The Search for a Relational Home

An intersubjective view of therapeutic action

Chris Jaenicke

• Publisher: Routledge
• Year: 2014
• Print ISBN:
  9781138796997
• eBook ISBN:
  9781317633334
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

In The Search for a Relational Home, Chris Jaenicke gives the reader an inside view of what actually happens in psychotherapy and how change occurs. He describes how both participants – the patient and the therapist – feel, and how they affect each other. The reader is encouraged to vicariously partake in the process from the perspective of his or her own life experiences.

The book describes the nature of therapeutic action through a radicalized version of intersubjective systems theory. It demonstrates how psychotherapy is an outcome of a highly personal encounter between two unique human beings, and how, while the goal of psychoanalysis is to help the patient, this can only be achieved inasmuch as both participants are willing to undergo transformation. Jaenicke clarifies how both successes and failures as well as personal strengths and weaknesses play a constitutive part in the psychotherapeutic process. The Search for a Relational Home also provides theoretical and practical guidelines for supervision.

Jaenicke presents here a unique approach to the process of psychotherapy which will be vital reading for psychoanalysts, psychotherapists and those in training as well as students in all fields of mental health.

Chapter 1 Basic premises

DOI: 10.4324/9781315757490-1

Thoughts on success, failure and cure in psychoanalysis

I’m yelling. I’m yelling as loud as I can, but no sound is coming out. I’m screaming, screaming so hard that the cords of my neck stand out. Even then only a barely audible croak comes out: “It’s not the perfect cure that I want for my patients!” No answer from the person I’m addressing. In a final attempt to reach him I whisper: “You think what I’m doing is fascism?” The man raises his sharp chin and looks down at me out of the corner of his eagle-hooded eye, and says: “Yes, fascism.”

This was a recent dream. In fact, it is a dream I have often in various scenarios, rageful screaming with no voice. George Atwood (2012) writes “Dreams are autobiographical microcosms, symbolizing the subjective life of the dreamer” (p. 90) According to Atwood (2012):

Dreams capture something that is incomplete in one’s conscious life. Impressions, feelings, memories, thoughts all in a swirl, not worked out, insufficiently articulated, incompletely thought through: This is the stuff of dreaming … and dreams are attempts to resolve subjective tensions.

(p. 97)

One such tension in my dream is that I can’t make myself heard. So why write another book? After the first two I always eagerly awaited reactions. When they came – and many were positive – they lifted me up. But it was like a brushfire feeling, quickly extinguished. This was when I understood, finally, that the holes I have within me won’t be filled. I felt bereft, stripped, irrevocably flawed, but relieved. And yet, the question remains: What is cure? Are we cured, do we cure? After encounter groups, transactional analysis, Gestalt and body psychotherapy, a psychoanalytic training, a body psychotherapy training, and four analyses I am not cured. I’m better, I’m different. I’ve achieved some measure of professional expertise. I’ve overcome fears in the sense that now I know how afraid I’ve been. I still feel small. My strength is one which is compacted out of that which remains and part of that is my curiosity. The curiosity then is the leading edge of an inner tension, which finds some measure of temporary release in writing (Atwood, 2012). Creativity is one way out of simultaneous feelings of being and nothingness. What happens in psychotherapy and what, if anything, cures? How do we define success and failure? That’s what this book is about. A continuation of my search. Answers? We will see. “It’s only rock ’n’ roll”, the Rolling Stones sing; and, in my case: it is only psychoanalysis, but I like it.

We have come to understand that the therapeutic dyad is a system intertwined with and subject to the influence of a network of systems (Coburn, 2009; Boston Change Process Study Group, 2010). As part of a system, I argued in Change in Psychoanalysis (Jaenicke, 2011) that for a therapeutic process to succeed, both participants had to undergo change. In this book, I attempt to explain how it is our understanding of the patient–analyst dyad as a system that will further and deepen our understanding of how therapy works and how we can begin to conceptualize cure. Furthermore, it is my contention that in order to conceptualize the notion of cure, we must develop a new perspective on the notion of failure. I argue that failure and suffering are integral parts of our subjectivity, and that they serve as a valuable medium to allow us to learn how to be with one another. In-depth examinations of the interaction of differently organized subjective worlds in psychotherapy show how closely weakness and strength, cure and failure are entwined in any psychotherapeutic process. The negotiations of limitations and failures of both participants are pivotal for an understanding of the therapeutic treatments we engage in. Sometimes what we may consider to be our strengths will lead to failure, while our limitations may be considered as helpful. On the level of the bi-directional encounter, the process of cure has to do with how the idiosyncratic strengths and short-comings of both participants become entangled and are subsequently dealt with in the working-through process. While this provides the basis of our silent understanding of the therapeutic process, the asymmetric setting is upheld and the focus of our work remains on our patients.

In my previous work I have tried to show how interwoven our subjectivity is with our choice of theories and with our clinical practice. A related goal is to be able to do this in the way that I write. Hence, I began this book with a dream that will serve as a frame for the questions that I will pursue. I hope to use my own subjectivity and the way I write about it, “… in a form to which others can relate in empathic dialogue” (Atwood and Stolorow, 1984, p. 7); a form of communication which includes dreams, associations, snippets of songs, metaphors, and personal meanings in order to better bridge the gulf between the idiosyncracy of my subjectivity and “the experience of being human in universal terms” (p. 7). In much the same manner, the intersubjective field, in which patients can come to their own truthfulness, is particularly well suited to demonstrate the potential of shared human possibilities.

If I interpret my dream as a part of my pathology I could understand the lack of my voice as a problem of self-definition and myself as an “as-if-personality”. I could view my disorder as a “basic fault” whose developmental origins lie in a lack of primary love (Balint, 1968): my failure to find a voice for my fallibility and to be heard by my rejecting listener resulting in a failed attempt to be reconciled with my imperfection. What do the realization that I am not “cured” and the fear that I cannot cure then mean? Perhaps there is no cure? Are “the holes I have within me that can’t be filled” my transience, my incompleteness, my death? I suspect that my dream about cure was a flawed attempt to free myself from the shackles of pathological accommodation (Brandchaft et al., 2010), my soundless scream a sabotaged attempt at authenticity, a plea to be accepted, despite a felt demand for implacable perfection – an illusory attempt to gain a love that was long lost or never given?

If I follow my feelings about myself as failed and small further, I arrive at a core conviction that I am not here. I do not exist. That is the basis of my lack of voice and my deepest terror. In The Abyss of Madness (2012) Atwood describes states of annihilation as extreme forms of pathological accommodation. And yet, I am. I was helped, I do help. But in my heart of hearts, both states exist. All of these thoughts form the background; frame my questions concerning cure. What is the counter-part to my basic feelings of non-existence and terror? I suspect that I may have to re-define my understanding of cure. As Keith Richards says: “It’s good to be here … it’s good to be anywhere” (Scorsese, 2007).

When we speak of our patients we may say someone is in a state of fragmentation, dissociation, denial, or as feeling rejected, excluded or so alone as to feel bereft. Such states lend themselves and often are safely ensconced in the otherness known as patients, but therapists need not see themselves exempt from such feeling-states. Since my 20s, I have been afflicted from time to time, seemingly inexplicably, with a feeling of bleeding out internally. I feel extremely vulnerable then with a desire to vanish. I understand this as fantasy in which escape comes at the price of annihilation, in an imagined identification with those who didn’t see me, a union in nothingness. Perhaps the antidote to the internal wound is not happiness, but a relational home for those of us whose despair takes the form of feeling invisible. The experience of exclusion and the concomitant feeling of “existential shame” (Jaenicke, 2011), both intricately linked with the experience of annihilation may be so profound that it is often not in reflective awareness, while at the same time being distributed in so many systems of relatedness as to centrally organize our experiential worlds. When, finally, within reflective reach, in the safety of an analyst-patient dyad, it may result in states of excruciating terror in our patients. He or she feels excluded or rejected doesn’t cover it, doesn’t begin to convey the feeling from within. This is why one of self-psychology’s central contributions to psychoanalysis – namely, the need for deeply validating understanding, cannot be overemphasized.

If I reflect further on my own experiences of feelings of annihilation, I would go back to a dream that I had in my training analysis almost 30 years ago. In the dream my earlobe was pierced by a golden nail. The nail symbolized my feeling that I couldn’t escape listening to the suffering of my mother. The theme of pathological accommodation is not new to the genesis of the making of an analyst. I mention it to underscore my point that for those of us in a profession dealing with suffering, our own suffering plays an intricate, ongoing and irrevocable part in each of our encounters with our patients. It is not our patients who are called upon to understand or be responsive to our pain, it is we ourselves. Shame, that ghostly jailor, prevents us from accepting this as a matter of course. In this context, which I have called the myth of the healthy healer, it is not so important what happened to me, but that I don’t deny it. My friend Robert Stolorow (personal communication, 12 April 2012) referred to “the myth of the healthy healer” as an oxymoron.

In order to put what I have written about myself in a theoretical framework and to explain my objective, I again quote Atwood and Stolorow (1984) in full:

Psychoanalytic histories must … go beyond the narrative … they must bridge the gulf between the concrete particularity of an individual life and the experience of being human in universal terms. The task of writing a psychoanalytic narrative is one of transposing the analyst’s understanding into a presentation illuminating the life under study for the intellectual community at large. This means unveiling the experiences of that life in a form to which others can relate their own personal worlds in empathic dialogue. The intersubjective field of the analysis serves a mediating function in this regard, providing the initial basis of comparison for describing the pattern of the individual’s life as the realization of shared human possibilities.

(italics added, p. 7)

I am trying to use the same principle in the intersubjective field between myself and the reader.

Fairly late in life I have come to realize just how tortured most of my existence has felt. That is hard to accept because outwardly I grew up in a family with all the trappings of middle-class success. Both grandfather and father served as ambassadors to their country. The emblematic eagle was a standard on the car and on the shield next to the entrance of the residence. Children of diplomats, like myself, are often not firmly rooted but always under pressure to uphold the code of the Corps: the eagle-hooded eye in my dream. So I feel shy when claiming my pain. It seems braggart, without justification. But when I listen to the endless stream of profound self-distaste and hatred of many of my patients and the way they are so closely interwoven with the fabric of their being that it is almost invisible to themselves, so normal it could nearly be over-heard, it doesn’t seem so strange. These patients who are, like myself, still vibrating from the upheaval of their original catastrophes, quietly humming the tune of disaster. In presenting self-psychology theory I have repeatedly been confronted with such statements as: “So you believe in the good of mankind?” “Aren’t you coddling your patients?” “What about the 87 wars happening right now in the world?” I felt embarrassed, somehow caught out. But, perhaps these critics are motivated by the need to snap the tension inherent between suffering and survival, between a life that is crowned by death? I circle back to the question of cure.

If I want to write about cure, I have to write about illness. If I want to define therapeutic success, I have to look at therapeutic failure. If I don’t believe therapy is something that I do to you, but rather that we change and become who we are through one another, then who we aren’t and can’t be is as important as who we are and try to become. Therefore trying to understand what we are able to achieve with patients means looking equally how we fail with them. When I and Ron Bodansky tried – unsuccessfully – to put together a journal on failures in psychotherapy, with the exception of two colleagues, all answered – if jokingly – that they had no failures in their practices. Since then, Goldberg (2012) has published a book, The Analysis of Failure, in which he describes how colleagues literally fled from him when he asked them to take part in a seminar on failure. Goldberg described his book as a failure because it did not clearly define failure (e.g., p. 215). But, I do not agree. In his “final thoughts” in the book, Goldberg writes:

One salient feature of the study of that situation (failure) is the resistance to its investigation. Failure is such a dreaded experience that it is regularly ignored, denied, displaced elsewhere. At the very least, this book may succeed in letting failure come out of the darkness and allowing its presence to be acknowledged. One must live failure long enough to allow a personal struggle that in turn may open a proper objective scrutiny. Feeling a failure should not merely be an impetus to be rid of it, to learn how to avoid it in the future, or get over it, all perfectly reasonable and worthwhile goals. At long last, it should be an opportunity. The success of the book rests on its embrace of failure.

(p. 217)

I admire Goldberg’s (2012) courageous decision to write about failure and acknowledge with respect that he was the first analyst to do so in the form of an entire book on the subject. While I think that with “living it long enough to allow a personal struggle” to develop, he means the ability to finally face failure in oneself, I doubt that an “objective scrutiny” is possible without embracing the idea that failure is woven into the very fabric of our being. In my view, failure is synonymous with subjectivity, in the sense that it circumscribes our limitations and ultimately our finitude. Kohut’s term for this was “Tragic Man”. The possibility of living forever would face us with a different quandary; but, as Atwood (2012) writes,

Who said a person should smile more and cry less? Who determined that less suffering is to be recommended over more suffering? I do not believe that God informed us of that principle of life. What if there is a good reason for suffering?

(p. 162)

Nonetheless limitations, failure and finitude and living itself undoubtedly remain a hard road to go. The difference between my view and Goldberg’s may seem like a nuance, but in essence it reflects the difference between a natural and a human science perspective. To “clearly define” and “objectively scrutinize” failure didn’t succeed because it still entailed an understandable, but doomed attempt to place it outside of oneself. One cannot objectively define failure because failure is a subjective phenomenon, dependent on the idiosyncracies of the unique, individual therapist in conjunction with the unique interplay of the specific dyad.

To illustrate the difference in perspective let me shed some more light on my dream. Perhaps the daunting figure was not primarily my own unforgiving demand on myself to cure my patients, but rather an expression of mute rage and helplessness in the face of unresponsiveness and judgment.The fears that I have felt in connection with my emphasis on the bi-directional aspect of psychoanalysis and the risks of relatedness which I have described as essential to the process of understanding and thus to therapy itself, have left me with an unsettling feeling. A deep unease of being culpable of “an allegedly neurotic furor sanandi” (Orange, 2011, p. 101), an accusation that was raised first against Firenczi as it was seen as “a massive challenge to the authoritarian orthodoxies in psychoanalysis and other forms of psychotherapy” (Orange, 2011, p. 101). My plea is that it is not perfection that I seek but a wish for an understanding that I am as defined by my neediness, inadequacy, doubt, and confusion as are my patients, that I, too, am weak to the core. Or, more precisely, is an attempt at one and the same time to describe and seek relief from an understanding of a suffering-free professional who is able to unilaterally bestow health on the patient. One of the reasons I am so insistent on placing such an emphasis on my limitations is that I hope to lay the ground-work for the basic idea that on a systems level of discourse, it is the system that is or isn’t healed, rather than what one monadic expert does or cannot do for a monadic patient. The idea that the clinician unilaterally, uni-directionally heals the patient is medical model thinking, a natural science outlook that doesn’t apply to psychoanalysis. This is what Daniel Stern (2012) referred to as “an internist’s view”. Maybe now we can get a first inkling of how to view cure. It is not a digital, either–or state, all or nothing, ill or healthy. It is in some sense a mess, but a mess from which we can extract meaning and a measure of human dignity, as we create a space in which the truth about someone’s life can find a home (Atwood, 2012).

In my view it is a joint enterprise – a process that we must allow to unfold over time. Rather than it just being the patient’s transference that develops, it is a system, comprised of the two transferences, as well as the level of implicit relational knowledge (Boston Change Process Study Group, 2010) that has to establish itself. It is not something that I possess or that is yours to give. It is survival in the face of suffering, a belief in one’s existence in face of finitude, an acceptance of one’s strength in spite of our frailty. It is something that must be found and accomplished together. An acceptance of suffering may have a positive side: an increase in humility. I do not believe that the dungeons of our childhood ever totally disappear, nor that the ghosts that inhabit them ever completely fade. For that there are too many states that seem like moving, but that are standing still. Trying to escape the past is like running in quicksand, the faster you run, the quicker it pulls you down. “If you think y...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• 1. Basic premises: thoughts on success, failure and cure in psychoanalysis
• 2. Rafaela: a case description
• 3. Ending treatment: Rafaela redux
• 4. The shadow man: a case description
• 5. Supervision from an intersubjective perspective
• 6. Epilogue
• References
• Index