain agnostic as to the ultimate causes or explanations for such synchronistic and unconscious experiences.

But, to the degree that the function of dreaming remains mysterious, and unknown, perhaps we can only approach such mysteries with faith.

And to learn how our dream lives, whatever their origin or function, can serve to deepen our connections to each other and the world around us.

There was this man…And there was this road…
And if only I could remember these dreams…
I know they’re trying to tell me…something.

Ooooeee. Strange dreams.
Strange dreams

~ Laurie Anderson, Sharkey`s Day, lyrics

copyright © 2013
All rights reserved Martha Crawford

The Way Forward

January 27, 2013 By in Depth psychology, Ecopsychology, Ecotherapy, psychoanalytic theory, Psychotherapy and climate change Tags: , , , , , , , ,

I have Guilt on the brain.

I did a presentation a few weeks ago with a colleague on Winnicott, and his Sense of Guilt as it pertains to adoptive families (transcript at alliesandagitators.com for those interested) and suddenly I see Guilt absolutely everywhere.

(And, perhaps, as a component of our collective denial, defensiveness, hopelessness and paralyzed impotence in the face of ongoing human oppression and ecological destruction too)

Healthy guilt, obsessive guilt, pathological guilt – guilt repressed, denied, disavowed. Guilt projected on to others, guilt internalized and disproportionate. Guilt dressed up and hidden in every kind of costume and disguise.

Not shame. Shame can destroy in its own ways, no doubt. Yet shame is an illusion, a falsehood that insinuates there is something inherently wrong with who you are at your core, something grotesque or reject-able, contemptible or unloveable, lurking in your True Self. Shame is a lie that others convinced you of.

Guilt is the cold hard truth.

Emotional, psychological guilt (as distinct from to legal/moral guilt) is the healthy and accurate feeling that we experience when we come understand that we have been engaging in destructive behavior. That we have caused another harm. That we have benefited from another’s loss. Guilt is the responsibility we take for the unintended consequences of our actions.

The road to hell is paved with good intentions of course. Good intentions cannot not spare you from responsibility for the destructive outcome of your actions.

Guilt, if you can feel it, is a good and healthy thing: It means you give a shit.

It means you love or care for something and you feel remorse for the pain you have inflicted down the causal chain – whether you meant to or not, whether you knew what you were doing or not.

If you can withstand it, through its hot burn and sharp sting, it will become rich fertilizer for the roots of empathy.

But so many seem to have forgotten, if they ever learned, how to find their way through the processes and stages of guilt, if it ever even rises to the level of consciousness at all.

And most fight it off with everything they’ve got.

We get stuck:

In primitive denial and repression:
“I did NOTHING wrong! I have nothing to be sorry for!”

In defensive overstatement:
“Oh, I suppose this is all MY fault.”

In obsessive, over-compensated un-doing.
“I’ll replace it! I can fix it as good as new! I promise I will NEVER do it again!”

In imploding, self-negating, undeserving, hopeless and/or defensive internalization:
“You are right. I’m a total fuck-up. I’m stupid and selfish and worthless. I can’t ever do anything right. What is the point of doing anything”

In paranoid reversals:
“Stop TRYING to make me feel guilty!”

At first dawning: Guilt is great and terrible and terrifying. Annihilating.

The weight of deep remorse, when you first take it on to your shoulders can make you regret being born. It takes extraordinary fortitude, and self-compassion to bear it.

And there is a great deal of destructive behavior to feel crushing guilt about – intentional or not – that each of us indulge in individually, generate accidentally, or participate in collectively, culturally, and nationally:

Greed, aggression, inequity, privilege, economic violence, disproportionate consumption, institutional racism, the xenophobic and objectifying oppression of human beings in all its forms.

And the contamination, exploitation, disruption, extinction and depletion of the planetary climate, air, water, food, plants, animals and destruction of our own human habitat.

Guilt, initially, is an almost unbearable crisis.

Melanie Klein describes the child’s very first experience of guilt as one of utter despair.

Using breast-feeding as a metaphor: she describes the infant as suckling without remorse or empathy on an archetypal, omnipotent persecutory Bad Breast. A breast that withholds, dries up, over- or under-produces, hides itself, and controls the entire feeding experience. The infant attacks, bites, gums, hits, hates, devours, demands, and releases its frustrations into it, with no guilt, whatsoever.

Or as Winnicott might say: Ruthlessly.

Klein calls this the Paranoid Position.

Yet, at some point, according to Klein, the child wakes up – realizing that this breast is finite, and perhaps even connected to a finite human being, a human being that soothes and cuddles, loves and tickles. Biting, attacking, devouring demanding have new implications – they can cause harm, perhaps in the child’s mind significant harm to the beloved parent.

This is a shocking, terrifying crisis. Remorse, grief, anxiety, despair are activated and intolerable.

We feel that we have suddenly become all bad. And the object of our empathy: all good.

This is Klien’s Depressive Position, and the emergence of what Winnicott calls: “Ruth”

The extraordinary pain of first guilt, of the crisis of the Depressive Position is so overwhelming, that the child turns tail and retreats back to the relative comfort of the Paranoid one.

Both these theorists would say that the infant, the child, the adolescent, and the adult will spend the rest of their lives moving forward into the depressive position, becoming overwhelmed, and collapsing back into the paranoid position.

And that we will toggle back and forth, working these through with every relationship we encounter.

The greater our awareness of these processes and the more consciously they are faced – the more quickly and successfully we can move through these cycles.

The more compassion we can have for ourselves and for others.

To quote one of my favorite bodhisattvas:

Sometimes people are good. And they do just what they should.
But the very same people who are good, sometimes,
are the very same people who are bad, sometimes.
Its funny but its true…..

(~ Fred Rogers, from The Mr. Rogers Songbook)

And if bravely, consciously faced, healthy guilt will deepen our capacity for empathy, responsibility, and mature concern.

But how?

How do we get out of the terrible cycle of paranoia and depression, of painful advance and frightened retreat, of self-loathing remorse and defensiveness?

There is a way.

Reparation must be offered and accepted.

Winnicott says, somewhere in The Maturational Processes and The Facilitating Environment that the reparative gesture must never be rejected. If the therapist, or the parent, or the loved one that we perceive we have harmed (or merely wished to use ruthlessly), actually rejects our little gift, our silly Hallmark card, or the cookie we offer as a token gesture of remorse – they will deprive us of the symbolic act that allows us to begin to bear the weight of responsibility for our destructive energies.

Rejection of reparative gestures sentences us to return to the state of persecution and defense. And the cycle begins again.

Reparative gestures are the behaviors which transform fresh overwhelming guilt into mature concern.

As guilt, made conscious, begins to mature into Winnicottian Concern and attuned responsibility, symbolically reparative acts repair our ability to emotionally withstand, have empathy for, and accept responsibility to those who have experienced harm or sustained losses that have resulted in our gain.

Reparative gestures do not actually repair what has been harmed, lost, destroyed, or disrupted for the Other.

The attempt at “repair” is only symbolic, not literal.

The symbolic nature of reparation rests upon the awareness that the guilty one cannot literally give back, repair, or undo what was lost or broken. the symbol expresses our concern about the destructive effect we have had and signals our acceptance of the injured, angry, reactive consequences that proceed from our actions.

And quite often, deep listening to the injured party, and withstanding the intense, guilty discomfort that is activated within us, is the deepest reparative act of all.

In my office this very frequently looks like this:

I am running five minutes late, and a client in crisis sits and waits – feeling increasingly angry, abandoned, and forgotten.

When they enter, they let me know the effect I have had. They are angry, hurt, the pain they came in with must be set aside, because now they must process feeling upset with me in its place.

I can and do offer up the compensatory 5 minutes at the end of the session, but that is merely for equity’s sake, and I have no expectation that it will or should undo what has already occurred.

I could “promise” that it won’t happen again – but, frankly, it might, and similarly it won’t undo or give back the five minutes that they needed me and I was not there.

I could subtly defend my intentions, my work load, remind the client of all the times they have been late or that I gave them extra time – and try to make them feel remorseful for having activated my sense of guilt.

I could aggress and become defensively enraged myself, call them ungrateful and go on the attack, creating an effective diversion from my own culpability.

I could collapse in shame and self-loathing, become so flooded with guilt that I caused harm and discomfort to a client, that I require the client to reassure me about all the ways that I am a wonderful therapist.

Or I could offer reparation: I could ask them to tell me everything they are feeling, I could have empathy for the state that I left them in, I can struggle with my remorse, and let them know that my remorse exists, but is secondary to my caring and my concern for their feeling, and take responsibility the effect that my actions, intentional or not, have had on them.

Reparative gestures repair the relationship itself, not the injury – and help the guilt-ridden to stay in open, active empathic relationship to those who activate our guilt-sense without resorting to defense, denial or collapse.

In a eco-psychological model, for example, what would an individual gesture of reparation look like?

Like carrying your own shopping bags. Like packing your lunch. Like reducing your meat intake, like walking or taking public transport and avoiding unnecessary car trips.

Such gestures won’t save the world, or single-handedly reduce CO2 emissions.

Those who believe they will are not in a state of mature “ruth” but are attempting to negate or undo what years of abuses have created.

We must acknowledge that we have fed on Mother Nature ruthlessly.

And it cannot be undone.

What such small reparative gestures can do is build up and repair our capacity to tolerate the guilt we feel about the injuries we have inflicted upon our eco-system. It can put us back into relationship, it can help us tolerate the remorse, the grief, the overwhelming depressive position we find ourselves in, without having to retreat to primitive denial.

Such gestures move us from ruthlessness, beyond the crushing regret of ruth, toward the mature Capacity for Concern, the empathic, responsible relationship to our communities, to all those who have harmed, and to the Earth itself.

copyright © 2013
All rights reserved Martha Crawford

Fire-Mouth

January 6, 2013 By in Persona and False Self, psychoanalytic theory, Supervision Tags: , , , , ,

Persona: (Latin, “actor’s mask”) One’s social role, derived from the expectations of society and early training. A strong ego relates to the outside world through a flexible persona; identification with a specific persona (doctor, scholar, artist, etc.) inhibits psychological development. ~ Mario Jacoby The Analytic Encounter

Man is least himself when he talks in his own person. Give him a mask and he will tell the truth. ~ Oscar Wilde, quoted in The Book Of Symbols: Reflections On Archetypal Images

It started with a dream about red lipstick.

Bright red. A color I’ve never worn, except maybe during my onstage past.

When I woke up – I let my mind wander, and could almost smell my grandmothers lipstick, the blot of red lips imprinted on the tissue paper that floated down toward the wastepaper basket from the vanity.

My maternal grandmother – a farmer’s wife – put on her red lipstick, her girdle, her clip on earrings and sensible shoes before church on Sundays, or maybe in anticipation of a day trip up north to the city. By the time the car pulled off the rural route and back up the driveway home, the girdle, the earrings and the lipstick were all off – removed in the car on the trip home, if not even earlier in a powder room somewhere, stuffed in her handbag.

My paternal step-grandmother – on the other hand – wore red lipstick, and carried a long black cigarette holder in every photo and every single time I ever saw her (which was not all that often) at home with a martini playing bridge or for dinner at the Lafayette country club.

Their red lips marked them as surely as their affectionate kisses marked their grandchildrens’ cheeks: as women of a certain age and era, as women who were beyond thinking what the young thought of them – in the early 70′s the young wore heavy eyes and no lips – or no make up at all – and as old women who had no further interest in current fashion or trends.

Perhaps, in their twenties and thirties in the 1920′s and 30′s the same crimson mouth carried different connotations. Maybe at first a certain youthful, flapper-esque daring, and later a hat-wearing-lady-like respectability.

I thought of it as the fire-mouth, a severe slash of horizontal seriousness and propriety, as a war-face applied before heading into the fray. You took grandma seriously when she wore it. When the lipstick was on, she meant business, and would put up with no truck from a whining child. Red lips meant she had expectations of you.

I’ve never worn red-lipstick, because I associated it with elder maturity, the mark of the Crone, the kiss goodbye to youth and girlhood. For me, red lipstick is what white-haired old ladies, who you do not want to mess with, and who don’t give a shit about looking young anymore, wore when they meant business.

As I dozed and remembered the smell of my grandmother’s lipstick, the eye-watering pain of clip on earrings, and the click of a string of costume beads or the tap of the black cigarette holder in the ashtray and brittle looking ankles rising out of suede high heels I laughed to myself – realizing that already, twenty years younger than I ever remembered either of them being – I am already a white-haired woman, who doesn’t give a shit any more.

And who is done putting up with nonsense.

Time to bust out the red lipstick – and claim my own fire-mouth.

All transformations are invested with something at once of a profound mystery and of the shameful…. Metamorphoses must be hidden from view, and hence the need for a mask. Secrecy tends toward transfiguration: it helps what-one-is to become what-one-would-like-to-be;…. The mask is equivalent to the chrysalis. – Circlot: A Dictionary of Symbols.

As a kid, I was “taught” make up at the local community theater where I spent as much time as possible – as part of the actors craft. It made me younger when I needed to play a smaller child, could change my coloring and ethnicity when coupled with a blonde wig, and could turn me into a boy when needed. It’s first application marked the transition from rehearsal to performance. I once even raced from the theater, still covered with painted freckles, to my mother’s second wedding.

The directors who led our motley troupe – in a pick up truck and gun rack town – were older men: actors, opera singers, musicians who had modulated their big dreams to fit into an underfunded ramshackle theater in small town suburbia. After three or four years of loyalty and hard work as part of the repertory, at 14 or so I was invited to my first “grown up” cast party. The front door opened and I saw men known to me in the rehearsal hall as beige, gray, unshaven, and irritable, in all their glory: A silver turban, a sparkling purple beaded robe, an ivory kaftan with golden thread… and those rosy faces, cosmetically shaped jaw lines, flushed cheeks, dramatic eyes…

and of course, bright red lips.

The finicky and easily exasperated “old” men (probably younger than I am now) who barely tolerated a precocious child actor and regularly shushed me in the wings were suddenly alive, smiling, embracing me – offering me my first ever sip of their gin and tonic: “Just one sip! I do not want your mother to hate me!”

As beautiful as butterflies, as shimmery as peacocks.

Their painted masks introduced me to who they really were.

There are aspects of self that are only accessible and able to be revealed through a mask – as the external image and persona is manipulated to reveal aspects of our true selves that would remain hidden otherwise.

Since the mask stands between one’s self and the world it has a dual nature: It looks both in and out. A mask can disguise, cover, veil, lie, capture, release, reveal, project, protect, disown, recollect, deceive, dissociate, embody and transform. ~ The Book Of Symbols: Reflections On Archetypal Images

Winnicott speaks of the True and False self in the same space that Jung speaks of persona and for both the false socialized self is seen as healthy and necessary to some degree for social functioning – without it we would say and do things impulsively, selfishly, that could expose our vulnerable true self or harm others. Healthy false selves keep us from killing when we feel murderous, or initiating sexual contact with everyone we are attracted to.

It also protects what lies underneath: Winnicott says that the False self often brings the true self to treatment – like a protective babysitter – to make sure that the therapist is safe enough, and has created a safe enough environment to let the True self emerge.

Aggression, rejection or distortion aimed at someone’s consciously crafted persona is annoying, but the same act committed upon a True Self is utterly annihilating.

Winnicott also chillingly describes the pathology of the False self:
A False Self that has convinced itself it is the True Self.

It is common for clients to present in therapy in great distress when they have become lost in their persona – when their relationship to their external facade has become disrupted, uncomfortable or painful as internal pressures, changing life-stages, or external events require the surrender or adjustment of the face they have constructed and presented to the world.

Clients can lose their jobs, their function, or their standing in the community that they equate with their identity: How will I recognize or myself if I am no longer wearing the mask of a philanthropist, a church volunteer, a doctor, an artist, a lawyer, a psychotherapist?

Some attach to their role in the family system: as spouse, son, daughter, parent, sibling. When the family system is disrupted by death or separation, divorce, adoption or reunion – they find themselves disoriented in relationship to their own persona.

Internal prods, the insistent Unconscious eruptions of the psyche, the push of pain and the pull of hope also can put us in a dissonant relationship to our mask of choice:
“I never thought of myself as some one who would have an affair”
“I used to love my profession, but I’m so burned out I think I may have to give up teaching”
“I’ve become someone who only takes care of children – if I don’t figure out who I am other than a mother – I’m going to explode – I can’t take it anymore!”

Suddenly, the soul demands that the old persona retire itself and a new mask must be painted that creates a face that matches and protects newly emerging aspects of the self.

Age and body changes associated with adolescence, mid-life and old age should move us through our make up and wardrobe transformations as well – some of us accept such mandated role and costume changes more willingly than others, and for some they evoke profound identity disturbance as their appearance no longer fits how they think of themselves.

There are darker functions served by masks as well:

Masks are also instruments of lies, tricks, and self-deception Our culture endorses the manufacture of many “good” and “branded” personas which mask greedy, devouring and destructive behaviors. Many of us think of ourselves as exemplary citizens while we have hidden from ourselves or flat-out ignored the destructive effects of our cars, consumption habits, institutions, corporations and governments on unseen or disenfranchised others and on other species, and upon the planet itself.

Pigs wearing lipstick abound:

Our culture denies bias, racism, and heteronormativity even while it remains manifest, food labeled “healthy” masks toxic farming practices. Clean coal. Industrial growth is the face of the dark trickster that depletes planetary resources.

Disasters emerge to pressure us to shake off our collective, cultural facades and bring our false fronts into alignment with our realities: terrorist acts, war, extreme weather events, gun violence. But, too often it seems that our collective cultural and national False Selves have usurped the Truer collective spirit.

We all lie to ourselves and to each other continuously. Those who hold on to their personas lightly are willing to adjust their sense of self to accommodate new information about their effect on others. Those who cling tightly to a false self, delete and deny any information that disrupts their status and sense of public persona.

Therapist’s very often find themselves sitting with clients who are actively consciously, or unconsciously deceiving themselves. Sometimes, they choose to maintain the front at all costs, as they hang on to a persona at the expense of their souls. Re-painting the house while the pantry is empty: Staying in dead marriages for fear of the neighbors’ judgement, managing to other parents competitiveness rather than to their own children’s needs, arranging outer-appearances to look just so while mess, chaos, and destruction storm within.

A mask is a disguise which transforms the wearer, hides or heightens his personality, or identifies him with the character of the mask. Purpose: Impersonation of deified natural forces, spirits of the dead, totemic, hunted or phallic animals, respected or derided human beings for:
1) arousal of a desired emotion: bravery, self-esteem, prophetic trance
2) exorcism of baneful sprits
3) coercion of more favorable spirits.
4) Social prestige
5) Moral control and social therapy by fright or burlesque
6) Entertainment by presentation of stories, sacred or secular or by laughter producing satire

Usually more than one motive is involved.

~ Funk & Wagnalls Standard Dictionary of Folklore, Mythology, and Legend.

I still put on my make up when it is time to perform.
Not much really, it’s the ritual that I require, the transition from the comfortable introverted privacy of home to the extraverted bustle of the city and the rigors of the office.

It puts my impinging vulnerabilities away inside. It draws out my sense of strength for those who need to see me as stronger than I may be.

I stand in front of the mirror as my grandmother did, as I did for years in the dressing room before curtain.

I stand still and look squarely in my own eyes: I pull out my brushes, with long black handles. Like my grandmothers cigarette holder, like the set of brushes that waited for me in the drawer at North County Community Theater.

I put on clean smelling lotion, and some translucent powder. (interesting slip – I first wrote “power”) I apply some mascara- I need big eyes to see deeply into complex problems.

And the last thing before leaving the house: I apply my fire-mouth:
For screwing my courage to the sticking point.
For telling difficult truths.
For giving voice to intuitions from the edge of awareness.
For calling bias, contempt, racism, objectification, and abuse by their true names.
For finding words for the destructive realities that we hide from ourselves.

And for reminding the world that I have expectations, and I am well past the point of putting up with nonsense.

copyright © 2013
All rights reserved Martha Crawford

Touched

October 28, 2012 By in Countertransference, How therapy works, New therapists, Projection & Transference, psychoanalytic theory, What to talk about in therapy Tags: , , , ,

Michael (a highly fictionalized/conglomerate but all too real client) was scared as hell and little more than a month away from aging out of the group home he had lived in. At the close of the session he was trembling. I had seen him twice a week for the very first three years of my private practice (many many years ago now) and I had fielded at least as many hours of emergency and crisis phone calls. Hired as an independent contractor by the group home agency, I had watched him, week after week, grow from a gangly coltish boy, into a young self-identified gay man, as tough as he was pretty.

He had no one.
His parents, both severely mentally ill, profoundly sadistic, and long gone. He had lived in an undisputed, unfathomable house of horrors, tortured and feral, until he was removed at age 7. He had then been bounced, through a series of group homes – staffed by indifferent, and often explicitly abusive workers.

He reported being harassed by homophobic staff and peers, called a “girl” a “she-male” and much much worse because of his carriage, style and orientation. He had decided to remain at his current placement as it was “better than all the others.” A month or so earlier several staff members in the group home had been pulled out of their offices by police and taken away in handcuffs.

I had decided that I would remain available, and give Michael the opportunity to continue in treatment with me, and told him of my decision. He knew that the agency would no longer pay for my services after his birthday, and protested that it wouldn’t be fair to me. For my part, I had watched him grow up in my office, and I couldn’t let him disappear into an abyss. He had been through too much. We set a fee of $1 a session.

I wanted to spare him even more loss. And I was inflated and foolish enough to think that I could. Michael knew better, knew that what was to come would be too much.

The truth is I was terrified for him, terrified of the horrors he had absorbed and of the wounds he would carry forever. Terrified that the tortures he had survived, the abruptly cold bureaucratic transition ahead, in combination with the genetic predisposition he had inherited, would result in a terrible psychotic break, one that I could not contain in my office, even if I saw him five days a week. There was no sign, no observable evidence of it yet, but I felt it coming like a storm beyond the horizon.

I wanted to stop it from happening. I wanted to stand between him and what I feared was inevitable. I wanted to hold him together. For both our sakes.

I had just left the mental health system. I knew what lay ahead if the worst happened: I knew what kinds of counselors and rehab techs and psychiatrists, and day programs, and residence workers, and group leaders, and intensive care managers could become his treatment providers. Some caring and gifted, and as many, or even more: hard, shaming and incompetent. I knew the institutionalized food he would be fed, the sedating medications that he would be compelled to take in order to be seen as “compliant” and worthy of treating. I knew the groups he would sleep through, and the hospitals that would re-traumatize him, restrain him and discharge him long before he was stabilized. I knew how committed I had been to offering clients the opportunity to heal in a system that merely wanted to manage behavior and how impossible it was.
I knew how horrible it had been to watch people I cared about succumb simultaneously to their illness and a broken system.

You will see that the analyst is holding the patient, and this often takes the form of conveying in words at the appropriate moment something that shows that the analyst knows and understands the deepest anxiety that is being experienced… There are times when you carry around your child who has earache. Soothing words are no use… but eventually, it will be understanding and empathy that are necessary.
~ D. W. Winnicott in the Maturational Processes and the Facilitating Environment

There is a question I have been very commonly asked, in varying forms, by other peoples’ clients and by younger clinicians, since first I began publishing my writing on line:

When is it okay to hug a client?
My therapist held me and rocked me, is that okay?
What kind of physical contact is all right in my therapists office?
My therapist takes my hand and it makes me feel better but my friends say it is dangerous. How can that be if I asked her if she would?
Can I hug my therapist?

These questions can only be answered with many many more questions:

What is the need? What is the impulse? What is the intention? What might the outcome be? What is the nature of the alliance? What are the expectations? Why is this emerging at this point in the relationship? What are the forces, conscious, and unconscious that make physical contact in a talking therapy seem necessary, natural, or like a good idea? What does contact communicate? What might the short term consequences be and what are the long term implications? What kind of touch? What is the message being expressed and what is the message that might be received? How are these the same or different?

Will the experience, memory, and interpretation of physical contact be consistent over time? Who is initiating contact? How might the inherent power differentials between therapist and client skew their interpretations and experiences of physical contact? What is the history, examined or unexamined in either party, of infantile or early childhood deprivation? Of sexual abuse? Of severely disrupted attachment? Of sexual acting out?

Is touch in and of itself being seen as solution, a mechanism of cure, an intervention? Why, if the therapist has only been trained in one of the many variations of the talking therapy, would the therapist want, need, think that this form of touch was within their purview of expertise?

Why can’t the wish for physical contact be translated into words? What words might touch suppress, avoid, or circumvent?

As Michael blew his nose, and wiped his tears to leave the session he said:
“Thank you for not leaving me” he said. “I wish I could hug you, but its probably against the rules?”

He looked unbearably young and vulnerable.

I hugged him and he held on tight. I felt life a life guard dragging a drowning boy to shore.

Margaret Little in her lovely therapeutic memoir, Psychotic Anxieties and Containment, (which doesn’t sound lovely at all but it is) speaks about her own treatment, and need for dependent regression to infancy and merger with Winnicott:

“Here I feel it is appropriate to speak of the two things about which there has been misunderstanding – holding and regression to dependence. D.W. used the word holding both metaphorically and literally. Metaphorically he was holding the situation, giving support, keeping contact on every level with what was going on, in and around the patient and in the relationship to him.

Literally, through many long hours, he held my two hands clasped between his, almost like an umbilical cord, while I lay, often hidden beneath the blanket, silent, inert, withdrawn, in panic, rage, or tears, asleep and sometimes dreaming” – Margaret I. Little

Our bodies have needs, and there are wounds that need to be processed in and of themselves with preverbal, experiential, tactile, somatic interventiions. Touch is sometimes felt to be necessary by and on behalf of those who have suffered profound disruptions in their earliest experiences of sorting their insides from their outsides, whose capacity to attach has been disrupted, who have never been safely held.

But that does’t mean it is safe or healthy for any therapist to hold any client.

In the weeks ahead, the break I feared erupted, more violently than I could have imagined. Michael was wild, entrapped in thick and convoluted paranoid fantasies, he had several physical altercations on the street, with others in his group home, with strangers. He continued coming to session, regressed, disorganized.

Michael next began leaving voice messages on my machine in a voice not his own. The last one I listened to, cold hard and threatening, filled with chilling contempt, caused the blood to drain from my face, my hands to shake, and a cold sweat to break out on my forehead. A voice which Michael must have heard whispered his own ear through out childhood said this:

“Don’t you feel stupid? Don’t you feel foolish for caring about me now? You will regret ever having known me. I hate you more than you can ever know. I’ll make you pay.”

When I called the group home – he had not yet transferred out – the worker said:

“Oh yeah, she’s been walking around here for weeks screaming about you, saying she’s gonna kill you. Talking about all the different ways she’s gonna do it. She’s gonna get a gun, get a knife….” All of which were easily accessible to Michael.

Yeah, thanks a lot for letting me know and coordinating care – oh and, remember all that “duty to warn” stuff? Well done. A pleasure working with you and your organization.

Fuck.

If murder threatens, you call in the police to help not only yourself, but also the client. In all these emergencies you recognize the clients cry of despair because of the loss of hope of help.

~ D. W. Winnicot in The Maturational Processes and the Facilitating Environment

I called the brand new group home supervisor and told them to have Michael taken to the ER and assessed.

Winnicott was in his primary professional identity, a pediatrician. “Psyche and soma for him were not separable… He kept a stethoscope, sphygmomanometer, and clinical thermometer handy and used them” (Little, Psychotic Anxieties and Containment)

My training is in the verbal therapies: I know many acupuncturists, massage therapists, cranial sacral therapists, that act as defacto counselors and do very deep healing and emotional work. I also know osteopaths and somatic psychologists who are trained and sought out for their expertise in therapeutic touch. I have great respect for their work and I regularly refer clients who need tactile intervention to such care providers – as well as trainers, martial arts masters , and yoga instructors – following the clients leanings and preferences – so that the somatic intervention can be delegated to a specialist and we can hold the case, and the client’s whole Self, together as a team.

That being said:

When I worked with young children, I never once rejected child’s hug, nor would I, but neither would I impose one.

I have willingly and appreciatively, accepted hugs from clients that were clearly spontaneous expressions of gratitude, appreciation, or connection.

I have covered clients in regressed states with the blanket in my office, and sat on my ottoman near to them.

I have been known, on occasion, to hug a receptive client good bye after a long stretch of deep work, or to re-greet the same client with a hug hello after a lengthy absence.

I have escorted terrified, suicidal or decompensated clients to the psychiatric emergency room holding their hand, or with my arm around their shoulder.

I have encountered clients in medical crisis in and outside of the office and held or touched them to assist them in getting to medical treatment, or to keep them calm until help arrived.

I have occasionally put an arm around clients, with their permission or at their request, when they have been in very significant crisis or after a sudden or shocking death, or following a life-threatening event.

And sometimes contact has emerged as a spontaneous expression of joy after a miraculous surprise. One or two clients over the course of the past two decades may even be able to report that I danced a little jig, and engaged with them in a sort of silly mutual square-dance-like ring-around-a-rosey while squealing with glee like kids at the circus.

I recall my own analyst hugging me as I left the office for the last time on the eve of motherhood, as I left to meet and hold the baby boy who would become my son.

We are human and share the need to grieve and celebrate physically together sometimes.

But all these instances are the very rare exceptions that sustain the rule, and were extensions of well-established and mutual trust in the relationship, Moreover, contact was not offered as a treatment, a solution, or as an intervention in itself. Nor did contact stifle or divert us from talking about the feelings, positive or negative, about our relationship, what the physical gesture meant, or the events and context around us.

In my office, we work together to speak of physical impulses, and assign language to the states that move through our minds and bodies. I have expressed verbally to clients that I have an image in my mind of rocking them, hugging them, or some other impulse associated with early holding functions. I recently verbalized an absurd impulse to cross the room and give a client a good tickle – All seemed to have as deep, if not a deeper holding effect than actual contact.

If physical contact ever feels like it needs to be kept secret, if it is ever sexualized or seductive, if the client feels uncomfortable or has mixed or shifting feelings about it, even if they value or initiated the contact – then it was impinging, a boundary violation, a very significant error, and perhaps a sanctionable act on the therapists part.

I never saw Michael again. The hospital that admitted or discharged him never contacted me, or asked about his treatment or my understanding of his history or his future needs. The mental health residence that took him in, the day treatment program that assumed responsibility for his care never asked about our three years of work together.

Michael did call me himself. I would hear from him about once a year. Sometimes twice a year, for six or seven years after our work together, before the calls stopped.

He always profusely apologized for what had happened between us. And I had a several chances to express my own sorrows about my inability to keep us both safe in a way that would have allowed us to sustain our work together. He complained that he had grown unrecognizably fat from the medications he was taking, and that I wouldn’t know him if I saw him on the street. Sometimes he would call, off medication, confused, agitated, disengaged from whatever program he had been “non-compliant” at, and ask if I could be his therapist again.

Once, I got a phone call from his intensive case manager letting me know he had violated the terms of his outpatient commitment, asking if I knew his whereabouts.

The last time I heard his voice, he left this message:

“Don’t hate me. I hope you don’t hate me. You must hate me, you have a right to hate me, but please, please don’t hate me for what I done.”

When I listen to the case, as told to me by my own, younger self, with a supervisory ear, I want to unburden that clinician, to assure her that both she and Michael were caught in an impossible situation, that there was no real holding for therapist or client, that Michael’s break was and deterioration was inevitable, unpreventable in this era, with the resources available, with the current system, and that the wish to hold him together physically, emotionally, psychologically was human, loving and understandable.

But at my core, I still hear Michael’s voice:

“I wish I could hug you, but its probably against the rules?”

What if I had asked: What rules Michael? Perhaps they were his own internal, unspoken rules and parameters – a mandate that his primitive dependence not be activated in any setting that could not truly contain him. If I hadn’t hugged him could we have maintained an alliance through the break? Did I activate primal needs impossible for either of us to contain? Did I make a terrible scenario that much worse? Could I have mitigated or advocated for him within the system? Could I have softened the blow?

If I knew then, what I know now, could I have helped him to hold on?
Could I have held both of us better?

Occasionally holding must take a physical form, but I think this is only because there is a delay in the analysts understanding which he can use for verbalizing what is afoot.

~ D.W. Winnicott in the Maturational Processes and the Facilitating Environment

copyright © 2012
All rights reserved Martha Crawford

Follow

Get every new post delivered to your Inbox.

Join 2,324 other followers

%d bloggers like this: