Psychoanalytic Approaches to Problems in Living

Addressing Life's Challenges in Clinical Practice

Sandra Buechler

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351204972
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalytic Approaches to Problems in Living examines how psychoanalysts can draw on their training, reading, and clinical experience to help their patients address some of the recurrent challenges of everyday life. Sandra Buechler offers clinicians poetic, psychoanalytic, and experiential approaches to problems, drawing on her personal and clinical experience, as well as ideas from her reading, to confront challenges familiar to us all.

Buechler addresses issues including difficulties of mourning, aging, living with uncertainty, finding meaningful work, transcending pride, bearing helplessness, and forgiving life's hardships. For those contemplating a clinical career, and those in its beginning stages, she suggests ways to prepare to face these quandaries in treatment sessions. More experienced practitioners will find echoes of themes that have run through their own clinical and personal life experiences. The chapters demonstrate that insights from a poem can often guide the clinician as well as concepts garnered from psychoanalytic theory and other sources. Buechler puts her questions to T. S. Eliot, Rainer Maria Rilke, Elizabeth Bishop, W. S. Merwin, Stanley Kunitz and many other poets and fiction writers. She "asks" Sharon Olds how to meet emergencies, Erich Fromm how to live vigorously, and Edith Wharton how to age gracefully, and brings their insights to bear as she addresses challenges that make frequent appearances in clinical sessions, and other walks of life.

With a final section designed to improve training in the light of her practical findings, Psychoanalytic Approaches to Problems in Living is an essential book for all practicing psychoanalysts and psychoanalytic psychotherapists.

Chapter 1

Capacity for aloneness and relationship

Love between two solitudes

[T]he love that consists in this, that two solitudes protect and border and salute each other.

Rilke (1934, p. 59)

Rilke’s Letters to a Young Poet is a wise, compassionate expression of challenges that face all human beings. How do two solitudes extend love to one another? How do those in love adequately retain their solitude? How can we cultivate our own, and others’, capacity to live at the border of self and other? In this chapter, I consider the ability to be comfortably alone and the ability to be in a loving relationship as one task, and I discuss some ideas about how it is achieved.

Personally, I have never found a piece of writing that describes the twin challenges of solitude and relationship with greater insight than Rilke’s. He advises us not to be confused by our desire to break out of solitude. The fact that aloneness and relating are difficult doesn’t make either undesirable; on the contrary, their very difficulty is part of their value. In his own words:

To love is good, too: love being difficult. For one human being to love another: that is perhaps the most difficult of all our tasks, the ultimate, the last test and proof, the work for which all other work is but preparation . . . Love is at first not anything that means merging, giving over, and uniting with another (for what would a union be of something unclarified and unfinished, still subordinate?), it is a high inducement to the individual to ripen, to become something in himself, to become world, to become world for himself for another’s sake, it is a great exacting claim upon him, something that chooses him out and calls him to vast things.

(pp. 53–54)

Rilke goes on to decry the tendency of the young to try to lose themselves in the beloved, which results in perplexity rather than genuine connection. In these passages, Rilke expresses some of our greatest, timeless challenges. In my view, there is no better textbook for the developing clinician (and, more generally, the developing human being) than these ten letters, written by the established poet, Rilke, in answer to an unknown, young, hopeful writer’s pleas for guidance.

Rilke’s solitude, like his conception of love, requires the individual to be fairly mature. In order to be one of his two loving “solitudes,” the individual must be able to distinguish self from other, be able to want to protect the other, and be able to be moved to develop for the sake of the other. This describes someone who is highly individuated. At the other end of the age spectrum, Winnicott’s (1965) landmark paper on the capacity to be alone deals with the earliest phase of this process. I think his paper rewards very close rereading.

Winnicott highlights the need for the presence of a mother (or substitute) dedicated to the infant’s well-being in the initial stages of the development of the capacity to be alone. The connection with this mother figure provides the benign environment that allows solitude to feel safe. In his words:

The relationship of the individual to his or her internal objects, along with confidence in regard to internal relationships, provides of itself a sufficiency of living, so that temporarily he or she is able to rest contented even in the absence of external objects and stimuli. Maturity and the capacity to be alone implies that the individual has had the chance through good enough mothering to build up a belief in a benign environment.

(p. 32)

Thus, for Winnicott, the capacity for solitude is born out of the connection with our first relational partner. My way to say this is that the capacities for solitude and relationship are twins, conceived in the benign environment created by our first love. Elsewhere (Buechler, 2012, 2017), I have described the problematic end of the spectrum, where these capacities are not sufficiently achieved and all relationship, including the treatment alliance, is threatened.

It is important to note that Winnicott is writing about the capacity to be alone, not the preference or proclivity. Whether one is a loner or highly socially active, the ability to be alone is as essential as the ability to be in a relationship. For both Winnicott and Rilke, each of these capacities is necessary for the other. Another way to describe this is that the person who has had the chance to internalize benign caregivers eventually feels safe enough to be alone and to form a relationship with a fully differentiated other. In Rilke’s language, “To be a part, that is fulfillment for us: to be integrated with our solitude into a state that can be shared” (Baer, 2005, p. 31).

Looking at both Rilke and Winnicott, it seems to me that the fortunate person, born into good enough caretaking, will (at some point) become able to withstand impulses to merge or flee in order to feel safe. This well-cared-for person will be able to bear difficult passages of solitude and relationship. The hard moments inherent in both aloneness and connection will not have the power to persuade her that the inner or outer world is unbearably dangerous. In other words, both difficult aloneness and difficult relating will be non-traumatic challenges. This fortunate child/adult will feel able to navigate these challenges without resorting to drastic measures, such as merging with the other or fleeing.

I think of this fortunate person as capable of object constancy. The inner object’s stability allows her to weather fluctuations and absences of the (external) other. Another way to say this is that the intact inner object fills and centers the self. Thus, the fortunate person can continue to love, despite changes in the beloved, and can continue to feel emotionally grounded during periods of aloneness.

In his great sonnet, “Let Me Not to the Marriage of True Minds,” Shakespeare (1996) advocated for love that withstands all change.

Let me not to the marriage of true minds

Admit impediments. Love is not love

Which alters when it alteration finds,

Or bends with the remover to remove:

O, no! it is an ever-fixed mark,

That looks on tempests and is never shaken;

It is the star to every wandering bark,

Whose worth’s unknown, although his height be taken.

Love’s not Time’s fool, though rosy lips and cheeks

Within his bending sickle’s compass come;

Love alters not with his brief hours and weeks,

But bears it out even to the edge of doom.

If this be error, and upon me prov’d

I never writ, nor no man ever lov’d.

(p. 332)

Shakespeare tells us what true love can withstand. Neither change in the beloved, nor life’s upheavals, nor time, nor implacable fate, alters it. One way to understand this is that not looking outside ourselves for completion of the self, we are able to love no matter what happens and feel that fulfillment is possible even in isolation.

In my language, one of life’s greatest challenges is to “love life anyway,” despite its inevitable pain. Can we achieve “object constancy” toward life itself and/or humanity itself, no matter how it “alters”? For me, my relationship with life itself, as well as all my other internal and external relationships, ask this of me. For all of us, how can we love (ourselves, each other, life) anyway? And how can we bring this part of our experience of being human into our work as analysts? An analogy to Oedipus comes to mind. For me, the essential meaning of the Oedipus saga centers on the issue of desire. What happens when we want the (m)other that we can’t have? Exquisite regret, eternal shame, unending punishment? We all want what we can’t have. We all bear profound disappointments. Yet we need to say “yes” to life, with all its humiliations, indignities, piercing sorrows. If we can forgive life, perhaps our grief can become just grief, and not grief potently mixed with rage, guilt, and regret. Whatever life gives, it also takes away. Can we forgive life for that? Can our love for life look on tempests without being shaken? Can we love it anyway? To me, nothing is harder, or more important, than this ultimate test of object constancy.

For me, it is a small step further to think of self-love and love of the other as one and the same. They are just different aspects of an enduring love for humanity as a whole. In his extremely popular book, The Art of Loving, Erich Fromm (1956) defined love as “the active concern for the life and growth of that which we love” (p. 24). In my opinion, this does not differ in spirit from Sullivan’s (1940) definition: “When the satisfaction or security of another person becomes as significant to one as is one’s own satisfaction or security, then the state of love exists” (pp. 42–43). Much later, Harold Davis (1988) defined love as “the relatedness of two selves, which allows each to grow” (p. 163). Unlike early Freudian theory, in which it was assumed that we each have a limited supply of cathexis, so that the quantity of self-love takes away from the quantity of love of another, Fromm, Sullivan, and Davis see love of the self as compatible with love for another. This has enormous clinical implications. For example, as we listen to a patient describing his relationship with his partner, what assumptions guide our focus? When he complains that his selfish wife doesn’t love him, I believe that how we understand love will affect what we don’t notice, because we take it for granted, and what we question, associate, remember later, and so on. Love is, literally, at the heart of our own lives and our patients’ lives, and how we understand it will affect how we hear a session. What do we readily engage as problematic and worthy of clinical exploration? What do we easily see as therapeutic progress? How do we each think about love?

Pathologizing solitude and valorizing relationship

Society at large and our analytic culture often fail to distinguish a preference for solitude from an incapacity for relatedness. All too often, in my opinion, the child who prefers her own company is seen as problematic for that reason. Paul Tillich (1987) once said: “Language has created the word ‘loneliness’ to express the pain of being alone, and the word ‘solitude’ to express the glory of being alone” (p. 217).

A textbook used in medical schools, aptly titled What’s Normal? (Donley & Buckley, 2000), examines assumptions about medical, intellectual, and psychological health. The authors declare: “Too often we convert normal and healthy variabilities into diseases or disorders because they differ from the ideal norm. This reluctance to accept normal variations makes people who are only slightly different from the norm feel unacceptable” (p. 3). Regarding the issues at hand here, I wonder if there can be a “norm” at all.

In this section, I examine some of the values about aloneness and relationship that subtly shape the analyst’s views of health and the goals and methods of treatment. I explore the tendency to view inclinations toward relationship more favorably than preferences for solitude. What is a “healthy” capacity for aloneness and relatedness? How do we imagine it is attained, within and outside psychotherapeutic work? How might it affect our theories if we acknowledged the capacity for solitude as sprung from the same source as the capacity for relatedness?

Anthony Storr is surely one of solitude’s most eloquent spokespersons. In Solitude: A Return to the Self, Storr (1988) makes the case for its legitimacy and normality. He criticizes the assumption that human happiness is a product of intimate relationships. Not only does he cite examples to the contrary, but he believes that putting all our eggs in that basket, so to speak, is detrimental to happiness.

It may be our idealization of interpersonal relationships in the West that causes marriage, supposedly the most intimate tie, to be so unstable. If we did not look to marriage as the principal source of happiness, fewer marriages would end in tears

(p. xiii)

Storr especially decries our tendency to associate the craving for solitude with interpersonal dysfunction. Pointedly, he asks: “[I]s the predilection of the creative person for solitude evidence of some inability to make close relationships?” (p. x). Although this question is raised early in the book, it is already clear that Storr’s answer will be a resounding “no.”

The “craving for solitude” certainly had another champion in Rilke. Baer (2005) writes of Rilke’s belief that:

Every rite of passage-birth, adolescence, love, commitment, illness, loss, death-marks such an experience where we are faced with our solitude. But this is not a melancholic thought for Rilke. He revalorizes solitude as the occasion to reconsider our decisions and experiences, and to understand ourselves more accurately—and his words can serve as uncannily apt guides for such reflection.

(pp. xi–xii)

Later in the book, Baer quotes Rilke as feeling a need to inhabit his loneliness in order to regain his creativity after a fallow period. In Rilke’s words:

This is the way I would gradually like to become again, but in order to do so I have to remain as alone as I am now; my loneliness first has to be firm and secure again like a forest where no one ever set foot and which has no fear of steps. It must lose all emphasis, exceptionality, and obligation. It must become routine, completely natural and quotidian. The thoughts that enter, even the most fleeting ones, must find me all alone; then they will decide to trust me again.

(p. 87)

As I understand this, Rilke felt he had to bear aloneness in order to make enough room for his relationship with ideas to be truly fruitful. What (societal, psychoanalytic, personal) attitudes toward this way of valorizing loneliness do we each bring when we consider our patients’ experience and our own?

Storr (1988) holds late Freudian and post-Freudian analysis responsible for much of society’s negative attitude toward the preference for solitude. These analytic theories assume that “salvation is to be attained by purging the individual of the emotional blocks or blind spots which prevent him from achieving fulfilling interpersonal relationships” (p. 2). Although the wording of this statement is somewhat tongue in cheek, it is not far off. For example, in the Handbook of Interpersonal Psychoanalysis, Schlesinger (1995), summarizing the Interpersonal point of view, suggests that “[f]or Interpersonalists, disconnection from others is the ground of human malaise, and the search for connection is life’s project” (p. 2). I do not disagree with the premise that the search for connection is a crucial aspect of life’s project, but I think it is important to consider whether we have neglected to focus on other aspects sufficiently.

I suggest that our emphasis on relating may stem, in part, from our own loneliness. Elsewhere (Buechler, 1998, 2017), I have explored the loneliness that can be a significant aspect of the analyst’s experience. Briefly, the analyst is not alone, but may, nevertheless, feel intense loneliness during sessions. At times, we may feel permanently unable to communicate to anyone the experience we are having with some patients. Depending on our own character and development, this may trigger acute loneliness. If we have put aside focusing on our own feelings to prioritize the patient’s, we may inadvertently exacerbate our loneliness by losing touch with ourselves. I think several consequences are likely. The lonely analyst may rationalize an overly active stance, justifying it as in the patient’s best interests. Of course, sometimes that is true, but it can also be used to grant ourselves permission for intrusive, disruptive pursuit of contact with the patient.

Nina Coltart (1993) counted loneliness as one of the hardships of life as an analyst:

The problems are loneliness of a certain sort, and the emotional strains of continually and voluntarily offering oneself to the inner suffering of other people in the hope-or faith-that there is something in the way this self-exposure is offered which may be of therapeutic aid to the other person.

(p. 1)

Aside fro...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• List of Permissions
• Introduction: Problems in Living
• 1 Capacity for Aloneness and Relationship: Love Between Two Solitudes
• 2 Mourning
• 3 Healthy Aging
• 4 Cognitive, Emotional, and Interpersonal Sources of Resilience
• 5 Bearing Uncertainty, Upholding Conviction, and Maintaining Curiosity
• 6 Finding Meaningful Work and Nourishing Interests
• 7 Transcending Pride, Shame, and Guilt: Some Sources of Feelings of Insufficiency
• 8 Forgiving
• 9 Societal and Personal Attitudes About Suffering: Conclusions and Speculations
• 10 Training
• Index