The following is a summary of my thoughts about my therapy session on July 24, 2017.  The thoughts are especially tentative.  I do not have a high level of confidence in these ideas.

I started the session by saying that I brought two critiques with me.  Last week I had forgotten to bring the critique of the previous week’s session.  I said that I also brought a critique of the session on July 17.  I said that the latter critique was twelve pages long.  “Oh, twelve pages long.  Let’s discuss that,” she said.  I proceeded to talk about how I continued to be preoccupied with the issue of attunement.

Somewhere into the session the therapist said, “I have the feeling that you want something from me.”  “What would that be?” I said.  “I feel that you want perfect attunement from me . . . ” She proceeded to list other things that she felt I wanted from her.  I can’t remember what she said.  I said, “Yes, I want all those things.”

In a previous session, I had criticized the therapist’s work.  She said, “I don’t know what you’re expecting from me.  Do you want me to explain my theoretical orientation?”  In that latter case, she attributed the quality of my “wanting” something in response to my oral critique, which she may have experienced as a narcissistic injury.

I note the fact that the therapist is never without her water bottle, which she sips from at least once in a session, seemingly at moments of agitation.   The therapist is mildly overweight. 1/

My mind went back to my work with two previous therapists.

In 1991 I was in therapy with William D. Brown, Ph.D.  He sometimes commented on my wanting things.  I recall that I once mentioned that I had gone to see a movie the previous weekend.  He asked who I went with.  I said I went by myself.  He said, “Would you have wanted to go with somebody?”  Dr. Brown emphasized my social isolation in my sessions and frequently encouraged me to get socially involved.  It all seemed perfectly reasonable behavior by a therapist: that he would inquire whether I wanted somebody to accompany me to a movie.

The idea of my wanting something emerged from time to time in my sessions with Dr. Brown.

On one occasion he said, “You want Akin Gump (the law firm where I worked) to offer you an associate position.”  I said, “No, not particularly.”   He said, “Come on, you want them to hire you.”  He became insistent about it.  I never gave any indication that I wanted to practice law at that firm.  At a previous firm (Hogan & Hartson)  where I worked as a paralegal I actually went so far as to submit my resume for an associate position.  But I made no such effort at Akin Gump.  There was no reason for Dr. Brown to insist that I wanted to practice law at that firm.  I processed Dr. Brown’s attribution of “wanting” to me as coercive and projective.   Was there something that Dr. Brown wanted?

Dr. Brown sipped from soda at our sessions.  He once offered me a soda.  I once saw him entering the office with a case of soda cans.   I interpreted his behavior as expressing oral cravings.  Was there some relationship between Dr. Brown’s apparent oral cravings and his insistent imputation of “wanting” to me?

Years ago I was in therapy with a psychiatrist who saw my “wanting” things as a major aspect of my pathology.  He said, “You want too much.”  At times he would talk about what I wanted from him.  I said, “What do I want from you?”  He answered, “I know a lot of things about you.  You want me to tell you what I know, you want to know the products of my expertise.”

The psychiatrist had noticeable oral cravings.  He smoked cigarettes, he sipped water from a mug throughout the session, and he had a refrigerator in the office and snacked on pretzels from time to time.  The psychiatrist placed special emphasis on my social isolation.  He asked me from time to time why I didn’t have friends. 2/  He would always answer his own question.  “You don’t have friends because you want too much from people.”

Was there a connection between the therapist’s apparent oral cravings and his insistent attribution of “wanting” to me?

These observations seem to be related to ideas I presented in a previous letter about the current therapist.

“When the therapist invokes the dyadic attachment dance she seems to necessarily confine her concerns to anaclitic issues that involve feelings of helplessness and weakness; fears of being abandoned, and strong wishes to be cared for, protected, and loved in which pre-oedipal, dyadic issues predominate. Dyadic anaclitic concerns are primarily oral in nature, originating from unmet needs from an omnipotent caretaker. Introjective concerns are related to the (more developmentally advanced) formation of the superego and involve the more developmentally advanced phenomena of guilt and loss of self-esteem during the oedipal stage.”  Kemmerer, D.D. “Anaclitic and Introjective Personality Distinctions among Psychotherapy Outpatients: Examining Clinical Change across Baseline and Therapy Phases.”  Published Ph.D. Thesis.

Is there some relationship between a therapist’s imputing “wanting,” or craving, to me and the therapist’s own anaclitic, oral cravings.

I also note that the state of envy is a state of wanting.  A person who envies another wants something valuable that another possesses.   3/  Is a therapist’s attribution of wanting to me a veiled reference to her feelings of envy, an expression of the therapist’s feelings of wanting projected on to me as a person who wants something?  And is there a relationship between a therapist’s feelings of narcissistic injury emanating from a patient — perhaps the therapist feels devalued or undervalued by a patient — and the therapist’s experience of envy of the patient and subsequent attribution to the patient that the patient wants something.

1/ I have strong oral cravings myself. I see myself as having strong introjective qualities as opposed to anaclitic qualities. Drew Westen describes a type of anorexic personality that is preoccupied with food but is also strongly introjective. Westen D., Harnden-Fischer J.”Personality profiles in eating disorders: rethinking the distinction between axis I and axis II.” Am J Psychiatry 2001 Apr;158(4):547-62. Westen has identified the following introjective qualities in this food-preoccupied cohort: tends to be self-critical; sets unrealistically high standards for self and is intolerant of own human defects; expects self to be “perfect” (e.g., in appearance, achievements, performance, etc.); has moral and ethical standards and strives to live up to them; tends to feel guilty; is psychologically insightful — is able to understand self and others in subtle and sophisticated ways (possibly indicating strong self-object boundaries or a high level of individuation); is creative; is able to see things or approach problems in novel ways.

2/ I once told Dr. Palombo that I was not interested in having friends. He said, “That’s sour grapes.” It’s as if he was saying psychoanalytically, “You deny your oral cravings.” Yes, that’s exactly what anorexic patients do. They deny their oral cravings. But that overlooks the fact that guilt (or introjective concerns) are a major issue in one cohort of anorexic patients. See 1/, above.

3/ Envy appears to be related to greed.  I note that I may have an unusually strong trait of unconscious greed that causes me to soak up the projections of others, tending to make me a scapegoat of paranoid people (including paranoid therapists).  Calef and Weinshel found that “[i]n the regression from the oedipal impulses some, perhaps many, people retreat to the introjective (oral) mode of defense. The authors describe, under the rubric of “gaslighting,” an outcome of the introjective defense in which a victim and a victimizer join psychological modes in expressing and defending themselves against oral, incorporative impulses (greed), each in his or her own way. ” Calef, V. and Weinshel, E. “Some clinical consequences of introjection: gaslighting.”  Are my current therapist and I engaged in an attachment dance in which she plays the paranoid party projecting onto me while I, employing an introjective defense,  soak up her paranoid projections?  (A word about terminology.  Calef and Weinshel are referring to “introjection” in the sense of orality and not in the sense of superego formation.)