Estragon: I am happy.
Vladimir: We are happy.âŠ
Estragon: What do we do, now that we are happy?
Vladimir: Wait for Godot.
Estragon groans. Silence.
(Beckett, 1954, p. 39)
Lately it seems to me that, within the psychoanalytic process, both patient and analyst find themselves, sooner or later, waiting for Godot.
The patient, especially when new to analysis or analytic therapy, comes with a long-held hope of transcending existential pain and struggle. This hope often, especially with patients struggling with addiction (the majority of my caseload), takes a literal or concretized form. Here a patient awaits a romantic partner or some actual caregiver-figure, possibly including the therapist, to literally transform or ârescueâ them from misery, in a way that guarantees ongoing care and attunement, and detours around unspeakable or unnamable (Atwood, 2012) traumatic feeling-states which âreturn one again and again to an [earlier] experience of traumatization ⊠fracturing oneâs sense of unitary selfhoodâ (Stolorow, 2015, p. 133).
We analysts recognize that such concretized yearnings on the part of the patient, for the reliable circumvention of such overwhelming states, might represent a curative fantasy (Orenstein, 1995)âimplying the eventual disillusionment of a patientâs hopes when such fantasy fails to materialize. For some analysts, for reasons I shall explicate, this may lead to a dread or apprehension of âfailingâ or harming the patient, which in turn may foster repetitions, enactments or ritualizations within the dyad.
We understand, intellectually at least, that if any actual self-expansiveness is to be found, it will likely involve the revisiting of the dreaded, painful affect which a patient has repetitively numbed or averted since an archaic environment demanded it. In fact, the need to repetitively numb such affect is often what fuels addiction in the first place.
It is easy to underestimate the potent persistence of an archaic âcommandâ to maintain the sequestering of trauma-related affect. Such an affective amputation continues to trap the patient in the remains of a structural tie, to caregivers who initially demanded the blunting or segregation of âentire zones of [the patientâs] subjectivityâ (Brandchaft, 2010, p. 199). With many if not most of my patients, some form of pathological accommodation is at issue, an underlying adhesion to archaic demands for affective riddance.
Brandchaft often noted how such rigid self-organizations sustain a terror of change, no matter how deeply such change is desired by the patient. An irreconcilable paradox: Godot is wanted or desperately needed, while such need itself must remain âoffstageââforbidden, a sign of shameful weakness. This can then lead to a seeking of concretized solutions, bypassing vulnerability.
Of course, it is that very vulnerability which may be the âGodotâ we analysts seek, awaiting the emergence of painful or shameful affect, for the sake of empathic inquiry and relational home-building (Stolorow, 2007). How or how long to sustain such inquiry remains an ongoing question, as we hope to cultivate an increased tolerance of a patientâs vulnerability, existential âpermissionâ for fundamental differentiation while ensuring that current analytic ties remain intact. Some patients decide that this is too risky or âslow,â and would rather work with a life-coach, fitness trainer, or psychic reader. Many patients become dismayed at âhow long this takes,â in a marketplace glutted with âquick fixes.â
Part of the challenge for patients trapped in rigidly accommodative self-organizations, is the struggle to safely exit âwhat has become a closed and noxious systemâ (Brandchaft, 1994, p. 63); such an exit is perceived, then and now, as stepping off an existential cliff. Thus, the patient waits for a Godot who guarantees freedom while preserving cohesion and aversion of a feared breakdown (Winnicott, 1974). An analystâs fear of the latter can lead to the provision of antidotal (Stolorow, Atwood & Orange, 1997) reassurances, affective detours.
Of course, some degree of âantidoteâ may be necessary, as the challenge with many such patients is that emotionality itselfâespecially including developmental desiresâremains âa solitary and unacceptable state, a sign of loathsome defect ⊠that must be eliminatedâ (Stolorow & Stolorow, 1987, p. 72). This can mean thatâdepending on the acuity of a patientâs trauma, and self-protectivenessâa patientâs âGodotâ is deemed ready to arrive when and only when an analyst has enabled them to bury âverbotenâ aspects of selfhood six feet under. Brandchaft (1994), ever prescient, observed that such âinsidious defensive processesâ ensure that âdevelopment on the basis of authenticity of experience ⊠is repetitively foreclosedâ (pp. 62â63).
I am beginning to understand how impossibly paradoxical are such developmental yearnings, for patients seeking relief from terrifying affect which has not and cannot even be acknowledged intersubjectively. This in turn only underscores the furtive seeking of concretized or ritualized means of relief, which protect even as they foreclose authentic strivings. (Addictive behaviors, for instance, both fleetingly âsatisfyâ and exacerbate desires for relational expansiveness.)
Often a patientâs emotionality has been so devalued that its toxicity is beyond question, simply how things are, an âabsolutized beliefâ (Brandchaft, 2010, p. 199), no matter what intellectualized lip service is given to âfeelings;â vulnerable or vitalizing self-expression, seeking a more intimate relatedness, remains âan inarguable demonstration of ⊠stupidity and willfulnessâ (Brandchaft, 1994, p. 63).
Nothing to be done, as Estragon says in Godot.
Often a patientâs hopes for signs of analytic âprogress,â guardrails against a terrifying plunge, imply the elimination of the analystâs own uncertainties and limitations, what Stolorow (2007) calls âfinitudeââour human imperfections, or being-with-uncertainty, an inability to foreclose a patientâs existential suffering or portkeys perceived as potentially fatal. As we shall see, the latter is no exaggeration, given some patientsâ archaically unrecognized trauma. âIt feels like it will never end,â some patients say after experiencing retraumatization, as the recurrence of such long-unacknowledged pain appears to attack their very going-on-being (Winnicott, 1965). Uncertainty is itself traumatic for many patients (Brothers, 2008)âand an inevitable aspect of the analytic process.
In the meantime, dyadic glimpses of the very spirit which the analyst hopes to free are precisely what may frighten a patient into self-protective paralysis or retreat. Such self-protections are usually followed, in my experience, by a collapse into shame and self-loathing, as the patient feels he is disappointing a caregiver-figure yet again. Or we might sense implicit or overt demands that analysis âget somewhere,â especially when a patient has been pushed into therapy by a partner or family member demanding âprogress.â We may become disappointed in ourselves if we sense we are disappointing the patient in this instance.
The patient might, in other words, begin to resemble Beckettâs Pozzo or Lucky, âGodotâsâ master and servant, respectivelyâhelpless or demanding in the extremeârather than the sibling-in-darkness, or co-dweller within the relational home (Stolorow, 2007) we hope to provide.
We analysts are thus ourselves waiting: for signs of our own effectiveness, confirmation that patients understand, or recognize, in some part at least, our care or concern for them.
We may also be waiting for signs of enlivening relatedness, the fleeting appearance or exploration of developmental strivings, for emotionality to become valued rather than loathed; for opportunities to employ âspontaneous disciplined engagementâ (Lichtenberg, 1999)âfor some clues, so help us, that all this effort is âgetting somewhere.â Repetition can be wearying, such as a patientâs epically-embedded ritualizations or self-protections, or other manifestations of an âexacerbated [transference] dilemma,â which puts the analyst in the grip âof a requirement to provide the patient with an unbroken ⊠experience uncontaminated by painful repetitions of past childhood traumataâ (Stolorow, 1993, p. 33), forestalling analytic traction.
Examples of such âgripsâ include, in my case, a patientâs seeking a âprescriptionâ of how to stop âwantingâ to drink or use drugs (often to please an impatient other); determining whether or not he has a frightful disease based on somaticized symptoms; or how to exit an abusive relationship in a way that ensures the other will not collapse. In such cases, a patient often becomes frustrated or deflated if I cannot detect or articulate their feelings from afar, conceptually perceived, that I am âforcingâ them to dwell in pain rather than analyze or surgically remove such affect for the sake of âcuringâ or cleansing them, finally, of overwhelming, obtrusive, or even contemptible emotion.
Here too I may sense I am âfailingâ the patient in my inability to provide an assuredly safe prescription, as if my own analytic orientation, or fallible subjectivity (Orange, 2006) is shamefully at issue, that if I come up short or offer something âdeficient,â the patient may become endangered, or exitâas they sometimes do.
Estragon: Use your intelligence, canât you?
Vladimir uses his intelligence.
Vladimir: I remain in the dark.
(p. 12)
Such situationsâthe Godot situation generally, with these specific variationsâcan be especially problematic for those of us who survived a âgifted childâ (Miller, 1997) upbringing, resulting in a fraught intersubjective resonance (Stolorow & Atwood, 2016) when vulnerability becomes perceived, by patient and/or analyst, as dangerously or contemptuously risky. An eerie dĂ©jĂ vu ensues, as I once again appear required to provide an asymmetrically âperfectâ responsivenessâlest I become a kind of âanti-Godotâ to a person I hope to help. In my own childhood, not knowing or having answers to âobviousâ questions asked by agitated or angry caregiversâin an attempt to prove that the feelings I was expressing were âimmatureâ or âirrationalââmarked me as inadequate, a longstanding killer-organizing principle (Stolorow, 1999) of my own.
Atwood (2015) describes this âgifted childâ scenario as being a âtraumatic conditionâ called âthe situation of the lost childhood,â which âhas developed early in the lives of almost every psychotherapist I have known,â especially those of us who treat acutely disordered or dissociated patients. In such histories, whenever the child or âlittle psychotherapistâ dares to pursue vitalizing self-expression, âthe parental response may be, âWhy are you killing me?ââ (all quotes, p. 150).
Atwood describes how such a child becomes beholden to the needs of parents for whom differentiation produces âreactions of great distress ⊠sometimes rageâ (p. 15...