The following are some of the issues I covered with my therapist at our June 26, 2017 session:

At the beginning of the session I told the therapist that I brought with me copies of documents about scapegoating.  I explained that I felt I had been a scapegoat in my family and later in the workplace.  I explained that according to Froma Walsh,  in families that scapegoat a child there is massive projection onto the scapegoated child while a second sibling is idealized: the scapegoated child can do no right while the so-called omnipotent child can do no wrong.  I saw myself as the scapegoat and I saw my sister as the omnipotent child.  I said I feared that the therapist herself was scapegoating me with her projections.

I talked about how previous therapists seemed critical and judgmental of me, telling me that I didn’t talk about my feelings, that I didn’t know how to do therapy correctly, that I needed to talk about my feelings.  I explained that at GW my psychiatrists  always talked about how I was not doing things correctly: “I have recommended medication for you and you won’t take medication”; “You don’t talk about your feelings”; “You should be working, why are you not working?”

I talked about how I remained unsure of what “vulnerability” in therapy was.  I had the feeling I was supposed to be vulnerable in therapy, but that I didn’t understand that concept.  I asked:  “If a person can simply be vulnerable in therapy and talk about his deep feelings, and get benefit from that in a once a week program of psychotherapy, why would a person go to a psychoanalyst 3, 4, 5 times a week for 3, 4, 5 years or more?  There must be a reason why a person would do psychoanalysis when he could simply be vulnerable, talk about his feelings, and get benefit out of that.”  I talked about how chastisement by my therapists triggered guilt feelings in me.  I felt I was being judged, criticized and condemned by therapists.

I talked about Janet Malcolm’s book, Psychoanalysis: The Impossible Profession.  I talked about the work of the psychoanalyst Hartwig Dahl and the linguist Virginia Teller at the N.Y. Psychoanalytic Institute who were doing linguistic analyses of psychoanalytic sessions.  Malcolm reported that Dahl talked about a patient whose sessions were being tape recorded; he permitted Malcolm to listen to one of the sessions, a session he said was the most important session in the analysis.  I stated that Malcolm reported that after listening to the session she was struck by the fact that the patient seemed only to talk about trivialities, yet the analyst had concluded that these seeming trivialities were very important, a kind of review of the patient’s entire pathology. Malcolm wrote:  “I turned on the [recording] machine, and listened for fifty minutes to a young man’s halting, rambling soliloquy describing ordinary trivial events and expressing commonplace thoughts and feelings.  It was like listening to a boring, self-absorbed acquaintance.  Freud had been right: an outsider eavesdropping on an analytic session gets almost nothing from it; he is like an eavesdropper on a conversation (or monologue) in a foreign language.  Only later, on reading the annotated transcript of the hour, did I laboriously decode the secret messages from the unconscious that the patient had wafted toward his analyst years before, and which Dahl, following Freud’s instructions about loose, desireless, undirected listening, had ‘intuitively grasped.'”  I said that Malcolm’s report relieved feelings of guilt in me: to know that if I were in psychoanalysis my narratives might be totally acceptable; that the guilt I felt about being chastised about not talking about feelings was simply an artifact of a form of psychotherapy that demanded that I be vulnerable and talk about my feelings.  I reported that on two occasions I said to Dr. Palombo: “I feel I am not talking about important things, that I am not bringing up significant material” and that he responded, “You’re doing fine.”

Later, I talked about my sister, my perceptions of her as an emotionally vulnerable person.  I said that I contrasted that vulnerability with my own seeming emotional resilience.  I seemed to imply that emotionally I was a stronger person than my sister.  Here the therapist spoke up: “I get the feeling that you are judging your sister.”  The therapist emphasized her feeling that I was being unfairly critical of my sister.

As in previous sessions, the therapist seemed to be projecting her feelings about me onto my relationship with or perceptions of another person.  It was, no doubt, the therapist who felt I was unfairly critical of her–that I judged her.  The therapist experienced my critiques of her work as a narcissistic injury and projected that mental state onto my sister.

I find this significant.  It is as if the therapist only concentrates on things that I talk about that arouse a narcissistic injury in her.  She ignores most of what I say that does not arouse a narcissistic injury in her.

  1.  When I criticize past therapists the therapist says, “People who idealize some people devalue others.” 1/ Translation:  “I feel that you devalue me.”
  2. When I talk about a previous psychiatrist who bragged about his job interview she says, “People seem to feel they need to prove themselves around you.”  Translation: I feel I need to prove myself around you.
  3. When I talk about my sister’s emotional vulnverability, the therapist mildly chastises me, “I get the feeling that you are judging your sister.”   Translation: “I feel that you judge me.”

The therapist comes off seeming insecure and paranoid. More and more I feel that I am trapped in my therapist’s paranoid universe in which the only things significant about me (in her mind) are those things that arouse a narcissistic injury in her.  If I talk about an issue that does not arouse a narcissistic injury in her, she ignores what I say. She seems convinced that her emotional responses to me reflect only my motives or unconscious concerns. She doesn’t seem to appreciate that in many instances she is the author of her emotional responses — not I. It’s as if her professional work as a therapist provides an adaptive niche for her paranoia, as if she thinks: I can automatically assume that my (paranoid) emotional responses to the client can be used to understand the client. That confuses countertransference with paranoia. It is well to keep in mind: “Most countertransference reactions are a blend of the two aspects’, personal and diagnostic, which require careful disentanglement in their interaction.” Jacobs, M. Psychodynamic Counselling in Action(London 2006), p. 146.

How did previous therapists respond to my written critiques?

My last therapist was amused by my writing about him.  He chuckled and said, “I can’t believe you invest so much energy, go to so much trouble in analyzing what we talk about, what I say. This is amazing.” That therapist was the author of that response — not I.

In 2009 I provided Abas Jama, M.D. a written critique of his work.  At the next consult he said, “You did an excellent job of analyzing our session.  That was good work.” Dr. Jama was the author of that response — not I.

At GW I regularly provided written critiques of my psychiatrist Dimitrios Georgopulos, M.D.  He had no reaction at all to my letters.  At one point I even wondered if he read my letters.  That’s how unaffected he was by my letters.  He confirmed that he read the letters. Dr. Georgopoulos was the author of that response — not I.

In February 2016 Monica Acharya, M.D., the attending psychiatrist at DBH said to me: “I spoke with several of your past psychiatrists.  They all said they liked working with you.  They all say they learned from you.”

I sense that my current therapist seems threatened by my critiques of her work.  It’s as if my critiques dominate her thinking about me.  The therapist does not see our relationship as one between an anaclitic therapist and an introjective patient.  The anaclitic therapist might look for signs of affiliation from a patient, while the pathologically introjective patient will be preoccupied with self-definition and the need to verify and confirm his identity through comparison with another.  “The focus [in the introjective personality] is not on sharing affection—of loving and being loved—but rather on defining the self as an entity separate from and different than another, with a sense of autonomy and control of one’s mind and body, and with feelings of self-worth and integrity.”  One wonders whether this seeming anaclitic therapist can work with a pathologically introjective patient.

With regard to my relationship with my sister — my seeming judgmental posture — perhaps one could see that as reflecting my introjective pathology.  “It is suggested [that the introjective person’s preoccupation with self-definition] stems, in part, from a past in which important others have been controlling, overly-critical, punitive, judgmental, and intrusive—thus creating an environment in which independence and separation was made difficult.”  The therapist in focusing on my judgmental posture towards my sister seems to expose once again her paranoid-schizoid anxiety.  She focuses on me as judgmental — depicting me as having agency (the bad object) and depicting my sister as having no agency (the good object) — while ignoring my developmental experience of having been unfairly judged in an environment  in which parental figures had agency (the bad object) and I was the passive object of their aggression (the good object).  The therapist’s paranoid-schizoid anxiety may prevent her from seeing me as a target of aggression (the good object).  We do know that she is unable to see that I was the victim of inadequate past therapists.  (“People who idealize some people tend to devalue other people.”)

It’s also important to observe that in a dysfunctional family that scapegoats a child, it is the scapegoated child who tends to be the most emotionally stable member of the family.  “The scapegoated child is unjustifiably assigned the “problem child” role by others within the family or even wrongfully blamed by other family members for those members’ own individual or collective dysfunction, often despite being the only emotionally stable member of the family.”  Do not my observations about my sister’s emotional vulnerability and my own seeming emotional resilience relate to my role as scapegoat in my developmental environment, a role that conditioned me to be the only emotionally stable member of the family?  (Compare Kernberg’s observations about aggression in groups: According to Kernberg an individual who does not regress in the group setting and who retains his individuality, his thinking and his rationality in the regressed group will be attacked (scapegoated) by group members.)

Note how the therapist ignored all the material I raised about the issue of guilt: my guilt about being judged by my past therapists and the “absolution” I experienced in reading about the psychoanalytic patient who was allowed to talk about seeming trivialities and the “absolution” I experienced in reaction to Dr. Palombo’s statement that I was “doing fine” in therapy.


1/  The therapist should know that idealization is not simply a facet of identity diffusion (black and white thinking) or narcissistic disorder.   Idealization can also be symptomatic of dismissive avoidant disorder.    “There appears to be considerable overlap between attachment processes and what Kohut (1971) described as ‘idealizing needs.’   Both concepts emphasize the sense of strength and security that results from connection with another who is seen as more powerful and competent than oneself.  Self psychological theory stresses the importance of parental provision of soothing and calming of difficult affect states and proposes that self-regulatory difficulties such as vulnerability to fragmentation will ensue if parents are deficient in serving as idealizable selfobjects (e.g., Wolf, 1988). Similarly, both attachment theory and self psychology stress the importance of affective attunement in development. Sensitivity to an infant’s or child’s affect, or appropriate responsiveness to mirroring needs, is considered central to the development of secure attachment and a cohesive self (emphasis added).”  Connors, M.E. “The Renunciation of Love: Dismissive Attachment and its Treatment.” Psychoanalytic Psychology, 14(4): 475-493 at 487-88 (1997).  My current therapist does not serve my mirroring needs.