February 15, 2009

I’m leaving in a few minutes for a week-long work trip to Upington in case you’re wondering why there’s no posting or commenting happening here at the Couchtrip. I was planning to do a post on relationships in line with Valentine’s Day but I guess that will have to wait. But what I can leave you with is this – an interesting journal article on Donald Winnicott and Masud Khan.

In the December 2008 issue of the journal Psychoanalytic Review, James Hamilton explores the “tragic misalliance” of these two very famous psychoanalysts. I’d heard of Khan in the way that you hear about examples of psychologists to avoid copying. Very talented but rather disturbed, Khan was kicked out of the British Psychoanalytic Society for misconduct which included sexual indiscretions with supervisees. Winnicott, in contrast, was hugely influential in understanding the mother-child relationship and promoting ‘good-enough mothering’, as well as establishing the mother-child relationship as the template for good psychodymanic therapeutic practice.

What makes the connection between the two interesting is that they had an “intricate personal and professional affiliation, which included Khan being in analysis with Winnicott for 15 years”. Two quotes to whet your appetite:

Winnicott had enormous therapeutic ambition, and an overriding need to be a rescuer …. This trait predisposed him to take on unusually difficult patients as well as marry his first wife, an artist, despite advice from friends not to do so because they considered her “mad: that is, she claimed she could communicate with T.E. Lawrence, with whom she was infatuated, through her parrot. (Rodman, 2003, p.291)

In summary, Winnicott’s intractable guilt over not being able to alleviate his mother’s chronic depression and for outliving friends killed in World War I was instrumental in his becoming an analyst and a rescuer who was prone to overestimating his therapeutic effectiveness while refraining from exploring the vicissitudes of aggression in his analytic work. This internal obstacle … in Khan’s case, promoted harmful acting out that was harmful to his patients and supervisees while ensuring his professional downfall.” (Hamilton, 2008, p.1032)

Have a good week.

The dance of therapy

October 16, 2008
Butterfly by Tommok at Flickr

Butterfly by Tommok at Flickr

I took the plunge and went for a session of therapy with a new therapist yesterday. The first session was a bit like a first date. I made sure I looked good and arrived on time, was pleasantly surprised that my “date” was well turned-out and that his room had a comfortable (red) couch and a laidback seriousness about it. I filled in a form, he asked me if I wanted a drink (water thanks) and then we were off. I’m always amazed at how much ground can be covered in 50 minutes.

Afterwards I thought it went well and had no hesitation in asking for a second date (even though it’s not exactly cheap). He had to check his diary and then agreed. He said something about discussing the terms of meeting. That makes it sound like negotiations, which I suppose is what the initial sessions are. There’s an assessment and then a negotiation of terms. A weighing-up on both sides and then an agreement to a controlled dance.

I was surprised at the stuff that came up. An old “crush” that I hadn’t intended to discuss at all. There was at least a year of my life where I thought about her almost every day (and possibly several times a day), each time with a mixture of pain and longing. Yesterday I was a lot more detached. She was definitely not serious relationship material, I said. But I added that it had taken me a good while to sort out all my own projections.

Coffe with an old friend beforehand also brought back happy memories of our time in Master’s class. The end result of all this stirring up of memories was that I slept fitfully.

Today I’m thinking about therapy as playing and dance.

“Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together.” (Winnicott, 1971).

“… sometimes the patient doesn’t like the frame but it may nevertheless be constructive and useful to maintain it— both for the analyst’s self-interest and for the patient’s ultimate benefit. … A patient once brought a boom box into my office, turned it on, and asked me, “Do you ever dance with your patients?” I replied without hesitation: “No. Never.”” – Gabbard (2007)

But Gabbard also acknowledges that the dance needs to happen metaphorically. At the end of his article he says:

“One of the great lessons of analytic work that applies to frame management is that one has to dance the patient’s dance steps for a little ways down the road. If one refuses to do so, the music may stop.”

My experience tells me this is not just metaphorical. It’s about getting into a similar emotional and physical place. The mirroring of body postures for example. Research in empathy has shown that when a therapist is “in tune” with a patient that there are similar physiological processes going on within the two of them.

I suppose the earlier point about the frame is that we need to be careful that our patients don’t take us for a ride or dance rings around us. But even if they do, is it always a bad thing? Perhaps it’s inevitable in terms of how their relationships happen. The trick then is to bring that awareness into the therapy and to modify the dance perhaps.

In the meantime, the verdict on whether the new therapist will be a good dance-partner is still out. One thing that bothers me is his seriousness. I want someone who can laugh (and play) in therapy. He asks good questions though (which is a form of playing). But does he have a sense of the absurdity of life? Of course life is serious, but that’s why we laugh.

Learning from Obama (Psychology and Politics)

October 8, 2008

Kathleen Parker in The Washington Post put it well. First she likened Obama to Mr Cool himself, Frank Sinatra.

He’s a cat. He’s doesn’t sweat… anything. He is the envy of cucumbers. When everything is collapsing around him — the economy, the Dow, the job market — Obama is perched on the stool like Frank Sinatra between sets.

But then she made the point as to why it seems the majority of Americans are leaning towards Obama for president:

He was at his best projecting the grown-up at the kitchen-table as he answered the question: “How can we trust either of you with our money when both parties got — got us into this global economic crisis?”
Said Obama: “I understand your frustration and your cynicism, because while you’ve been carrying out your responsibilities — most of the people here, you’ve got a family budget. If less money is coming in, you end up making cuts. Maybe you don’t go out to dinner as much. Maybe you put off buying a new car. That’s not what happens in Washington.”

It’s certainly not Obama at his most eloquent but it’s connecting where it counts – on economic issues. It’s a small point with huge implications. Leaders need to understand people’s daily frustrations and keep their cool as they plot a way out of the mess.

But I don’t want to beat the drum for Obama today. I’m interested to bring a psychological understanding of this election campaign. I’ve been reading Adam Phillips’s book on Winnicott and one of the things he says is that mothers need to be able to survive the baby’s rage. The way that the baby tests whether the mother is really trustworthy or not is basically to destroy her (in unconscious fantasy). The baby will throw his/her toys out of the cot, have a screaming tantrum and the mother-figure (which incidentally is often the father too) needs to be able to survive that without shaming the baby into conformity. I guess this stuff is second-nature to most parents in the US and the UK these days but it’s worth repeating.

If, in Winnicott’s terms, the self is first made real through recognition, the object is first made real through aggressive destruction; and this, of course, makes experience of the object feel real to the self. … If the object will not allow itself to be destroyed, and does not retaliate: if it survives the full blast of the subject’s destructiveness, then, and only then, can the subject conceive of the object as beyond his power and therefore fully real.

I think we’ve seen that in this election numerous times. Obama vs Clinton was possibly a decisive turning-point. As much as Clinton tried to destroy Obama, he took the punches and kept going. At the end of an at-times bitter campaign, Hilary had the grace to rally behind her opponent and support his bid. If Obama hadn’t been through the mill, so to speak, would Americans have been able to put their trust in him? Perhaps that’s one of the benefits of the US election system – that it puts the candidates through the wash not just once but many times. (There are obvious disadvantages as well in terms of populism and style over substance but that’s not the point here.)

Politicians can learn something from this – that it is when the electorate really seems to hate you (cf. Tony Blair and the British public) that they are in fact testing you. How will you stand up to the pressure? Will you become all defensive and go on the attack or will you take the “slings and arrows of outrageous fate” and stay on course?

There are numerous implications for South African politics. A large section of the public appears to be really fed up with the ANC at the moment and the party could split into two. How do political leaders in this country deal with criticism and dissent? Do they force people into compliance with the dominant view? Play “you’re either with us or against us” games? Or do we have a robust debate about the problems facing our country and accept the criticism and move forward?