A review of Clinical Implications of the Psychoanalyst’s Life Experience: When the Personal Becomes Professional edited by Steven Kuchuck. New York, NY: Routledge, 2014. 254 pp.
By David H. Thurn, L.C.S.W., Ph.D. (2015). Contemporary Psychoanalysis, volume 51 pages :562-571
Every psychoanalyst knows how much her or his professional work is an expression of uniquely personal experiences of early development, professional training, and later-life events. Still, it is too seldom that we have a chance to hear our colleagues reflect at length on the particular ways in which this is true for them. Steven Kuchuck has given us this chance in a fine collection of essays gathered together under the title, Clinical Implications of the Psychoanalyst’s Life Experience: When the Personal Becomes Professional. Each of the writers included here understands that the work of analysis occurs only within the shifting and often unexpected currents of personal experience, which pull us off our “professional” footing into the confounding depths of our own histories. Of course, this is necessarily the case when it comes to the work of psychoanalysis which, like the navel of the dream, finally outruns all professional “technique” and reaches down into the unknown.
This has always been true, but because much of contemporary psychoanalysis, in all its interpersonal and relational variants, has put in question the rules of formal technique, including the classical “ideals” of abstinence, anonymity, and neutrality, it has revealed the very personal face of this work like never before. Still, although many have argued for the intersubjective, reciprocal, mutual, or co-constructed basis of clinical practice, there is still relatively little autobiographical writing on the subject of how the analyst’s personal history shapes her or his theoretical and clinical choices in the consulting room. Of course, there are notable exceptions, as Kuchuck acknowledges in his introduction, citing, among others, work by Margaret Little, Richard Isay, Barbara Pizer, Darlene Ehrenberg, Patrick Casement, and Muriel Dimen—as well as several important collections, including The Human Dimension in Psychoanalytic Practice, edited by Kenneth Frank (1977), and The Therapist as Person, edited by Barbara Gerson (1996). The essays gathered together here, which offer moving testimony to the professional impact of a wide range of personal experiences—adoption; divorce; the holocaust; immigration; coming out; illness; difficult encounters with matters of race, gender, and sexuality; experiences of secrecy and shame; the residual damages of training; old age; and death—make a significant contribution to this autobiographical strand in the literature.
The project, Kuchuck tells us, took inspiration from a number of things, among them his experience of conflict over his sexuality, which he felt forced to hide for years in response to familial and, later, professional pressures; the events of 9/11, which thrust a shared experience of trauma into his consulting room, upsetting his usual protocols regarding selfdisclosure; and broader shifts in the field instigated by feminist, interpersonal, and relational challenges to psychoanalytic orthodoxies. It is not surprising, therefore, that Kuchuck considers his collection a kind of celebration, “an emergence from hiding on the part of authors, analysts, and a profession” (p. xxiv). The book is divided into two parts, each featuring nine essays, the first part dealing with earlier life events, the second part with later. In this discussion, I will not follow the developmental scheme suggested by the structure of the book.
Coming first in the collection, Sally Bjorklund’s moving essay on her adoption exemplifies the dilemma we face whenever we try to give an account of experience, psychoanalytic or otherwise—a dilemma that marks in various ways the entire project of this book. Bjorklund had planned to write about her experiences as a lesbian analyst, but while she was preparing her essay, her adoptive mother died, an event that leads her to open a strongbox her mother kept, which contains documents relating to her adoption. She opens an envelope marked “Sally,” and finds papers indicating that she had “lost three mothers by the time she was three months old” (p. 7). This moment may be read as a kind of primal scene that disrupts the identifications that might support a cohesive, if ultimately illusory, narrative of identity. Indeed, the fragmentary state of the adoption record, whether written or spoken, often leaves the child, according to Bjorklund, trying to fit together the pieces of a puzzle that turns out to have no single organizing frame. Denied access to her origins when her birth mother refuses contact, Bjorklund feels her identity is defined by an internalized emptiness, shored up by little more than her certificates of professional accomplishment.
Bjorklund believes that her attraction to the work of psychoanalysis derives from both the longing for connection and the backdrop of separation that define her experience as an adopted child. Caught between desire and loss, Bjorklund must accept that the very words she uses to establish her place in the world bear the traces of her dispossession: “There was no one,” she writes, “who witnessed my experience from intrauterine life to being handed over to the fourth ‘mother,’ no one who could narrate it from the outside, to help me integrate it coherently” (p. 10).
In a painful variation on this theme, Deborah Pines’s essay takes us vividly into the shattering experience of a stroke, and its deep impact on her marriage, her family, and her career: “One minute I was able to place my feet on the ground, and the next moment, the ground had disappeared from beneath me” (p. 224). Her life now radically altered, her friends, family, and colleagues feel abandoned by her, even as she feels abandoned by them. Abandoned by her brain itself, she tells her story from the side of a groundless and overwhelming grief of her tortuously slow effort to reconnect. At one point “barely able to type a single sentence” (p. 230), Pines now writes with great pathos of her incremental gains in awareness, only ever retrospective, of what she had lost. The narrative is punctuated by phrases symptomatic of her lagging comprehension: “Only in retrospect have I realized. . . .”; “At the time I didn’t realize. . . .”; “now that I am able to see so much more. . .” (p. 228). The significance of what she has lost with her stroke emerges only later, by a kind of deferred action, which in turn triggers troubling memories of a childhood during which, unable to reveal her true feelings, she remained cut off in important ways from both herself and others.
The experience of profound loss links many of the essays in this collection, among them Bonnie Zindel’s affectionate account of her long analysis with Emmanuel Ghent—and her ongoing struggle to come to terms with his death. Relying on notes she had taken after each session with Ghent, Zindel wonders whether she writes in order to remember or to forget, to express her feelings or to freeze them, to grasp or to let go. In any case, she feels she has no choice but to write. With a poet’s eye for detail, Zindel conjures Ghent’s warmth, wisdom, and aphoristic charm, his unusual blend of nurturing support and creative challenge, his ability to crack open psychic enclosures, to facilitate a surrender to the unknown. Ghent has taught her that transformation entails a readiness to respond to the invitations of chance, a willingness to put systems of meaning at hazard. We learn that Ghent wrote Zindel’s first dream on “a 5 × 7 yellow index card” (p. 209). This curious image of dreams, written on index cards (perhaps stored in a file box?), is an apt metaphor for our conflicting needs for order and (creative) chaos, for flights of imagination and the stable ground of reality, for freedom and containment, for preservation and surrender. It is a paradox that marks Zindel’s essay as she struggles to recall, in order to let go of, what has been irrevocably lost: “How do I say goodbye when I never got a chance to say goodbye?” (p. 222).
Hillary Grill writes of grief suddenly reawakened when she learns that her patient Lara’s father has been diagnosed with a brain tumor, for her own father had died of a brain tumor some eight years before. The news plunges Grill into confusion as she struggles to distinguish Lara’s experience from her own. She initially has an uncanny sense of almost telepathic rapport with her patient, feeling that she fully understands what Lara is going through—but is soon taken aback to hear Lara say that she wishes her father won’t return from surgery. Lara’s blunt expression of rage and hate towards her father shatters Grill’s illusion that their experiences are the same, and breaks open a well of long-suppressed anger that Grill had sealed off when her own father fell ill and became more vulnerable, and so, better able to respond to her longings for closeness. Lara gives Grill “a second chance to mourn” (p. 185), helping her, in the course of a complex, mutually therapeutic dance together, to acknowledge the full range of her ambivalent feelings towards her father. Thus, Grill testifies to the benefits of working through her grief, but she also, like many of the writers in this volume who describe unexpected revivals of losses long past, implies that the work of mourning is ongoing, and even, perhaps, interminable.
In their joint essay, Noah Glassman and Steven Botticelli take us again into these poignant depths as they reflect upon their experience of gay fatherhood. Glassman writes of how their adopted son, who throws himself with abandon into the masculine rumble of competitive sports, stirs up dormant memories of his very different experience as a “girlyboy,” and all the attendant feelings of sadness, regret, loss, and even terror as he is forcibly recalled to scenes of childhood trauma. Like Grill, Glassman rediscovers his need to mourn, which, in his case, is linked to the many losses he endured as a gay boy denied welcome in conventional kinship groups. He recalls the attraction he felt as a child to the non-traditional families of comic-book superheroes. Fanciful tales of Superman and Aquaman gave him the sense of belonging he had trouble finding in ordinary life.
In his contribution to the essay, Botticelli writes of the way in which parenthood offers gay men, who often struggle with the transition from shame to pride, a “dignified” way of entering middle age (p. 169). But he explains that this “normalization” of gay life exacts a toll when it entails a sacrifice of sexuality and imagination to the conventional demands of parental life. Loss, for both Glassman and Botticelli, seems always to shadow the joy of having a child. And, of course, their experiences both as gay men and as parents complicate their work with their gay patients, as when Botticelli feels yanked back into his own past by a patient mired in the suffering that comes from long hiding in shame, as if it is a kind of punishment for his own happy life.
In an essay by turns funny, moving, and reflective, Eric Sherman describes his own experience of being gay, of his first attempts to have sex with a man, and of coming out, which he understands not as a single event, but as a lifelong process. From the moment he first managed to tell someone (a school counselor) that he was gay—“Well, in truth, I told my sneaker,” he admits (p. 113)—he has come to think of coming out not only in connection with his sexuality, but as an emergence from hiding that he practices more broadly both in his writing and in his work with patients. Psychoanalysis has become for him a means of helping people to address the contradictions, multiple self-states, and dissociations that hinder the passage out of secrecy.
Susie Orbach also understands her work, especially with girls and women, as an effort to facilitate both the passage out of secrecy, and the cultivation of personal and political agency. Orbach sees the roots of her work in her experience of secrecy as a child in an atheist, socialist, Jewish family, which included a blacklisted uncle, a father who undertook covert diplomatic missions to the Middle East, and a mother who kept chocolate orange slices hidden on top of a cupboard. Traversed by tensions associated with secrets both personal and political, this domestic space gave rise to Orbach’s interest in the deleterious power of things left hidden and unspoken. And so, as a psychoanalyst, feminist, activist, and writer, Orbach has dedicated herself to challenging the psychic and cultural taboos that impede personal growth and political change.
Several essays present fascinating stories of women whose lives and clinical work have been variously shaped by experiences of war, immigration, racial prejudice, and the Nazi terror. Galit Atlas writes candidly of her struggle to find her place when her home was falling apart under the impact of the Gulf War, the “hornet” of sexual desire, and the effects of Israeli prejudice against the Mizrahim, Jewish immigrants from the Middle East and North Africa. She recalls how her family felt obliged to disavow its Arab and Farsi heritage, and to embrace its “Jewish, Zionist, white identity” in order to assimilate—but Atlas cannot shed her sense of otherness, and ultimately “lock[s] [her] history in a suitcase,” leaves her parents, and moves to New York, “looking for words to create a narrative, to tell myself who I was” (p. 33). She comes to recognize, however, that we cannot grasp in any totalizing way the truth of ourselves, that our encounters with otherness, although they may lead to greater self-knowledge and inspire important personal growth, also force us to acknowledge a loneliness more existential than circumstantial, and to accept that underneath whatever makeshift homes we are able to piece together, we are all in an important sense essentially homeless, living on the border of what we do not know.
Chana Ullman wrestles with the challenge of living on this border, where she feels called to serve as a witness to unacknowledged trauma, and more generally to the otherness that often lies concealed behind glibly reductive empathic identifications. As an Israeli psychoanalyst whose parents endured the Nazi conflagration, who participated for several years in a human rights group that monitored the checkpoints controlling Palestinian movements in the West Bank, and whose daily work as a clinician draws her into depths of experience that resist easy translation, Ullman understands that to serve as a witness is to accept an ethical demand without limit. To be a witness, that is, is to accept that recognition must not assume reciprocity. It is a lesson powerfully expressed by her father, who, when she told him that a group of German analysts have asked for her parents’ forgiveness for what they suffered during the Holocaust, replies, “[t]ell them we recognize that they want our forgiveness” (p. 100).
Anna Ornstein, in a moving account of the development of her clinical subjectivity, makes a similar argument, insisting that the analytic literature on Holocaust survivors is full of diagnostic formulas and theoretical generalizations that obscure what is unique in the experiences of these patients. (In this connection, see Phillip Ringstrom’s interesting essay, included here, on what he feels is the overuse of the word “trauma” to explain forms of suffering that might better, and more modestly, be considered as failures to adapt to broken relational expectations.) The strong implication of this literature, Ornstein argues, is that all of these patients belong to a kind of psychopathological dead zone, trapped there by depression, profound regression, and forms of negative identity defined by an internalized void.
Her own experience is a powerful argument to the contrary. Growing up in Hungary in the 1930s and 1940s, Ornstein endured the rabid anti-Semitism that restricted her education as a girl, and that later fueled the mass deportations of March 1944, her imprisonment at Auschwitz, and the annihilation of most of her family. But despite the overwhelming impact of this destructive violence on her life, Ornstein wants us also to recognize as part of her story the resourcefulness, the will to endure, and the embrace of cultural and familial values that allowed her to sustain a hope for new beginnings. It is not surprising, therefore, that she would be drawn to the work of Heinz Kohut, whose developmental theory emphasizes the reparative power of affirmation and identification with an idealized other. Ideals, to put it simply, allow us to overcome rupture, and to reclaim hope in the future.
Michael Eigen, in a wonderful anecdote drawn from his consultation with D. W. Winnicott, captures a central dilemma that appears in these and other essays in the collection, the dilemma of how to stand as witness to the experience of others without reducing this experience to the terms of one’s own narcissism. As he struggles to convey to Eigen something about his clinical method, Winnicott finally hits upon a memory of a patient who “tried to center his image in a hand mirror” (p. 128). In response, Winnicott leans over, sees that his face is a bit off center, and moves to center it. He immediately knows that he has made a mistake, and has done so because he was unable to tolerate his patient’s need to keep the image of his face off-center. This remarkable scene may serve to remind us of the role played by the blinding power of our imaginary identifications in our efforts to understand the other.
The essays by Joyce Slochower, Irwin Hirsch, and Kenneth Frank offer a neat triptych on how authoritarian aspects of the training experience affect the development of analytic style and subjectivity. Slochower tells of her struggle to discover her own professional idiom amidst a confusing array of influences, including her upbringing by Freudian analyst parents, experiences of dogmatic supervision both Freudian and interpersonal (“This is not psychoanalysis!”; p. 39), and the multiple perspectives on treatment now available as a result of challenges to traditional notions of analytic authority, objectivity, and certainty. Analytic identity, she argues, is the expression of an evolving negotiation, carried out in a complex dialectic of identification and repudiation, with the “psychoanalytic other.” She well recognizes that her personal history has led her to prefer theoretical models that emphasize empathy, but also acknowledges that her clinical deployment of theory reflects a constant effort to manage, sometimes therapeutically, sometimes defensively, her encounter with the protean forms of otherness.
Kenneth Frank, who nearly 40 years ago published an anthology of essays similar to this one, traces the path of his career from his early years in training, when, inexperienced, anxious, and pressured by expectations regarding proper technique, he learned to keep a low profile, to retreat into hiding, giving himself cover with the classical rule of analytic anonymity. He comes to feel like a “poseur,” however, playing a role at the expense of true authenticity. Fortunately, he reaches a turning point in a second analysis, which allows him to blossom. He begins to write and becomes a co-founder of the National Institute of Psychotherapies (NIP). Leaving behind the oppressive influences of his training, Frank now moves with ease among his many roles at NIP, and has become much more open and playful with his patients. It is telling that his office is both a professional and a personal space, for it doubles as a family room in his own home. Here patients discover important aspects of Frank’s personal life—his books, his art, his pet dog, and his collection of orchids and African violets. This alone is enough to suggest the nature of Frank’s clinical style, which he says is based upon “a willingness to be known” (p. 79), and a conviction that whatever we might call “technique” is useful only in the context of a collaborative, real relationship.
Irwin Hirsch’s bracing essay stands in striking counterpoint to Frank’s. Where Frank was shy, tentative, and uncertain of himself, Hirsch confesses to having been oppositional, confrontational, and negative in response to the prevailing trends in his training. Hirsch doesn’t mince words. He considered the psychiatrists associated with the Veterans Administration where he worked to be “either totally incompetent bureaucrats or professional bottom-scrapers who used tyranny to compensate for their inadequacy” (p. 53). He admits to having been too contemptuous of therapeutic approaches deriving from Winnicott and Kohut, which he felt were “overly nurturing and infantilizing” (p. 58). He has little patience with “the ruling class” in the field, and does not hesitate to let this be known. This proclivity gets him essentially expelled from the NYU Postdoctoral Program. Hirsch has learned over time to tone down his bristling negativity, which he now views with some regret, but it is clear that his passion for speaking his mind is rooted in a view of treatment that assumes the primacy of relationship. His clinical work is based on the conviction that “emotional problems and personality formation have little to do with inherited biology or neurology and everything to do with the history of internalized relations with key others, and the unconscious repetition of these patterned configurations” (p. 52).
A number of these essays, including those by Eric Mendelsohn and Steven Kuchuck, exemplify those moments in analysis when the professional relationship is suddenly and uncomfortably disrupted by the intrusion of personal events. For Mendelsohn, it was his separation from his wife, an event both “painfully private” and “painfully public” (p. 192), which leaves him “dislocated, wrenched from what is familiar and catapulted into spaces that feel new and not yet “known” (p. 194). For Kuchuck, it was his discovery that his patient is dating his own best friend. This chance event plunges him into conflict over whether or not to disclose to his patient what he has learned. Caught in the whirlwinds unleashed by these events, Mendelsohn and Kuchuck each struggle to manage the disturbance in the analytic space, but each recognizes that there is no “technical position” (p. 198) no “rudder” (p. 136) to guide them in making their clinical decisions. Mendelsohn feels that “there is simply too much to keep in mind” (p. 194), whereas Kuchuck feels pulled in every direction by the echoing voices of his analyst, his supervisors, and other professional ancestors.
It is surely a measure of how much has changed in the field that we are rather startled, in the closing chapter of this very “relational” collection, to hear the late Martin Bergmann, the only Freudian in the chorus, discuss his cases in the language of id, superego, and Oedipal conflict. But he offers an absorbing, at times lyrical account of how he and his practice have changed over the course of a long career—he was nearly 100 at the time of writing—and of what it is like to practice in the shadow of death. Perhaps because he is now looking back on his career with an equanimity gained only after long struggle, Bergmann exhibits little of the anguish, strife, and confusion on display in so many of the other entries in the book. He suggests as much when he tells us he once joked with a colleague, “We analysts can never retire; it takes us so very long to become any good” (p. 243). This simple truth provides an apt coda to this rich collection of essays.