Review – The Therapist as a Subject

Clinical Implications of the Therapist’s Life Experiences: When the Personal Becomes Professional
By Steven Kuchuck
New York: Routledge, 288pp., $47.95, 2014

Some time ago, I wrote a short personal essay about my conflicted relationship with my Jewish identity for a small journal on religion. Shortly after it came out in print, I learned that the journal also maintains a website on which all of its articles are available and openly accessible to the public. The editor never informed me that the essay would be posted on the journal website. In fact, I only found out about its existence when a patient told me that she had Googled me and read the essay online. My personal life was out there and available to anyone who went looking for me, and I didn’t even know it—I felt completely exposed.

After my patient revealed what she had found out about me online and told me about her reaction to this discovery, I went through what felt like a slow-motion internal self-inventory: How do I feel about my patient’s newfound portal into my private life? How does she feel about it? Who else has read my essay? How do I fix this? Where can I hide? Even as I weathered my internal meltdown, I somehow had the wherewithal to recover myself and reengage with my patient despite my shock, and together we were able to go on to explore the meanings of the somewhat personal feelings and divulgences exposed in my essay, both for her and for our work together. But after our session I felt haunted by a lingering vulnerability, protectiveness over my privacy, and some real concern about the potentially negative effects the article could have on other patients and on my professional identity in general. Was this a part of myself I wanted to reveal to the world? Was this a part of my personal life that I felt prepared to integrate into my impression of my professional self?

What to do with the analyst’s subjectivity? This question has been tackled in various iterations throughout the history of psychoanalysis from its very genesis, beginning with Freud’s papers on technique. His famous injunction to psychoanalysts to “model themselves during psycho-analytic treatment on the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skillfully as possible” (1912/1958, p.115) successfully banished the person of the analyst from the standard practice of psychoanalysis for some decades, relegating it to the shadowy corners of the consulting room in the form of perceived analytic misdeeds and shameful feelings of analytic contamination.

But though he seemingly exiled the individual person of the analyst from the room, with the innovation of his theory of countertransference Freud inadvertently planted the seed of potential for the analyst’s subjectivity deep underground. With the evolution of psychoanalytic theory and the advent of postmodern thinking, the influence of the analyst’s subjectivity on psychoanalytic treatment has slowly been unearthed, blossoming into arguably one of the most important issues in contemporary psychoanalytic discourse today. Steven Kuchuck’s new collection entitled Clinical Implications of the Therapist’s Life Experiences: When the Personal Becomes Professional (2014) is the latest outgrowth of the movement to throw off the repression of Freud’s dictums and excavate the personal life of the therapist—a sort of group exposure therapy meant to bring the collective person of the therapist out from shameful hiding as a reparative counterbalance to its previous expulsion from the consulting room.

Indeed, Kuchuck views the edited volume as a challenge to the shame-inducing secrecy of the classical tradition, stating in his introduction that the book “is borne of the storming in of my own and the profession’s subjectivity…a collection that celebrates an emergence from hiding on the part of authors, analysts, and a profession” (p.xxiv). And the book accomplishes this goal to a large extent through the exceedingly personal autobiographical accounts the analyst-authors offer in each of their unique chapters. Each narrative explores some idiosyncratic historical experience or character trait that the author feels has shaped his/her subjectivity and particular psychoanalytic identity. In the process, the reader is taken into the storyteller’s confidence as the intimate gaze is turned inward—but in this case with a view toward telling the private stories of those who customarily do most of the listening.

As my patient told me about her experience of reading my personal essay online and the internal shake-up that ensued, I found myself in deep identification with her experience. The incident brought me back to a time at the beginning of my own analysis, when after a few weeks of treatment, I Googled my own analyst’s name. As I scanned through the ample search results, weeding out others with the same name as I went, I came upon a news article in which my analyst was featured as an expert on helping people deal with certain tragic life events. Tentatively, I read through the piece with my eyes partly shielded—I kind of wanted to know, but I also kind of didn’t. My stomach sank as I read it through; the article quoted her extensively, revealing that she had experienced the same misfortune in her own life as those she was helping. It all felt shockingly personal, too much information that I had not expected to find and did not particularly want to know. I was devastated. It was the beginning of my analysis and I felt like the safety of the analytic space was tenuous, and the power of my analyst to help me to contain and understand my own tragedies limited at best. The experience felt violent, both in my intrusion into my analyst’s privacy and in the intrusion of her private life into my analysis.

Encountering otherness in the psychoanalytic situation carries a particular weight and can be a powerful catalyst for change that reverberates intrapsychically and interpersonally for both participants. For me, coming into contact with such personal information threatened my need to feel held by a strong container, some- one who did not need to be pathologically accommodated or narcissistically shored up. But her inadvertent disclosure on the Internet ushered in another part of my analyst that I could not help but incorporate into a painful transferential narrative based on my own history. I didn’t know how it would ever feel okay. Being in analytic training, I realized I should probably talk to my analyst about the article, so I eventually broached the subject with her—slowly and carefully. But talking to my analyst about all of this turned out to be a harrowing experience and the seed for the first rupture of the treatment—with emotions running high on both sides. I desperately wished I could unknow what I now knew about her, and she expressed regret that the author disclosed her name in the article without permission. Despite my feelings of guilt and insecurity, we got past the rupture, and I eventually folded the “real-life” version of the analyst I discovered on the Internet into the fantasy of who I needed her to be. But we have never discussed her inadvertent disclosure in the article, its impact on me, or the rupture again—at least so far.

The therapist as a subject poses a special relational dilemma. How to introduce otherness when the presence of an other has often been historically traumatic for the patient and/or analyst? Can we be expected to conceal large chunks of who we are in order to shield the patient from experiencing us as invasive or insensitive intruders? The asymmetry of the analytic relationship imbues it with the power to catalyze deep change. But with that power comes responsibility for monitoring the impact of one’s interventions and one’s unique person on the therapeutic relationship to safeguard, as Kuchuck puts it, “a patient’s right not to know” (p.xix). Over the course of a treatment the pendulum swings from awareness of difference to fantasies of sameness, each with their own potential to heal and hurt; analysts are constantly taking the temperature of the transference/ countertransference, trying to get a han- dle on the needs of both participants, and are often forced to make fraught, difficult choices about how to relate to competing needs for recognition and privacy in both patient and analyst.

It is difficult to theorize prescriptively about the analyst’s subjectivity because the topic is slippery, often creeping into a more concrete discussion of self-disclosure. Perhaps we can more freely theorize about self-disclosure by virtue of the fact that it has long roots in our analytic tradition, is a part of our common language, and is a concrete clinical event about which we can construct definitive guidelines. With the rise in popularity of postfoundational thought and with our respect for the idiosyncratic outlooks of every individual, it becomes more and more difficult to draw out theoretical conclusions that are generalizable to many. There are no more universal “truths,” and this often leaves us without ways to effectively communicate with each other about how to “do” psychoanalysis, except for in highly individualized ways. By definition, subjectivity and its impact on the analytic situation comprises an aspect of the therapeutic relationship that we can try to understand on an individualized basis, but is not something we can make blanket value judgments about as it pertains to particular attributes of the analyst’s self.

But one does sense that some subjectivities are better than others, and over the ages, discriminative determinations have been made about the desirability of various personality traits and subjective characteristics within the psychoanalytic profession. This topic is of particular significance to psychoanalysts, since as a group, most of us struggle with issues around concealment, accessibility, hiding, and exposure. By revealing the influences that have shaped the practices of the established psychoanalysts who share their lives with us in this book, Kuchuck has widened the range of the acceptable subjective qualities that shapeour professional roles. More importantly, he has helped detoxify potentially shame-filled personal experiences that might otherwise be sidelined or dissociated in the consulting room. Indeed, Kuchuck opens the door for psychotherapists and psychoanalysts to examine more of their theoretical leanings and personal styles without judgment and thus make one’s personal makeup and history more of a live and living part of the therapeutic relationship.

When I next met with my patient again after that fateful session, I had access to more of myself and was able to more nondefensively broach what meanings she had imbued into her newfound knowledge of my private thoughts. And this felt good. It feels good to be able to transcend the “facticity,” as Sartre called it, of the human condition—to go beyond the concrete facts of a person’s life to dream up a fantasy of what we think or even wish it could be. For in the end, it is not really the reality but the meanings we imbue it with that give relationships their vitalizing power.

Even as I dealt with my patient and the feelings our enactment brought up, I also deliberated on my presence on the Web and my corresponding needs for privacy. It was and remains important to me to give patients the option of not having to know any personal information they find out about me on the Internet. In the end, I called up my editor and we negotiated a compromise that felt satisfying to both of us. If the article had to be out there and my name had to be on it, I wanted to leave the possibility of doubt open to those who wouldn’t want to know. I told the editor that he could leave my article on the site, but only if he removed the byline that contained information that identified me in ways that would indisputably link me as a person to the personal feelings I had written about in my article. That way, I reasoned, if a patient did an Internet search and read the article, she would have the choice of whether she wanted to credit it to me or maintain the doubt that some other person with the same name wrote it. A small difference, but to my mind it keeps open some potential space that protects the patient from intrusion, leaving the objective truth in the realm of play, somewhere between fantasy and reality. What’s more, it provides the illusion of protecting my needs for privacy by giving me a slight sense of flexibility around my identity. I like the idea of having the option of hiding, even if it is only in fantasy.

When one talks about subjectivity there is always some slippage—what feels certain in the intimacy of one’s own mind can become convoluted in its communication to an other. This is partly because subjectivity has no fixed content—as time passes, every moment of life reveals a new sense of self (Oksenberg Rorty, 2006). Subjectivity and the ingredients that go into shaping distinctive affective experiences have been the topic of much discussion in psychoanalytic circles of late. In fact, the term has become a political symbol of sorts, with different analytic camps fashioning their battle cries around the claims they make on subjectivity and its construction. And it is a subject worth fighting over. The study of the complicated ways that inner experiences interact with and reflect life events can disrupt and expand our notions of what is possible, on individual and communal levels. What makes life real? What is a “good enough” life? The study of subjectivity holds out the promise of organizing the chaos of human relations into a model of a life well lived; indeed, it holds the seeds of potential for reclaiming and transforming the way we think, the way we feel, our deepest senses of self (Kleinman & Fitz-Henry, 2007).

Kuchuck’s new collection brings the hopefulness of human narrative into the psychoanalytic collective consciousness, allowing us to recover sidelined parts of self as active agents with the power to decide for ourselves what it means to be a real person and a good psychoanalyst. Whether it is Galit Atlas’s reclamation of herself as a woman and as a sexual being, Irwin Hirsch’s ability to turn his failures and disappointments into generative learning opportunities, or Anna Ornstein’s tenacious ability to turn the most unspeakable tragedy into a life-affirming ideology, the stories told in this book remind us again and again that we have the power to author our own lives. Our transformative life experiences recursively intermingle with intimate internal processes that together have the potential to become both the sources of deep suffering and the roots of a satisfying life full of meaning. As Sartre said, “[Y]ou can always make something out of what you’ve been made into” (cited in Flynn, 2013), and Steven Kuchuck generously holds up the invitation and the challenge for all of us to do the same.

REFERENCES
Flynn, T. (2013). Jean-Paul Sartre. In E. N. Zalta (Ed.),
The Stanford encyclopedia of philosophy (Fall 2013 ed.). Re- trieved from http://plato.stanford.edu/archives/fall2013/entries/sartre/.

Freud, S. (1958). Recommendations to physicians practising psycho-analysis. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 12, 109–120). London: Hogarth Press. (Original work published 1912)

Kleinman, A., & Fitz-Henry, E. (2007). The experiential basis of subjectivity: How individuals change in the context of societal transformation. In J. Biehl, B. Good & A. Kleinman (Eds.), Subjectivity: Ethnographic investigations. Los Angeles: University of California Press.

Kuchuck, S. (2014). Introduction. In Steven Kuchuck (Ed.), Clinical implication of the psychoanalyst’s life experiences: When the personal becomes professional. New York: Routledge.

Oksenberg Rorty, A. (2006). The vanishing subject: The many faces of subjectivity. History of Philosophy, 23(3), 191-209.

Upcoming Presentations

October 19th-20th, 2017: Grand Rounds Presentations to Department of Psychiatry at SUNY Upstate Medical University and APsaA Psychoanalytic Study Group, Syracuse, New York.

October 21st, 2017, 9AM: 40th Annual International Association for Psychoanalytic Self-Psychology (IAPSP) International Conference: "Empathic Depths and Relational Leaps: Creating Therapeutic Possibility" Panel Discussant for “The Analyst's Subjectivity: A Double-Edged Sword”. This Panel's participants will provide clinical material and theory to further our thinking about the double-edged sword of the analyst’s unique subjectivity as it emerges in specific analytic relationships: the double edge being that the analyst’s subjectivity is the only lens through which we can see and engage therapeutically with our patients but at the same time is an aspect of the analyst’s person that at times can create barriers to emotional intimacy or pull for particular manifestations of the patient’s pain and his problems in living.
Palmer House Hilton, 17 E. Monroe Street, Chicago, Illinois

November 4th, 2017, All-day Seminar: Pittsburgh Psychoanalytic Center Keeping Our Work Alive Seminar Series. More information to follow

December 9th, 2017 9 AM - 12:30 PM: Institute of Contemporary Psychotherapy and Psychoanalysis Annual Conference. The Love That Dare Not Speak its Name-- On the Therapeutic Action and the Limitations of Romance and Desire in Psychotherapy and Psychoanalysis. This presentation will address an historical and current-day taboo; the loving, romantic, and erotic feelings that often arise on both sides of the couch, but seldom get discussed in the literature. Through exploration of newly evolving theory and detailed case examples, Steven Kuchuck will explore ways in which these therapist--patient subjective responses become a vital component of the therapeutic action and/or interfere with progress in treatment. Particular attention will be paid to the implications of these dynamics for male analytic dyads in which sexual orientation is discordant. Ample time will be allotted for audience discussion. Silver Spring Civic Building 
1 Veterans Plaza 
Silver Spring, MD 20910