Seeing a therapist/analyst multiple times a week arises the incisive question of separations, be that from death, disease, retirement or vacation. How does that kind of emotional dependency play out when faced with an interruption of the routine? This is perhaps the hardest and most challenging aspect of analytic work, both for the patient and the therapist. If the therapist talks too much about an impending separation then he/she risks seeming to have an elevated sense of self-importance. On the other hand, if no mention is made of an upcoming separation, then the insensitivity of the analyst is both painful and revealing of an avoidant pattern in the analyst. Should the thought of this dependency, played out in the anticipation and then actual distance make potential patients flee the scene? Clearly, I think not, as this separation is ripe with windows into previous dependencies, both for the patient and the analyst. The art of psychoanalysis is to deal with these separations both in a sensitive way, but also in a way which might, with some patients, heal previous wounds of callous departures.
Although I intend this post to be the beginning of a long discussion-intermittent, as most of my discussions tend to be-I would like to begin by citing an example of Dr. Mor, a psychoanalyst, many people joke about being “less and not more”. Dr. Mor appears to feel overwhelming guilt when he goes on vacation, yet at the same time, he takes on average of eight weeks per year, sometimes divided over two-week vacations, and sometimes a month-long. Ernie, a long-term patient of Dr. Mor’s, explains to him that his apparent guilt for going on vacation, as evidenced by the awkward and uncomfortable way in which he (Dr. Mor) announces his upcoming separation, mandates him (Ernie) to soothe Dr. Mor’s ill-feeling. Ernie is not left with any space to experience his feelings as he feels compelled to make sure that Dr. Mor does not “fall apart” from his guilt.
Ernie comes to me for consultation with regards to his relationship with Dr. Mor. “It sounds like, as with so many relationships, the more narcissistic person in the couple mandates all the attention, since his fragility makes you behave in a way in which you cannot be authentic.” I say, highlighting that although we all have narcissistic needs, if these needs enter into the forefront of a relationship in a large way, then these needs crowd out the narcissistic needs of the other. In essence, the more narcissistic person in the relationship is the more domineering. This domineering quality often leaves the other person feeling stifled and constricted.
Ernie is mesmerized by my understanding, but still stuck in a tremendous amount of pain and anguish. He now understands that Dr. Mor has “crowded him out,” leaving Ernie to feel compelled to shore up Dr. Mor, at Ernie’s personal expense. Yet, Ernie has grown under Dr. Mor’s care and so he has a very painful dilemma. “Why don’t you see how you feel during this upcoming separation?” I ask Ernie. “That’s a good idea.” Ernie replies. “Dr. Mor has helped me reflect on my internal process, so in a weird way, he has helped me see how he hurts me.” Ernie replies both grateful and aggravated with Dr. Mor at the same time “Mixed feelings,” I say, highlighting the layered and deeply conflicted feelings that Ernie is feeling. “Let the dimension of time, see how these feelings play out for you,” I say, thinking of my previous post about the “Etch-A-Sketch Brain”. “Time is a wonderful opportunity to see how your internal workings play out for you. ” I say, trying not to say the platitude that time heals all wounds, but to say that time is an added benefit for reflection. “You can both reflect in the moment and over time, and see how that goes for you,” I say, emphasizing that being mindful of one’s own mind, not just during meditation, but over time, is both fascinating and useful to making good decisions. “The separation might be good for you,” I say. “Yep, surprisingly so,” Ernie replies.
Shirah Vollmer MD 