Several problems emerged in my session with my therapist on June 19, 2017.

During the session I recounted the following anecdote regarding a previous therapist.  I stated that at one of my sessions with a past therapist, a fourth-year psychiatry resident, the pychiatrist reported that he had had a job interview that morning.  He bragged about his performance at the interview, telling me how much the interviewer had been impressed with him and what a good job he did at the interview.

My current therapist offered the opinion: “Perhaps people feel they need to prove themselves around you.”  She was implying that I induce these feelings in others as a way of moderating my own feelings of insecurity.  That’s a valid interpretation.  Perhaps I am an insecure person who devalues others in subtle ways in order to make others feel insecure about themselves.  My attempt to make the therapist feel he needs to prove himself perhaps relates to my struggle with envy and my need to defeat the therapist through rivalry and competition. Dr. Kernberg viewed persons with narcissistic personality disorder as among the most difficult to treat because much of their effort goes into trying to defeat the therapist. For the treatment and the therapist to be effective, these patients must deal with their intense feelings of competitiveness and envy that someone else has good qualities that they lack. Gabbard, G.O. Psychodynamic Psychiatry in Clinical Practice at 499 (Washington, DC: American Psychiatric Press: 2014).

But there are other interpretations.

1. Perhaps the psychiatry resident was grandiose and needed to brag about himself. It is telling that at another session he said: “I have never masturbated in my life. Never! I have never masturbated.”  On another occasion I pointed out to the resident an instance of what I termed counter-transference.  He replied: “I do not show counter-transference.  Counter-transference only happens in inexperienced psychiatrists.  I so not show counter-transference.” These comments suggest that the psychiatrist felt he was perfect and that he needed to brag about his perfection in different ways.  Is there a link between grandiosity the perceived need to prove one’s self? 1/

2. Perhaps the psychiatrist was an insecure person himself and felt even more insecure working with a highly intelligent patient. It is well to keep in mind the following anecdote. In the year 1989 I visited the Sheppard Pratt Employee Assistance Program to obtain a psychiatric referral. I spoke with a social worker who said she would look into a referral for me. I had given the social worker a copy of an autobiographical writing (The Caliban Complex). About a week later I returned to her office at which time she said: “I am referring you to Floyd Galler, M.D. (a personal friend of Dr. Palombo’s, incidentally — they had done a psychiatric residency together at Harvard). He’s a top notch psychiatrist. You can’t see just any therapist. You need to see a top notch person.” I later had occasion to read my chart of confidential mental health information at Sheppard Pratt. The social worker had described me in her notes as a “brilliant man.” ( She also described me as schizoid rather than narcissistic).  Perhaps the issue is that I make less than top notch therapists feel insecure, make them feel they need to prove themselves around me. That raises the relational issue of what happens between a highly intelligent patient and therapists who have their own personality problems or intellectual limitations. Cf. Modell, A. “Narcissistic Defense against Affects and the Illusion of Self-Sufficiency,” at 296: “[An] environmental trauma may occur [in a young child where there is] disillusionment with the mother based on an accurate perception of the mother’s faulty judgment. For example, one patient who was in fact intellectually precocious perceived at the age of two or three that his mother was mad, although the extent of her madness was hidden and this fact was not acknowledged by her family or by her neighbors. The child, however, observed that his mother’s judgment was off and that he could not rely on her.” Perhaps similar dynamics apply to the relationship between me and some of my therapists — the relationship between a gifted patient and less than stellar therapists.

3. Perhaps there was an issue of jealousy between me and the therapist based on a three-way relationship. The psychiatry resident was supervised by Earle Baughman, M.D., a senior psychoanalyst at St. Elizabeths Hospital. I had provided Dr. Baughman a copy of my book Significant Moments. Dr. Baugheman is an expert in literature, particularly the writers of the American South, such as William Faulkner. The psychiatry resident often told me about glowing comments that Dr. Baughmann made about me, about how much I had going for me. The resident said: “Dr. Baughman often opens your book and reads passages from it to me to illustrate different psychological points.” How did this resident react to his supervisor using his patient’s book as a teaching tool? One wonders.

Perhaps these comments by Dr. Baughman to the psychiatry resident aroused jealousy in the resident and caused him to feel he needed to prove himself around me. (There is a possibility of anti-Semitism here, also. The resident mentioned a number of times that Dr. Baughman was Jewish and he knew that I was Jewish also.  The resident was a non-Jew.  Perhaps the resident at some level felt that the Jews were ganging up on him.) These observations point to how shallow and simplistic my therapist’s opinions are. She says she is interested in relationships but she has no feeling for the complexity and subtlety of relationships and seems unable to go beyond her own projections. Apparently, this therapist felt that it was she who needed to prove herself around me and proceeded to project those feelings onto my previous psychiatrist. That procedure was strikingly simplistic and projective.  (Dr. Palombo mentioned that my personality showed signs that I was struggling with the effects of jealousy in my developmental environment.  Peter Blos points out that a father’s rivalry with his young son can be an important issue in the dyadic father complex that predates the boy’s Oedipal struggle.   Blos points out the link between this issue of pre-Oedipal paternal rivalry and the boy’s early fear of maternal engulfment.   Fears of maternal engulfment appear to be important in my case.  My current therapist failed to see how my possible struggle with paternal jealousy in a previous therapeutic relationship relates to my transference fears of engulfment by her — and in a grossly simplistic fashion points to the issue of my eliciting grandiosity from my previous therapist.   Blos, P. “Freud and the Father Complex” at 431.  The Psychoanalytic Study of the Child, Vol. 42 (New Haven: Yale University Press: 1987). My sister reports that on one occasion she witnessed my father beating me when I was an infant — perhaps evidence of early paternal jealousy. One wonders how struggles about paternal jealousy molded my character and the possible link to my fears of maternal engulfment. See Blos, above.

4. Perhaps the resident was envious of me. Perhaps the resident felt he was in competition with me. Dr. Kernberg points out that competitiveness can be a sign of envy.  Perhaps the resident himself was struggling with his own intense feelings of competitiveness and envy that someone else ( that is, I) had good qualities that he lacked.

5.  Note how the therapist revealed a paranoid-schizoid split in her thinking.  At a previous session the therapist described me as feeling that I was special and that I felt I needed to be an unforgettable patient.  In effect, the therapist was pointing out my grandiosity.  At this session, the therapist was saying that I was eliciting grandiosity in my previous psychiatrist.  There is an old Jewish saying: Jug falls on rock, jug breaks.  Rock falls on jug, jug breaks.  Poor jug!  Notice how the therapist evidences a split in her thinking.  Only I have agency (or drives or defenses) (I am a bad object).  The people with whom I interact have no agency (no drives or defenses) (they are the good object).  If I puff myself up I am grandiose.  If another person puffs himself up in relation to me it is because I am grandiose and am eliciting grandiosity from the other.  What is interesting is that these dynamics in a parenting context engender serious pathology in the child.  Where the child is always treated as if it is he who is in the wrong, a severe guilt reaction in the child can ensue. Such a parenting style can engender introjective pathology in the child that centers on a struggle around the issue of guilt. Reis, S., Grenyer, B.F. “Pathways to anaclitic and introjective depression.” Psychol. Psychother. 2002 Dec;75(Pt 4):445-59. I appear to have serious introjective pathology. Is this therapist helping me, or actually reinforcing my pathology?  Is this therapist actually making my condition worse?

1/  I had the distinct feeling that a previous psychiatrist at GW, Suzanne Pitts, M.D. felt she needed to prove herself around me.  On one occasion I saw Dr. Pitts talking in a friendly manner with a senior psychiatrist in the hallway in the psychiatry department.  At my next session, Dr. Pitts asked me:  “What did you think of me talking to Dr. ———?”  On another occasion I asked Dr. Pitts to look into assigning me to a different resident.  I said: “If there’s another resident who is better suited to treat me, I would like to see that resident in treatment.”  Dr. Pitts responded:  “There is no one else.  There is no one better suited to treat you.  I am God-like!”  God-like?

Barry Stern, what say you?

Glenn Gabbard, what say you?