Analyzing Bad

 

http://www.latimes.com/nation/la-na-c1-albuquerque-breaking-bad-20140131-dto,0,3467725.htmlstory#axzz2s1Q0nxNK

This series, ‘Breaking Bad,’ has brought television to a psychological depth, never seen before, as far as I can tell. Walter White, played by Bryan Cranston, depicted in the photo above with a gun pointing at the audience, demonstrates a middle-aged man looking for meaning and power. We, as an audience, relate to his struggles, while at the same time, we despise him for making meth, a toxic substance, ruining the lives of so many addicts. As today’s LA Times article describes, although Walter White is a chemistry teacher turned meth cook, the show is about his search for meaning, in a world which feels to him, to be so empty and so unfair. He turns passive into active by taking charge of his “partner” and former student, Jesse, played by Aaron Paul. Together, they form a relationship that is complicated, twisted, manipulative,  and loving. There is no relaxing while watching this series, as each moment is tense with surprises and disappointments, like a life lived with such passion, that there is no room, or desire, to coast. I, for one, could feel my blood pressure rise and fall during each episode, as I cared for these characters, needing to remind myself that they are not part of my caring world, only my imaginary world of wanting to understand motivation and wanting, but failing, to have some sense of predictability of their behavior. The one thing I could count on is that I would feel each character’s need to make a difference; each person’s strong desire to be seen, to be heard, and to matter. How each of the main characters translated this desire into behavior was where the writers took my breath away. The lines between good and evil faded, not just within each person, but in a constant shifting sands where the confusion of sympathies created a blood-boiling tension. I confess that I binged on this series as I was intensely curious to know the next chapter, like a life that is constantly on the edge of change. This is the curiosity that drives my work, but that is so rarely driven by media. ‘Breaking Bad’ broke me into a rapt consumer. I am not alone, and yet, I feel the show touched me as an individual. I am still thinking of the characters, wondering how they are doing, needing to remind myself, they are not real. That is a good show.

The Therapist Needs The Patient: Is This So Bad?

Beginning psychotherapists, beginning psychoanalysts, depend on their patients to accumulate hours for a license or a certificate. Many times, the patient consciously or unconsciously is aware of this dynamic, giving some patients an opportunity to wield this power dynamic in ways which are further grist for the analytic mill. “Yes, I do need you to come to get my hours, but at the same time, I want you to do what is in your best interest and that is more important to me than getting my credit.” I propose that comment to my class, resulting in, what seemed like, a collective gasp. An active discussion ensued leading to a heated debate about honesty versus burden. “Is the ‘name it to tame it’ adage appropriate here?” I ask. Perhaps the honesty of saying yes, I do need the hours, but I also have integrity in my work, so that trumps my need for my hours, goes a long way towards diffusing the hidden issue in the room. Or, perhaps stating the need for the patient to come burdens the patient and thereby applies unnecessary guilt if the patient wants to discontinue treatment? My contention is that the therapist holds the anxiety that the patient’s termination compromises her training, then the analytic ear is sacrificed. One cannot listen when one is anxious, and so the ‘name it to tame it’ adage does apply. Putting the anxiety out there in a package which says there is a reality to my wanting you to continue, which is totally about me, and not about you, and that is a known limitation in our treatment, but having said that, let’s keep in mind the most important thing is that you do what is in your best interest, because, in reality, another year in training is something that I can deal with. This honesty takes away the potential for conscious or unconscious manipulation of the patient. My students proposed however, that the blunt statement of needing the patient, might, in fact be coercive. I countered by saying that the exposure of the reality creates an honest, although not ideal, relationship, which can then be discussed in an open manner. I was pleased to present a challenge to my bright and stimulating students. I was also knocked off-center by their startle response. I am thinking.

Blind Spots In Psychotherapy

 

A good therapist fails. How do we understand this? What, anyway, is a “good therapist”? Is there a “good therapist” or a “good therapist-patient fit”? These are the questions which have no answers, but generate more questions. Often, when I am asked for a referral, I think about “fit” but I recognize that this is largely an intuitive process which involves educated guessing. The dyad brings up issues for both the patient and the therapist, and if the injuries in the patient hit close to injuries in the therapist, this can cause a “blind spot” as James McLaughlin has described. Monte and Marla come to mind. https://shirahvollmermd.wordpress.com/2011/08/10/monte-and-marla-on-the-rise-again/. Monte and Marla, both psychiatrists have been working together for many decades. By working together I mean that Monte has sought guidance from Marla for his career, but the relationship has bled into personal matters as well. Monte grew up in a family where he felt he had to please his parents. So did Marla. When Monte spoke about his narcissistic parents, Marla defended his parents by saying “they did the best they could,” thereby making Monte feel dismissed. Monte came to see me, and in our work together we postulated that perhaps Marla could not help Monte cope with being unseen by his parents because Marla has never resolved this very same issue with her parents. The collision of these two traumatic experiences created a blind spot in Marla which caused Monte considerable distress. Unresolved traumas create a defensiveness when a similar situation is described, either in film, in literature or in person. So too, with psychotherapy, unresolved issues in the therapist, can lead to a coldness when these same issues are presented by the patient. This coldness is a way for the therapist to avoid the deep pain associated with her past. It is a wish to think that therapists have resolved all of their issues such these blind spots never happen. They do happen, making the  hope in the ability of the therapist to come to recognize the deficit and try to move the therapy forward. Like my last cartoon post, like life, we want the path of psychotherapy to be linear, but in fact, it goes up and down.

Life

Wallow

 

What is the difference between wallowing and self-reflection? Jon, my frequent commenter (is that a word?), brings up this discussion. To stay with pain, with affect, requires a patience and tolerance for discomfort. To run quickly away from this discomfort brings about defensiveness and limited understanding of deep processes. On the other hand, to stay in a place of pain, can mean a paralysis, which to caring others, can be frustrating and difficult. Where is this line between paralysis and sitting? This is the challenge of my work, both as a psychotherapist and as a blogger who hopes to bring psychological issues, and their struggles to the forefront. As a teacher of psychoanalysis, sitting with pain is a consistent theme in my class. Helping people just sit with their experience, without a mandate for change, is often the first step towards deepening one’s understanding of one’s experience. The effort to sit with challenging feelings creates a variety of reactions in others. Anger, withdrawal, somatic symptoms, can all be manifestations of this resistance to self-reflection. Ina, forty-two, comes to mind. “My husband keeps telling me that I should get over the death of my father, which has already been six months, but I still feel a lot of pain around that,” she says, as if wanting me to get mad at her husband. “And how do you handle that?” I inquire. “I tell him he is an asshole and I leave the room,” she says, as if I already knew that. “Maybe you could explain to him that this is where you are in your journey, and you hope he can understand that and be patient with you.” I say, giving her words to help her husband help her deal with her loss. “I guess I feel guilty for not being over it,” Ina says, helping to clarify her mental space. “That guilt is something we can explore,” I say, feeling hopeful that our work is going to lower levels of her mind. I begin to see how she is helping me understand that although she yells at her husband for not being more understanding, she is also mad at herself for feeling grief. Projection presents as anger. Having feelings can be seen as wallowing. Understanding and patience is my plea.

The King Lear Story

 

 

 

http://en.wikipedia.org/wiki/King_Lear

 

Esther, fifty-five, refers to herself as Cordelia, the daughter of King Lear who refused to sell her love to her father, leaving the King to buy the false marketing, but pleasant sounding words of his other two daughters. By her account, her pure love was overshadowed by her manipulative sisters, and as such, she was abandoned by her family. “It sounds like you are so lonely and misunderstood,” I say to Esther, thinking that I need to re-read King Lear. “Yes, but I am also angry,” Esther says firmly and directly. “I tried so many times to explain to my father my perspective, but he did not listen,” she says with sadness and frustration. “Do you feel that I listen?” I wonder, if she has assumed that because her father did not hear her, nobody does. “Yes and no,” she says. “I think you hear me sometimes, but sometimes you go off on your own tangent.” Esther says, again with characteristic directness. “When I go off on a tangent, does this make you feel like you have disappeared in my mind?” I ask, wondering how hurtful that is to her. “Absolutely,” she says, as if there were no other way to think about it. “Maybe I am being self-centered, and focusing on my own thoughts, but if you remind me, I can get back on track and connect with you,” I say, highlighting that there is a difference between lapsing into my own brain and erasing her from mine. “I need to think about that one,” she says, with rapture about my comment.

NYer Cartoon Contest

It is a good user interface…you cannot lose it!

Boundaries…

Re-Posting Because of Today’s LA Times: Father Boyle

 

http://www.latimes.com/local/la-me-0126-lopez-homeboy-20140126,0,3300815.column#axzz2rYqlcmp4

Previous LA Times….http://www.latimes.com/news/opinion/commentary/la-oe-newton-column-homeboy-industries-greg-boyle-20120423,0,5754852.column

Father Gregory Boyle, a jesuit priest,http://www.npr.org/templates/story/story.php?storyId=3911907 , and http://latimesblogs.latimes.com/jacketcopy/2010/06/father-boyle-la-times-bestsellers.html reminds me of my earlier post  https://shirahvollmermd.wordpress.com/page/16/. Father Boyle knew intuitively that when gang members can find an alternative sense of belonging they can find a new way to be in the world. He proves, through his life’s work, the value of attachment. He invests emotional energy in “kids” who have never “experienced dignity before.” By dignity, he means that when one begins to respect the individuality of these gang members, then the adolescent can change their lives and contribute to society. He gives them work skills and in so doing he proves to the ex-gang members that they have hope to make their lives better. In my mind, he re-parents these young adults such that these youngsters can “navigate the treacherous waters of their lives.” As Father Boyle says “people say I give them a second chance, but I say, it is really a first chance.” “Gang members are coming from a place of despair” he says. Without formal mental health training, Father Boyle recognizes the essential need to have a family that instills hope in the future. He teaches coping skills, parenting skills, and responsibility such that they can deal with the challenges of their world. His work inspires therapists to work on a one on one basis to change lives, by believing in their client, such that the client can eventually change course and live in the world in a new way. Inspiring.

The Impasse

 

According to Webster’s definition, an impasse is a “predicament from which there is no obvious escape.” “I felt held at an emotional distance,” Judy Kantrowitz MD writes in her paper entitled “Impasses in Psychoanalysis” which we will discuss in my class next week. Like M& M, morbidity and mortality rounds, in Internal Medicine, reflecting on what went wrong is, by my way of thinking, an admirable part of my field. Learning from our mistakes, on the one hand, seems so elementary, but on the other hand, is an intense act of humility, and sometimes shame. Bila, forty-one, female, enters my mental space as I think about therapeutic impasse. One day she comes in sleepy and disengaged. She moved from topic to topic, all relevant but with no affective charge. She felt lacking in curiosity about anything. “I wonder if you are afraid of the closeness in our relationship, so you have shut down,” I said, hoping to put us on a path of meaning and interest. Instead, Bila responds, “I think it is time to end our treatment,” with a flatness and detachment in her voice. “I wonder why that is coming up now,” I say, thinking that Bila and I had just been discussing her frustrations with her romantic relationships. “You don’t seem to listen to me,” Bila said with intense anger. ” I can hear that you are disappointed with me and I would like to understand that better, ” I say, hoping to understand the shift from deadness to anger. “I just don’t think I can go anywhere with you. I think we have done all that we can do. I think I am limited in how far I can take this therapy.” Bila says with sadness and frustration. “It seems like you started to get angry with me, but now you are angry with yourself,” I say, reminding her of her familiar dynamic where her angry feelings, almost always, turn back on herself. This was a brief impasse, as she quickly said “yes, that is what I do, and I am angry with myself all the time, and I don’t want to stop treatment.” Bila says, with tremendous relief that she could backtrack and feel more authentic about her narrative. Her initial deadness transformed into anger towards me and then anger towards herself, leading us to understand that she was afraid of her anger, so she became flat, and then she gave herself permission to express anger towards me, and with the safety of our relationship, she could then own her anger, as a chronic state of unhappiness with her decisions. In this case, the therapeutic impasse was a means to deepen our work. Of course, therapeutic stalemates do not always lead to such happy endings, but it is nice when they do.