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Chapter
1
Burton, then and Now
This book is a joint effort, literally co-constructed. It is a dialogue between us and a dialogue between psychoanalysis and infant research. We begin with the treatment of Burton which became the foundation of our collaboration as it got underway in 1972. We present Burton in the way we understood him at the time (Lachmann and Beebe, 1983) and then we revisit the case in the light of our study of infant research.
The Burton case illuminates the theme of the book, the ways that new knowledge about human development can expand clinical understanding and therapeutic intervention. The contrast between our understanding of the case then and now illustrates the revolution that our field has been living through since the publication of Daniel Stern's (1985) The Interpersonal World of the Infant.
This book is written in the "we" voice. Allow us to introduce ourselves, however, by describing our separate backgrounds and how we came to collaborate. I (Frank Lachmann) was a supervisor of psychology graduate students at a university mental health clinic for just one year, 1972 to 1973. For an hour and a half each week, three graduate students and I discussed one case treated by each of the students. One of the students was Beatrice Beebe.
In 1972 I had been in practice for a number of years and taught ego psychology at the Postgraduate Center for Mental Health in New York City. I had been particularly influenced by the work of Edith Jacobson. I was also participating in a study group led by Martin Bergmann, where I had become acquainted with the work of Heinz Kohut, especially as it contrasted with the work of Otto Kernberg. Looking back, I can see that my ego-psychoanalytic theoretical bent was slowly bending. I was becoming interested in diverse ideas that ultimately would turn out to be difficult to reconcile with my classical psychoanalytic background. But in 1972 the schisms had not yet appeared, and I was as convinced as anyone of the soundness of the basic Freudian paradigm as articulated by Arlow and Brenner, and Jacobson.
What I liked about Edith Jacobson's (1964) Self and the Object World was the thrust of her developmental perspectiveâever-upward, striving toward greater autonomy and independence. Looking back, I can see that all my psychoanalytic influences were one-person psychologiesâpsychopathology resided in the patient. As an analyst I was the kind of onlooker who would be able to free the patient's encumbered developmental strivings by addressing unconscious conflicts. Given new opportunities for growth, belated developmental steps could then take place.
My formal psychoanalytic training at the Postgraduate Center spanned the years from 1960 to 1964. For my first analytic case, I treated a very difficult patient, a suicidal, depressed, bisexual man with an intense, conflicted erotic transference. The analysis lasted 10 years and was extraordinarily challenging, personally and theoretically. The classical analytic technique that I had been taught was of little help when this man spent a weekend leaning out of his window wondering whether or not to jump. During my training, the input of supervisors exacerbated my problems with the patient and his problems with himself. Finally, I found a supervisor, Asya Kadis, who was able to understand the patient. She saw this man's desperate efforts to connect with me, rather than his more superficial attempts to ward me off and resist or "destroy" me. This way of looking at the transference made an enormous difference to my way of being with the patient and to the patient's ability to be with himself. This experience also veered me toward a model of treatment that focused on the patient's self-protective strivings.
With all this in mind, I listened to the cases brought to me by the student therapists at Teachers College. Beatrice Beebe had been assigned a patient who was even more "outrageous" and difficult than the one I had treated in my training. In retrospect, I think I was intrigued by the opportunity to provide for this patient and this therapist what had taken me several years to find. I felt that I had learned how to work with one very difficult patient, and learned, too, what not to do. Here was an opportunity to test out what I had learned.
I (Beatrice Beebe) began graduate school in 1968 at Teacher's College, Columbia University in a joint program of developmental and clinical psychology. Heinz Werner, Jean Piaget, and constructivist views of development were my earliest influences. In 1969 I met Daniel Stern in my search for someone doing research on early emotional development. I wanted to study mother-infant "reciprocity." Looking back, I do not think I knew what that concept meant to me, but I know I had these words in mind when I began graduate school. Stern was filming mothers and infant twins in their homes, and he took several graduate students with him. I remember one particular day when I played with a baby whose face was full of joy. As I watched her face responding to mine, going up and up and up, tears came to my eyes. I was so moved by how closely she tracked my face and by her bursting into a sunbeam. It was that day that I decided to do my dissertation with Stern, examining that very process of positive facial affect, how it builds to a crescendo, ebbs, and resurges.
Herbert Birch was at Teachers College at that time. My idea for a dissertationâan in-depth case study of one mother-infant pair, a frame-by-frame analysis of positive affectâwas very different from the Zeitgeist of that era. Nevertheless, Birch championed it, making it possible for me to work with Dan Stern. Birch patiently taught me how to think about data and how to evaluate what infants might actually perceive. While I was still in the early stages of analyzing the data for my dissertation, Birch died, a great blow to me.
Stern led a group of infant researchers that included Joe Jaffe and Steve Bennett. We met weekly, with Stern giving exciting accounts of conferences he had attended, as the study of mother-infant face-to-face interaction was just beginning. Stern's first paper, "A Microanalysis of Mother-Infant Interaction," came out in 1971. The data for the analyses lined his office wall. We were thrilled to see the intricate ways in which mothers and infants interacted, especially since psychoanalysis in that era saw infants as much less complex, active, and social than we do now. Dan Stern's way of thinking about mother-infant interaction shaped my research career. Steve Bennett later sat with me as I analyzed the "chase and dodge" film during my postdoctoral fellowship with Dan Stern. Joe Jaffe became a lifetime collaborator.
Meanwhile, I had to figure out the clinical side of my training. From 1971 to 1972 I went to Yale for my clinical internship. There I met Sid Blatt. He was extremely receptive to my background in the ideas of Werner and Piaget and to my interest in self- and object representations. With him I pursued the question of the origins of self- and object representations, which has remained one of my central interests. I saw a range of rather disturbed adult outpatients at Yale, and I treated one psychotic depressed inpatient under Blatt's supervision.
My supervision with Blatt prepared me to meet Burton, the patient assigned to me at the Teachers College Clinic. Without the work I had done with Blatt I would not have had the common language that Frank and I recognized in each other at the beginning of the group supervision. To the dismay of the other two students, Frank and I actually believed that this extremely disturbed Columbia sophomore could be treated psychoanalytically.
Over the following eight years, my treatment of Burton continued in private supervision with Frank. Sometimes I was frightened by this patient's suicidal struggle, but I was always sure of Frank's deep involvement and confidence in me. Out of this supervisory relationship was forged a bond between Frank and me that was to outlast the supervision and provide the foundation for the years of collaboration that continue.
Burton became the subject of our first joint publication (Lachmann and Beebe, 1983). As we now review our report of his treatment, we see that our language and concepts would be radically different today. Our description of the treatment was limited to the patient's experience and to the therapist's verbal interpretations. We left out of our original account the intensity of the therapist's involvement with Burton, especially the agonized moments when Burton was suicidal or out of reach.
The theory we followed in the treatment of Burton focused on the consolidation of the self. We believed that separation issues occupied a central position in Burton's difficulties in the structuralization of the self. His pathology was seen as a result of merger wishes with consequent difficulties with separation. We assumed that the sense of self consolidates along three dimensions: (1) selfâobject differentiation, (2) the capacity to tolerate positive and negative affects, and (3) the experience of continuity over time, an essential ingredient of self- and object constancy. Whereas the term differentiation was used to refer to the process through which self and object were distinguished, separation was used to refer to the ability to maintain this distinction. Separation resulted in a diminution of an imperative need for the object's actual presence.
We also held that a consolidated sense of self was a prerequisite for the emergence of psychological conflict. Psychopathology that reflected difficulties in the structuralization of self-experience was distinguished from psychopathology that reflected a self in conflict (Stolorow and Lachmann, 1980). In Burton's treatment, especially in the later stages, we tracked the oscillations of pathology as one kind was, at times, more salient than the other. Early in the treatment, we viewed the pathology as based on deficits in structuralizations.
We used these theoretical constructs as our response to an ever-present danger of "fragmentation" in Burton's sense of self. We believed that, through an emphasis on these dimensions of experience, Burton would gradually be able to address his conflicts and defenses. And to some extent our expectations were borne out, although it took many years. During the treatment, we used the notion of "increments of separation" (Lachmann, Beebe, and Stolorow, 1987) as a theoretical touchstone to afford Burton a safety zone in which to organize his continual back-and-forth fluctuations into manageable proportions. Reciprocally, we viewed any retreat from a particular step of separation not as necessarily equivalent to a remerger with the feared and enticing mother, but rather as part of an oscillation. We believed that this line of interpretation would gradually enable him to modify his all-or-none fantasy that to separate meant isolation or death. This slow process was assumed to establish psychic structure by minute transformations.
Burton began his treatment as a patient at the university clinic and followed me (Beatrice) wherever I worked for the next 10 years. In the ninth year, a major consolidation of his personality took place. The severe pathology that had characterized him since early childhood diminished markedly. When we wrote up the ninth year of his three-session-per-week treatment, we named him Burton. Only an actor such as Richard Burton could play the role of such a volatile, tempestuous man. In a similar spirit, we named his first wife Liz and his second wife Sybille.
Burton began treatment, his fifth attempt at therapy, at the age of 20, as a college sophomore. He felt that life was not worth living; he complained of his self-destructiveness,- and he catalogued an extensive involvement with drugs (LSD, ritalin), periodic alcoholism, stealing (for which he had already spent a month in jail), and persistent suicidal ideation. He heard a persecutory voice located "in the back of my mind" criticizing him, mocking him, and telling him to kill himself. He described difficulties in concentration, racing thoughts, lapses of memory, and out-of-body experiences. He felt that he was losing his sense of being alive, and he believed that he had a terminal disease. His sense of time was severely distorted-time was either speeding up or in danger of stopping. He made daredevil forays into dangerous neighborhoods, carrying a gun, planning to fight the drug dealers who supplied heroin to Liz, his girlfriend, whom he married in the third year of his treatment.
Whenever Liz rejected him, took drugs, or disappeared all night, Burton would simultaneously want to murder her and kill himself. He would then become dangerously suicidal. When Liz left him, in the seventh year of his treatment, Burton was hospitalized (his third hospitalization in the course of the treatment) for a severe depression that continued for a full year after the hospitalization. Burton, however, was able to use his ideal as a scholar to force himself to ignore urgent impulses to reconnect with Liz. They were divorced the following year.
Burton's strengths were also extremely impressive. He had a rich imagination, outstanding intellectual ability, a sensitive capacity for self-reflection, and intense concern for his friends. He consistently maintained a high academic standing and was able to pursue graduate work throughout the treatment. The vitality of his struggle suggested a passionate commitment to life.
At the start of the ninth year of the therapy, Burton was consciously attempting to become less preoccupied with Liz. By this time he was already living with Sybille, whom he later married. As we enter the clinical material at this time in the ninth year, Burton had begun to miss sessions for four weeks in a row. Burton thought that, by rejecting the therapist's help and missing sessions, he was stopping the process of tearing himself away from Liz. He began to panic, to feel that he had lost himself, that he had lost Liz, and that both he and Liz were evil. He made elaborate plans to shoot himself. His pull to reconnect with Liz was interpreted as a remnant of his early merger with his sadistic, abusive mother. The interpretations at that time addressed the many meanings of separation.
Much work had already been done on his relationship with his mother. Early in the treatment he had described, "We are like Siamese twins,- both of us would die if we were separated." He had recalled a repetitive early nightmare of being locked in a coffin, with his mother outsideâor vice versa. Separation meant being killed and killing. Burton recounted, "My mother would freak out for days, going crazy, nothing could stop her. I know what it's like to love someone who is determined to annihilate herself. When Liz would get self-destructive, I'd feel I'm getting shut out, killed. She's killing me, I'll kill her." Burton's fundamental metaphor was that separation meant death.
Lengthy reconstruction of his early relationship with his mother revealed memories of her as grossly inconsistent, alternately all-good or murderous, sexually seductive and then abruptly abusive. The repetitive nightmare in which either Burton or his mother was locked in a coffin at night with the other outside captured his simultaneous suicidal and homicidal preoccupations and the fluid interchangeability between images of himself and his mother as killer and victim. Such memories as these were used in the crucial ninth year to remind Burton how much of his relationship to Liz reevoked his early relationship with his mother, so that at times he found it nearly impossible to distinguish the two sets of experiences.
Burton now began to experience himself more directly as evil and murderous for even thinking about separating from Liz. He was convinced that his relationship with his new girl friend, Sybille, was a betrayal of Liz. It was at this point in the treatment that Burton was first able to recover memories of his father's lifelong affair and his rage at his father for betraying his mother. Much previous work had already been done on his relationship with his father, for example, working through his memories of his father's beating him in the crib, his identification with his father's depression, and oedipal themes. This new material, however, ushered in a crucial missing link in the conflictual identification with his father, namely, his father as someone who had separated from and betrayed his mother.
To the extent that the identification with his father was paramount, the material increasingly lent itself to interpretation along conflict and defense lines. Interpretations were offered to Burton that he felt that he had betrayed Liz by the new relationship with Sybille, just as he felt that his father had betrayed his mother with his relationship to his mistress. In competition with his father, he had to be both more faithful than his father and the betrayed one, the abandoned one. Thus, he placed himself in his mother's position rather than being the one who left. Burton's ability to maintain cohesion and to experience conflict was fragile, however. What had begun as a bond of fidelity to his mother quickly evolved once more into a merger in which Burton experienced himself as all too similar to his abandoned, betrayed, helpless mother. In response to interpretations concerning his conflictual identification with his father, Burton reported a dream in which he stabbed his father to death because his father had been deceitful. At this point fears that separation would mean death again emerged.
In a rising panic, Burton attempted to convince me that he would die without Liz. The swings toward and away from Liz escalated. He needed to see Liz to repair the rift and to save her. Simultaneously, he announced his decision to accept a divorce from her. He still felt enraged and wished to kill her: "I miss her, I hate her. I want to get rid of her. I want to run back to her."
His functioning became disorganized: "I can't handle business. I can't get my books to the library. My apartment is a mess. My life is falling apart. I am not living, without Liz. This is not separation; this is the end." This disorganization culminated in a suicidal state reviving a merger with his mother as dying: "This is a subjective car accident. It's like my mother dying. I want to blow my brains out. I want to lose myself now."
Frank and I understood this process as an indication of the tenuousness of Burton's self-structure. He was unable to tolerate such intense affects. The self-object distinction was lost, and he reentered a merged state with Liz essentially similar to that which he had had with his mother. Homicide and suicide were interchangeable. Both he and his mother were dying. He was both killer and victim. Yet interpretations of his inability to tolerate these intense affects and his loss of the germinal self-object distinction only resulted in his losing himself further and becoming overtly suicidal. In contrast to the back-and-forth oscillation that characterized much of this period, at this point Burton temporarily lost this flexibility. I (Beatrice) accepted this dramatic reversal of the prior fleeting increments of separation as part of the process.
The vanishing time dimension inherent in the merger state was reintroduced by my pointing out to Burton that he imagined being trapped in the feared state forever. These interpretations enabled Burton to progress from his suicidal and merged position to an acceptance of a more differentiated and dependent state. He felt unable to take care of himself and overtly acknowledged his need for me. He dreamed of a woman who let him suck her breasts, whom he identified with me. He used these images to comfort himself in the face of the dread of murderous separation. He reintegrated various qualities of himself, not only as aggressive but also as needy, able to be comforted, and having sexual...
