Getting From Here to There

Analytic Love, Analytic Process

Sheldon Bach

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134914692
• Edition: 1
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

It is clinical work with the most difficult patients - those with severe narcissistic, sadomasochistic, and borderline disorders - that poses the greatest challenge to the therapist's guiding assumptions about clinical process; indeed, such work often leads therapists to question beliefs and expectations that formerly seemed self-evident. In Getting From Here to There: Analytic Love, Analytic Process, Sheldon Bach elaborates the holistic vision that guides him in work with just such patients. He dwells especially on the "attentive presence" through which the analyst effects a "meeting" with patients that invites the latter's trust in the analyst and in the therapeutic process. And he writes of love - of patient for analyst and of analyst for patient - that grows out of this mutual trust and sustains therapeutic process. For Bach, analytic therapy aims at understanding the person as a mind-body unity that manifests particular states of consciousness.

This holistic vision of treatment sustains a flexible clinical orientation that enables the analyst to "meet" states of consciousness in order to bring them into a system of which the analyst forms a part. Bach thoughtfully explores the clinical issues that enter into this taxing process, among them the establishment and maintenence of basic trust; the patient's or the therapist's presence in the other's mind; and the shifts in agency between patient and therapist. And he describes at length the frequently exhausting, even demoralizing, transference-countertransference struggles that enter into this type of analytic work.

Throughout, Bach is guided by the conviction that work with extremely challenging patients promotes the psychological growth and increased self-knowledge of patient and analyst alike. And he is admirably clear that the "mutual living through" of such treatments nurtures a kind of love between patient and analyst.

Getting From Here to There not only records the clinical lessons learned by an unusually gifted analyst; it also chronicles the movement of psychoanalysis itself from the dissection of love into component parts to a synthetic grasp of its vital role in psychoanalytically informed treatment.

1

ON BEING FORGOTTEN AND FORGETTING ONE'S SELF

But were I granted time to accomplish my work, I would not fail to stamp it with the seal of that Time, now so forcibly present to my mind, and in it I would describe men, even at the risk of giving them the appearance of monstrous beings, as occupying in Time a much greater place than that so sparingly conceded to them in Space, a place indeed extended beyond measure, because, like giants plunged in the years, they touch at once those periods of their lives—separated by so many days—so far apart in Time.

—Marcel Proust, Remembrance of Things Past

Although in the real world our experience of seeing, hearing, smelling and touching people guarantees their existence for us, their continued existence when not within the grasp of our senses is guaranteed only by our memory of them. And just as we keep people alive by remembering them, so we ourselves sustain our own feelings of aliveness not only through the ongoing awareness of our actual physical being but also by feeling that we exist and are remembered in the minds of others. This chapter is about those people who cannot feel continually alive in the present because as children they did not feel continually remembered and alive in the minds of their primary caretakers.

I first became interested in this topic when a patient, Jeffrey, mentioned that as a child he was well known at Macy's department store because his mother would regularly have to come to the lost-and-found department to retrieve him after she had lost him while shopping. Although Jeffrey recounted this as an amusing story, it turned out to be only the tip of an iceberg of isolation and despair of which he had remained largely unconscious.

From the beginning of the analysis I noted how often, after mentioning a name or incident, he would casually ask, “I've told you about him, haven't I?” or “Have I told you about that?” My countertransferential anxiety alerted me to the importance of these questions, but it took a while before we could discuss his belief that I really would not remember what he had said the day before or the day before that. It took even longer to bring out that when he returned to a subject from a previous meeting he often unconsciously tried subtly to remind me of the ground we had already covered so that I would be filled in even if I had entirely forgotten it.

The Oxford English Dictionary (1989) defines forgetting as “to miss or lose one's hold” on something or someone, and Jeffrey's conviction that he would be forgotten had led him to lose his hold on many things in his own life, most notably on a secure sense of himself.

Jeffrey presented with many phobias, one being a fear of flying. Since his executive position required him to fly on a fairly regular basis, he was constantly living with an anticipatory fear that at times would become so severe that he would walk off a plane he had already boarded. After an appreciable time in the analysis, when the transference had entered an early maternal phase, he began to get frightened on the couch; he would feel that he was drifting, had no direction, and become unable to think or talk. As these moments increased in intensity, he would often feel the necessity to sit up and look at me, which usually relieved his anxiety. Eventually it became clear that he was terrified of “losing his connection” with me and that sitting up and looking at me reassured him that I was still there and keeping him in mind. For many months we explored his anxiety about drifting without direction, and we learned that it culminated in a terrifying fantasy of falling endlessly into empty space. But we were still not sure what this fantasy was about.

When Jeffrey flew on business he was usually accompanied by Matthew, a young assistant whose career he had mentored and to whom he had a close attachment. We had both assumed that being accompanied by someone helped to reduce his anxiety, and, indeed, when frightened on the plane, Jeffrey often turned to Matthew for some kind of relief. But one day Matthew became ill shortly before their flight, and Jeffrey was obliged to fly without him. Much to our surprise, he discovered that he felt much better on the plane when Matthew was not with him “because I suddenly realized that even if I died there would be someone alive who would still remember me."

It thus became increasingly clear that at the heart of his many phobias and anxieties was a primary fear of being forgotten, a wordless fear of falling out of his mother's mind in an endless tumble into the oblivion of nonremembrance. This primary anxiety, which has been touched on in diverse ways in my own work ( Bach, 1985, 1994), as well as in that of Winnicott ( 1965), Ogden (1985), and Modell ( 1990), among others, seems to be related to a disturbance in the capacity for evocative constancy and a consequent difficulty in the establishment of stable representations and reliable self- and object constancy (Auerbach, 1990, 1993). While the importance of a reliable maternal presence for the development of evocative constancy has often been noted, Jeffrey's case highlights the importance not only of the mother's physical presence, but especially of her psychic construction and holding the child in memory. In the next chapter I report, from the other side, as it were, the case of a mother whose repeated suicidal threats and attempts ended only when she became able to retain the memory of her children-with-herself-as-mother as part of an expanded state of consciousness. So this mutual holding in memory may well have life-and-death implications for both child and mother.

In Jeffrey's case, in addition to his fear of flying, he also suffered from an elevator phobia, a claustrophobia associated particularly with bathrooms, a fear of public speaking, and a generalized social phobia. As we analyzed each of these phobias in detail, we learned that they formed an interconnected network radiating from the same fear of being forgotten. Although we later began to use forgotten and not being remembered interchangeably, the phenomenological experience of the fear was of not being remembered.

And, indeed, that seemed an accurate enough assessment—for, with Jeffrey's mother at least, the state of not remembering her child seemed to be the more frequent and natural one, whereas forgetting him was often linked to her more deliberate but still unacknowledged withdrawal as punishment when Jeffrey had crossed her in some way. Phenomenologically for Jeffrey, being the Forgotten One still permitted an identity centered on himself, whereas not being remembered obliterated his self and shifted the center to the other person, as if the act of being remembered by someone were literally what was keeping Jeffrey alive.

Who actually was this mother who appeared to be, both in Jeffrey's memory and in our analytic reconstructions, someone who could not remember her own son? Here I should mention that I am not unaware of current controversies about childhood amnesia and reconstruction of the past (e.g., Fonagy 1999), and I know that for a long time now it has been out of fashion to attend to Freud's (1919) admonition that “analytic work deserves to be recognized as genuine psycho-analysis only when it has succeeded in removing the amnesia which conceals from the adult his knowledge of his childhood from its beginning” (p. 183). Nonetheless, my clinical experience has repeatedly reinforced my belief that in many cases it is possible to reconstruct a patient's childhood with a reasonable degree of certainty and, moreover, that often the very process of this reconstruction is of great therapeutic importance.

Jeffrey's mother was still alive, and he continued to see her frequently; hence much of the material we worked on came from their telephone conversations or other interactions, often only a few hours or days old. Furthermore, Jeffrey's reports of his mother's current behavior and his recovered memories of her from his childhood showed a remarkable consistency over many years, and the understanding we eventually came to of her behavior allowed us to predict accurately what she would do in different and unfamiliar situations. Finally, as is typical in such cases, Jeffrey's initial conviction was that he had experienced the most normal of childhoods, that his siblings were all wonderfully content, and that his own symptoms and emerging childhood memories of confusion, pain, and despair were proof that there was indeed something terribly wrong with him.

Over the course of the analysis I indulged a fantasy that I was learning to understand Jeffrey's mother's psychology. This fantasy was based on the convergence of my two primary sources of information, Jeffrey's emerging memories of the interaction between himself and his mother and our own reenactments in the transference and countertransference in the course of the analysis. This process of coming to understand his mother involved a good deal of work, and its result was that Jeffrey now believed that he understood his mother's mind—a belief that is, I think, integral to his understanding of his own mind. Before that point in the analysis Jeffrey usually felt confused by his mother's mental operations and, indeed, quite hopeless about ever comprehending them. In the transference he was sometimes equally confused by my thinking, and it was very important that he come to understand not only how his mother's mind worked but also how my mind worked. I now believe that understanding how our mother's or father's mind operates belongs to the work of growing up but that this understanding has gone awry for many of our patients.

For example, when Jeffrey developed a serious medical condition that called for a decision about whether to opt for drug treatment or surgery, his mother urged surgery without even really listening to his explanation of the complex issues involved. By this time Jeffrey was able to see that she could not tolerate complexity or ambiguity and he could comment, “That's the way she is—she just does things and doesn't think about them and that way she can actually deny that anything really bad has happened!"

And, indeed, his mother, although an educated and intelligent woman, seemed to live in a world without ambiguity, complexity, or continuity, a world in which Jeffrey had been immersed to an extent that he had not fully comprehended. In his mother's world things were either good or bad, right or wrong, smart or stupid, friendly or dangerous. Nothing existed between these extremes; it was an either-or world. Furthermore, her children could find themselves in the smart or good category one moment and in the stupid or bad category the next without having any idea what they might have done to warrant this shift. What Jeffrey had experienced throughout his childhood and what he conveyed to me through transference enactments was that for his mother, and so for him in her world, there was no real concept of process. In practice this meant to Jeffrey that things could occur in extreme and arbitrary ways—if you sneezed that meant you were sick and going to die, or if you asked a question that meant you were stupid and didn't belong in the present company.

By paying attention to and reflecting on this uncertain and capricious world that Jeffrey inhabited with his mother, we slowly came to realize that one of its main characteristics was the pervasive absence of a sense of process. One day Jeffrey said,

It seems to me that each time I meet my mother it's like having a new experience… as if we were starting afresh… I don't think I feel that way with most people… Sometimes I have a good conversation with her and I feel connected, but then I'll meet her again and it's almost like meeting a different person… I think that it's very upsetting to me… there's no continuity…

When I was a kid, I used to take karate class… and I liked it a lot. The instructors there thought I was very good and they always picked me to demonstrate to the other kids. So I would be coming out of my karate class where they thought I was wonderful, and then I would be expecting her to pick me up. And she didn't come and I was waiting around wondering if she would come or not. And then I would start to have these fantasies about meeting some big guy on the street who insulted me and said I was only a kid and then I challenged him and used my karate and he was really amazed when I laid him out flat!… I guess I must have been real angry at my mother but then it never even crossed my mind…

And I used to dream about coming out of karate class where everyone thought I was so wonderful and that my mother would be there and I would jump into the car and tell her how great the class was and she would be excited along with me…. In my dreams it would all come together, the excitement of the class and my mother's excitement and everyone thinking I was great… But in reality it was always split apart.

And it was in just that way that we learned the details of the discontinuities in Jeffrey's life that had never been repaired, the ruptures that had never been mended, the rents in the fabric of his ego that brought him to a halt in whatever he might undertake, whether in work or in love. He seemed to live without the ordinary confidence that the past was connected to the present and would flow into the future and that each little piece of daily experience would fit into the overall pattern of a meaningful life.

On the contrary, when he first came to analysis Jeffrey's life was fragmented and was lived for the most part in discrete moments experienced as unconnected to each other in any meaningful way. Although he desperately felt the urge to make contact with other people, he could neither figure out how to do this nor manage somehow to pull together the scattered fragments of his life experience. Thus his memories of his life were split off from each other and stereotyped in such a way that living memories were covered by a screen of words. Emotional memories from his early years were almost entirely absent. One could say with some legitimacy that Jeffrey had forgotten his childhood.

I puzzled over that to myself for many months until one day Jeffrey came in angry with himself and began by saying,

J: I called my mother again… but why do I call her? Out of guilt or some other kind of obligation ? She kept asking me if I had written a thank-you note to this person I hardly know who did something or other for my brother that has nothing to do with me…. She's so concerned that I should do the right thing but she doesn't seem to have any idea about who I actually am… I can't understand why I keep calling her.

T: You keep calling her to make sure that she doesn't forget you.

J: [Seemingly taken aback] That makes a lot of sense. I never thought of it that way, but it's true…. Did I ever tell you that I always say “Mom, it's Jeffrey,” as if she wouldn't recognize my voice, wouldn't know who I am?

In fact, he had never told me this, but it dovetailed perfectly with his transference expectations that I would forget the things he told me and also with his subtle attempts to remind me about what had happened in our previous sessions. It made sense that Jeffrey would keep reminding his mother who he was and, expectably enough, at the height of this transference paradigm I occasionally found myself forgetting who the next patient was when the next patient was Jeffrey, whom I had been seeing at the same hour for years.

It was at this point that I began to realize more fully how we are bound together in time by a network of expectations of which we are dimly aware and that become clearly visible only when they are disrupted by dysfunction or pathology. I was reminded of a patient I had seen many years before who would regularly ask me, “When you come into the waiting room, how can you be so sure that it's me who will be there and not another person or some giant insect or a plant?” Although at the time I was able to respond in an appropriately analytic way, it now seemed to me that I hadn't fully appreciated the depth of anxiety and uncertainty that was expressed in that poignant cry of doubt.

While I had assumed from early on that there must be some kind of projective identification going on between Jeffrey and his mother that made her forget him, over time we began to learn things about his mother that made her own part in this equation loom even larger than expected. For as Jeffrey began to feel less need to call his mother so frequently, it became evident that she felt no need at all to call him. And so they went from speaking to each other several times a week to not talking to each other for weeks on end until Jeffrey called her, at which point she would reproach him for not having called sooner. His mother was apparently unable even to entertain the possibility that she might have called him.

I now learned that when Jeffrey was at college his father died and his mother had not even notified him beforehand of his father's illness. She had called him to return for the funeral only at the last minute so as “not to disturb his studies.” In the period of mourning following his father's death she spoke only of her own loss, never once even acknowledging that Jeffrey also had lost someone important to him. And when it came time to distribute some of his father's legacy which had been left entirely to her, she divided it in such a way that Jeffrey was clearly deprived of his fair share.

But, of course, the most significant consequences of his feeling not remembered by his mother were his pervasive sense that he was an unworthy and unmemorable person and his own inability to vividly remember his childhood and so have a past. By not remembering his childhood he was forgetting a very important dimension of himself, and one that not only existed in the past but that also was unconsciously affecting his every thought and action in the present as well as his hopes and aspirations for the future.

In his repeated references to the concept of Nachträglichkeit, Freud (1896) insisted on the continual two-way interaction between past and present. He noted not only the delayed effects of trauma, but also the mind's capacity retrospectively to attribute a causal meaning to the past. In this way both the past and the present are constantly reorganizing and retranscribing each other in human memory in ways that clearly influence our expectations and have crucial importance in shaping our futures.

It was this vital and sensual world of his childhood that Jeffrey had lost, and it began to emerge in bits and fragments only as the analysis proceeded. In the course of our explorations, I repeatedly sensed that Jeffrey's amnesia with respect to his childhood was in some way connected for him to his experience of not being remembered by his mother and that the memories he was recovering in analysis were continually reorganizing themselves around his experience of being remembered by me.

It was then that I realized that a person's memories and experiences are like individual beads; only when they are strung together to become a necklace do they achieve continuity and a gestalt form. The string on which they are assembled is the child's sense of his own continuous existence in the mind of the parent, where the beads of experience are strung together and become the necklace of a connected life. We know, for example, that many people whose pare...