Psychoanalytic Perspectives On Women

Elanie V. Siegel

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9781138869202
• eBook ISBN: 9781317736783
• Topic: Psychology
• Subtopic: Clinical Medicine
• Index: Psychology

First published in 1992. A collection of case studies and essays which present new Freudian and post- Freudian psychoanalytic views on how women develop. Contributors look at women who had cold, dominant mothers and at women who had suffocating, intrusive mothers, at why some women become homosexuals and more.

Daddy’s Girl: An Interactional Perspective on the Transference of Defense in the Psychoanalysis of a Case of Father-Daughter Incest

Kenneth R. King M.D. and Theodore L. Dorpat M.D.

Daddy’s girl

In quiet desperation

Sought dissociation

From painful violation

Bid heart and soul good-bye.

Mrs. D, from “Daddy’s Girl”

These lines just quoted from a poem by Mrs. D, whose analysis we shall describe, capture the sense of “deadening down” or “numbing out” that is so frequently part of the aftermath of incest.^* Midway through her analysis, Mrs. D described herself as a “mechanical doll” who did not know who she was or what she felt; she had indeed bade her “heart and soul good-bye.”

Although there is considerable psychiatric, epidemiologic, and case work literature regarding the incidence of, psychopathologic effects of, and family characteristics surrounding sexual abuse and incest (Finkelhor, 1979; Goodwin et al., 1981; Herman, 1981; Mrazek & Kempe, 1981; Westen et al., 1990; Woodbury & Schwartz, 1971), there is still a meager literature with respect to psychoanalytic psychotherapy (Margolis, 1977, 1984; Stone, 1989b) and psychoanalytic group therapy (Ganzarain & Buchele, 1989) of incest victims. There is a mere smattering of psychoanalytic case reports regarding sexual abuse and seduction (Furman, 1956; Gillman, 1986; Katan, 1973; van Leeuwen, 1988; Williams, 1987) or incest per se (Abraham, 1907; Bernstein, 1989; Bonaparte, 1953; Dewald, 1989; Kramer, 1983; Levine, 1990; Rascovsky & Rascovsky, 1949; Reich, 1932; Richards, 1988; Shengold, 1980, Soll, 1984).

This is somewhat surprising, considering that Freud’s (Breuer & Freud, 1895) original theory of pathogenesis was the famous seduction theory. Furthermore, even though Freud later (1914) shifted his focus to the complemental series, namely, the interplay of actual events and trauma, intrapsychic fantasy and conflict, and constitutional factors, to the end of his life he continued to stress the pathogenic importance of childhood seduction and sexual overstimulation (1917, 1918, 1933). Furthermore, Ferenczi (1933), one of the major psychoanalytic pioneers, described with penetrating insight in his last published paper the deep regressions and intense transference-countertransference reactions that occur in the analyses of incest victims. Perhaps because of the rift between Freud and Ferenczi at the time, this astounding paper, now considered by some to be a “rediscovered classic,” which constitutes a pioneering application of object relations theory to the clinical situation, was ignored until recently (Rachman, 1989; Zaslow, 1988).

One of us (Dorpat, 1989) has hypothesized that for many years analysts, perhaps under the sway of an undue emphasis upon intrapsychic fantasy alone rather than its interdigitation with real life events, have unconsciously colluded with society’s denial of incest. Thus, patients’ previously repressed incest memories have often been treated as fantasies. Another possible explanation for the relative dearth of psychoanalytic case reports of incest is that many incest victims suffer such severe ego and characterologic disturbances that they are not suitable for psychoanalysis. Steele and Alexander (1981) report that incest victims often suffer from profound feelings of shame, guilt, and inferiority, along with “non-integrated identity, poor basic trust, repressed anger, unresolved identifications and fixations, and profound difficulties in establishing and maintaining warm, successful adult human relationships” (p. 233). Sexual dysfunctions and aberrations are a common residue of incest. Flugel (1953) found that nearly 70% of Chicago prostitutes were introduced to sex through father-daughter incest.

There is a growing body of evidence that severe sexual abuse, particularly incest, is commonly encountered in the history of patients with borderline personality disorders (Briere & Zaidi, 1989; Bryer et al., 1987; Gross et al., 1980–81; Herman, 1986; Herman et al., 1988; Ogata et al., 1990; Stone, 1981, 1989a, 1989b; van der Kolk, 1989; Westen et al., 1990; Zanarini et al., 1989; Zivney et al., 1988). There is a much higher frequency of an incest history among psychiatric patients than in the population as a whole, especially for hospitalized borderline, schizoaffective, and/or actively suicidal female patients (Stone, 1989a), and participants in patient-therapist sexual exploitation (Kluft, 1989). Suicide attempts are a particularly common clinical problem for incest victims (Brooks, 1982; Herman, 1986; Molnar & Cameron, 1975). A large percentage of patients with severe dissociative symptoms have suffered incest (Braun, 1984; Chu & Dill, 1990). Simpson and Porter (1981) find a significant link between self-mutilation in adolescent girls and earlier incestuous experiences. Richards (1988) reports a psychoanalytic case of father-daughter incest in which the patient engaged in self-mutilative acts. During psychoanalytic treatment, the dramatic recovery of the memory of intercourse with her father during late adolescence, along with memories and reconstructions of other sexual experiences with her father, proved central to the understanding of her self-mutilative behavior and her eventual cure.

Now psychoanalysts are “rediscovering” incest. In 1981 Anna Freud stated, “Far from existing only as a phantasy, incest is thus also a fact, more widespread among the population in certain periods than in others. Where the chances of harming a child’s normal developmental growth are concerned, it ranks higher than abandonment, neglect, physical maltreatment or any other form of abuse. It would be a fatal mistake to underrate either the importance or the frequency of its actual occurrence” (p. 34). For the last few years there have been discussion groups at meetings of the American Psychoanalytic Association addressing the problem of sexual abuse and incest. Many of the recent case reports, however, are of child analytic patients who were sexually abused on a few occasions by people outside the immediate family and did not endure years of incest (Gillman, 1986; van Leeuwen, 1988).

Certainly sexual abuse and incest are prevalent problems. Furman and Furman (1984b) report that 10% of children who receive treatment at the Cleveland Child Analytic Clinic have been sexually abused and that the percentage is far greater in the private practices of Cleveland child analysts. The most recent epidemiologic study (Russell, 1986) revealed that 19% of San Francisco women have incurred incest, 4.5% with a father, adoptive father, or step-father. The actual figures are probably much higher, because women who are repressing or denying the trauma cannot be expected to answer such surveys accurately.

Our main intention in presenting aspects of the analysis of Mrs. D is to describe certain defenses that created difficulty in the transference-countertransference interplay and how careful analysis of these defenses and unconscious role relationships led not only to the revelation of past long-standing incest but also to characterologic change. (Here we are using countertransference in the broad sense of the term to include not only the analyst’s own neurotic response to the patient, but also his reactions evoked by the patient’s behavior toward him.) Incest patients may have intense transferences to the analyst or therapist who, in turn, may experience intense countertransference reactions. Some seasoned psychoanalytic veterans in this field (Ganzarain &Buchele, 1989) have advocated psychoanalytic group therapy using cotherapists, partially so that the transference-countertransference intensity can be kept at a manageable level. Countertransference reactions range from the therapist’s wish to avoid or deny the horror of what has befallen the patient to a counterphobic or voyeuristic desire to “get all the details.” Equally common is the therapist’s avoidance of feeling guilty by opting to provide a “corrective emotional experience” by maintaining a nurturing role, rather than tolerating and interpreting the patient’s negative transference and concomitant angry attacks upon the therapist. As Erna Furman (1989) has so wisely put it, the analyst “becomes the abuser and the abused.” Difficulty tolerating being perceived as abusive contributes to many therapists focusing the patient upon “blaming the perpetrator” in the past. These strong transference-countertransference reactions tend to lead even experienced psychotherapists to focus predominantly upon the “there and then,” namely, the details of the incest trauma, rather than the “here and now” resistances, transference, and interaction.

This is quite reminiscent of Breuer and Freud’s (1895) long-outmoded abreaction model of therapy. The therapist’s hot pursuit for memories of the incest experience can be an unconscious collusion on the therapist’s part in repeating interpersonal aspects of the incestuous relationship. Though such an approach may have temporary palliative benefits, the inappropriate focus upon genetic and traumatic antecedents often interferes with the patient’s changing the compulsive repetition in the present of prior destructive relationships. On the other hand, careful attention to resistances and interpretation of the patient’s internalized object relations as they are subtly revealed, often nonverbally, in the therapeutic interaction may assist the therapist in avoiding enacting with the patient one more edition of a coercive and abusive relationship and help the patient see his or her active role in unconsciously eliciting such behavior.

Anna Freud (1936) decisively expanded the concept of transference when she described how the patient transfers into the analytic relationship not just impulses or wishes from the past but also characteristic defenses against such urges and their associated affects. This phenomenon she labeled transference of defense. Contemporary object relations theorists (Kernberg, 1976; Sandler, 1976a, 1976b; Sandler & Sandler, 1978) have further deepened the concept of transference to include how the patient may tend to repeat or “actualize” his or her self-and-object role relationships in the analytic situation.

Psychoanalytic Case Study

In the following summary of the psychoanalysis of an incest victim, the primary focus will be upon the analysis of the patient’s transference of defenses, especially those shared with her parents. Much will therefore have to be omitted.

Opening Phase

Mrs. D, an intelligent professional woman in her late 30s, entered psychoanalysis for treatment of anxiety, depression, insomnia, recent rapid weight gain, “lack of self-confidence,” and “feeling too dependent on others for what I think of myself.” She was an attractive, although overweight woman who smiled and laughed anxiously a great deal and attempted to make small talk with the analyst. She complained, “I seem to eat as a way of trying to feel more secure.” She was ashamed of “crying at the drop of a hat” with no awareness of why she was crying. Her 17-year marriage to a highly domineering, affectionless, and withholding professional man was deteriorating. She was not orgasmic with him. They had adopted two children due to the couple’s infertility. She was the oldest of three children and claimed to have had an idyllically happy childhood. Her father had worked as a photographer. Her housewife mother had died three years prior to the analysis.

In her first session, she expressed her reluctance to lie down on the couch and sat on it instead. She handed the analyst a humorous article, which was a short, tongue-in-cheek letter from a psychiatrist to his patient of detailed information for the patient’s insurance company. One item was a charge for a replacement for an ashtray and another was for fixing a dent in the wall made by the ashtray. Mrs. D laughingly said that she didn’t think she would throw any ashtrays. This proved to be a harbinger of the issue that would later arise around her intense fear of her angry impulses. She presented an initial dream in which she walked into a room full of doctors and their wives for her first appointment with a woman psychiatrist. The psychiatrist kept her waiting, and finally Mrs. D became so angry that she left. Mrs. D’s associations included her wish for a female therapist, her fear that the analyst might be a “male chauvinist,” her distaste for controlling physicians, and her fear of revealing “deep, dark secrets.” The analyst suggested Mrs. D must be worried whether it was safe to expose such “secrets” to him for fear he would either control or ignore her. He added that she seemed to feel ashamed of her wish to back out of the analysis with him, so that in her dream she had resolved these conflicts by, first, having him be a woman and, second, by having him offend her so that she felt justified in leaving. This latter maneuver, seeking offense so that she would then not feel guilty for her own hostility, proved to be characteristic of her and contributed to the eventual demise of her marriage.

In her first year of analysis, she used denial and conscious suppression; she sometimes explicitly refused to free associate if it made her anxious. She frequently asked questions or said that she was thinking but not what she was thinking. With a kind of “pseudoimbecility” (Kramer, 1983) she acted oblivious to the central task of the analysis, and she often filled the hour with material in which she clearly had little affective investment. She felt hurt when the analyst did not answer her questions, tell her what to do, or tell her how she should feel. Such behavior created a role responsiveness pull (Sandler, 1976b) for the analyst to talk more than usual, thereby reassuring her of his interest and concern for her. Similarly, her frequent vagueness, chitchatting, superficiality, Polyannishness, and obviously conscious avoidance of almost anything anxiety-provoking seemed guaranteed to elicit countertransference responses of feeling tantalized, wanting to ask probing questions or to repeatedly confront her, and finally of feeling irritated or bored with her. Her vagueness was typical of the cognitive style of a hysterical personality disorder (Horowitz, 1977). She had numerous dreams full of fog and nebulousness, with herself sometimes tantalizingly half concealed behind veils and gauzy blinds; these dreams simultaneously reflected her “vagueing out” defenses as well as her conflicted wish to entice pursuit and penetration. It became apparent that her major conflictual themes and transferences were often conveyed more in her modes of thinking and interaction than in the content of what she said.

Whenever she had successfully seduced the analyst into asking questions or otherwise probing for clarification, she consciously then experienced him as caring for her. Close attention to her flow of associations, however, revealed that she simultaneously unconsciously perceived him to be controlling and intrusive. The analyst confronted her with how she seemed afraid of linking her thoughts and feelings together in favor of getting the analyst to serve those functions for her. He showed how this perpetuated her feeling inadequate, ill defined, and controlled in the relationship with him, just as she hated feeling with her husband. Gradually, in response to such interpretations, she revealed how she resented her father’s hovering, smothering, and subtly coercive behavior. Whenever he came to visit, she constantly felt guilty whenever she wanted to preserve any boundaries in the relationship by not acquiescing to his incessant, seemingly solicitous badgering to reveal why she was in analysis, what she was upset about, the details of her marital life, etc. Accordingly, she felt guilty revealing such a complaint about her father, perceiving herself to be a disloyal daughter to her ostensibly loving and concerned father.

In this context of analyzing her inhibitions against her assertive impulses, she revealed how she had undergone multiple artificial insemination trials. She had hated the bright lights and the way she had to passively allow genital penetration. She had not wanted to become pregnant anyway, but had, like an automaton, done what her husband wanted. She had a nightmare in which, all alone, she gave birth to vermin. In exploring the dream she abreacted a long-repressed memory: at five years of age, her mother had informed her that their already limited times of closeness were coming to an end because she would soon give birth to another child. Mrs. D had shoved her mother, who then fell and later that day suffered a miscarriage. Her parents blamed her for the miscarriage, and the patient felt extremely guilty. Feeling very insecure that night, the patient had crawled into bed with her father and had felt his erection against her. Her father then rejected her, telling her that there was no place for her in their bed. She had felt terribly guilty and evil. This episode had contributed to her developing a massive reaction formation against her aggressive impulses, and yet this important memory clearly served screening functions for what was to emerge later in the analysis.

She revealed her erotic father-transference longings for the analyst in dreams in which he ignored other patients in order to lie on the couch beside her. She wanted a “more personal...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Contributor
• Introduction
• Females in Bondage: The Early Role of Mother and Father in the Woman’s Tie to Abusive Men
• The Encapsulated Maternal Introject: In the Service of Survival
• Somatic Symptoms, Psychoanalytic Treatment, Emotional Growth
• Daddy’s Girl: An Interactional Perspective on the Transference of Defense in the Psychoanalysis of a Case of Father-Daughter Incest
• Aspects of Homosexuality
• Object Relations Insights Concerning the Female as Artist
• Thumbelina and the Development of Female Sexuality
• The Forbidden Room: A Pair of Fairy Tales as Developmental Metaphor