Psychoanalytic Case Studies from an Interpersonal-Relational Perspective

Rebecca Coleman Curtis

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351356695
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalytic Case Studies from an Interpersonal-Relational Perspective contains reports of long-term treatments, including many dialogues and dreams, with commentaries following each one. Drawing from theories that have been developed since Freud, the analysts focus on problems in living as opposed to diagnoses and repressed sexual and aggressive urges. They also express their own feelings towards patients and even their own dreams.

The cases themselves include sexual abuse, a man whose father killed his mother, a change in sexual orientation, as well as those of depression, physical problems, and difficulties relating interpersonally, such as fear of rejection and rejecting help. Actual dialogues of sessions are featured, so that readers can see what takes place in psychoanalysis. The analysts here draw from theories of Sullivan, Fromm, Horney, and Fromm-Reichmann, Kohut, Winnicott, and more recently Levenson, Mitchell, Bromberg, Donnell Stern, and Aron, to name a few.

Most contemporary case reports come from short-term therapies and many rely on techniques of changing conscious cognitions and encouraging new behaviors. The treatments in this book, while often including such interventions, explore more in-depth processes that may be unconscious and related to transferential expectations from previous relationships, encouraging new experiences and not simply explanations.

Psychoanalytic Case Studies from an Interpersonal-Relational Perspective will be of great interest to interpersonal and relational psychoanalysts and psychoanalytic psychotherapists in clinical practice.

Chapter 1

Mark the leper

Robert U. Akeret

As Krishnamurti (1998) stated, when you are listening to someone completely, you are listening to the feeling of what is being said, not just the words. For a therapist, the ability to empathize with another human being is infinitely more valuable than all the psychoanalytic training in the world.

There, I said it! And I absolutely stand by it.

I have known therapists with years of intense training at highly respected institutions – brilliant scholars, fully versed in the most accepted psychological theories and therapeutic techniques – who nonetheless lacked the capacity for simple human empathy. The result is far too often a complete inability to foster meaningful, positive change in the lives of patients.

I have also known talented therapists with a natural inclination toward empathy who do all they can to suppress those feelings during sessions. They do this, against their own instincts, in the mistaken belief (reinforced by their supervisors) that any empathic response on their part will create obstacles to effective therapy.

The reasoning put forward in support of this attitude is that if one becomes too close to a patient personally it will block transference. The patient who sees you as a “friend” will never be able to express his or her true emotions to you – or so it is claimed.

I believe just the opposite: that a well-developed capacity for empathy is one of a therapist’s most valuable tools, and is absolutely necessary to forging the kind of bond required for truly effective work. During my more than 40 years of practicing therapy I have seen colleagues with less than stellar training who nonetheless manage to effect wonderful, life-affirming transformations in their patients – due almost entirely to their innate talent for human empathy.

I also see the power of empathy every day as I walk through Riverside Park and observe the mothers and nannies who congregate there with their charges. I notice that there is almost always one woman who shines as the magnetic center of the group. She is the one to whom all the rest flock for understanding and guidance. This woman exudes empathy! I think, as I sit and listen to the conversations taking place only a few feet away from me:

If I were in charge of selecting candidates for a top psychoanalytic institute, I would choose this intuitive and empathic woman over any of the supposedly brilliant psychology students who excel at “left brain” anatomizations of the human psyche, yet too often shut out their own “right brain” intuitions as untrustworthy.

For me, that choice would be a “no brainer,” but for many therapists (and for almost all of the people who train them today) the idea of trusting one’s empathetic intuition is unacceptable. They believe empathy is too imprecise to be meaningful. It cannot be measured by tests or quantified into discrete units, so they relegate it to the pseudo-scientific waste dump they reserve for numerologists, invisible energy practitioners, and religious healers.

Empathy as an effective tool for healing has little appeal to the scientific or medical mind. It is in the arts that empathy is respected and cultivated – particularly among writers and actors. These artists must learn to see and feel the world intuitively from inside someone else’s skin in order to do their jobs properly. But while most people are willing to grant the vital importance of empathy to artists, they stop short of recognizing how essential a highly developed capacity for empathy is to be a truly successful therapist.

I believe an individual’s basic talent for empathic response, much like a talent for music or mathematics, is a gift. Some are blessed with a great deal of it; others not so much. But just as a talent for music or mathematics can be nurtured and developed, so too can one’s talent for empathy – even if there is very little there to begin with. It starts with learning how to become aware of one’s empathetic powers, faint as they may be, and allowing them to grow. That isn’t easy for some people.

The two most critical elements to developing robust empathetic powers are, first, an appetite (or at the very least, a willingness) for taking risks; and second, having the patience and faith necessary to gradually begin believing in and trusting one’s own empathic instincts. At its most extreme, empathy can mean entering into what the German philosopher Edmund Husserl (1970, p. 108) called a person’s Lebenswelt (lived world) experiencing viscerally the way in which that person parcels out and evaluates the contents of his or her world.

Probably the greatest risk a therapist takes when it comes to this level of empathy is that of temporarily abandoning his or her own personality in order to “become” this other person, if only for a few moments. It can feel like jumping out of an airplane without a parachute. But taking personal risks in the pursuit of helping our patients is what we do.

Ultimately, I see empathy as a supreme act of love. It is precisely this willingness to “become” another person that conveys – more forcefully than words ever could – a loving belief in the patient’s potential to overcome the issues that are preventing them from leading a rich, full life.

Like love, empathy can be daunting and tricky; inevitably, empathetic “misreadings” will occur along the way. But even misreadings can turn out to be valuable in the end.

This is what happened in the following case, which I call “Mark the Leper.” With this patient, the empathic experience that I thought would help me relate to him most deeply turned out to be only skin deep literally. I had to delve much more deeply into my own most painful fears and regrets to understand fully what “the Leper” was really going through – to truly empathize with him.

I could tell immediately that Mark, my new potential patient, was going to be more difficult than most. He was perched on the edge of a chair in my waiting room when I first saw him, his back to my office door: a clear sign that he didn’t want to be here.

“Hello. I’m Dr. Akeret,” I said by way of my usual greeting. “Come on into my office and we’ll get started.”

Even from behind him I could see weariness and despair in his body as he forced himself to stand. When he turned around, I was surprised to see that he was unusually handsome – he could have easily been the young leading actor in a romantic film.

But his face, as handsome as it was, displayed nothing: no life energy, no appetite for experience – no interest in anything at all.

“I’m not even sure I should be here, Doctor Akeret,” he said, tonelessly. “My brother had two years of therapy and then killed himself.”

I knew all about this from Mark’s aunt, a former patient. She also warned me to expect difficulties with Mark, as well as serious opposition to any kind of psychoanalytic therapy from his parents.

“Do you think that if we decide to work together you might commit suicide?” I asked. “Are you considering suicide, Mark?”

“Nah,” he said, as if he were so dispirited he didn’t even have the energy to kill himself.

“That’s my mother’s fear, really. She’s a total pessimist.”

“Well, I’m just the opposite, Mark. I’m a total optimist. Makes life much more interesting, wouldn’t you say?”

He shrugged. We were still standing in the waiting room. He’d made no move to come into the office, and I was determined he should initiate that move. “How about your Dad?” I asked. “What does he think about therapy?”

“He says there is absolutely no scientific proof therapy works. And there really isn’t, is there?”

He gave me a smug, self-satisfied look, as if he’d gotten me.

“Absolutely none,” I said cheerfully. “No scientific proof whatsoever. But I’ll tell you this, based on more than 40 years of working with patients: when it works it really works!”

“And when it doesn’t work?” he asked, “What then?”

“I can’t promise it will work with you,” I told him honestly. “But I will promise you this: that if we do decide to work together, it will be an experience you’ll never forget.”

“If you say so,” he muttered.

“I do. And I promise something else. There will be change. Positive? Negative? I don’t know. But you won’t be the same, stuck in this same rut you are now when we’re through.”

“How do you know I won’t be the same?” “Because I won’t let that happen,” I said.

I saw the first glint of life in his eyes since he’d stood up. I could tell he liked what I had said. What I couldn’t tell yet was how it was going to go. Usually I can see in the first few minutes whether a new patient and I will be able to forge a working relationship, but in this case I was stumped. It could go either way.

We were still standing in the waiting room. He wasn’t about to make a move. “We could keep standing out here or we can go into my office and sit down,” I said finally.

Another thing 40 years of therapy had taught me: sometimes you have to be flexible to move forward.

“Tell me about any previous therapists you have worked with,” I said after we were settled inside.

“I’ve seen a few therapists, but I could always tell pretty much what they were going to say next. So I gave up on them. You guys are so predictable.” I took that as a direct challenge. I hesitated briefly, deciding whether I should do something unpredictable – then decided that would be the most predictable thing of all to do.

“So, what changed your mind and brought you here?” I asked. “The hell I have to go through every morning,” he replied.

“And what hell would that be?”

“I tried to masturbate this morning, as I do most mornings, but it’s just too painful. I have psoriasis all over my body, even my penis. You can’t possibly imagine what it’s like to live with all those sores and pus.”

“Maybe I can; I have a pretty good imagination.”

“Then imagine this, Dr. Akeret: being a young guy like me, with normal urges, and realizing you’ll never ever have sex with a woman or have children.” “You sound as if you don’t believe your psoriasis will ever get better.”

“Why should it? It hasn’t really changed since the first outbreak five years ago, ju...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Notes on contributors
• Introduction
• 1 Mark the leper
• Commentary on Akeret’s case: empathy, therapist need, and the muddy in-between
• 2 A change in sexual orientation: a case of pseudo-relatedness
• Commentary on Samstag’s case: the presentation of “Art”
• 3 The curative power of an interpersonal approach in the treatment of a patient whose father killed his mother
• Commentary on Quinones’ case: going where we need to go
• Commentary on Quinones’ case: a view from a second interpersonal frame
• 4 Defying destiny: genetically doomed?
• Commentary on Cheselka’s case
• 5 The dance of dissociation in healing trauma
• Commentary on MacIntosh’s case: creepiness
• 6 Surviving sexual abuse: a chameleon looks in the mirror
• Commentary on Feit’s case
• 7 Failure to thrive: an eye for the I, and an ear for the here
• Commentary on Levy’s case
• 8 Faced with death: death in the countertransference
• Commentary on Hunyady’s case: the “see” between us – closeness and connection in psychoanalytic psychotherapy
• 9 A lost, depressed woman: love, Narcissus, and Echo revisited
• Commentary on Valentin’s case: a therapeutic dyad in search of a third
• 10 Rejection by a boyfriend: from idealizing transference to “real” partner
• Commentary on Kaufmann’s case: transforming the reparative quest in the transference
• 11 Tolerating his vulnerability: first at age 10, then at 50
• Commentary on Hartman’s case: the multiple meanings of parental failure to provide empathic guidance
• Index