THERAPIST’S SHALLOW UNDERSTANDING OF PSYCHODYNAMIC CONCEPTS
At the consult on July 24, 2017 the therapist at one point attributed extravagant wanting to me. She said, “perfect attunement from me is not possible.” You will recall that at another point in the session she said, “I feel that you want perfect attunement from me.” I interpreted the therapist’s observation as relating to my letter writing. The observation seemed to rest, at least in part, on the therapist’s assumption that I am not getting what I want from her and that I am writing letters as a form of acting out. The therapist seems to assume that the letters are fundamentally other-directed and not self-directed, consistent with ego structuralization.
The therapist’s observation merits scrutiny from two perspectives.
First, let’s look at the following analogy. A prisoner serving a life term keeps a diary in which he records his thoughts and feelings about his confinement. The prisoner experiences his confinement as oppressive and longs for his release. You can say to the prisoner, “You will never be released. What you want is not possible.” In fact, the diary is a form of self-soothing. In the face of the impossibility of the gratification of his wants, he writes a diary to assuage his distress. The prisoner’s act of writing a diary is a self-directed activity. He is not writing the diary to submit to the parole board as evidence to support his petition for parole.
Second, the therapist uses the assumption that I am acting out in therapy to support the further assumption that in my childhood relationship with my mother I acted out when my mother did not gratify my wants.
But what about the issues of optimal frustration in the mother-child relationship and consequent ego structuralization? The therapist ignores these issues as they might apply to me and instead imputes to me the behavior of a toddler. (As a projection the therapist’s failure to consider issues of internalization in me, i.e., the view that I am responding to the dictates of internal objects and only to external objects, may indicate an infantile trend in the therapist’s personality.)
Kohut considered optimal frustration the most important aspect of the earliest mother-infant relationship. “Tolerable disappointments” in the child’s relationship to mother lead to the establishment of internal structures which provide the basis for self-soothing.” Kohut, H. The Analysis of the Self. What about the possibility that frustrations in my relationship with my mother led to structuralization, i.e., the development of internal objects permitting self-soothing, rather than to a disposition to acting out behaviors?
The therapist’s interpretations are defective in several ways. First, the child’s experience of frustration may not necessarily lead to acting out behaviors, but to internalization, or structuralization. Second, a child who acted out in early childhood in response to maternal frustration will not necessarily be an adult who acts out in response to frustration. Keep in mind that ego structuralization is a process that continues into late adolescence. See, e.g., Kroger, J. “Ego structuralization in late adolescence as seen through early memories and ego identity status.” J. Adolesc. 13(1): 65-77 (1990).
The therapist’s emphasis on my “not getting what I want” is misplaced. I am not simply troubled by the therapist’s lack of attunement. I am troubled by getting things from the therapist that I don’t want. It is vitally important that a psychiatrist “meet patients at the developmental level of their ego structure” [to meet the patient’s particularized needs for identity recognition and provide an outlet for actualization of his ego capacities]. Comprehensive Handbook of Psychotherapy, Psychodynamic/Object Relations edited by Jeffrey J. Magnavita. By attributing to me the characteristic behaviors of a toddler, the therapist is failing to make interpretations consistent with my level of ego structuralization. There is a strikingly amateurish quality running through all of the therapist’s work.
I had earlier provided a writing to the therapist that indicated my high self-soothing ability. The therapist failed to draw the logical conclusion from that writing, namely, that my self-soothing ability must be evidence of a high level of ego structuralization. She persisted for weeks in offering interpretations about my behavior that rested on the assumption that I do not have a high level of structuralization, i.e., that I responded to “not getting what I wanted” from mother by acting out behavior. This seems to be evidence of the therapist’s projections (paranoia) and possible infantility. The therapist appears to have a shallow understanding of psychodynamic concepts.
The following is the writing I provided to the therapist in early June.
I sometimes feel that my therapists want me to be a vulnerable person in therapy. My current therapist pointed out a few weeks ago that I was expressing vulnerability with the implication that that was good.
I am not often vulnerable in therapy and never needy. This seems to trouble therapists. I don’t know what to do about that, if anything should be done. I was never vulnerable with Dr. Palombo. I saw him for a year and he never talked about that. I’m not a vulnerable person in life, so how would I be a vulnerable person in therapy?
When my mother died in early January 1980 it was the first week of my second semester of the first year of law school. Despite the pressures of law school, I did not become vulnerable. I did my studies and finished my first year at the top 15% of my class.
When I got fired from my job in 1991, I didn’t become vulnerable at the termination meeting. Some fired employees might get into a tizzy with the employer, particularly one who was fired suddenly for no good reason and who had a stellar employment record. When I was told I was fired I just packed up my stuff and walked out. It was just another day at the office. The last day had come !
On the afternoon of October 12, 2004 I got a knock at the door. Outside my door were ten police officers and four FBI agents, some of whom entered my apartment. After talking to me for a while, they hauled me off in handcuffs to D.C. General for an emergency forensic psychiatric examination. I wasn’t particularly concerned. I thought, “I’ll talk to the psychiatrist and go home.” My only nagging concern was “How am I going to get home?” When the police hauled me off, they didn’t give me time to get my wallet. I had no wallet and no money. All I thought about at the hospital was, “How am I going to get home?” In the end the psychiatrist gave me money. Nice psychiatrist. (Diane Martin, M.D.).
It is well to keep in mind, one of the criteria of high ego strength is, “Faces reality calmly.” I face reality calmly. How do you do therapy if you are a person with high ego strength?
I read the following account on the Internet written by a therapist, about the therapist’s need to see the patient in a vulnerable position.
I often felt Nick attempting to communicate with me as if we were colleagues, rather than turning to me in a vulnerable, needy way as my client. In one session, he talked about how much he liked to be the one dispensing wisdom: what he really wanted to do, he said, was write a philosophical-type book and get paid for speaking engagements. It felt as if he were making some comparison between us. In a later session, he made similar remarks; I addressed the ongoing comparisons and told him that it was deeply painful for him to compare himself to me, a man the same age, and to feel what he might have done with his life. The loss of potential, the waste of the years, the shame about his damage felt excruciating and unbearable.
“The loss of potential, the waste of the years, the shame about his damage felt excruciating and unbearable.” I am struck by that line. The same could be said for me, but I don’t have these feelings.
I think of the line from Significant Moments:
“Perhaps my best years are gone. When there was a chance of happiness. But I wouldn’t want them back. Not with the fire in me now. No, I wouldn’t want them back.”
–Samuel Beckett, Krapp’s Last Tape.