Fat Patient, Thin Therapist

It is usually assumed that in a room with a slender therapist and a fat patient, it is the patient who has a weight problem. That therapist, benefitting from thin privilege may well assume that the way she eats, what she eats and how she exercises are what make her different from her patient, what make her thin and her patient fat. She may believe that because she carefully monitors what she eats and faithfully exercises, that she has control over her body, control that the fat woman could have if only she tried harder and did as she does. There is nothing in the media or even the professional literature to contradict her assumptions.

There are powerful transference/countertransference forces operating in therapy when fat enters the picture. As a fat patient I came to work with slender analysts with a full set of baggage and expectations based solely on my fears and projections about how my fat body would be experienced and regarded. Nothing in my experience with others contradicted these fears. And more often than not, my fears were borne out as valid. The language used to describe obesity – words like “grotesque”, “gargantuan”, “repulsive” – betray much about feelings toward fat people. It is important for the slender therapist to look within about her own attitudes and responses to fat.

A fat patient who wants to talk about weight exclusively, as if it were all that matters in life, is as much avoidant as is the fat patient who ignores weight entirely. And in either case, the therapist needs to be aware of how her own biases and/or discomfort play a role in this. There are very fine lines here. Weight and appearance and being outside the established norms are touchy things. It is difficult to become accepting of one’s own deviant(in the sense of differing from whatever is considered ‘normal’) body, to be at home with being different. The ambivalence is massive. The longing to fit in is right there next to defiance and anger about not being accepted. The therapist needs to walk that line without falling to either side, either by urging and cajoling weight loss or by denying the difficulties of being different from the expected norm. These are tricky waters for a therapist with thin privilege to try to navigate.

Just as we now know white analysts need to learn about African American culture, our fictional slender analyst needs to learn about the life her fat patient leads, about fat experience, about the experience of being reviled, judged, shunned, pathologized on a daily basis. And consider what her own unresolved body issues might be, because as Barbara Miller writes:

the experience of the analyst may…have to do with his or her own neurotic blind spots. And the analyst needs to consider such a possibility. Concerning neurosis Jung writes, ‘Behind a neurosis there is often concealed all the natural and necessary suffering the patient has been unwilling to bear’… And we can say that the analyst’s own not suffered pain can all too easily be disowned and then ‘found’ as the pain of the analysand: the neurotic countertransference. 

A female therapist, regardless of her weight, has had to deal with the expectations that women should be slender and attractive. Most likely she has dieted or thought about  dieting, fretted about any fluctuation in her weight, and experienced some anxiety about whether or not she is pretty enough, slender enough to attract a partner. In this sense she and her fat patient have shared experience, but her patient’s anxiety and fretting have not resulted in the slender body that the therapist has. And this can well become a source for a blind spot in the therapist – if she has been able through diet and exercise to be thin, then why wouldn’t that also be the answer for her fat patient?

That slender therapist needs to consider where her ideas about fat and fat people come from, what supports those ideas. The one article in Quadrant, a Jungian journal, in which obesity is even addressed carries bias right in the keywords given for the article: obesity, gorging, overeating, gluttony, hunger. 

Outside of the realm of fat studies, the Health At Every Size movement, and fat acceptance circles, the fat person is not seen as trustworthy or reliable about her own lived experience because it is assumed she is always defensive and denying the reality of her condition. If she says she eats moderately, often it will be asserted that she is in denial about how much she actually eats or some comment will be made about the unreliability of self-report. The fat woman is simply not trustworthy. 

Wilfred Bion’s dictum is to approach each session without memory or desire. If the therapist has in mind that her fat patient needs to lose weight in order to heal, whatever that means, then she is in fact imposing her agenda without determining if that is what the patient wants or needs. When the therapist holds this desire for her patient to change in particular ways, when she asserts her own agenda for the patient, Barbara Stevens Sullivan suggests that desire “reflects a yearning to be helped. “If I can put all the woundedness I sense in the room into the patient, and if I can fix it in him, I will be fixed, too”

The assumption, for both therapist and patient, most often is that if the patient loses weight and becomes slender, she will become more the person she is meant to be, that she will be healthier and happier. For any fat woman, her fat identity will remain no matter her weight — her memories of being fat, of her longings and pain alongside secret delight in her big body — are part of the fabric of her being and need to be heard, witnessed, and accepted. For the thin therapist this may mean receiving anger toward her as a representative of thin privilege, as one of the oppressors her fat patient has lived with. I think of my own rage when my first analyst blithely suggested I could lose a few pounds no matter my goals. A paradox for the therapist of a fat patient is that as Sullivan says,  “the analyst must let go of desire, even the desire to help, at the same time as she remains involved and concerned, desiring the best for her patient” and, I would add, accept that the best for her patient may not be what she herself would want or choose.

Even Good Guys…

This week there was a thread on Twitter about Irvin Yalom and how kind he is. I have read many of his books and have no doubt that in general he is indeed a kind person. 

I have been thinking and writing about the essay, “Fat Lady” in Irvin Yalom’s book, Love’s Executioner, which I read soon after it was published in 1989, for years. I was horrified by what he wrote:

The day Betty entered my office, the instant I saw her steering her ponderous two-hundred-fifty-pound, five-foot-two-inch frame toward my trim, high-tech office chair, I knew that a great trial of countertransference was in store for me.  

I have always been repelled by fat women. I find them disgusting: their absurd sidewise waddle, their absence of body contour‚ breasts, laps, buttocks, shoulders, jawlines, cheekbones, everything, everything I like to see in a woman, obscured in an avalanche of flesh. And I hate their clothes‚ the shapeless, baggy dresses or, worse, the stiff elephantine blue jeans with the barrel thighs. How dare they impose that body on the rest of us? (Yalom, 1989, pp. 94-95)

Yalom has been much praised for openly admitting such strong prejudice, such clear negative countertransference. And indeed it takes some courage to openly admit such feelings.  But in most of what I have read about that essay, no one questions that his revulsion in fact dominates the entire therapy. Nor are questions raised that he could think and feel this: “How dare they impose that body on the rest of us?” as if any of his patients owe it to him to be pleasing to his eye. Then again, it is acceptable to hate fat and to think ill of fat people so there was little chance of serious criticism except from the fat acceptance community whose opinions could be dismissed as defensive. Nevertheless, he does deserve credit for daring to say what no doubt many therapists think. But it is not enough to do that nor to feel bad about having done so. To fully understand how bad this kind of countertransference is, change “fat” to “Black” or “African American” — there would be a huge outcry over expression of such prejudice, even when admitted. But Betty was fat so many people felt and feel the way Yalom did.

In the course of the treatment described in Yalom’s essay, Betty loses 100 pounds. Of course, because weight is seen as the cause of her depression, because she loses so much weight, the therapy is deemed spectacularly successful.  Another story is revealed in the end of the essay when Yalom says:

“It’s the same with me, Betty. I’ll miss our meetings. But I’m changed as a result of knowing you .”  

She had been crying, her eyes downcast, but at my words she stopped sobbing and looked toward me, expectantly.  

“And, even though we won’t meet again, I’ll still retain that change.”  

“What change?”  

“Well, as I mentioned to you, I hadn’t had much professional experience with the problem of obesity.” I noted Betty’s eyes drop with disappointment and silently berated myself for being so impersonal.  

“Well, what I mean is that I hadn’t worked before with heavy patients, and I’ve gotten a new appreciation for the problems of… “ I could see from her expression that she was sinking even deeper into disappointment. “What I mean is that my attitude about obesity has changed a lot. When we started I personally didn’t feel comfortable with obese people.” 

In unusually feisty terms, Betty interrupted me. “Ho! ho! ho! Didn’t feel comfortable. That’s putting it mildly. Do you know that for the first six months you hardly ever looked at me? And in a whole year and a half you’ve never, not once, touched me? Not even for a handshake!”  

My heart sank. My God, she’s right! I have never touched her. I simply hadn’t realized it. And I guess I didn’t look at her very often either. I hadn’t expected her to notice!” (Yalom, 1989, p. 123)

Yalom was naïve to think that his distaste for Betty’s body had not been evident to her. She lived in a world that reviled her body and likely she, like many fat people, expected to encounter judgement. A more interesting question is why, given that she knew all along of his distaste, did she continue to work with him? The answer? She herself carries and directs those same feelings of disgust at herself.

We don’t know how Betty is now, more than thirty years later. Statistically she most likely has regained all of the weight lost and probably gained more. That is what happens when we try to tame the body through dieting. She may have had bariatric surgery and be among the minority who have not experienced complications from the surgery. Or perhaps she is in that tiny minority who succeeded in maintaining that weight loss. But in the years since the essay was published, no one questioned what losing weight was about for her and how working with a therapist filled with contempt and disgust for her body effected her feelings about herself. About what happens in a patient if even the therapist finds one’s body repulsive, even if the repulsion is not expressed.

It is all but impossible for a fat person, no matter the reasons for being fat, not to have a host of emotional issues about her size and her body. Every day the culture is telling her that she is too big, too much, not acceptable. Finding the courage to talk about those feelings in the presence of someone who finds her as disgusting as she herself often does is quite a feat. How does she find her voice about her anger at what she encounters? How is she to lovingly care about her body and for herself  if her therapist sees her body with the contempt and hatred she so often feels? And what if she is tired of having to devote herself to losing all that weight? The operative assumption is that in a room with a normal weight therapist and a fat patient, it is the patient who has a weight problem. What is it at work that makes it so difficult for the fat patient to be perceived as a whole person who might not share much less welcome the therapist’s agenda about her weight? 

One Voice of the Dark Goddess

I often hear people apologize for complaining about things in their lives, as if complaints are invalid and unnecessary. I carry in mind something I remember from a book I read  years ago, Sylvia Brinton Perera’s Descent to the Goddess. Here is one very memorable quote:

  Complaining is one voice of the dark goddess.  It is a way of expressing life, valid and deep in the feminine soul. It does not, first and foremost, seek alleviation, but simply to state the existence of things as they are felt to be to a sensitive and vulnerable being.  It is one of the bases of the feeling function, not to be seen and judged from the stoic-heroic superego perspective as foolish and passive whining, but just as autonomous fact — ‘that’s the way it is.’  Enki’s wisdom teaches us that  suffering is part of reverencing.

This sentiment feels really appropriate now that we have reached the one year mark of life being altered by the COVID-19 pandemic. In a way this past year feels like a lost year — I don’t know about you but I find it hard to remember many specifics about the last year, except for a pervasive anxiety and a desire for something resembling normal to return. We all number losses, some in our families, among our friends, and overall a number of dead too big to really comprehend. That hope is now available as we become vaccinated and greater freedom of movement has lightened the collective mood a bit and whatever will be our new “normal” begins to seem possible again, so too do we begin to hear complaints — about masks, about waiting, about lines. Anxiety about the vaccines — I had my second dose this past week with no ill effects, but many people are fearful and rumors abound in some media sectors. The anxiety of last March and April when even finding supplies of toilet paper was confounding is lessened to be replaced by chafing to get out, to do things and see people. For myself, I can hardly wait to be able to hug my children, touch my grandchildren, to be in their physical presence. And I know I have much company in this. Somehow I and the people I know and work with have to reach down inside and find just a bit more patience and continue to exercise caution.

We can complain to our heart’s content — that is a way to express the feelings of this last year. Complain and weep and feel anger and look forward. Because it will be better soon.

Entering Old Age

This past week several patients fretted about their fears of looking old and unattractive if they stopped coloring their hair. This has provoked for me a lot of thought about later life and what it means for us and how we respond to it. Midlife has gotten lots of press. Midlife crisis is so widely known it is all but a cliche. As with many life issues, as the Baby Boomers turned 40, we began to write about midlife. And as we Boomer women reached menopause, we began to write about it. And now, we , those of us like me on the leading edge of our generation, have moved firmly into what is the last quarter of life. And apart from a lot of articles about how to live to be really old and pieces about retirement, there doesn’t seem to be much yet about entering the last chapters. Some of us may live longer, but this period, from 60-85, seems to be the place of late life issues.

Let’s look at this quote from Jung:

In the secret hour of life’s midday the parabola is reversed, death is born. The second half of life does not signify ascent, unfolding, increase, exuberance, but death, since the end is its goal. The negation of life’s fulfillment is synonymous with the refusal to accept its ending. Both mean not wanting to live, and not wanting to live is identical with not wanting to die. Waxing and Waning make one curve. 

The goal of all life, the end point, death is what lies in front of us all. And in this last quarter, it looms larger than it has before and is much more a part of consciousness. To be fully alive is to know that death lies ahead.

Between here and death, there is a lot of territory. Work to be done to deal with things left undone, to reconcile ourselves to our past, to seriously consider the story we have been living with an eye especially toward any changes we want to make in the remaining years.

For those of us near or past our 60s or 70s, the issues of midlife no longer seem so relevant. We wrestle with the conflict between the desire to do and the body that no longer wants to. With the bubbling up of creative possibilities that we do not know we can bring to fruition. We have to prioritize in a new way. If there is something I want to do, want to create, I must come to terms with the certain knowledge that I have to get down to work now because time is passing swiftly.

How do we to wrestle with these issues without succumbing to despair or melancholy and regret is a major concern. What does it mean to become old? How to come to terms with a body, a face that is not the face or body I carry in my mind’s eye of myself? Finding a new rhythm. Finding people willing to wrestle with me. These are the issues I see right off. 

Old age is difficult to imagine in part because the definition of it is notoriously unstable. As people age, they tend to move the goalposts that mark out major life stages: a 2009 survey of American attitudes toward old age found that young adults (those between eighteen and twenty-nine) said that old age begins at sixty; middle-aged respondents said seventy; and those above the age of sixty-five put the threshold at seventy-four. We tend to feel younger as we get older: almost half the respondents aged fiffy or more reported feeling at least ten years younger than their actual age, while a third of respondents aged sixty-five or more said that they felt up to nineteen years younger. 

Researchers have found a sizable difference between the expectations that young and middle-aged folks have about old age and the actual experiences reported by older Americans themselves. Young and middle-aged adults anticipate the negative aspects associated with aging such as memory loss, illness, or an end to sexual activity at much higher levels than the old report experiencing them.

One of the things that I find irritating is that those of us who are no longer young are now lumped together as “the elderly” or,  what to me is worse, “seniors” — I really hate that term. Or strangers feel comfortable calling me “Dear” and may speak to me in that slightly sing-song tone used with those assumed to be less than. 

Of COURSE, our bodies slow down. Some body parts stop working properly. Others give out. Mysterious aches and pains show up. It’s what bodies do. The key in old age is to adapt but that’s for another day. But it helps – a lot sometimes – to learn that other people are struggling through the same things you are. It doesn’t mean we don’t also laugh, read books, go to the movies and whatever else engages us that is still possible. But letting off steam together kind of clears the air. To be willing to be publicly old in our time is a bold act. We have a president who is 78 — that is old — but he is not at all free to be old. He must present as younger than he is. Nancy Pelosi is 80, which is definitely old, but she too must present as younger lest she be forced out by virtue of her age. I sometimes feel almost the rebel for having silvery white hair at a time when I have patients fearful of stopping coloring theirs.

Watch this space for an announcement in early spring for a group for women over 60 who want to take a deep dive into the issues and struggles of growing old.

Finding Home

My dad was in the Army when I was growing up. My brothers, who were much older than me, spent their childhoods among extended family in Massachusetts and Connecticut. I grew up moving every two to three years, first to Japan then to Kentucky then to New Mexico then to Germany then to Pennsylvania. 

Where was home? Was it where my grandmother lived? But she died when I was not yet 14. Or was it where I was born? But we moved away from there when I was 5 and never lived there again. People would ask me where I was from, what place I called home and I would freeze with uncertainty — because I didn’t know. For me, home had become where my stuff and I lived; my stuff made home for me.

So I have thought a lot about home over the years — what it means, what makes home.

In December I was asked if I would like to offer a program at the Maine Jung Center. I immediately jumped at the chance and told them I wanted to present on “What is Home?”. And so on 3 Sundays in March I will meet with folks to talk about and write about Home (follow the link if you’d like to attend — it will be on Zoom).

I have lived in Maine since 1972 — it just hit me that is almost 50 years! If home is to be had in my life, then it is Maine. I lived in and not far from Portland for almost 30 years. I loved Portland and especially loved the duplex I lived in there my last 7 years — in fact when a fire destroyed it around 5 years ago, I felt its destruction keenly. In 2005 my husband and I moved to Belfast, Maine. For the last 16 years we have rented a house with perhaps the best view in Belfast, though the house itself is, to be charitable, a bit funky. The view of the bay has been enough for all this time to make the quirks of the house tolerable. But things became a bit difficult when the steep stairs began to pose problems for me. Then came the knowledge that the owners hope to sell it. Through the network of friends we have here we learned of first one possibility then another. And so it has come to be that in a couple of moths we will move to another house, less than a mile from where I am writing this today. We will lose the view but gain a house that is less quirky and easier for us to live in. The sixteen years I have lived in this house has been the longest I have lived anywhere. I’ll miss the view — the house not so much. 

After all these years it seems home is still in large measure where I live with my stuff, so long as my stuff and I are in Maine.

Seeking Normal

I love amaryllises. Most years I order a new one. I watch as those from previous years bloom and re-bloom. One year when my new one arrived, I got distracted and didn’t plant it right away. When I finally remembered and rescued it from the paper bag it had been in, it had started to grow but clearly had suffered from my neglect.The stem and bud were almost white. And as you can see the stem was bent almost over on itself. It had done everything it could to realize itself within the confines of the small paper bag. 

I felt terrible about what had happened and decided to see if it could recover. So I potted it in some nice fresh soil. And put it on my plant shelf where it would be blessed by the morning sun, hoping that the sun and the plant’s tendency to bend toward it would help it recover at least a bit.

In the days after I potted it, the sun did done its work, or as much as it could. The stem and bud became green and the stem straightened some. The bud began to swell. And the flower appeared.

In Natalie Borero’s Killer Fat, she relates

“most of the people to whom I spoke talked about a desire to lose weight to be normal, to be able to wear a smaller size, to blend in, and to avoid the stigma and discrimination faced by fat people. This pattern held not only for people like Tina, who had undergone surgery in order to lose weight, but also for people engaged in less invasive weight-loss attempts.”

The multi-billion dollar diet industry is built on this desire to achieve the ever elusive “normal”, a size or weight or look that remains just out of reach.

In psychotherapy,

“Patients typically seek a “cure” for their wounds, their anxiety, their obsessions and addictions. Jung denies that “perfection” – which may be thought of as a synonym for “cure” – is possible. My own experience, on both sides of the couch, suggests that even “healing” may be a problematic word. In some sense, a person is her wounds. A sapling, planted beside a supportive stake that the gardener neglects to remove, will grow around the stake. The stake’s presence will injure the growing tree; the tree will adapt by distorting its “natural” shape to accommodate the stake. But the mature tree will be the shape it has taken; it cannot be “cured” of the injury, the injury is an intrinsic aspect of its nature.” Barbara Stevens Sullivan

I think of the futility in both instances. That amaryllis once deformed by neglect could not be as it might have been under ideal conditions. But that did not keep it from being an amaryllis. There is no way to become the person I might have been had the circumstances of my life not led to the wounds I carry. I can become freer of their negative effects. I can become conscious of the wounds, how they came to be and how I might respond differently going forward. But I cannot be “cured” because I am my wounds, just as the tree in Sullivan’s example cannot become other than the way it is. Normal for me is who and how I am. 

Now consider the fat person who wants to be “normal”. Her chances of reaching that mythic place are something like 5%. She may lose weight, lose a lot of weight even but she is quite likely to regain it and there goes that chance at “normal”. If the tree in Sullivan’s example is its own normal, because it is the shape it has taken and that shape reflects the conditions of its growth, then is that not also true of the fat person. There are so many causes for and reasons for being fat. But in essence do they not all come down to the conditions in which that fat body has grown and developed? A complex stew of genetic, biologic, emotional, social, familial factors that as the container in which that person develops shape that body. How is we cannot, collectively, acknowledge that there is no cure for this body, that the fat body is its own normal? 

The person with significant emotional wounds often does need help to come to terms with those wounds and the shape they have given to her life. What therapy can do for the fat person is help her come to terms with her normal, to find her way through the pain of stigma and being different. We all are our wounds, no matter the form they take or shape they give us. 

Really? Whatever Comes To Mind?

I have posted before about secrets in therapy and every time I have, questions arise. Often people conflate privacy with secrets. So today let’s revisit this somewhat difficult issue.

Privacy vs Secrecy

Privacy is the state of being unobserved; changing clothes for example — that which I keep private, I am merely withholding from public view. Private matters are those traits, truths, beliefs, and ideas about ourselves that we keep to ourselves. They might include our fantasies and daydreams, feelings about the way the world works, and spiritual beliefs. Private matters, when revealed either accidentally or purposefully, give another person some insight into the revealer.

Secrecy is the act of keeping things hidden — that which is secret goes beyond merely private into hidden. While secrecy spills  into privacy, not all privacy is secrecy. Secrecy stems from deliberately keeping something from others out of a fear. Secrets consist of information that has potentially negative impact on someone else-emotionally, physically, or financially. The keeper of secrets believes that if they are revealed either accidentally or purposefully,  the revelation may cause  harm to the secret-keeper and those around him or her.

So that which is secret often contains an element of shame that private does not. We may keep something private for all kinds of reasons, but most of the time, we keep something secret out of fear and shame of what others would think if they knew. We keep something secret because we believe the cost of telling is so high that it’s virtually not a choice at all. Privacy is voluntary; secrecy is not.

Private: I got terrible grades in high school.

Secret: I forged my degree.

Keeping something private is an act of choosing boundaries and staying comfortably within them.

Keeping something secret is an act of hiding from the pain of disclosing something shameful.

This difference centering around the feelings about the information which is withheld is the principle factor in the difference between what is held private and that which is secret. It is this element of shame or fear attached to the secret that makes it different from something private.

Secrets, like an affair or a gambling problem or some misdeed or money problems — the kind of thing we lie awake and worry about, worry about others discovering — are often a big part of what brings people into therapy and what patients find most difficult to talk about. Shame and fear of judgment fill the room. The carefully cultivated image of respectability or responsibility or moral superiority will surely shatter into a thousand pieces the moment anyone, even the trusted therapist, finds out what is concealed beneath the facade. Each patient with such a secret imagines herself to be alone in the world, unlike and apart from all the rest of humanity, unable to imagine that the therapist has heard similar tales many times before. 

When we carry secrets like this, they become barriers between us and everyone in our lives, cutting us off from real intimacy. Anything which threatens to reveal what we seek so to hide becomes a source of anxiety and must be avoided. Maintaining the facade, the persona which covers the shame of the secret becomes paramount. In Japan I am told there is a saying that first the man takes a drink, then the drink takes a drink then the drink takes the man. The same is true of secrets as the secret comes to own the life of the person carrying it.

Secrets in therapy

Psychotherapy, like the confessional, offers a unique opportunity to break the secret and its hold on the life of the carrier. First comes the mustering of courage to say it, to tell the therapist what has been held in shame, to brave the condemnation and the rejection, the fear of which maintains the grip of the secret. And once spoken, then the work of discerning the meaning of the secret and opening to the shadow. 

I hear from people about things they are afraid to discuss with their therapists, secrets they carry and feel shame about. I know how hard it is to open up the dark corners of our lives and let another see in. It feels like a huge risk. But what is the point of being in therapy if, at some point, the secret is not told? If it remains untold and unexplored, the therapy in a very real sense is a lie because it never gets to the truth of the patients life and feelings. So we say to patients that they should say whatever comes to mind and mean to include the secrets as well.

Here are some of Jung’s thoughts, all taken from Vol. 16, pp.55-60:

Anything concealed is a secret. The possession of secrets acts like a psychic poison that alienates their possessor from the community.

All personal secrets … have the effect of sin or guilt, whether or not they are, from the standpoint of popular morality, wrongful secrets.

…if this rediscovery of my wholeness remains private, it will only restore the earlier conditions from which the neurosis, i.e. the split off complex,  sprang.

All of us are somehow divided by our secrets but instead of  seeking to cross the gulf on the firm bridge of confession, we choose the treacherous makeshift of opinion and illusion.

Jung here underlines the corrosive effect secrets have because there is no way, so long as the secret is held, for its bearer to know that she is not worse than everyone else, that the secret does not make him unlovable. The revelation of the secret within the container of a secure psychotherapy relationship begins the  cleansing effect of exposing it.

Those things which a person decides to hold private, even in therapy, may in fact be secrets rather than merely private matters. Because if there is no shame attached, then why the need for keeping such a thing outside of the secure container of therapy? 

It is by no means easy to let go of our secrets, whether we feel,  that do so would be rude or because we fear being judged or rejected or abandoned. It is hard work and takes time. But it is important to keep at it.

Saying whatever comes to mind is a goal and one it takes work to reach. An important part of that work is exploring the difficulty we have in getting there.

Let’s Talk about Dreams

This painting by Edward Robert Hughes makes me think of the oddness of dream images. And so today I want to start to talk about dreams.

A few years ago I found  Yorem Kaufman’s The Way of the Image. It is a lovely little book of essays about dreams, images and therapy. The first 2 essays, “The Way of the Image Part 1” and part 2 are about his way of looking at dreams and about how he works with dreams in therapy, an actual technique essay, something a bit uncommon in Jungian writing.Then in the 3rd essay he writes about the analyst as he or she appears in dreams. These three essays are rich and deeply rewarding for anyone seriously interested in dreams and working with them. 

A few juicy bits from Kaufman:

“Everything that has ever been created was preceded by an image— streets, a blender, theory of relativity. Thus, we have the power of images for immense good or horrible destruction. All the history of mankind is, in essence, the unfolding of a series of images.”*

“…every individual has within themselves a unique set of images peculiarly their own. They speak ultimately to them. Although such images may be shared with others, and those others may be affected, they will not be affected equally, and they will not share in the transformative energy to the same degree. It is both the science and art of analysis to find this unique imaginal language for every analysand.”*

“I am saying that the images that an analysand brings to the analysis, in whatever form, be it dreams, his behavior, body language, etc., contain, in addition to whatever psychic messages that they bring, also a set of instructions to the analyst as to what is the best, and sometimes the only, way to conduct the analysis. Contrary to what may have emerged at the dawn of the psychoanalytic movement, there is no single technique that would be suitable for every analysand. It has been a source of continuous astonishment and awe for me that in more than 30 years of practice, I have found that I work with every analysand in different ways.”*

Over the next little while I’ll write the essays and add my thoughts. If you have a Kindle Unlimited account, this lovely book is available free. I hope some of you will read along with me and that we can talk about the book together. 

If you don’t record your dreams, consider starting. Keep paper and a pencil or pen by your bedside and as soon as you awaken, write whatever dream or bits of dream you can capture. 

 

*Kaufmann, Yoram  (2009-07-16). The Way of the Image  Zahav Books Inc.. Kindle Edition.

Mistakes

“People do not grow in sterile containers with perfect analysts; they grow in messy human relationships with analysts who try their best to do right by their patients  but whose best must frequently consist of reparative efforts vis-á-vis the difficulties they have created.”

Therapists make mistakes. I make mistakes. How do we recover from the mistakes that we make? We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for more than 40  years and I still make mistakes — different ones, but mistakes nonetheless. 

We must start with accepting the patient’s feelings of hurt or anger or other feelings affected by our error. Which means at least initially not trying to get the patient to understand or accept an explanation of our good intentions— we have to avoid yielding to the very human effort to defend and explain. When we do that — try to explain — it is  really for the therapist, an attempt to soothe ourselves and to see ourself again in a positive light. 

 Initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully. 

Sometimes the therapist’s mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.  

A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists — one who fell asleep in a session with him and another he found unsympathetic. So I knew I started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now I knew I had left no indicator of who I was or why I was calling, but it didn’t matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. And these days with the ubiquity of mobile phones, the chances that a message I might leave will be heard by someone other than the intended recipient is pretty small.

Sometimes with the best intentions, like Humpty Dumpty, all the king’s horses and all the king’s men cannot put the therapy back again.

It is hard to let go but what I want for a patient may not be what is best for her in her eyes — and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way — and sometimes patients do come back– but at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most. 

Muddling Through

For the last couple of weeks I have written about traditions and their importance for the holidays. Today I am thinking about the song, “Have Yourself a Merry Little Christmas.”

The first time I remember really hearing the lyrics to the song was when I was in college. I was home with my parents. At the time they were going through a very tough period and it was a far from joyous holiday. They lived in suburban D.C. then. It was Christmas Eve, raining and we went to a sad little restaurant for lunch. I heard the song and it resonated so deeply with the mood I was experiencing. Though no one said it, I knew each of us was hoping that the next year all their troubles would be out of sight. 

The song comes from the movie, “Meet Me in St. Louis” with Judy Garland who of course sings it. It happens that this movie is one of my daughter’s all time favorites so I have seen it many times. It’s not the song that most people remember from the movie — “The Trolley Song” is the one most people associate with it.

So many of the songs we hear and sing to celebrate this season are about joy and celebration, but his one and one other, “I’ll Be Home for Christmas” stand out because they strike a different note — one of sadness. Not coincidently both songs came out during WW II.

Here are the lyrics, as sung by Judy Garland, in the movie and try to see them in the context of our current situation. In 1944, when the movie came out, the future was very uncertain and many were separated from loved ones, a situation not unlike ours today.

“Have yourself a merry little Christmas,
Let your heart be light,
Next year all our troubles will be out of sight.

Have yourself a merry little Christmas,
Make the Yuletide gay,
Next year all our troubles will be miles away.

Once again as in olden days,
Happy golden days of yore,
Faithful friends who are dear to us
Will be near to us once more.

Some day soon we all will be together,
If the fates allow,
Until then we’ll have to muddle through somehow,
So have yourself a merry little Christmas now.”
~Hugh Martin

The circumstances in which we are living — over 315,000 people in the US dead from the virus as of this writing– and our anxiety about its spread, the admonitions to avoid travel and to stay at home, seem so similar to the mood my parents talked about of WW II. Last weekend my husband and I drove to where my adult children live to drop off their Christmas gifts. It was a chance to get out of the house, something we both needed. And it was wonderful to see them. But as we drove away from my daughter and her husband, I felt an ache — the ache of having been able to see them, talk with them for a bit outdoors, separated by distance and masks and unable to do the natural hug and touch that is so much a part of being with family. My whole body ached from that necessary distance. 

My son and his family, my daughter and her husband, and I and my husband — we all have Christmas trees decorated with ornaments accumulated over the years. Each one conjures up memories of Christmases past, times when we could be together and laugh and hug and be with each other. This year it seems especially important to honor those traditions in every way that we can given the limitations COVID-19 has imposed. This evening my husband and I will choose one of the many Christmas movies out this year and watch it and I will talk with him about what it was like when my kids were little. Tomorrow we will virtually gather together via Zoom. We will open presents. Laugh. Enjoy what we can and do our best to muddle through and have a merry little Christmas now.

I wish for you, whatever your traditions around this time of year — whether Christmas or Solstice or Hanukkah or just winter — that you immerse yourselves in them. That you, as I and my family will, hold on the hope that next year we really will all be able to be together, that fates will indeed allow that. And for this year, like me, you will muddle through. Celebrate being alive. Share love and kindness. And if the sadness and stress and worry become too much, reach out. You can find me via email. And I will be here.

Merry Christmas! Happy Holidays!