Monday, December 21, 2009

A Festival of Film

By Kevin Murphy,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

The link between psychoanalysis and film is, believe it or not, long established. At first glance it might seem as if they are strange bedfellows. What has the business of therapy got to do with cinema? Well, psychoanalysis was put on the world map, so to speak, by Freud’s most famous book ‘The Interpretation of Dreams’ in 1900. And movies were born at much the same and, by their very nature, are the art form that most closely replicates the dream state. They are visual, switch from scene to scene, can frighten or inspire, and generally have a meaning that, blockbusters aside, is not immediately obvious and often cleverly disguised. As such, they provide rich pickings for psychoanalytic enquiry.
But it goes further than that. All the major neuroses, psychoses and perversions first outlined by Freud have been touched on by film makers over the last century in one way or another. One that immediately comes to mind is Hitchcock whose 1945 Spellbound with Ingrid Bergman and Gergory Peck had dream scenes designed by Salvador Dali. But there are endless more examples.
Every murder story has an undercurrent that psychoanalysis loves to examine. Every love story is a search for the missing part of all of us. Every comedy lets us access unconscious truths that would normally go unsaid. It goes on and on. In fact Freud himself was asked on numerous occasions to write a movie script with Hollywood offering him large sums to do so. He turned all the offers down.
And Italian director Bernardo Bertolucci, who was the honorary president of the First European Psychoanalytic Film Festival in 2001, has been in psychoanalysis since the late Sixties, and has spoken about the way in which this experience coloured the films he made immediately after his analysis began: Last Tango in Paris, The Conformist, The Spider's Stratagem, 1900 . 'I found that I had in my camera an additional lens,' he once said, 'which was not Kodak, not Zeiss, but Freud.'
This is by way of noting that a Festival of Psychoanalysis and Film, jointly sponsored by The Irish Forum for Psychoanalytic Psychotherapy (I.F.P.P.) and Independent Colleges Dublin , is taking place in Dublin on January 29th and 30th. I include details below for anyone who wants to book a place. It promises to be both interesting and entertaining. It will be held in Independent Colleges on Dawson Street, Dublin 2.
The theme of the festival is ‘Love and Madness’ and the format will be that participants will have a choice of three movies at any one time. Each movie will be introduced by the person chairing it and afterwards there is a discussion. For those within the psychoanalytic area it will be a celebration of film and a chance to hear and air views on their possible meanings, both intended and unintended. For those new to psychoanalytic thinking it will be a chance to offer new and different perspectives.
There is an opening reception at 5pm on Friday 29th after which the choice of movies starting at 6.35pm are the Oscar winning Black Narcissus (1947) which is a story of five young British nuns in the Himalayas who succumb to earthly temptation. There is also Lars and the Real Girl (2007), a comedy in which an awkwardly shy young man in a small northern town brings home the girl of his dreams to his brother and sister-in-law's home. The only problem is that she's not real - she's a sex doll Lars ordered off the Internet. The third movie of Friday evening is The Talented Mr. Ripley (1999) which is about a 1950s Manhattan lavatory attendant, Tom Ripley, who borrows a Princeton jacket to play piano at a garden party and ends up going to extreme lengths take on another persona.

On Saturday 30th, the first three films at 10:00 a.m. are The Pervert’s Guide to Cinema which takes the viewer on an exhilarating ride through some of the greatest movies ever made. In it, philosopher and psychoanalyst Slavoj Zizek is variously untangling the famously baffling films of David Lynch, or overturning everything you thought you knew about Hitchcock. Alternatively you can see Estamira (2006) a documentary about a sixty something woman in Rio de Janeiro, who is an insane but happy woman that has been working for more than twenty years in the city dumpster in Gramacho. The third alternative of the morning session is Donnie Darko (2002) about a young man who doesn't get along too well with his family, his teachers and his
classmates; but he has a friend named Frank - a large bunny which only Donnie can see.

At 1.15pm on Saturday the three film choices are Safe (1995) which is about California housewife Carol who has it all but who succumbs to a curious illness and seeks to find a cure with a phony guru. Some Like it Hot (1959) is the second choice and is the classic Billy Wilder comedy with Jack Lemon, Tony Curtis and Marilyn Monroe. The third movie is The Soul Keeper (2003) which is the true story of Sabina Spielrein, a patient of both Freud and Jung. She has an affair with Jung which, when it becomes public, he denies.

Then at 4pm we have Reign Over Me (2007) which has Adam Sandler playing a riveting role as a man who loses everything and almost loses himself. He finds a path out of his situation through the friendship of an old college mate. The second choice is Betty Blue (1986), a French movie about the beautiful Betty who slips into madness despite the intense love of her boyfriend Zorg. And the third movie is Ai No Corrida (1977) one of the most notorious films in movie history that is based on a true story set in pre-War Japan about a man who engages in a perverse affair with his servant. Banned at its premiere at the New York Film Festival in 1976 it is not for the faint hearted.

So a veritable feast of cinema with the promise of lively discussion and debate afterwards. The organisers tell me that the cost is €25 for the full programme, €15 for one day and €5 for an individual film. Booking is essential and can be done through calling 01-6725058 or by emailing Caroline at or Eve at

* The next blog will appear on Tuesday January 12, 2010.

Monday, December 14, 2009

‘We Are Cured Because We Remember’

By Kevin Murphy, MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

I have had a number of clients in recent weeks who have all said the same thing in their own different and unique ways. They have no memory of their childhoods. That's not to say that I insist on people having a memory of one thing or another. One of the fundamental 'rules' of psychoanalysis and psychoanalytic psychotherapy is that people choose to speak about whatever they want. There is no direction in terms of 'you must speak about this'. It is a freedom that runs to the heart of analytic work.

That's why the comment had such resonance. These were very different people from different walks of life who each came up with the same statement by different routes. Each had a sense of simply not remembering large chunks of what is, essentially, their past. They did remember bits and pieces here and there but their own perception of it was that this part of their personal history was, to put it bluntly, forgotten.

The second interesting thing about it was that all of them saw nothing unusual about this. So essentially, you have a situation where people go through life unable to remember much about what they were like in their earliest experiences. And, hand in hand with that, they are quite accepting of it.

Now it should be said that there will always be parts of our childhood that remain forgotten. Very few of us remember every detail although there are some people who do. Remembering is a patchy experience for most of us. But the experience, and it is not uncommon to come across it in practice, of 'not remembering one's childhood' has other aspects to it.

Often we forget not because we simply have bad memories but because we unwittingly push things out of consciousness. Why do we do this? Sometimes yes the memory is bad, or sometimes the experience of being dependant was unpleasurable for us, or we may have acted in a way that we care not to recall, or we may have had a fright or a scare or a fearful moment or disappointed someone dear to us, or even disappointed ourselves. Our memories are being repressed all the time. Even as adults, we often forget the name of someone we are less than enamoured with, or we forget an appointment that we never really wanted to commit to, or we have no memory of a holiday that was ghastly. It is part of our defence system and sometimes it is useful.

But being unable to access or visualise memories of this kind can often have a downside too. You particularly find it with people whose lives are being badly affected with anxiety or depression or sexual issues or even obsessive and compulsive symptoms. These kinds of conditions are usually experienced by people as being of relatively recent origin. Most point to their teens as being the time of onset. And, for the most part, that is true in the sense that this was a period in their lives when they became aware of their symptoms.

But becoming aware of something is not the same thing as pinpointing when it started. Often you find that the roots of anxiety or depression or many other debilitating conditions reach much further back. The person who became badly affected by a teenage or late childhood experience was already emerging as the kind of child much earlier who would be susceptible to that.

This is why having access to memories can be so important. Understanding who we are now is as much to do with understanding the present as it is to do with understand our past. Someone once said that if we do not understand history we are doomed to repeat it and the same could be said of individuals. Within all our memories, especially the ones we cannot access, there is valuable meaning tied up and unexplored. There is also a degree of energy being used to keep it from view. Memories don't just stay inaccessible without some effort employed to keep them that way.

Yet it is surprising how many people believe that memories are of no value and should not be considered when looking for answers, or that they are intrinsically painful and should be left well alone, or that they are impossible to recall and so no effort should be made in that direction at all. And so a vital avenue of exploration gets closed off.

And yet what analytic practice teaches again and again is that memory can unfold slowly, bit by bit. Once one memory is recalled, then it is possible for another to follow and then another. A foothold is all that is needed and then the links which bind all our memories start to operate and more and more pictures emerge. If we even get a glimpse of who we once were it is of huge value in adding the missing piece to the jigsaw of who we are now.

French psychiatrist and psychoanalyst Jacques Lacan once said we don't remember because we are cured, we are cured because we remember. The act of remembering is the cure. Being able to remember is a sign of health. Being willing to remember is a sign that fear is abating and confidence is returning. It is the lifting of the veil, the new light that we shine into an old part of ourselves that brings new meaning. And we use this meaning to combat the emptiness, the lack, the void, the agonising puzzle that is at the heart of anxiety and depression and so many contemporary ailments.

  • Next week I'll be highlighting an upcoming Psychoanalytic Festival of Film in Dublin.

Monday, December 7, 2009

Depression in the modern world

By Kevin Murphy, MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

It is good to see the popular advice around depression making it seem a less threatening ailment than it first appears. Pretty much wherever you look these days, the language you hear is usually the same - calming, practical, commonsensical. Seek help, talk to someone, don’t get isolated, consider medication, go to therapy, tell someone you trust how you are feeling. If your job is making you blue, change it. If you are feeling lonely, get out and make friends. The emphasis is on de-stigmatising and de-mystifying which, in themselves, are good things.
And when it comes to the causes of depression, which is a crucial question when in Western society it is reaching pandemic proportions, you usually find that the commonly provided view is that it is a mix of things: some social, personal and biological factors. It is hard to argue with any of this, especially as all the bases seem to be covered. Even genetics is usually thrown in for good measure.
Where psychoanalytic theory and practice differs from the usual run of advice and information, is that its focus on cause is more detailed, more directed at the individual sufferer and more relevant to our contemporary society. You could say it is a hand-stitched approach rather than a production line one.
Why? Because it includes two other sources of depression that other theories either ignore or don’t recognise. These are the unconscious, the individual unconscious of the person suffering depression, and the wider cultural context as it has evolved today.
This notion struck me at the recent 16th Annual Congress of the Association for Psychoanalysis and Psychotherapy in Ireland (APPI) which was held in St. Vincent’s University Hospital, Dublin. The theme of the Congress was ‘Depression and Melancholia in Modern Times, A Psychoanalytic Understanding’. When the papers for the event are published I may do a blog summarising each of them, because they give a flavour of the unique way that psychoanalysis has in approaching this subject.
I won’t go into the history of it but if you want to read the seminal paper then Mourning and Melancholia (1917) by Freud is the place to go. Since then the theory has been steadily evolving and it was fascinating to hear what contemporary theorists and practitioners had to say about it at the recent Congress.
While most commonly accessible advice on depression focuses on the social, personal and biological aspects that cause depression, psychoanalysis hones in on the fundamental place that the individual takes up for significant others in his or her life. It posulates that we are driven to be the thing that drives important others. Put another way, our true desire is to be the desire of the other person. Depression, therefore, is essentially caused by a setback that sees us ‘tumbling out’ of this desire of the other. As perspectives go it is a fascinating one. But, equally, it is not something we are consciously aware of. It is all happening at the unconscious level.
Talking to people suffering from depression in the consulting room, it is striking how they speak the language of loss – this brings us back to Freud’s paper above, in which he was the first to see that depression had a great deal in common with mourning. They understand that something, or someone, has been lost to them but they do not know what it is in those people that has been lost to them. On the conscious level, they understand that they experience the unpleasant symptoms of depression – something within themselves has been lost – but they do not know what that something is - the loss is at an unconscious level. For psychoanalysis the thing that has been lost is this essential position within the human dialectics of desire, the place of being the desire of a significant or important other or others.
The theory also depicts how, as a result of this tumbling out of the desire of the other – a mother, a father, a main carer, a lover, a friend, a sibling - the individual is then thrown onto a trajectory of essentially attacking him or herself as a result of this failure. Failing to be the desire of an ‘other’ means that an ideal they had of themselves – something we all need to get us through life - has been damaged. And, because they were unable in some way to sustain this essential ideal, they then become the target for self-hate and self-loathing.
That’s the unconscious part. Then we have the wider cultural context. Changes in the role of fathers, in the methods of child rearing, in the responsibilities of mothers, in the value systems of society, in the importance of ideals of bodily perfection, in the decline of religion and authority, in the rise of scientific and capitalist discourses and in a devaluation of human individuality, has meant that it is harder for people to find sustainable ideals. By this I mean, ideals that are within reach, that come without too much expectation, that are credible and workable.
In the Victorian era people lived according to a widely understood and often unspoken command to ‘obey’. It was an era characterised by obedience, self denial, the repression of bodily desire and obedience to church, state, community and family. We can never go back to that because the world has evolved, for better or worse, depending on your point of view.
Today, we live according to a widely understood and often unspoken command to ‘enjoy’. For some, it is an easy one to follow because it matches perfectly our contemporary desire to escape, de-stress, find meaning, be happy, be free, experiment, give free rein to our curiosity. For those who suffer depression, however, it is just as ferocious and unrelenting a command as the earlier one to obey. And this, among many other reasons, is how psychoanalysis is different to other approaches.

Sunday, October 11, 2009

Traumas Big and Small but Mostly Small

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

I was reading a study on the impact of trauma on refugees from Chechnya recently and how the fact of other people knowing about the trauma makes a big difference in terms of recovery. Obviously the people of Chechnya underwent severe and real trauma. The report outlines the various traumas suffered and an extensive list includes such things as bombardment, execution, massacre, torture, forced breakup of families, rape, illness without access to care, malnutrition and robbery. The main finding of the study* was a negative correlation between social acknowledgement of trauma and post traumatic stress disorder, concluding that social acknowledgment of trauma could promote recovery from it.
That’s why the reconciliation efforts in South Africa and Northern Ireland have had to base so much of their work on simply acknowledging the traumatic reality of what had taken place for all sides in those conflicts.
Obviously there is no mistaking trauma when it occurs during war or civil unrest. A bomb or a murder is unmistakable in terms of the consequences it can have for people.
But we can be mistaken if we tend to think of trauma as exclusively belonging to these incidents.
Psychoanalysis sees trauma – broadly defined as an unpleasant experience that we feel overwhelmed by, that often takes us unawares, that has no obvious meaning to it and that we are unable to do anything to defend against – in these terms too.
But there is another form of trauma that is far less dramatic or noticeable. Freud in his early theorizing wanted to know what it was that turned relatively healthy people into neurotics whose lives became unmanageable. His first idea was that some trauma had occurred that had effected them badly.
He postulated that it must have been sexual trauma of some kind. He eventually moved away from this notion because it was simply unsustainable to believe that everyone with a problem had been sexually abused. But what he did discover was that trauma, under the definition above, was possible during normal human development, in almost inconsequential ways, especially when we are infants.
The nature of unexpected or unwanted things happening to us at an early age, such as the necessary absence of our primary care giver for however short a period of time, can be mildly traumatic on us. Hunger, weaning, the arrival of a new sibling, unexpected frights, the dark, and later moving on to all sorts of fears that young children have about monsters under the bed, worries about their parents and so on.
Each of these mini-traumas have two features: they teach us how to cope and adapt to the nature of absences of comfort, or security, or food and so on, so that we can learn to develop as more mature functioning beings.
Secondly, they can often leave miniscule traces of fear behind that linger within us until triggered later by real experiences in life. Very often, part of the negative impact of larger traumas is that they can reinforce a pattern already laid down by these early traumas and make it very difficult for a person to ‘get over’ them.
If we don’t overcome or only partially overcome a particular ‘mini-trauma’, say coping with the temporary and necessary absence of our primary care giver, we can grow up unable to let anyone dear to us out of our sight or suffer greatly at any form of separation from a significant other.
Or if, say, as young children we react instinctively to a fright or any form of unpleasantness by 'freezing' until the threat has receded, it can lead us to an adult life where we use denial, or a refusal to communicate, or emotional paralysis when faced with a new threat.
Freud said famously that the earliest traumas that we undergo as infants are simply not noticed by our conscious mind. Or, as he put it in a 1917 lecture ‘The Paths to Symptom Formation’, “The significance of infantile experiences should not be totally neglected, as people like doing… They are all the more momentous because they occur in times of incomplete development and are for that very reason liable to have traumatic effects.”
This is the context in which I am talking about what we might call ordinary trauma, as opposed to the direct, blunt trauma of war, sexual abuse or violence in general.
Often you find in therapy that people are looking for the direct, blunt trauma, the ‘incident’ somewhere in their lives, that will throw light on why they are the way they are.
But very often there is no big incident. The ‘trauma’ is buried in the smallest of details within the particular experiences of their lives. Sometimes it is buried in even the most trivial of things.
This is not to say that people are somehow misguided in looking for the big ‘incident’. As I said, Freud himself was convinced of this line of thinking for a period in his own life.
Undoubtedly some people will have had horrendous real events that have happened to them. Others will have found their experiences so normal that it is only when they talk them out and hear themselves say it, that they begin to get a sense of how unusual they might have been.
And still others believe that because there has been no big ‘incident’ in their lives that they are being self-indulgent in feeling the way they do. But this latter group falls directly into the category around which so much of psychoanalytic theory revolves. The ordinary business of living can be traumatic by itself and can leave traces that echo and repeat throughout peoples’ lives.
The study about Chechnya confirms something that psychoanalysis has been saying since the late 19th century: acknowledgement of trauma by a single other or many others can promote recovery.

* ‘Is Acknowledgment of Trauma a Protective Factor? The Sample Case of Refugees from Chechnya’: (in) European Psychologist, Official Organ of the European Federation of Psychologists’ Associations (EFPA); Vol 14, No 3, 2009. pp 249-254.

Friday, October 2, 2009

Men Who'd Like to Be Don Juan

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

Do all men who approach women with the intention of having a sexual relationship act from a position of confidence? I know we’d like to think so. There is an inherent allure in the notion that men are some kind of switched-on sexual hunters that are driven by a relentless desire to win over and conquer as many women as possible. And that they are unaffected by any concerns of self consciousness, lack of confidence, or questions about their desirability or sexual ability. Oh, and that they never fail in their quest.
Certainly there are men like this but they are far from being in the majority. That is to say, of those men who are seeking a partner only a certain element, it could even be a minority, see it as a serial occupation that is both a continuous and seemingly effortless exercise.
When you take into account the broad spectrum of men within any given population seeking female partners, the majority settle, after the traditional process of trial and error, for one woman.
How then does the Don Juan* image have such a hold over not just women’s general perceptions of men, but also men’s perception of themselves?
I suppose I ask that question because I was talking to a number of men recently on the subject of sex. It was interesting for a number of reasons. Two had female partners that they did not want to have sex with, instead preferring online porn as a way of finding satisfaction. One of them liked it that way and was going to have difficulty changing. The other didn’t want to live that way and wanted to change.
Another man had just finished a long term relationship with a woman who had dictated the terms of the relationship and when they could have sex together. He loved this woman very much but she was so dominant that he became overwhelmed by her constant rules and demands and eventually had to end the relationship.
A fourth man was more Don Juan-ish and he had no difficulty finding women, they seemed to come out of the woodwork for him, as we say in Ireland. But he had a fear of them when it came to being intimate and was unable to engage in sex. The fifth man had no difficulty finding women either but while he had no difficulty engaging in the sex act, he was unable to reach orgasm.
Five very different approaches to the issue of sex, sexuality and, I suppose we could say, gender identity. By gender identity I do not mean that these heterosexual men had an issue around whether they were gay or not. Gay and lesbian issues tend to dominate when it comes to considering gender identity, for understandable reasons, but we often forget a more obvious question that arises in this area. Each of these men had, in their own unique way, a question around what it meant to be a man.
It’s very difficult to find consensus as to what it means to be a man. Everyone has a different definition. Some believe it is about being tough and having muscles. Some believe it is about being strong but fair, protective and understanding. Others see it in terms of physical prowess and we could include sexual prowess here, and still others see it in terms of bravery and courage in the face of adversity.
If we were to look for a common element we could simply say that having a penis is perhaps the baseline for being a man. That and perhaps being able to sire children. But not everyone who has a penis either feels like a man or acts along the lines of the male stereotypes set out above. Nor is a male who cannot sire children any less of a man because of it. So you see how difficult it becomes to find an absolute benchmark for what it is to be a man.
French psychoanalyst Dr Jacques Lacan, following in a long tradition within psychoanalysis, says that one’s biological makeup is no guarantee of gender. Biology is not it. Rather he postulates that the decision is made at the level of the unconscious and that we each take up either a male or female position as a result of the infinitely detailed and almost inconsequential experiences of our lives from infancy onward.
You can trace this line of thinking back to Plato. In his play The Symposium, one of the characters explains how the Greeks believed that once upon a time people were both male and female but that the gods split us in two, hence making men and women. This is the origin of the idea that we eternally seek our other half.
So, where does that leave us in terms of the Don Juan notion? Some analysts see the fictitious womanizer as someone engaged in a pathological quest for the perfect other, the other female person who will satisfy all desire and stop us yearning. Yet it is a quest that is at once both pitiful and doomed to fail because the thing that quells all desire can never be found. It is the act of searching to which he is addicted and in every new woman he hopes to find the answer.
If you accept this version of things, then consider how attractive the mythic concept of Don Juan is for many, many men. Some are drawn to it to the point of living out either dominant or partial elements in their lives. Others who are less confident in their abilities with women see it as an ideal to which they aspire and a standard against which they rebuke themselves if they believe they fall short.
Not every man is an accomplished lover but that does not make someone a failure in the game of love either. And yet a mythic concept operates at an unconscious level against which men measure themselves. A myth based on a fictitious figure endeavouring to satisfy what could well be a pathological need to be loved.
* Among the best known versions of the Don Juan myth are Moliere’s play 'Dom Juan ou le Festin de pierre'(1665); Byron’s epic poem 'Don Juan' (1821) and most famously ‘Don Giovanni’, the opera by Mozart.

Friday, September 25, 2009

Refusing to Get Help

By Kevin Murphy MSc.,
Psychoanalytic Psychoanalyst,
Dublin, Ireland.

A question I get asked regularly is how can someone get their son, daughter, husband, wife or partner who is in bad need of therapy to agree to go? It is usually asked by a distraught loved one who has watched, witnessed, or taken the brunt of some pretty bad behaviour over an extended period of time.
And it is usually asked because the person in need of help is refusing to entertain the notion.
The problems can range from the sexually inappropriate, to aggressive acting out, to binge drinking and other addictive behaviours, on to emotionally manipulative and controlling acts. There is no end to what some people can inflict on those around them in a seemingly unending cycle of unhappiness and negativity.
So, is there a way of ‘getting’ someone to go to therapy when they don’t want to? The short answer is no. Therapy is often the last thing that these people will want to undergo. They are, to put it this way, in love with their way of doing things. It brings them a form of pleasure – one that may come disguised as un-pleasure – and they are usually very unwilling, or unable, to give it up.
It is only when, like those addicted to alcohol, they hit a personal ‘rock bottom’ that they eventually wake up to what it is they have been doing. But there is still no guarantee that everyone will do so. One person’s ‘rock bottom’ is another’s ‘half way down’ and vice versa. And there are those who, despite having chaotic lives, continue to blame everyone else for their woes.
Sometimes an extreme outcome makes them see sense. It is when a loved one has been driven away, or when their mental or physical health or their financial independence is at risk, or when their actions have brought them to the attention of the law, or when they have simply had enough of their own downward descent, that’s usually when they choose to seek help on their own account.
I was reminded of this reading Sigmund Freud’s 1937 paper ‘Analysis Terminable and Interminable’ in which he talks about resistance. Resistance is a classic psychoanalytical concept in which the person in therapy actively ‘resists’ letting out any information about themselves. Freud argues coherently that our defense mechanisms are laid down at an early age in our lives when we are facing external and internal experiences that may not be pleasant and so constitute threats that we are pretty much powerless to deal with.
In order to deal with external threats we can complain, or cry, or move away in what ever way we can. But internal threats, such as anxiety or surges of energy, or fear or discomfort, or anything unpleasurable that causes us to resist the experience, means we must put into effect defense mechanisms.
These mechanisms can be denial, repression, shock reaction, introverted-ness, a splitting off of ourselves from reality and so on. The point Freud makes is that while they were once directed against former perceived dangers they recur in the therapy in the form of resistances. And what do these resistances act against? They act against recovery itself, he says. Or as he put it: “It follows… that the ego treats recovery itself as a new danger.”

Taking this concept and applying it to those who refuse, despite the evidence all around them, to accept that they need help of some kind, we come to an interesting perspective. If you accept what Freud says, then you are left with a picture of people who are resisting anything that might help them recover. This not only happens within the therapeutic setting but it is also a factor in people deciding not to enter the process in the first place. The difference being, however, that while resistance can be a challenge within therapy, at least the person has entered the process to begin with so their resistance can be dealt with in that context.
The person who refuses to go at all is a bigger challenge. Usually it is not until their own defenses have broken down, and so allow for the desire to recover to take root, that they can begin to help themselves.
Even getting someone through the door of a therapist’s office is not the victory that it might seem. If someone is unwilling or unready to undergo the necessary engagement and examination of themselves, then it will be just a sham. And do people engage in it for spurious reasons?
Unfortunately they do even if thankfully it is the exception rather than the rule. Why? Sometimes it is to keep troublesome family members off their backs. Sometimes it is to make it look like they are doing something about the problem when in fact they have no interest in doing so.
Some people like being the way they are. You could say they like their symptom and they can’t imagine life without it.
The harsh fact is that like so many endeavours in life, the more people put in to therapy the more they get out of it. It’s a simple proposition. But convincing some people of that idea is not simple at all.

Friday, September 18, 2009

Acting Out in Violent Ways

By Kevin Murphy MSc.,
Psychoanalytic Psychoanalyst,
Dublin, Ireland.

Another young man in Germany has attacked a school and caused bodily harm to his peers. Probably like so many of the cases we hear about, and Ireland has its own recent examples of young men being unexpectedly violent, we will discover that he was a quiet person who gave no sign of being capable of doing such a thing. Friends will probably recall that he was a doer of good deeds if a little shy, a bit withdrawn even. And yet he was probably friendly when people did talk to him.
His bewildered parents will probably remember him in their grief as a conscientious boy who had been a wonderful son. But in recent years he had become somewhat introverted. They first noticed this when he had a setback with school or friends or a girlfriend. He was not into drugs or drink. He was polite with most people. They cannot understand it.
I am not trying to read the future but rather draw on what we know from past experiences of this kind. In most of these cases that you read about, the individuals who are almost exclusively young or young-ish males have shown no sign of pathology. That is, they have not shown any obvious signs of being mentally ill. They have - up to the moment of their attack on friends, or school mates, or family –been living relatively normal lives that are subject to the same ups and downs that everyone experiences.
But what marks them out is that the act they committed involved, to a greater or lesser extent, some degree of planning, some degree of having been thought out beforehand. This makes what they chose to do rather different from blind rage.

French clinical psychiatry and Lacanian psychoanalysis, which is also French in origin, has a phrase called ‘passage à l’acte’ or passage to the act. It designates impulsive acts, of a violent or criminal nature, which sometimes mark the onset of an acute psychotic episode.
These acts mark the point when the person moves, almost in the blinking of an eye, from a violent idea to the carrying out of the act. Because these acts are attributed to the action of madness, however temporary it might have been, French law says that the person does not have civil responsibility for them. One could call them crimes of passion.
It was French psychoanalyst Dr Jacques Lacan who spotted the difference and laid out the finer points of the distinction between this kind of action and what is more commonly known as ‘acting out’. For him, both sets of actions were last resort defences against extreme anxiety but there is a distinct difference.
The person who ‘acts out’ remains within the scene he or she is creating. That is to say they ‘remain’ in that they have a knowing sense of what it is they are doing, despite it being wrong or harmful. This same sense of knowing allows them prepare petrol bombs or buy weapons and plan out their attack.
By contrast, in a ‘passage to the act’, the person who commits the offence or the crime does not stay in the scene but effectively exits from the scene altogether at the moment it happens. This is best illustrated by someone who, pushed to an arbitrary and personal limit of endurance, strikes out at someone they love in such a way that causes catastrophic damage and they remember practically nothing about it afterwards.
The action feels as if it is over in an instant, almost before they know it. In this sense the person they normally are leaves the scene momentarily, even while carrying out the attack, only to return ‘to their senses’ and the consequences of what they have done.
For Lacan, ‘acting out’ is a symbolic message addressed to the bigger society in which we live. It is a message sent to the big ‘out there’, to no one in particular and yet to everyone. It is one that wants its meaning to be inscribed on the person’s own past as well on our communal present and our future. It seeks to insert itself into myth, history and even language itself. It says ‘I have suffered and the world must know’.
A ‘passage to the act’ is the opposite. It is a flight, albeit one that takes place at an automatic level, from language, experience, interpretation and the salvation of the human relationship into the raw, unmediated, beyond words, almost too-real dimension of physical destruction. In carrying out a ‘passage to the act’ therefore the person is exiting from the intricate network of symbols, signs and language that tie us all together in the social bond.
The person who ‘acts out’ is having the same destructive effect except they are very much present in the scene. And while the rage that drives the desire to harm is similar, it has risen to consciousness much earlier and embraced the idea to strike out over a longer period of time.
The symptoms of internalized rage are obviously difficult to see. Especially when you consider how many times the acts of violent young men are described as ‘out of character’ by those who knew them well. So if they are not obvious, then perhaps it is time we paid attention to the less obvious, less observable, almost invisible signs.
For over 150 years, psychoanalysis has posited that aggression and the potential for violence lurks within us all. It is part of our structural framework but for most of us the effects of parents, family, society, our personal constitution and personalities ensure that we remain able to contain and master it. But it lurks there in our unconscious nevertheless. Maybe an approach that took more account of this aspect of our mental life could make us more astute in seeing the signs.

Friday, September 11, 2009

Allowing the Therapy Speak for Itself

By Kevin Murphy MSc.,
Psychoanalytic Psychoanalyst,
Dublin, Ireland.

Two separate clients decided to finish up their treatment at around the same time recently because each said they were feeling better. When I asked how they felt at the end of treatment compared to how they felt when they started, the first client said the things that were worrying them when they first came weren’t a worry anymore. These things hadn’t gone away and yet for some reason over the course of the treatment they had ceased to be a major, all encompassing worry in their life.
The other thing this client said was that before they started treatment they could not imagine a future in which things got any better for them or improved in any way. They said they had felt destined to live a life that was pretty much stuck in the same way of dealing with things, getting hurt at the same situations, at the same negative ideas that occurred to them, and they had become resigned to nursing themselves through life with practically no sense of self belief or joy in what they did.
By comparison, this client said that they were now experiencing optimism for the first time in a long time and that the future seemed to hold out a range of different possibilities and opportunities for improvement.
When I asked this particular client what they thought it was within the therapeutic process that had brought about such a change, they replied: ‘I don’t know.’
The second client I referred to had come to treatment because a particular compulsion was taking over their life. This particular compulsion had put their main relationship under pressure and it was threatening to make life difficult in terms of family and work relationships.
When this second client decided to finish up treatment I asked the same question about the difference between before and after. Before treatment this client had tried to hide the compulsion, disguising its effects in all sorts of ways from their partner, and had become obsessed with the negative implications it held for them. A lot of worrying and stress was carried out in private in case anyone should find out about it.
At the end of treatment, the client said they were no longer compulsively engaging in this behaviour and had stopped completely. Needless to say, I had not made any suggestions in this regard during the therapy. The client also said their main relationship had improved hugely and their sense of relief and self-belief had returned.
When I asked the same question about what they thought had taken place in the therapy to bring this about, they gave the same reply as the first client. They didn’t know.
It’s nice to see therapy work. But it is not always possible to say why it works, particularly from the client’s perspective. Not that it matters to someone very much if they manage to pass from fear or compulsive behaviour or whatever, to a more balanced, optimistic position.
But it points to the essence of what goes on in therapy. Psychoanalytic theory is rich in explanations and theories as to what the process does: it lifts repression, restores inner energies to their rightful places, brings into consciousness new understandings and meanings, undoes some of the damage of faulty ideas or imagined notions and concepts, allows us reconfigure past experiences that have remained unresolved, and places it all in a current context that allows us get on with our lives, right here, right now.
But from the client’s point of view, there is no direct experience of these things. There is often no putting a finger on exactly what it is that has made the positive changes take place. The experience of therapy will have felt like simply talking. And sometimes it will have felt like talking about the most random, most trivial aspects of one’s life. And yet somehow this activity contributes to a gradually improving sense of one’s self.
The act of speaking, in its fullest sense, in the choice of what one chooses to speak about, in the choice of words one uses to describe those things, in the way the thing spoken about before that or immediately after that might signal a connection or no connection at all with anything else. It is in these things that meanings make themselves felt, not always and exclusively between the client and the therapist because frankly not ever therapeutic session ends with a neatly wrapped up set of meanings that flood the client with insight.
No, it is more a gentle accumulation of meanings within the clients themselves, often not recognised at first, but over time these newer meanings insist their way into the person’s way of thinking about the world and their place in it.
It is not an obvious process. It creeps up on you before you realize it. That’s why the two clients above could point to definite improvements in their quality of life but were unable to say why it had taken place.

Friday, September 4, 2009

Losing Our Sense of Who We Are - 4

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

To conclude on the subject of anxiety, I finished last week on the idea that in anxiety we revert from having an objective sense of who we are, from a position in which we can stand back, evaluate, view ourselves relatively dispassionately, to an almost primal sense of vulnerable subjectivity. We come to painfully inhabit ourselves in a way that is so intense it paralyses us and shows us a frightening and fragile sense of control and incompleteness within ourselves.
Our identity establishes itself with an embrace of the visual image while the reality of fragmentation and un-coordination are essentially repressed, a point of division if you like. So, modern Lacanian psychoanalytic theory proposes that anxiety brings this moment of division crashing back into consciousness: it undoes our defenses, breaks the bonds that hold our sense of who we like to think we are, and so it leaves us open and vulnerable. But to what?
I cited a fascinating article two week’s ago that appeared in the 2002 edition of the International Journal of Psycho-Analysis and that was written by Dublin psychoanalyst Dr Olga Cox Cameron. It looks at the question of anxiety by considering the characters in Ian McEwan’s novel ‘Enduring Love’.
According to Cox Cameron, under the pressure of severe anxiety, and remember this is an invisible fear that has very primal roots in all of us, the visual image, or rather the object-ness on which our identity has been formed, collapses.
But, she says, it does not collapse into nothingness. Instead, and much more disturbingly, it collapses in a way that brings about an excess of our sense of ourselves as someone without supports. We are an object of our own anxiety but this time an object that is acutely, painfully and helplessly aware of the experience.
The intensity of anxiety can range all the way from mild but uncomfortable self consciousness to anxiety- ridden panic attacks and beyond. But this excessive experience of self is at the core of the anxiety experience that prompts people to seek treatment.
It is a ‘too much’ of ourselves, an intense focus on ourselves and on the uncontrollable fear that ruptures all other connections to the world around us and the supports and anchors that normally operate. We are cut loose, free floating, with only fear and an intense sense of our isolated presence to accompany us.
It is this experience, as Freud pointed out in his 1894 ‘Anxiety’, that is the polar opposite or the reverse side of, desire. It is marked by the lack of comfort, security, happiness, confidence, wholeness and peace of mind. And not only is it lacking in these ‘anchors’ but it is characterized by an excessive sense of ourselves as being present in the experience.
The final conundrum is why some experience it and others don’t. Some experience it acutely but most experience it in a mild and controllable or less disturbing form. Either way, it is part of the human condition, a result of childhood experiences and re-ignited or reinforced by life experiences and the stresses and strains of living.
The pressure of modern life is keenly felt by some, particularly those whose sense of identity is prone to being unsettled or whose sense of confidence and happiness is delicately balanced. Anxiety shatters the careful and, in some cases, tenuous bonds that tie us together and give us a sense of wholeness.
Along with wholeness, these bonds give us a comfortable sense of who we are as complete, coordinated and grounded individuals by sustaining a necessary distance from our weaker qualities. It is the overwhelming sense of ourselves as less than capable or competent or resilient or whole that anxiety floods us with.
Psychoanalytic theory offers practical tools with which to examine the particular experiences of anxiety that particular clients undergo. This is not a one-size-fits-all therapy. It is the therapy of the individual, and everyone is different, everyone has a particular set of meanings, non-meanings and truths that are not the same for anyone else.
So, what does the theory offer us in terms of searching out meaning, non-meaning and particular truths? It asks where the person is situated in terms of their network of human relations. What is the quality of relationships? Is there a sense of connection or rupture in them? If rupture, what are the parameters of that? It also asks about the nature of the person’s identity, their real bodily image, their imaginary image of themselves, and where both fit in relation to the ideals they might have about themselves and the ideals they feel others have for them? This is not the complete list but the psychoanalytic approach offers a matrix of essentially human guy-lines along which the often complex nature of therapy can steer itself.
But in the same way that it is not a ‘one-size-fits-all’ therapy nor is it a quick-fix therapy. By the time some people come for help they want an instant cure. Years of ignoring the signs have allowed anxiety build to the point of being unbearable.
Anxiety is experienced directly as a confusing and overwhelming fear. But behind the scenes it is usually made up of a number of different strands. Its power derives from the fact that its energy comes from a number of different sources, much like a powerful river with a number of tributaries feeding into it.
The work of psychoanalytic psychotherapy involves an investment of time in picking out these various strands so that the force with which anxiety strikes can be lessened and dissipated.

Thursday, August 27, 2009

How Anxiety Begins In All of Us - 3

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

To pick up where I left off last week on the subject of anxiety, I was writing about drawing on two notions from contemporary psychoanalytic theory. The first of these was that the roots of adult anxiety reside in infancy as a result of the experiences of connection and rupture, particularly the temporary but necessary connections and ruptures the infant experiences with its primary carer, and which each of us as infants undergo during our development.
The roots of anxiety reside in such moments even before the child has a developed ego with which to defend against the negative aspects, particularly of rupture i.e. the breaking off of contact by the mother to allow her do other necessary tasks. This process is part of the human structural framework and occurs most markedly at phases like weaning, in which the infant must either accept or not accept a loss.
But out of these experiences, a pattern, however primal, is laid down, a template if you like, that dictates future responses to issues of connection to the larger body of human society or, indeed, the rupturing from it, however real or imaginary they might be.
The second notion I wrote about last week was the power of the visual image of the infant at the Mirror Stage, from about six months onwards, to override the more real experience of the fragmentation and uncoordinated nature of its body. In other words, the visual image offers an answer to bodily fragmentation in terms of wholeness and perfection. And so in this way the infant gets its first answer to the question of who it is.
This is a jubilatory experience of recognition but at the same time is also a cause of anxiety. Why? Because the perfection of the image it sees, this ‘other’ that is perfect, has the potential to overwhelm it. In order to accommodate these opposing forces, the infant identifies with the image, owns it, incorporates it, takes it into itself, metaphorically speaking. And this is, in Lacanian psychoanalytical theory, the moment when the infant is jolted into a radically new direction in terms of its identity and in terms of the power of the visual image.
What we learn from this theory is that the birth of identity, the ‘I’ that we understand ourselves to be, takes place at a point of rupture in our relatively comfortable state of existence up to that moment. At the moment our identity is crucially formed we emerge from fragementation to embrace a visual image that offers the semblance of perfection. At the same time anything else about ourselves, the uncoordinated imperfection, fades into the background into that great holding area known in psychoanalytic theory as the unconscious.
From that moment on, ‘seeing’, witnessing, having the evidence of our eyes becomes the unassailable criterion for practically everything we will henceforth judge to be true or not true. And, equally, it inaugurates a distrust, disbelief, disregard, even fear for that which cannot be seen or corroborated by the evidence of our eyes.
The second thing we learn from the theory is that the birth of identity takes place, along with the accommodation of loss and rupture as structural elements of the human infant experience, alongside the experience of anxiety. The inaugural moment of establishing the first visual sense of who we are is woven in with the experience of anxiety.
The third thing it tells us is that in the moment when we are gaining our first tentative visual inkling of who we are, we are essentially an object in front of another object that appears before us. We become ‘I’, in our first moment of identity, by becoming the same as, identifying with, this other object. That might sound like an inconsequential point but what happens in adult anxiety is this very thing in reverse.
In adult anxiety we revert from having an objective sense of who we are, a perspective that allows us stand back, evaluate, view ourselves relatively dispassionately and one that anchors us to reality by various connections, beliefs, attitudes and relationships. Instead we are 'jolted' back to an almost primal sense of vulnerable subjectivity. We come to painfully inhabit ourselves in a way that is so intense it debilitates us and brings into sharp relief our fragile sense of wholeness.
When I conclude on this subject next week, I will be pointing to what contemporary psychoanalytic theory has to say about this reverting to a peculiarly unworkable subjective sense of ourselves, the experience we know as anxiety, and why it is so overwhelming for us.

Friday, August 21, 2009

The Roots of Anxiety - 2

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

I wrote in my last blog about the issue of anxiety as it is understood by psychoanalytic theory and, as I mentioned, I propose to elaborate a little on that. Anxiety is an omnipresent human experience that, for those who experience it, creates intense fear. It turns the world around us into a strange place, a place that was once familiar and that is now threateningly unfamiliar. It converts, in an instant, a sense of control over one’s life into a complete absence of control. With that absence of control comes the threat, the fear, the terror, that we will be overwhelmed by it. And that the part of us that functions as the person we know ourselves to be will be swamped and no longer exist.
You often hear people describing anxiety as a fear with no object – there is nothing visible that is causing us to fear. Or we often hear people describing triggering events in their lives that are relatively insignificant but which cause them massive, persistent anxiety. It is as if the triggering event couldn’t possibly be the cause of such an intense reaction, again suggesting that there is no good reason for such intense anxiety.
But with anxiety there is an object, albeit an invisible one; it is the fear of being made powerless, of being overcome, of being shut down as a person, of being unable to deal effectively with whatever life throws at us. At its core there is a helplessness that epitomises the sense of lack I spoke about last week. And so against our will we are thrown into a place where, rather than the desiring being that needs something and seeks satisfaction of that need, we become unable to do so because we are somehow lacking. Within this new and unpleasant experience we are not just powerless but we are also unrecognizable to ourselves, that is the identity we thought we had is missing, however temporarily, and that is what adds to this unnerving and frightening experience.
Unlike a great deal of theorizing in this area, psychoanalytic theory seeks to explain causes, especially those that are not visible or observable. Going back to the beginning, Freud and his adherent, child psychoanalyst Melanie Klein, believed anxiety was linked to the very earliest moments of the infant child and that anxiety in adults is a reactivation of these early experiences. These involve the connection and rupture that are part and parcel of the infant child’s relationship with the mother – the breast being given and the breast being taken away and so on. They bring with them the threat of annihilation in the world of the infant who has still no developed ego with which to defend against such threats.
In the 1960s and 1970s French psychoanalyst Dr Jacques Lacan moved the theory on by suggesting that there was another significant moment happening around this time in the formation of the child. This new ‘moment’ was something of a breakthrough that no one had theorized before but which has since been widely accepted by most schools of thought.
Lacan called it the Mirror Stage, a period or, indeed, a 'moment' in the infant child’s life, from six months onward, when seeing its own reflection for the first time - in a mirror or any reflecting surface, even the image of another infant - it gets its sense of identity.
The wholeness of the image the child sees in the 'mirror' is at odds with its fragmented and relatively uncoordinated bodily experience relative to its stage in life. It comes with a jublilatory sense of triumph, one that can be seen in the excitement of the child. But it also comes with a paradoxical effect because along with the jublilation of being 'whole' as opposed to fragmented, there is the threat that this other, this not-me could pose a threat.
As such this 'moment' marks a huge turning point both in terms of the mental life of the child - in terms of how it understands itself - and in terms of the importance which the bodily image, the visual image, will have for the child thereafter as it develops to adulthood.
The richness of the Mirror Stage as a theory is that it proposes that the child sees wholeness in the image while experiencing uncoordinated fragementation in the body. The allure and perfection of one is contrasted with the inhibition and imperfection of the other. In other words there is a conflict between the imaginary reflection and the reality of the body.
This conflict, deriving an identity of wholeness from something that is not intrinsically us, leads to aggressive tension because the wholeness of the image threatens to overwhelm the child with the threat of annihilation, a repeat of an earlier threat stemming from the serial connection and rupture with the breast. In order to cope with this aggressive tension the child identifies with the image it sees before it.
This resolution of conflict, this choosing of the image of wholeness and relative perfection in psychoanalytic theory, is the first moment of the formation of what we come to know later as ‘I’, my identity, the person who I perceive myself to be. And bear in mind, this is the very thing that vanishes in an anxiety attack.
In a fascinating paper on this subject by Dublin psychoanalyst Dr Olga Cox Cameron she says we can view the trajectory of this process more clearly in adult form, in an example taken from literature. This is in Shakespeare’s Henry V, most particularly in the famous speech Henry makes on the eve of the battle of Agincourt.
Faced with a weary, fragmented army that is due to take on a superior French army Henry conjures up for them in his speech an image of heroism that inspires them to victory. The heroic imagery presented wholeness, while the reality was one of fragmentation and un-coordination. Yet the image was the thing they identified with over the reality and it ‘lifted’ or ‘jolted’ the weary army into new life.
Drawing together these two strands; the roots of anxiety in infancy as a result of the experiences of connection and rupture, and the power of the ‘whole’ image to override the fragmentation of the body, next week I’ll look at how psychoanalytic theory explains the mechanism of anxiety as most adults experience it.

Friday, July 31, 2009

The Fear in All of Us - 1

By Kevin Murphy M.Sc.,
Psychoanalytical Psychotherapist,
Dublin, Ireland.

A client was telling me recently about their experience of an anxiety attack. It happened in the workplace and involved panic, sweating, a rising sense of fear along with racing, negative thoughts. Coupled with this was a twofold additional response. One was an unmistakable sense that the anxiety was out of all proportion to the event that triggered it – being asked to take on a new project. And second was a recoiling at the idea that it should have been happening to them and that it was a particular failing on their part to be reacting in this way. This latter being almost a fear of the fear itself.
So, this had all the signs of the classic anxiety attack. An unpleasant sense of fear, increasing rapidly in intensity, seemingly out of nowhere, that threatened to overwhelm this client and over which they had no sense of control
For a ‘disorder’ that is probably embedded in the widest range of psychical disturbances and emotional issues, there is still very little public understanding, or even medical understanding, of what really causes it.
Certainly there are plenty of descriptions of the symptoms of anxiety and many diagnostic categories that include the heading of anxiety. But when it comes to actual explanations of where it comes from they are pretty thin on the ground.
The official definition is that it is a psychological and physiological state characterized by cognitive (thoughts), somatic (bodily), emotional, and behavioural components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.
The same definition considers anxiety to be a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviours of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.
A degree of anxiety is considered to be a normal reaction to stress but when it becomes excessive or insistent, it falls under the classification of an anxiety disorder.
That is the official position on anxiety. Against this backdrop I thought it might be interesting to consider the psychoanalytic understanding of anxiety, in particular the Freudian/Lacanian approach (the Freudian position reinterpreted by French teacher, author, psychiatrist and psychoanalyst Dr Jacques Lacan), which in my view offers the richest theory available.
A good starting point might be to differentiate the rather obvious point about the beginnings of anxiety. Often you find that people come to therapy when anxiety becomes unbearable and unmanageable in their lives. By that stage, usually, they have lived with a reduced level of anxiety without any overt knowledge of its existence for many years. When it does emerge in a problematic way, a common description of the experience is that it simply cropped up, triggered by nothing they can point to as the cause, but that it has been having a debilitating influence ever since.
The most common request is to return people to the point in their lives when there was 'no anxiety'. And, equally, to act quickly in bringing about such a change.
But anxiety is not something that simply arises in someone’s life unannounced. In most cases you will, on deeper examination, find traces of it stretching back through their history. And, while it is possible for people to feel the benefit of beginning therapy almost immediately, ‘fixing’ anxiety is not something that can be done without an investment of time and patience.
Freud, as far back as 1894 in his paper 'Anxiety' first pointed to the link between anxiety and desire, an odd coupling you might think. And, incidentally, while you may often hear people say that Freud is old hat, like so many of his discoveries this link has been making its way down through psychoanalytic thinking and theorising ever since. Why is the link between desire and anxiety such a discovery?
Because desire is one of our earliest and most persistent drivers towards pleasure, comfort, security, happiness and everything positive. Its opposite is the thing we experience when all these positives are absent: anxiety. No-one before this had noticed that the striving for pleasure, well being, comfort, happiness, confidence, wholeness, peace of mind and even love was the opposite side of the same coin which included anxiety.
Anxiety is the lack of all these things. And in its adult form, it is the painful awareness, the uncomfortable truth, the frightening disappearance of our subjective autonomy, and even sometimes the disempowering realisation that we might lack these things.
So where does this ability to experience a lack of this kind come from? In my next blog I am going to look at how this happens. Far from emerging as a result of no known cause or triggered by small, ad hoc occurrences of daily life, psychoanalytic theory proposes that anxiety is an intrinsic part of human experience and is present from our earliest stages of life.

* The next blog will appear on Friday August 21,2009.

Friday, July 24, 2009

Aspects of Love

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

When we speak of romantic love we are talking about the most positive of human emotions, the one to which we are all drawn. Being able to love is our highest attribute and being loved our most treasured experience.
Yet, despite our inner capacity to love, we usually think of it as something that exists outside of ourselves. In one respect this is true. It can only be found in that inter-space between us and another person. And when we do fall in love, it again comes from from this place.
Love attacks us from the outside. We talk of being struck by love, of falling into love, of cupid’s arrow hitting us, of being smitten, and so on.
I was at a psychoanalytic conference in Paris in June and it was interesting to hear leading US author and psychoanalyst Bruce Fink give a talk on this very subject. He had been speaking of the mini-trauma that being ‘struck’ by love represents, a trauma that can lead to repetition compulsion such as repeatedly falling in love with the wrong person or unconsciously destroying our love relationships or never quite recognising it as love even with the right person.
Love by its very nature is not a solitary experience unless you are talking about mysticism. Rather, human love, as the title of the 1955 William Holden movie said, is ‘a many splendored thing’. Quite simply, the experience of love is dependent on our ability to engage at a very fundamental level with another human being. And, as a result, the experience of love is not the same for everyone.
For some it is salvation and the springboard to a wonderfully, happy and fulfilled life. For others, it is the precursor of misery and domination. Still others seem only to recognise it when it has left their lives completely and the most famous example of this is Shakespeare’s Hamlet. It is only after his true love Ophelia is dead that he can truly understand what it is he has lost.
I suppose I came to this topic because a number of people have been talking to me recently about love in one aspect or another. It occurred to me how varied people’s experiences of this one human emotion can be.
The first person described a magnificent love for another person in which they were transfixed, obsessed, helpless. And yet the other person did nothing but abuse this love, ending the relationship cruelly and creating emotional turmoil all along the way.
The second person left their partner because they were ‘bored’ and had a series of affairs afterwards, none of which seemed to satisfy their requirements. Yet when the original partner found someone new, suddenly this was the one true love that had been lost.
The third person fell madly in love with someone despite a history of previous relationships in which they never lost emotional control. Being in love was a new and wonderful thing for them until it ended when the love partner broke it off leaving the person who had been used to so much emotional control both devastated and disorientated.
The last person fell in love with the right person, a kind, considerate, caring partner, but they brought the relationship to an abrupt end with incessant demands for attention, for proclamations of undying love and for continuous reassurances.
We assume when we talk about love and about the search for it, that we are talking as if love is out there, simply waiting, and that when we find it we will be enveloped in its healing arms.
But clinical experience shows that this is far from the case. The reality is that love is not guaranteed. There is nothing written anywhere that says everyone will find love. At the same conference I mentioned above, one of the speakers made the comment that ‘Love is not contingent in any relationship, it may happen or it may not’.
If you look up the dictionary on the word contingent you will find it means: likely but not certain to happen. There is a second meaning of the word though, and it is, ‘dependent on or conditioned by something else as in ‘payment is contingent on fulfillment of certain conditions.
Now, in the realm of love just what these conditions are is difficult to define. But one of them is the ability I mentioned earlier to engage at a fundamental level with another human being. This condition in turn requires us to be able to trust another person, be relaxed in their presence, be confident enough to convey an essential part of who we are to them, to understand if our love is being reciprocated, and to intuit whether we are engaging with someone who is capable of loving and being loved.
This, along with the flood of positive emotions that we associate with the experience, is what allows us to recognise love when we find it. But it is not as simple as it sounds. Some recognise love only when it is an obsession with the wrong person. Others do not see love when the right person is standing in front of them. Some look all their lives and never find it because a 'better' love is just around the corner. Others bring a destructiveness because, paradoxically, they fear the relationship ending.
There is no end to the range of human responses to love. Its very power emanates from the unpredictability of its effects.
The game of love is the most unpredictable of them all. But we can test what we are experiencing by asking a very simple question. Is it enriching me or is it impoverishing me? If we can give ourselves an honest answer to this question, bearing in mind that love moves us out of the realm of logic, then we have created an important foundation to understand the kind of love we are experiencing.

Friday, July 17, 2009

Letting the Ideas Flow Naturally

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

A client stopped in mid-sentence recently to apologise for hopping and jumping from one topic to the next. I replied that there was nothing wrong with doing that, the best way of speaking in therapy is by allowing the free association of ideas to carry on unhindered.
The client had worried that the ideas had not been following a logical track towards an overwhelmingly sensible point. It seemed haphazard, offbeat, random whereas instead they had wanted their speaking to be logical, sensible and of practical value.
Two things were of interest in this situation. Firstly, this client had come to therapy because their life had become unworkable as a result of a compulsion that would not go away. It had no obvious cause and no obvious solution.
The second thing was this client had begun the session by reporting that since beginning therapy this compulsion had not been as much in evidence in their life.
Where is all this going?
The fact is that we love logic and sense and science and things to follow an order. The reality for most of us, however, is that our inner lives and often our outer lives don’t follow any such pattern, no matter how much we’d like them too. Impulsivity, contradiction, illogical forces, imaginary considerations and gut feelings that defy verbalisation are just as much a part of what we do and who we are, as are their rational cousins.
We are nuanced, if that’s the right word, between a logical, observable world and an almost illogical, invisible one. The business of psychoanalytic psychotherapy, at least in one of its aspects, is to form a bridge between these two registers. And often the work of building that bridge comprises simply acknowledging that these two diametrically opposed registers exist in the first instance and also that they are intrinsically linked.
Once we have that, we can then move on to the notion that the two registers are asymmetrical in terms of their scale and influence over our lives. By this I mean that there is not an equal dividing line between them. Rather the separation is pretty much 90-10 in terms of the invisible side of things.
As you may have gathered, I am talking about the unconscious mind, the hidden, invisible part of our mental life that we never see directly and that we can only know when it ‘erupts’ in our slips of the tongue, in our dreams, in our jokes and so on. In short, a form of personal truth slips out usually when we are looking the other way.
The unconscious was Freud’s discovery, and it was a point in history after which all subsequent understanding about the human psyche was never the same again. In terms of impact it has been compared to the discovery of 15th century Polish mathematician Nicolaus Copernicus who discovered that the Sun was the centre of our universe rather than the Earth, as had previously been believed. In both cases, a much larger force was now discovered as being the driving force behind a fundamental part of our existence while the role of the original centre of activity was relegated to a more dependant role.
I mention this preamble on the unconscious because in so much of our lives we encounter examples of human experience that are not explainable by logic or science or medicine. In fact, the medical profession has its own term, Medically Unexplained Symptoms (MUS), to cater for this very thing.
Anyone who heard Paddy Doyle, author of The God Squad, speak on Liveline on RTE 1 this week, will have got a glimpse of this. He is a sufferer of from chronic dystonia, a neurological movement disorder characterised by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or postures. If it is not caused by hereditary factors or brain injury – both absent in Paddy Doyle’s case - there is no clear medical understanding as to how it occurs.
Paddy Doyle himself quoted a psychiatrist he went to who said that the profound bodily movements he has displayed since around 10 years of age may be a replication of the bodily movements of his father dying from hanging, a scene he witnessed as a very young boy. The implication being that the trauma of the experience was written into the very contours of, and continues to re-enact itself repeatedly in, his body.
My client above faltered momentarily because of a belief that speaking in therapy should follow a sound logical path. There is a logic to the unconscious but it is not the same logic as we know in the observable, rational world. Psychoanalytic psychotherapy uses free association, the free, unfettered flow of ideas, as a tool with which to catch occasional glimpses of the vast and cavernous part of our inner lives that prefers to remain hidden. So in this context, veering off the path of the sensible and the logical is to be welcomed.

Friday, July 10, 2009

Getting Past the Trust Barrier

By Kevin Murphy M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland

For anyone who has difficulty finding trust in relationships, therapy must offer a daunting prospect. What, after all, is being proposed by the conditions of therapy? Well, the first requirement is that very thing, trust.
It is a professional relationship we are speaking about but in the same way that you have to trust your doctor or your dentist, the same kind of principle has to apply with your therapist. Except with one important difference.
The treatment that your doctor or your dentist offers you is not dependant on regular weekly or even twice weekly visits that build gradually into an in-depth knowledge of your inner life. No other professional is expected to go where a psychoanalytic psychotherapist is expected to go.
In short, no other relationship is quite like it. Jacques Lacan, the leading French psychoanalyst once said that the analyst 'pays with his/her being' and this is pretty much what he had in mind.
Therefore, and this might seem an obvious thing, the ease or ability or facility with which a person enters into and sustains a relationship, albeit a strictly professional one, is among the conditions required for a successful treatment.
Put it another way, someone who finds that their life experiences have led them to distrust the motives of others, to distrust the knowledge of psychoanalysis (or any other therapy for that matter), to distrust themselves or anyone else as capable of conducting fruitful, curative relationships, then they will have difficulty making a talking therapy work. Because it is not just a talking therapy; it is a relationship.
You can often find that some people are eager to make it work at first but they simply cannot get over their sense of mistrust. This can manifest itself as boredom, loss of belief in the process, dislike of the therapist, or a myriad of reasons ranging from not having the time to not having the money to not having the interest. But it is not a complete loss. Once a person has come for a few sessions, a process has been set in motion that continues for a very long time afterwards.

Be that as it may, this aversion to forming a relationship because of an inability to trust can also manifest itself in other ways. For those who find relationships difficult or troublesome, there are two aspects that represent a real risk.
The first is that the relationship will impose some form of dependency on the person seeking therapy. This is an interesting one because it leads some people to opt out of going to therapy because they believe, rightly or wrongly, that they will become dependant on it, or more importantly on the person of the therapist.
In a nutshell, they are denying themselves access to the kind of help provided by a trained other on the basis that they believe they might not be able to function without the continuous help of that trained other. It can be a difficult fear to assuage. Yet modern psychoanalytic psychotherapy has one goal; to allow the person stand on their own two feet, so to speak.
The second aspect is that, like all relationships, even the therapeutic professional relationship will come to an end. The end of a relationship (as opposed to the ‘end of analysis’ which is something both Freud and Lacan wrote extensively about) involves a separation. And while for very many people, it can represent a healthy 'leaving' to carry on with their own lives in a more positive and healthy frame of mind, for others it is not so.
They imagine, as they begin therapy, that this is something that will come to an end, that will involve separation (something that has deep roots for all of us) and that this separation will inevitably be painful and distressing.
This is a form of thinking that emanates from an imaginary position in which the person assumes reality will turn out just like it. And, paradoxically, it is the very thinking that the person opting for therapy is seeking to change. Unfortunately, it sometimes doesn't get that far and can just as easily divert them in a completely different direction away from therapy.
Psychoanalytic psychotherapy is founded on a relationship between two people, a professional relationship with very clear boundaries, but a relationship nonetheless. When it succeeds, it does so because it operates using the very tools that each and every one of us has been exposed to since birth. The human relationship is the fundamental soil out of which we all grow. The therapeutic setting is as much to do with recreating the conditions for growth as it is about anything else.

Friday, June 19, 2009

Memories Are Made of This

By Kevin Murphy M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland

Much of the work of psychoanalysis and psychoanalytic psychotherapy involves memory. Not that a person is forced to search out and reveal any particular memory from their past but invariably it goes that way naturally. The work of unravelling the meaning behind puzzling current symptoms inevitably leads back to earlier times in their life. And here we come to an interesting phenomenon.
Often you find that someone will have a memory they go back to again and again, a particular scene or a particular moment in their life on which they instinctively place a great deal of significance.
It might be a memory that comprises a harmless, bland scene that was somehow frightening for them; or it might be a scene with no obvious impact and yet continues to puzzle them for its insistence in their mind; or it might be a time when a change happened in their lives, a new school, a new home, after which, for no apparent reason, they believe that things were never the same for them.
It is as if the memory has an almost magnetic hold on them and yet they cannot figure out what it is. They believe it must be something important but just what is it?
In psychoanalytic theory, which has evolved and continues to evolve over the past 150years, there is a little known thing called screen memories. These are memories that cover up whatever is unacceptable to the conscious ego and so are defensive in nature.
The first mention of this was, as you would expect, from Freud in 1899, the year before his major work The Interpretation of Dreams was published. "Screen Memories" is a paper in which Freud evoked one of his own memories of childhood (though he ascribed it to someone else), in which he saw himself playing with other children in a very green meadow across which vivid yellow flowers were sprinkled.
Analysis led to a later memory, from adolescence, in which he was in love with a girl in a yellow dress. Thus the childhood memory was in this case screening off a later sexual wish: there was no childhood memory, but only a phantasy put back into childhood. The notion of screen memories, as he outlined it, was that they were false constructions, not intentionally so but with a particular purpose in mind.
This memory from the past therefore has a hold on us and yet appears devoid of any real meaning. This has often been used as the basis to undermine the accuracy or trustworthiness of childhood memories. But a child who has genuinely been abused is not constructing something that did not happen. There is a very real reason why the memory of that abuse will not go away as it contains all the meaning one needs to explain it, albeit meaning riddled with trauma, self contempt, and exploitation.
Screen memories, in contrast, have no meaning within themselves and are devoid of trauma. They are quite literally a screen. The desires that the memory encodes are displaced, temporally (from the near past to the distant past) as well as psychically (from one object to another).
And they introduced for the first time in the great man’s thinking the notion of phantasy. The importance of phantasy for Freud was that it replaced his earlier notion that neurosis had to be caused by trauma of some kind. Now it could be caused by ‘ideas’ a child employed, rightly or wrongly, to interpret experience.
Thinking since Freud has broadened out to include the possibility that screen memories have a screening effect on issues that were current at the time of the memory itself. In other words they have an iconic quality, drawing their power from events, relationships, and ideas both imaginary and real, that were happening at that same time in the child’s life. That is why some clients refer to these memories as puzzling. There is nothing in them, in themselves, that can give any clue as to why they are so enigmatically present in their memory. And yet through teasing out the ideas contained within them and exploring the other factors present in their life at that time, a new and more understandable perspective can be achieved. In short, they exist because something either then or much later was being defended against. They are not so much childhood memories as memories about childhood that come with an astonishing degree of clarity and paradoxically insignificant content. They are little like dreams, in that sense, with their meaning disguised and displaced onto less important details.

* The next blog will appear on Friday July 10th, 2009.

Friday, June 12, 2009

The Importance of Trust

By Kevin Murphy M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland

I was listening to someone recently talking about their experience of infidelity. They were describing their peer group and how there was an unspoken consensus in it that infidelity was not such a big deal. By which I mean it was not considered so big a deal that it prevented various members of the group, both men and women, from having affairs with other people.
There is something alluring about freedom of this kind, isn’t there? It offers the prospect of having one’s sexual curiousity satisfied, not to mention one’s sexual desires, in whatever random situation that happens to develop.
It was equally interesting listening to this person describe their peer group – all youngish who were not married and who had no dependants – from a position of anxiety. The question they repeatedly asked was how was it possible to have a relationship in which one felt secure, respected and loved? It was as if the prospect of all that personal freedom was too much to contemplate.
When this person went into the detail of various infidelities it was rarely a clear cut situation. Usually the cheated-on party was greatly hurt and a trust was broken. Or else the cheating party was keeping a secret that was leading to a strong sense of guilt, or was living with the prospect of being found out at some point.
Whichever way you looked at it, the picture this person was painting was one of personal freedom being exercised in a way that willingly risked sacrificing trust within an existing relationship in exchange for pleasure, however brief, outside of it.
Some people feel that this is a worthwhile exchange to make. Others get incredibly damaged by it. And I’m not just talking about those who do the cheating.
Another person I spoke to recently was having huge difficulty coming to terms with the devastating effects on their relationship of having a one night stand. The one night stand is part of popular western culture. It is an acceptable thing, in most instances. But this person was having huge difficulty not just in coping with their partner’s reaction to it, but their own reaction to it. It seemed as if they were more likely to achieve forgiveness from the partner before they would forgive themselves.
And I suppose I’m also thinking of a person I listened to recently who was on the other side of a similar situation. The partner this time had been having an affair and had admitted to it in order to appease their sense of guilt. Once again the issue of trust raised its head but this time in a curious context. This person began asking if it was naïve to expect trust to be part of a loving relationship?
And that I suppose is at the root of the questions that all of these people, and more besides, have been asking in one form or another. In an age of unprecedented sexual freedom one could legitimately ask whether there is a corresponding increase in happiness. Freedom brings with it great things but it is also capable of being abused.
So rather than taking it from the perspective of whether freedom should be restrained or curtailed, from a psychotherapeutic point of view we should ask what happens to trust in one’s primary love relationship if one’s pursuit of sexual freedom leads to infidelity?
The answer is that trust gets badly damaged, in some cases terminally so. And when trust gets damaged often the person whose trust has been broken gets damaged too.
And it is not just the innocent party who gets damaged in these situations. Those who stray are just as susceptible.
The occasional transgressor might be filled with remorse but the bulk are publicly unrepentant, they just betray their guilt in different ways. Look at the effort that goes into their defence mechanisms to protect themselves from accepting the possible enormity of what they have done? They use the classic psychoanalytic defences of denial, or projection onto others, or compartmentalisation of the issue in their own minds or they split themselves off from it completely.
This enormity that I am speaking of is not just meant in the narrow sense of what they have done to their existing partner or to their own sense of who they are or to the relationship they currently have. These are important issues, no doubt, but there is a further point that is rarely considered.
When opportunistic sexual gratification is on offer faithfulness can seemingly be jettisoned. So I suppose you could say we are down to a question of ethics now because the decision to remain faithful is at base an ethical one. But, like all ethical decisions, it is a difficult one to make.
It doesn’t come without some form of sacrifice. It doesn’t come without some form of refusal to indulge in extra pleasure. And neither does it come without a degree of personal strength being applied.
In this light, the enormity that I am speaking of also includes this sense of having failed in the face of a hard task, mainly because it was hard. Now some will say, how hard can it be to remain faithful to someone you love? And that too is a good question and one that needs to be considered.
The driving force behind infidelity is desire, in particular sexual desire. And, according to the psychoanalyst Dr Jacques Lacan, somewhere at the heart of this mysterious thing called desire is a misrecognition of completeness, of fullness, of the potential to find the thing that will fill up all our gaps, our lacks. But really there is no fullness at the heart of desire.
Instead it operates from behind a veil that hides our own narcissistic desires; we are satisfying something in and for ourselves. This lack at the heart of desire ensures we continue to desire.
This might sound like a fatalistic approach. But it is far from it. Once we recognise the essential deception in seeing the fulfilment of desire in every new sexual object, male or female, then we can begin to come to an understanding of how to love another person fully.
In that context, trust becomes an intrinsic element that is rarely even considered rather than a dominant issue that must be debated and negotiated on a continual basis.


Friday, June 5, 2009

Making Sense of Transference

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

Take someone who comes to therapy who wants to get to the root of a particular problem and who tries as best they can to speak about the ‘issues’. But at every turn they backtrack on themselves and question why they are doing it and whether they really need to put themselves through any self-examination and whether what they have just told you a moment ago is relevant or accurate or truthful in any way.
Or take someone who comes to therapy and apologies for being there and who wonders if they are taking up your time and whether there is someone with more important issues waiting to come in for the next session.
Or take someone who knows in their heart of hearts broadly what it is they should be talking about but who takes months and months trying to get even close to it.
Or, and I’ve used this example before, take someone who really wants to do therapy but who comes and finds they have a huge inability to speak?
At first sight these various examples might not seem to have anything in common. And in terms of the particularity of the clients on which they might be based, they don’t. Each is a separate condition that needs a separate and particular approach. And, yet, there is one thing they do have in common.
The therapeutic concept of transference is not a word that you hear very often in popular culture. You are more likely to hear terms such as repression, fixation, obsession, and so on. And yet transference describes something that goes to the very heart of the therapeutic process. In fact, if I remember correctly it was Freud who said that without transference there is no therapy.
What the above examples have in common is this concept of transference, the process whereby the client unconsciously relates to the person of the therapist/analyst as if they were someone significant from an earlier part of their life. When Freud first considered this concept he thought of it as a block to the eventual cure. How can the therapist help if the client comes in a has a conversation with someone from his past? Or who refuses to speak freely because the therapist is seen as such?
In this light, it is no wonder Freud first saw it as a stumbling block. It manifests as a shirking away from speaking about the issues that are real for the client. It is, just like any form of resistance, something that can put us back into the place of silence.
The therapist sitting opposite or behind us becomes a stern, judgemental figure who will look unkindly on what it is we want to say. And so we do not say it. That is transference.
Or equally, the therapist becomes an all-forgiving patient listener who knows a great deal and who will not mind whatever it is we want to say. Not only will he/she not mind, but they will forgive us. That too is transference.
Or the therapist is a fool who knows nothing and who only wants to hear me spill out my secrets so that he can get pleasure from seeing me suffer. I am not going to give him/her that pleasure and so I’m quitting. That too is transference.
Or, who do you think you are making an interpretation like that based on the little you know about me? What gives you the right to suggest such a thing? That too is transference.
It can be an impediment to progress in all but the most positive aspects of it. But then Freud discovered something else about it.
When you move away from the single notion that it is just feelings that are being transferred onto the therapist, and consider that the therapist is being transformed into someone from the past, then it can be used as a tool to help therapy along. And this is the second discovery that Freud made about transference. It now becomes a therapeutic tool.
How? In paying close attention to how a client interacts with the therapist through the transference it can be possible to gain an understanding of their position in terms of a significant relationship from their past. This can sometimes take time and involves building up a degree of knowledge about the person themselves.
As Jacques Lacan points out in his Seminar I, transference is not simply about feelings. Nor is it about simply swapping out the person of the therapist for some other human object from the client’s past.
No, it is about meaning and speech. As human beings we are essentially composed of speech and language and so we enter into a therapeutic setting – which is at base a human relationship – using the same medium. Our entire lives have been more or less spent doing the same thing, entering into relationships using the medium of speech.
But in therapy, no more than in ordinary life, speech has the power to define us, transform us, and convey and conceal meanings we don’t always notice. In that context, Lacan defined transference as ‘a hidden discourse’ taking the place of ‘an apparent discourse’.
Transference is one of the things that makes psychoanalytic psychotherapy unique in that it directs the therapist to listen for this hidden discourse, to attend to its nuances, to pick out in the various demands that people make of themselves and others, the ultimate demand for love.
Transference is not a cure. It is a tool that allows the therapist guide the treatment in the most fruitful direction. It is not the final destination, merely the compass that points the way.

Thursday, May 28, 2009

Seeing the Wood from the Trees

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

A client, who shall remain anonymous, said some things in the course of a session once that have stayed with me a long time. This particular client was suffering from a severe form of depression. What does that look like in reality? Well, it includes an inability to consider anything good about themselves, an inability to motivate themselves, a profound sadness and regret at who they are and what their lives have turned out to be, an absence of any hope for the future, and a harsh sense of judgement of themselves and their abilities.
It is depression and that is the diagnosis you would expect from a psychiatrist or a psychologist, which is valid in its own right. Psychoanalytic psychotherapists use the word too, in fact the theme for the 16th Annual Congress of the Association for Psychoanalysis and Psychotherapy in Ireland (APPI) next November is ‘Depression and Melancholia in Modern Times’. But where we differ is that this word depression is a starting point, rather than an end in itself. It is the place we begin a search, if you like, rather than the place where we settle down to consider the nature of the symptoms.
As I have said before, depression is a broad diagnostic label, one of many that give us the impression of understanding the issues involved when in fact they are only a very general guide. Description is not the same thing as understanding.
Taking the client I mentioned above, the things this client said in that session I referred to were that they (I use the plural to ensure confidentiality) were completely stuck on three ideas that had an almost persecutory quality.
One was the idea that the future would turn out bad. Something that had happened in their life was going to come back and haunt them in the form of unforgiveness from other people. There was some degree of reality in this, given the nature of this client’s background.
Secondly, this client was unable to stop thinking about a former lover, one that had since moved on to another relationship. The client felt extreme regret at having ‘lost’ this person through their own choice and now wanted this partner back even though the likelihood of that happening remained very slim.
And thirdly, as a result of this threat from others in the future, different options were constantly being considered to escape this threat. But the client experienced a deep depression around any of these options. In short, no matter where this client pictured themselves in the future, it was going to be awful.
The upshot of all this was a person who was deeply depressed about their situation and who was on the strongest depression medication available which, while keeping them from experiencing extreme pain, was far from blocking out all negative feeling.
The resonances I spoke of in this case were that this client was, while on the face of it anxious and depressed about the possibility of real things either happening or not happening in their life, the psychical reality was they were completely stuck. The ideation, or rather the process of idea formation, was almost exclusively centered around three identifiable issues, each with a modicum of real possibility about them. The tendency and indeed the temptation would be to work on the rationality behind these ideas and consider whether they might or might not happen while, along the way, work out options or strategies that might stave off the more unpleasant outcomes from taking place.
And yet that would be to ignore an essential point. It was not the content of the ideas themselves that was the source of distress for this client, even though at one level that was the case. It was more to do with the fixedness of the ideas; the fact that they could not escape thinking these ideas, despite the strong medication; that they could not escape the frightening and paralysing effect that these ideas had on them.
This form of thinking was, when we examined it more closely, quite similar to a style of thinking that this client had put into operation in many other areas of their life, both past and present. The gripping on to notions, and the worrying about them to an extreme degree, was part of a complicated internal defence strategy that they had learned over many, many years.
The issue was not what they needed to do about these ideas in themselves but what they needed to do about this kind of thinking. It sounds a bit like a behavioural approach to therapy doesn’t it? Simply teach the person to think in a different way. But it is not as simple as this either.
This kind of thinking is not simply un-learned and another more positive type inserted in its place. This style of thinking is, at a hidden level, designed to blot out many other aspects of the person’s life. It is, quite literally, a screen behind which the realities of their existence are kept concealed. So it is not a question of re-learning anything. It is, rather, a question of patiently and carefully dismantling a very sophisticated form of defence system in order to allow for a consideration of the fullest aspects of the life it seeks to conceal.
Now we are firmly back in the realm of psychoanalytic psychotherapy. A place where one takes one’s time and proceeds with the sense of caution and respect necessary to do a delicate job well. Unveiling things that have remained veiled for a great many years needs patience and care. It also needs a robust theoretical framework which allows for it to be recognised for what it is in the first place.