A wintry village
I (Fosshage, 1999) have selected an analysand and an analytic process transpiring over a course of 15 years and intermittently over another 5 years. More than 25 years ago, I received a phone call from a male analyst colleague. I will call him Jay. I did not know him well. He was a man in his early 60s. In my brief exposure to him, I had experienced him as bright, outspoken, and argumentative. Jay told me that he had fallen in love with an analysand of his. After consulting with his former analyst, he had decided to tell his analysand of his feelings for her and his desire for a social romantic relationship with her, and shortly thereafter had terminated the treatment. At his invitation, she began to live with him - four days after the termination. Three weeks later, they agreed that she needed an analyst and I received the call. Recognizing that this was a highly unusual and problematic situation. Jay, implicitly expressing his trust in me, inquired if I would be willing to see her in light of these circumstances. I told him that I would see her and suggested that she call me. He informed me that she was right there and put her on the phone. With a clear voice, she expressed in an enthusiastic and straightforward manner her desire to see me, whereupon we scheduled an appointment.
Comment: “With a clear voice, she expressed in an enthusiastic and straightfoixvard manner her desire to see me ” represented what I came to understand to be one dominant underlying affect state of Samantha. In this instance she was feeling hopeful and enthusiastic about seeking psychotherapeutic help.
Several days later, I saw Samantha. Samantha, a woman of 37, spoke well, was quite attractive, dressed in a casual, trendy manner, and demonstrated a charm and outspokenness. Her outspokenness, however, carried a tension that I sensed was part of her battle to overcome what had been experienced as squelching influences. Her mood was quite elevated. She was “flying high” and clearly in the thrall of an idealizing love of her former analyst/ now boyfriend. I sensed that her elevated mood was not only related to the initial stages of “being in love,” which commonly includes a mutual selfenhancing idealization, but also to a somewhat strained, yet valiant effort to overcome anticipated criticism as well as, perhaps, ambivalent feelings of her own. I liked her, felt interested and engaged, and wondered where our work would take us.
Comment: “I” refers to the analyst and principal author here and “we ” refers to the three authors of the book commenting, highlighting the implications for the three developmental pathways, underlying affect tones, and analytic ambiances that we are illustrating. I responded to Samantha’s enthusiasm with my own enthusiasm, cocreating a dyadic ambiance of liking each other, of mutual interest in one another, and of a mutual anticipation that we could work successfully with each other.
Samantha’s first treatment experience, she explained, occurred some years back when she was going through marital difficulties and, subsequently, a divorce. She had married in her early twenties and divorced three years later. Her therapist was a “Freudian analyst” who had known her family. She critically described him as “cerebral, un-empathic, detached, and unnurturing” - what I took as warning signals of what I should not be, and most probably, I thought, resonated with previous trauma. Experiencing the analyst as too close to her family and too removed to trust, she ended up “manipulating him in orchestrating the sessions to amuse him and to avoid certain areas.” Terminating after two years, she exclaimed to me, “I was fucked by him,” for she felt “blamed by him” and ended up feeling worse.
Approximately ten years later she sought treatment with Jay. At that time she was feeling profoundly depressed and periodically suicidal -what I subsequently realized was another underlying affect state, that is, a self-state dominated by conflict, anxiety, and depression, including negative views of herself, fury, and hopelessness. She said that she was conflicted “between what I was bred to be and my inner integral self...My inner self had been squashed and wants out or I will die.. .1 was the perfect child - forget it -1 am not the repressed, elegant Swiss-German girl.” She had been taught “to control [her feelings] cerebrally.” As a result, she felt “an Amazon woman in me emerging that was previously smashed.” She had entered into analysis with Jay on a 4-5 times-a-week basis and began to take Prozac. The analysis lasted for six months.
Comment: In her initial session Samantha was clearly intent on emphatically describing how her parents had not seen or known her “inner integral self” (in our language, authentic self). Instead, her parents had imposed upon her their image of a “repressed, elegant Swiss-German girl.” To maintain the attachment and secure affirmation, Samantha pathologically accommodated (Brandchaft et al., 2010) to her parents’ attributions and requirements to become “the perfect child”; yet, she was quite aware of an intense defiance - that is, “an Amazon woman” ready to emerge within her. This psychological battle between accommodating or fighting her parents ’ attributions intensified Samantha’s aggressive affect tone of rebellion and defiance. Her parents were quite successful, especially her father, which required defiance in an effort to claim herself. The family battle, along with her parents’ excessive expectations, undoubtedly encumbered her efforts to establish a career that belonged to her.
Based on her report, Samantha quickly became intensely engaged in the analytic work with Jay, fostered by her feeling deeply understood for the first time in her life. With the establishment of an idealizing and mirroring selfobject connection, her spirits lifted and medication was discontinued. Clearly the analysis had gone well until the analyst’s needs more directly entered the scene. She described how they had become very close, expressing their affection for one another. She recalled hugs at the end of the session, initiated by Jay. His occasionally giving her a ride home after a late-night session was somewhat confusing, yet it was experienced as part of an increasing closeness. Jay, who had been divorced for some time, then told her that he loved her and that he wanted to stop treatment and marry her. She responded positively, for she had never felt so understood or deeply connected to a man. They terminated the analysis and, very shortly thereafter, were engaged to be married.
Samantha and I had connected easily during the first session. Although I was well aware of Jay’s breach of ethics, I was most concerned about Samantha’s welfare. I did not report Jay, for it would have precluded Samantha’s analysis. I knew that Jay’s analyst was informed and carried the ethical responsibility. My priority was to protect a safe space for Samantha’s analysis. I decided not to express concern to Samantha about what had happened. Samantha was “in love.” Any hint of concern, I felt, would have evoked aversion in her in the service of protecting her love connection with Jay, foreclosing self-reflection and the expression of other feelings. I overcame temptations to prejudge the situation by reminding myself that I did not really “know” whether her relationship with Jay might work, as on rare occasions such relationships have succeeded. I believe that my openness to this possibility facilitated my listening closely to Samantha’s experience and to her feelings and assessments - that is, to listen from within an empathic perspective - that helped her “find” herself.
Comment: In light of what she had already said about a core conflict between her integral self and how she was bred, which left her authentic self unrecognized, I was quite aware of not wanting to impose on her yet still another judgment and agenda. In addition, “to know” another person requires understanding from within the other person ’s perspective (empathic listening), and at the moment she was “in love,” despite the problematic context.
Based on her initiative, we decided to meet on a twice-weekly basis, because, in addition to financial limitations, I believe we both felt that she did not want to jump quickly into yet another intense analytic relationship.
During the next session Samantha spoke about how her older brother had been killed in a car accident more than twenty years earlier. She was the only remaining child. Nevertheless, she focused primarily on her relationship with Jay and how her parents were distressed about him. Samantha described her parents as “cerebral, controlled, intellectual, and scared.” Her father had sarcastically quipped, “A patient marries her therapist, every woman’s dream!” He saw her as an “invalid daughter” who needed to be taken care of by a man - a powerful, disparaging parental attribution. Her mother was also critical and gave Jay what Samantha described as “a manipulative dose” during their first meeting, saying “You must have a pick of all your patients.” Samantha was, unfortunately, all too familiar with these undermining comments in the face of “bad behavior.” Shaken by her parents’ skepticism, it became even more imperative that she hold steadfast to her love and commitment to Jay.
Over the next six weeks, Samantha spoke about her inner experience, especially using her dreams and imagistic symbolic processing to create a narrative and deal with intense, dramatic conflict. What could not find explicit expression without jeopardizing her parental connections, her fragile state of mind, and her efforts to express and regulate her affects, erupted in her dream life. The first dream she reported, after four weeks of treatment, was as follows:
I’m an oriental woman; her skin is white, her hair dark, wearing no clothes. The sky is pale - it’s very quiet. There’s a big dune with white, fine sand. I was at the crescent of the dune to see the ocean - one place I have peace. At the bottom of the dune were two oriental children -small; they were dead. They were laid out on their stomachs facing the ocean. They had died because they had been thrashed on their backs with a huge bouquet of small pink roses. I had also been thrashed on my back.
I repeatedly went up to the crescent of the dune to see. The children changed. One time it was me and my brother - one time, my parents. I’m hurting them in my will to grow.
[She comments outside the dream] I did not intend to hurt others. Sometimes they were my children that I never had. I woke up with my body taut, like there were vultures going to pick my bones.
In our ensuing discussion, Samantha mentioned how, at one point during the previous Fall, she was feeling deeply suicidal; she developed a welt on her back and had a dream that her mother had put a knife in her back. Here, in this dream, the pink roses delivered the fatal blows. “Flowers were given in the name of love,” she described, “but they persistently killed me, brutalized me, controlled me. They did something so beautiful but deadly.” She spoke of two sides of herself: “What I was bred to be and what I am inside...I can’t bring the two together.” For her, to grow, to live from the inside out rather than from the outside in, was tantamount to hurting, even killing her parents for they had been so invested in creating a child in their image. She could find moments of peace fully exposed at the “crescent” of the dune overlooking the ocean, but below her lay the small dead children who had been killed. She ends up terrified of vultures. Retrospectively viewed, these core issues framed much of what was to come.
Comment: Gradually, Samantha’s life story unfolded during these first few weeks, but in an unusually piecemeal fashion. Her elaborate dreams would often bring up pieces that would then be filled out. While highly articulate in person, her waking narrative about herself had not yet become all that coherent. It was full of dissociated fragments. Her intense conflict between her own perceptual, affective, cognitive experience - that was “her" and could serve as a self anchor - and her parents ’ imperious expectations and wishes interfered with her striving for and consolidating a more cohesive, authentic sense of self. Consumed with these conflicts, and her parents with theirs, Samantha’s relational experience had not created the needed space and inner quiet to reflect, nor to form and articulate a more coherent picture of her life. Hence, even the following brief summary could only be constructed over a considerable period of time. I believe that her own narrative had been disrupted by her parent’s imposition of their narrative, which was replete with attributions that were either denigrating or full of grand expectations.
Her parents’ grand expectations were intimidating and left her prone to feel insufficient, a failure.
When Samantha accommodated her parents, she would become momentarily depressed with feelings of capitulation, of losing herself, of “badness," and hopelessness about impacting her parents - a self-state with underlying affects that would take over. With increased understanding of her upset, she felt fortified and would resiliently reassert herself.
Samantha’s father was highly successful in the arts and her mother was well educated, musical, and worked in publishing. Swiss-German in origin, they raised their family with strong interests in education, music, and culture, and strong values for hard work, compunction, and dedication. Rules, regulations, and achievement were the order of the day. Samantha often experienced her mother as hysterically and intensely talking above her and at her. Her mother’s quick temper and rages emerged a bit later in treatment. Samantha portrayed her mother and father as tense and busy people who insisted that things were to be done “right.” While tension was often in the air and expressed loudly, there was little room for reflectively relating emotional experience.
Analytic sessions became the place where she could express herself, aggressively assert herself, and find the necessary reflective, calm space to articulate herself.
Comment: In the family, fighting was routine between parents, between parent and child, and between children. Disruptions were not reflectively talked about and resolved in the family. Instead, self-injuries triggered rage that, in turn, undermined possible repair. Similar to their parents, Samantha and her brother, older by four years, fought intensely. Unable to open up the emotional tension to ferret out its meaning, her father finally nailed shut the door that adjoined their two rooms.
Samantha had experienced her family as ricocheted with tensions; yet, she had pride in her family. She was raised to be the perfect model child, the elegant young woman. While success on this front fostered the development of some confidence in her intelligence, attractiveness, and style, she seemed to realize that, in response to her parents’ powerful agenda, she had been forced to subjugate all too much of her own perceptual and affective experience. She continued to wage a terrible battle between “who I was bred to be and who I am inside.”
Comment: While her parents ’anxieties and impositions interfered with Samantha’s desired development of a successful intimate relationship and interfered with her career pursuits, her parents’ intelligence, success in the arts, and style certainly contributed to Samantha’s artistic style and interpersonal confidence. Her parents’ work ethic and success in the arts also opened up areas of interest and kindled ambitious desires and plans. Samantha first developed as a serious ballet dancer and later turned to writing as a career. So, the arts ran strongly within her and her family. Her parents’ expectations, judgments, selffocus, and the loss of a young adult child played havoc with her establishing her career (pathway for mastering the environment). Initially through ballet dance and, later, through focused exercise, Samantha has always been attentive to physical care and regulation.
A major tragedy befell her family when her brother was killed in a car accident in his mid-twenties. Her parents dealt with the tragedy by shutting down emotionally. They did not talk about her brother. It was as if he had never existed. Soon thereafter, they sold their beloved beach home where, for many years, and close to nature, they had lived more fully as a family. The loss of her brother, the further loss of emotional connection to her parents, and the loss of the valued beach home wreaked emotional havoc in Samantha.
Comment: While Samantha’s parents had accomplished and created a cultured family with considerable positive experience, they had great difficulty in dealing with emotional tensions and traumatic losses. At those times, anxiety, tension, and rage dominated the scene (that is, a low threshold for negative affects had been established) with scarce resources for reflective processing. The underlying affective tone was a deep anxiety that life was overwhelming and overtaxing. Samantha would often feel taken over by this anxiety. As we understood its source, the analytic sessions served to create the needed calm and reassurance that the issues could be managed. Analysis became a much-needed reflective harbor.
Her dreams, long and complex narratives, were often desperate attempts at trying to deal with these traumatic losses. A small portion of her second dream clearly tells the story:
I am at the age I was then, but also now. We are selling the house. A couple comes to see it. It is very important to me that they are a couple that understand the house. I don’t think there is such a couple. D, T (my parents), and I have spent all this time getting the house in shape in order to sell it. All of our hearts are full of grief. Each one of us does not want to give up the house for our own reasons, but we cannot communicate to each other what those reasons are. We are each locked in our own grief and sadness and led by this pain to pass judgment on ourselves and each other. We stand in judgment on ourselves and assume the rest of the family will also. We proceed to follow the correct “form” of what apparently needs to be done: getting rid of the house that reminds T (mother) of my brother. We follow her lead because she is so unhappy and make the explanation that the house is too big to maintain and therefore must be sold.
Meanwhile, during the first two months of treatment, Samantha’s relationship with Jay began to deteriorate. In contrast to the careful listening and understanding that had occurred in the analytic relationship, she began to experience him as controlling and demanding, with little regard for her wishes. She thought of herself as being a very sexual person; yet, she found Jay to be disrespectful and sexually controlling. He reacted to her objections and assertions with rage, which was all too reminiscent of her family. Samantha began to feel that she had given up too much of her life, a feeling that resonated deeply with themes of the past. She had a nightmare in which she was married to Frankenstein - it was Jay. She was trying to escape. In the dream, he and she were both malformed. Not only was this now her experience of Jay, it also reflected how for years she had thought that something was wrong with her. Now, in the ensuing throes of a rapid and unrelenting de-idealization, she began to see Jay as an older, lonely man who was desperately self-focused and controlling. Moreover, he was defensive and unable to reflect or talk about their deteriorating relationship. In turn, Samantha became horrified and ashamed about how she got into this situation. Recalling her analysis with him, she felt that when she had begun to express her sexual feelings, Jay had encouraged detailed elaboration of them. She realized that at times he had become sexually aroused. Subsequently, he began on occasion to respond with sexual overtones. She had responded in kind, which now horrified her. Yet, the ingredients of her response - feeling affirmed and understood, sexual excitement, intimacy, and capitulation - could still not really be assessed. Instead, her distrust and sense of betrayal, rage, and shame became increasingly intense. Within two months she had broken off the relationship, despite his angry protestations, and returned to her apartment.
Her experience of Jay’s abusive imposition and betrayal resonated with experiences from her past. Gradually, it emerged that her brother had made sexual advances and a trusted neighbor had insistently come on to her as an adolescent. Physical abuse occurred with her mother who, in rage, would strike out at her, slapping her face and “beating the shit out” of her.
Comment: In her relationships with her parents a sense of betrayal in the form of criticism and the imposition of their agendas pervaded. Physical and sexual abuse repeated the theme of domination and not being seen. Compliance or defiance dominated the scene.
Over the next four months, Samantha felt increasingly angry at Jay’s betrayal and manipulation of their trusting analytic relationship. She felt abused and victimized, and harbored deep shame about her involvement. She finally decided to sue him, which for her was an attempt to reassert herself, to impact him, to overcome the sense of victimization, to become a “doer.” Her lawyer asked for my participation. In considering the potential repercussions of this with Samantha, not the least of which was the potential for the suit to dominate the analysis, I emphasized the importance of protecting our analytic relationship. I also knew that the analyst in the courtroom is easily discredited as biased, leaving little to be gained from my direct involvement. While I was well aware of the importance of my support of the suit for Samantha, with her agreement I declined to participate directly in it. Later, she expressed her gratitude. At her lawyer’s request I referred Samantha to a psychiatrist who provided a psychiatric evaluation for the suit. After negotiations between the lawyers, Jay threatened violence against her and her attorney. Shortly thereafter, she agreed to a pretrial settlement with financial recompense, which provided some satisfaction along with a sense of retribution.
The experience with Jay had been traumatic, with considerable fallout, including destabilizing her trust of the analytic relationship. Could she really trust an analyst again? Could she trust a man again? She vowed never again to have sexual feelings for her analyst, which was clearly directed at me, for she felt that I, too, would be unable to contain them and would become stimulated and betray her. She felt threatened by an analyst’s power as well as by her own seductive capacity. She wrote,
I cannot accept that I allowed this to happen to me. I cannot understand that I was a victim. I cannot come to terms with my participation in this relationship...! feel violated, ashamed, revolted, helpless, sickened, furious, bereft, betrayed, abandoned, fucked, raped, abused, disgusted. I feel trapped by the trail of abuse and betrayal he has left in me. I feel unclean, unwhole, completely compromised. I cannot accept that I was helpless and powerless to act otherwise at the time.
While her compliance and victimization felt intolerable, her sexual response and active participation was equally unacceptable.
Comment: When distrust was in the foreground in the analytic relationship, I attempted to live in and explore her experience of the analytic relationship. We explored her experience, what we have referred to as the attributions of the transference (Lichtenberg, et al., 1996), to understand them in light of whatever triggers might have occurred between us. I understood her attributions to have been cocreated, through my contribution and through her anticipation or construction based on her lived experience in her previous analytic relationship and her parental and familial relationships.
Despite her wariness, Samantha appeared to experience me usually as protective and caring - hallmarks of an idealizing selfobject transference - which corresponded with how I felt toward her. She increasingly experienced me as “solid” in a way that helped to reassure her that our relationship would not get out of control, a fundamental prerequisite for our cocreation of a new relational experience where new expectations are learned. During this phase of the analysis, selfobject relatedness, for her, was in the foreground, and, for me, my “caretaking” or being concerned with her formed a reciprocal relationship (Fosshage, 1997) with her idealizing selfobject needs. This created a particular kind of closeness, similar to a father with a young daughter, that was satisfying to both of us. To experience me as a person who would have additional needs, however, was, at this juncture, a powerful trigger of terror. She dreaded that she would again be exposed to betrayal, domination, and abuse. Hence, her experience of me during this time, we learned, needed to be circumscribed around my “caretaking” efforts in order to cocreate the requisite safety and protectiveness.
Comment: Our consistent reflective processing of disruptions that were triggered within the analytic and outside relationships was creating a new procedure for reparation (through understanding the triggers and each other’s contributions). It was also gradually lowering the threshold for positive experience and was deepening a fundamental cooperative, trusting connection (that is, trusting that I honored her initiative and was not attempting to impose my agenda or understandings on her).
In the work arena, Samantha had given up a full-time position with a company in the arts where the corporate structure was experienced as oppressive and her boss was intrusive and controlling. She freelanced but struggled financially and suffered from a lack of career direction. She wanted to write but lacked confidence and had not been able to sustain a consistent effort.
In the course of the analytic process that ensued, Samantha began to deal with memories and with her affective life that had been frozen off (dissociated). Her dreams, which expressed her imagistic giftedness, were excruciatingly long and painful. As she wrote them, painful memories emerged. I have selected small portions of one dream that occurred approximately 14 months into treatment. The dream opens with Samantha on the beach watching the surfers play in the late afternoon. She must pick up her father and begins to worry that she will be late and be accused of being irresponsible. She writes:
I am on my way again to my destination. However, I am angry and feel I am “behaving” obstreperously. The surfers have gone, but have left their surfboards behind, standing in tumbles next to the pier. I can see the fish hooks in the sand and the fishing poles beside them. The hooks stick out from the surface of the sand. I sit and look at them first, and then very decidedly walk towards them, all the do’s and don’t’s and restrictions, regulations, controls, musts, have to’s, shoulds, always, never to, and will now do’s, given to me by my parents are ringing in my ears as I walk across the beach. I want to touch this dark blue surf board, it sits, fin facing me, the underbelly of it slightly worn down, the color rubbed slightly away from being pulled across the sand after being in the water. It’s like a blue finned whale. I walk across the fish hooks and feel and hear the hooks puncturing my skin, and curving into it, and out on the other side. I don't care. I must reach out and touch that blue board. I feel the pain of the hooks, but am disembodied from it at the same time.
In her undaunted effort to touch the “blue surfboard” that reminds her of a “blue finned whale,” she initially found it necessary to “disembody” herself from the pain of the impaling fishhooks. Later in the dream, she begins to feel the excruciating pain as she tries to free herself from the hooks. She knows that her parents will reprimand her. There is a concert that night, and she realizes that she has ruined their evening for they will need to take her to the hospital to have the hooks extracted. What stood out for us in our discussion was what placed her in jeopardy: her need to touch the blue board and to feel its beauty, despite the exposed fish hooks, and the need to defy her parents’ agendas, constant admonitions, and prohibitions. Her parents would not be sympathetic; they would be furious with her, reigniting the desperate struggle to find, in spite of the danger and in defiant reaction against her parent’s dictates, some beauty, some freedom, some peace as captured in the image of the dark blue surfboard. The blue surfboard was a powerful image for Samantha, capturing her desire for freedom of movement, for gliding with nature, for peaceful existence and beauty, as a way of creating a sense of agency and an enlivened affective experience. It was a solitary experience of enlivenment.
As she wrote this dream, traumatic memories burst into her awareness -having been hit by a car and then having been hit by her enraged mother; of being called to dinner, forcing her to leave her cat to die alone; of her broken arm, which her parents did not immediately take care of; of not being told the truth before she underwent dental surgery; of not being told of her brother’s death for eight hours after he was killed; and of her father’s screaming at her when she saw him naked when she was 11 years old -“the shame he made me feel.”
Comment: Her intention and determination to reach the freedom of the surfboard, “her destination,” still required painful, even dangerous, defiance of her parents’ agenda. With the lessening of her dissociation, she was able to feel the pain more fully and to recall the traumatic memories. As long as the pain was completely frozen (dissociated) we had not been able to deal reflectively with the pain and integrate the trauma.
Close variations of a dream, which had reoccurred over the previous 14 months, involved her checking her room before she and her parents leave the beach house after the sale. She finds the drawers and closets are full. She writes,
Everything I own, memories signified by my belongings, tumble, tumble out into my arms. I am always the last. Everyone else is pulled together. My parents appeared, or have denied, not to have any difficulty in leaving. This time they are on the ferry line, and I sit overwhelmed in my room finding more and more things to take with me.
I have already been chastised for having so many bags. The rest of the house looks like a museum -1 just wrote mausoleum. Only my room is chaotic or alive.
We understood that, on the one hand, she was laden with memories that needed to be sorted through, and, on the other hand, she was desperately trying to recapture and to hold on to the memories that could provide a sense of stability and self-continuity. Yet, in the face of her parents’ denial, impatience, and fury, she always felt in a panic. Panic became another underlying affect state - panic that her parents clearly experienced and were overwhelmed with. Samantha felt that she did not have the time or the parental help to sort through her belongings one by one, to assess, to reflect, to tarry, to keep them with her or to discard as she desired.
As Samantha dissociated less, her inner world of intense conflict and painful memories emerged more fully, at times becoming excruciatingly terrifying. She experienced powerful urges to jump out her 10th’ floor apartment window, which we came to understand was jumping out to “freedom,” free of the expectations, the restrictions, the inner turmoil. She became terrified, and I became deeply concerned that, at the height of pain, she might impulsively go for this last-ditch effort to end the intense suffering. Medication was prescribed, but the terrors of abuse and being taken over continued. I was seeing her four times a week and speaking with her on the fifth day, trying to create a sufficiently safe haven for her to express, contain, and understand her terrors. While she typically turned to me for safety, support, and understanding, when the paranoid fears became most intense, she became fearful that I, too, would torture her or attempt to control her for my own purposes. During one poignant moment when she was curled up in a ball on the chair and sobbing, feeling utterly helpless and hopeless in dealing with these terrors, I happened to tilt my rocking chair ever so slightly forward. Startled, she placed her hands up on the wall as if trying to climb to safety. I had a sense of a little girl being physically beaten and having nowhere to turn but to the wall. I calmly described the events that had just occurred and how she appeared to feel so unsafe and terrified. When she was calm, together we spoke about the power of her fears and of their relational origins.
During this particular period, however, her suicidal terror, her impulse to jump to freedom, intensified. Because she was living alone, we agreed, to the relief of both of us, that she needed a hospital to create a sufficiently safe place in which she could experience all of the emergent terrors and not feel all alone, but safe, so as to integrate her previously dissociated affects and memories. As part of this reintegration process, she needed a place, unlike a private office setting, where she could scream out the full intensity of her terror and rage.
Comment: Our dyad was serving as an oasis in a sea of dangerous turbulence, and the respect we each had for the initiative of the other allowed Samantha to participate as a partner in our cooperative effort to consider hospitalization. In terms of the incident in the office, Samantha, using her prior lived experience of danger and abuse, predicted my rocking chair movement indicated an incipient attack. Based on my lived experience with her increasing trust in me, I predicted my gentle description would facilitate her calming - which involved repair and restoration of the relationship - even after such a powerful disruption.
Fortunately, I was able to find a private hospital that at the time had one floor with a psychoanalytically oriented staff. She stayed there for a month and worked with a psychologist who, serendipitously, reminded her of me. The hospital served to provide her with the safety needed for her to experience the full range of her terrifying emotions and memories. She screamed her fear and her rage. She would cower in the corner, sob - and talk. At the hospital she had individual and group treatment, phone sessions with me, and the camaraderie and support of other patients who felt much of the same. All of these supports cocreated a sufficiently safe place, a holding environment (Winnicott, 1965; Slochower, 1996), in which to feel, express, and contain her terrors and rage.
During this period Samantha became terrified of her parents and refused to see them. She had remembered and recognized what had occurred in her family. Toward the end of her stay, she was prepared to see her parents, and she invited them to visit. Her mother, however, declined, ostensibly due to other commitments, and the meeting did not take place. Samantha was enraged, and this time expressed herself more assertively to her mother.
When Samantha was discharged, she was fragile, but stable. The terrors had diminished and we proceeded with our analytic work. One year down the line, she anxiously, yet with a sense of triumph, discontinued her medication. Over the next several years, the terrors subsided and our work took on a more even tone. Samantha dreamed:
I was taking a math class. Realizing that I needed help, I went back to the professor, who was kind and non-judgmental, which reminded me of you.
He spoke to me quietly, calmly, and my panic subsides. I still do not understand how he explains the process of finding the solution, but at least I feel less frustrated and isolated. He does an entire problem for me, from beginning to end on a page; he writes out all the short steps along the way, leaving nothing out. I watch him write - it is very comforting. He tears the page from his pad. When he is done, he hands it to me. Now I feel I have a way to follow, a frame of reference for the next problem I will be given. I leave feeling relieved, less scared, less frustrated.
In Samantha’s dream she envisions a protective, idealizing selfobject relationship in which the analyst is calming and knows how to solve the problem, providing a roadmap for the next problem she’ll be facing. She easily related these qualities to her experience with her analyst.
Comment: Working cooperatively together with a protective, older male, which made her feel “less isolated,” and sharing moments of enlivening experience were evident both in the dream and in the analytic process. Her dream rendering of the professor’s skill in meeting her precise needs draws on the child’s awe and admiration for the caregiver who knows just what she needs to be successful in carrying out an intention. The affectively laden sense of competence and safety emerging from learning new procedures for dealing with life’s problems, in turn, gradually raised the threshold for negative experience and lowered the threshold for positive experience and reduced the potential for panic.
Not working steadily and living alone, Samantha began to feel isolated and in need of more connections with people. She had particularly prized the groups in the hospital where she could just be herself - unlike what had been her usual experience in life. I suggested that she join one of my analytic groups, and she did. Group therapy became a place where she could practice being herself and speak her mind.
The themes of feeling judged, controlled, and imposed upon, as well as distrust of others, all entered the scene at one time or another.
Moreover, she became acutely aware of how she, now identifying with parental attitudes, could become the judgmental, controlling “Swiss-German good girl” who imposes her agenda on others. On a number of occasions, the therapy group became the threatening, problem-ridden family and she wanted out. These issues were reworked time and again. With an increasing sense of agency, of doer doing, and evolving selfdelineation and freedom, Samantha increasingly was able to respond empathically and perceptively to others, and her relationships - and our relationship - deepened.
Her relationship with her parents changed dramatically. A joint session with her mother facilitated communication. Samatha spoke far more directly and assertively with her parents. She skillfully extricated herself from her parent’s attempts to use her in their power struggles. Once, her mother tried to give her an art object of her father’s. Noticing her father wince, Samantha objected that her mother had not asked him, and turned to her father and inquired about his feelings. As she was able to hold her own with them and not feel overwhelmed, she was better able to accept their limitations and to receive what they had to offer. In turn, her parents appeared to become more often directly loving and supportive.
Comment: Samantha was able to help her mother and father reflectively process feelings that, in this instance, averted a possible disruption between her parents when her mother took action that was potentially injurious to her father and that might have evoked a rage reaction. A dynamic systems perspective would predict that as one member of a family changes - in this instance, Samantha - it might alter the family system and lead to change in the other individual family members. In addition, she was increasing her capacity to predict her own reactions as well as those of others - mastering intimacy.
Samantha began to date again. She seemed to have little difficulty in meeting men and in becoming romantically involved. She became more aware, however, of her tendency to rush into passionate sexual relationships with men before she had developed more a fundamental emotional connection. Gradually, as she became less expectant of being controlled and terrorized and, in turn, more willing to risk emotionally exposing herself, her relationships with men deepened.
Comment: Samantha was becoming able to attach in more complex ways: she was less frozen and more affectively present. Using more balanced sensuality' and sexuality, she was now able to forge a more lasting romantic connection. This contrasted with her previous attempts to enter into attachments more or less exclusively through sexual passion. Her balanced sensual/sexual connecting with men, along with a reduction of anxiety, was more in keeping with social normative expectations and enabled her to cocreate more easily shared enlivening experiences.
After four years of analysis, Samantha had improved considerably. She felt much better about herself, and more alive. Her affective experience was more available to her and more manageable. Her trust in me had grown immeasurably, and she was becoming more expressive of affectionate feelings for me. At the end of one session, she inquired at the door if it would be okay to give me a hug. She said that she was feeling close and wanted to thank me for hanging in there with her. She initiated the hug; with affection I received her hug and hugged her back - something that is comfortable for me when it feels as fitting as it did at this moment. For both of us, this was a poignant hug that powerfully communicated trust, affection, and gratitude. I was particularly struck by it, for, as we discussed in the following session, it was an expression of her trust that neither of us would misinterpret the hug. It was like a watershed after what she had come through in her previous analysis. Subsequently, upon parting after sessions, Samantha either extended her hand for a handshake, or wanted to have a brief hug, or else preferred, especially when she was upset with me, to have no contact at all. Our routine for parting developed in such a way that she could initiate whatever form of physical contact occurred to her as fitting and that articulated her feelings. I was convinced that this variable routine broadened her affective experience, her sense of safety, and the intimate connection between us. We were moving into what has been called “intersubjective relatedness” (Benjamin, 1988, 1995; Fosshage, 1997, 2003; Shane, Shane, and Gales, 1998; Stern, 1985): a realm of relating that requires an expanded expression of the analyst’s subjective experience to create a reciprocal (yet still asymmetrical) subject-to-subject intimacy.
Comment: Research on the topic of physical touch in psychoanalysis (summarized in Fosshage, 2000) indicates that hugs initiated by the patient are most often experienced as therapeutic, while hugs initiated by the analyst can more easily engender distrust. The analyst’s responsiveness to the patient’s initiative to hug can cocreate an authentic sense of being known, as well as a shared moment of enlivened lived experience.
After four years of analysis, Samantha had the following dream, which provided us with a sweeping view of what had been occurring. The dream was presented in three parts, as follows:
I. A village - It extends up (and down) a slope. It is not a steep slope, but gradual and graceful; it is feminine. It is winter. I am looking down on the village as if on a model train set. I see their roofs; they look like old leather books perched on each house. There are train tracks that wind through the village, unifying and connecting it, making it whole.
There are green pine forests, main streets, central squares, country roads hidden under the snowfall. It is quiet, peaceful, lovely. I know that I am the village as well as hovering above it. It is the landscape of myself.
II. A feeling of fear. I am filled with the kind of terror that sent me to the hospital. It is huge, unmanageable, overwhelming. It is all over me; I feel it on my skin, and inside of me. I am paralyzed with fright. This fear is old, familiar. The village goes into a state of suspended animation. It is frozen and still; there is no movement. The me that is in the village ceases to feel. I have the familiar sensation of fear followed by an absence of feeling.
III. Time has passed like in the telling of the Rip Van Winkle story. There is the feeling of 20 years (but I know it has been more) going by. The village has remained in its state of suspended animation. I have lived without feelings all this time.
There is a thaw; the village comes back to life. The cottages are in the same place but feel as if they have been moved to new locations. The relation of the train tracks to the villages and cottages looks the same when I view it from above, but the me that is in the landscape feels different. I am disoriented, but not afraid. I am thankful that the frozen sleep is over. There are icicles melting under the eaves of the cottages; the light falls with a different slant on the landscape.
At the end of the dream I am only in the landscape, no longer above it. I am finding my way through unfamiliar terrain. The thaw has caused patches of earth to appear from under the snow. The landscape is no longer pristine as it was in the beginning of the dream (when it was a model... a model child), but I feel grounded in it; it is much more real and filled with vitality.
We understood the dream as depicting a dramatic story of an ongoing psychological transformation. The Rip Van Winkle sleep of twenty years had begun when Samantha was nineteen: the beginning of adulthood, as she put it, and also the age when she met her former husband, although, as she notes in the dream, she had been asleep longer. Brought up as the model child, she was graceful and feminine, and had achieved some peacefulness, but at the cost of being “wintry” and distant from her own experience (“I know that I am the village as well as hovering above it”). In the analysis Samantha began to reconnect with feeling, encountered terror, and, as in the past, froze to put a stop to it. Gradually, as we understood and helped her work her way through the fear, she began to thaw, to be “within” her experience, and to become more alive.
Over the past five years, Samantha has pursued her writing, including graduate school, and has more and more successfully maintained her focus. Publication of her writing has been the reward that has added reinforcement and incentive. Along the way she shared her writing. I have felt appreciative and affirming of it. As is apparent from her dreams, she is highly capable with images and language. She knew that I wrote and inquired about it. We shared our writings and our experiences of writing. This sharing provided times of mutual recognition, of twinship experience - moments of intimacy involving intersubjective or subject-to-subject relatedness. Here we were clearly one person relating to another with mutual respect, affection, and concern for one another.
Comment: Sharing our writings and our experiences of writing provide us with “moments of meeting" (Stern, et al., 1998), or what we call “sharedenlivening moments” (Lichtenberg, Lachmann, and Fosshage, 2016). Included were moments of mutual surprise and admiration.
As the age of forty was closing in, Samantha became quite upset about the prospect of not having children. She was the last hope for her family.
While she felt her parents would be disappointed in her not having children, with my encouraging nudge she spoke with them and discovered, to her surprise, that they were not invested in grandchildren, but in her happiness. She developed what was her best romantic relationship up to that point, but the man already had children and did not wish to embark on that path again. Due to a variety of serious setbacks in the man’s life, the relationship came to an end.
Subsequently, Samantha and a close male friend began to express loving and sexual feelings for one another. He was in the process of extricating himself from another relationship. His and Samantha’s relationship progressed, including sexual intimacy. One day Samantha came in and excitedly said, “Jim, I am finally getting sex and a relationship together.” Samantha’s announcement of this progress additionally ushered in an increased intimacy in our relationship. As we explored the new experience she was having with a man we were also able to express positive and affectionate feelings for each other. She could do this more easily, for she now felt that the playing field between us was level. It was more person-to-person and, yet, asymmetrical (Aron, 1996).
Comment: Over the years of psychoanalytic treatment the tensions between us gradually ameliorated, ruptures were quite quickly repaired, and reflective awareness was far more easily recovered when momentarily lost. In addition, the lowered threshold for positive experience gave rise to a lightness, to a considerable increase in humor and play between us. Our acknowledging the effect of these positive changes on each of us promoted further developments in the areas of sharing moments of enlivened lived experience, heightened affective momen ts, and enhancing an authentic sense of engaging in the world and of being known. The underlying affective tone was shifting from anxiety and terror to calmness, playfulness, confidence in her creative work, and enlivenment. The anxious states, of course, could be triggered and, yet, recovery was much more rapid.
Samantha decided to take a high-paying, full-time position in the arts, heading up her own department. She had become more financially conscious and responsible and wanted to have material things for herself. She had built a good reputation for herself and negotiated admirably. In closing, I will present in summary from a recent session with some detailed exchanges that occurred the morning after her first day of work. The context of our having worked for a considerable time together needs to be kept in mind in reading the summary, for analyst and analysand are dealing rather quickly with primary thematic issues as they emerge in the session, currently triggered by her new job. These issues are quite familiar to us and we have mutually developed a reflective awareness, conceptualization, and vocabulary in regard to them. During the session Samantha was clearly struggling with the now long-recognized thematic battle between being herself and being controlled by those around her, now in the guise of corporate structure.
Samantha opens the session by saying, “This is the first full-time job since 1991 and I am stressed.” I inquire, “What’s the stress?” She responds, “Fear of being trapped.” I ask, “In what way?” She describes how she needs to eat every two hours (extensive use of antibiotics had totally dys-regulated her system) and does not want to reveal it, for it places her in a weakened position as the head of a department with people she does not know. We discuss how her response to being physically dysregulated on the first day at work is understandably upsetting. Yet, her reaction also appears to resonate with what became her own perfectionism - that is, with attributions based on being “the perfect child.” After focusing on various practical alternatives, Samantha ends up poignantly saying that she does not want to be at her new job and wants to go home. I continue to explore: “Any other reasons?” She responds, “It’s boring, unsafe, I don’t know what I’m doing.” She relates it to feeling trapped in school, bored and inhibited. With her freelance jobs, she could be in for six months and then “out of there.” In a somewhat pleading tone of not wanting to be forced to do it, she reiterates “boredom, claustrophobia, and complexity of relationships.” I emotionally join her and reflect, “Yes, in a freelance situation, you can work six months and then get out of there and you're fine.” She says, “Yes, and I could continue to do that. Why should I have to face forced commitment? My commitment to you comes out of desire, need. I love you and, if we have difficulties, we work them out.” I respond, “That’s a new model, a new way of doing things, in contrast to what it often felt like at home.” She answers, “At home I felt driven to be something I’m not. I’m not fully myself. I had to perform perfectly at home.” I reiterate a vision of “being” that we both “know” and, yet, she has momentarily lost touch with: “Maybe you don’t have to be so perfect at work; maybe you could take some time to absorb, familiarize, get your footing.” She picks up the message, “You know I only need a pad and pencil until I figure out what I’m doing.” She describes several interactions in which she was honest and “not perfect” and then says, “I feel like killing my father. The perfectionism came from him.” And then, with a slightly helpless tone, “I’m disappointed that it’s so deep.” I respond, “Yeah, that’s the way it is. That’s what happens when these neural networks get activated.” [Neural networks are something that we have discussed in detail]. We discuss again how one has to regain a reflective awareness of a theme and its origins to free oneself from its grip - in this case, the feeling of perfectionist expectations and demands. She is reminded of how, as a girl, she would sneak out of her window onto the roof - to be alone, smoke, and regain her equanimity. I respond, attempting to open up the new avenue: “Yes, there you couldn’t solve it in the relationship; now, perhaps you can; perhaps you can just be, and then you can be at home wherever you go.” She responds with feeling: “That would be wonderful!” There is a reflective pause. And then she exclaims flatly, yet with considerable satisfaction: “You know we did it! Thank you, I can breathe again!”
The theme of perfectionism, of being the model child, along with its underlying anxious affect, had once again been activated. Being quite experienced with this theme by this time, we were able relatively quickly to regain a reflective perspective about it and to reclaim a sense of freedom from the perfect-child self-state. In my responses, I reminded her of an alternative vision, of a way of “being” that had previously been achieved, to which she could now emotionally relate. Confirmation of this momentary success came in the group therapy session, four days later, in which she relayed what had happened and how “happy” she had been since the last session.
Looking back, Samantha and I have traveled a long way together. Development had occurred in all three of the pathways that we are emphasizing in this book: 1) the pathway of human relatedness and intimacy; 2) the pathway of mastering the environment; and 3) the pathway for a healthy body, physiological regulation, and a good mind-body connection. These pathways, while distinct, often intersect. More central to this transformative analytic process was expanded development in intimacy and mastering the environment. Samantha had developed a good-mind body connection throughout her life. During childhood and adolescence she had studied ballet and modern dance, with considerable success. In young adulthood, she decided not to make dance her career, for it had been so totally consuming. Subsequently, she chose musical dance workouts and speed walking for physiological and emotional regulation.
When Samantha entered psychoanalytic treatment, she was “flying high” from being “in love” with her previous analyst, and yet she expressed an underlying affect tone of anxiety’ and worry. After finding her way to extricate herself from her previous analyst/fiancee, we found that her underlying affect tone of anxiety primarily emanated from a frequently and powerfully activated core conflict of subjugation to or rebellion against her parents and their expectations and agendas - the way she was “bred” that Samatha experienced as so incongruous to her “inner integral self.”
Her anxiety was about “being enough,” about expressing her feelings and needs in the face of parental opposition, about “living up to,” defying, or subjugating herself to parental expectations. Her parent’s pressure and volatility had fragmented her self-narrative and resulted in an emotional shut-down and frozenness: “My inner self had been squashed and wants out or I will die...I was the perfect child - forget it - I am not the repressed, elegant Swiss-German girl.”
Yet, her parents’ cultural values, hard work, and success appealed to and resonated with her, stimulated familial pride, and contributed to the formation of her goals and self-esteem. If only her parents had not been so self-focused and forceful with their agenda, and even terrorizing, in their expectations. Feeling heard and understood created a new, desperately needed experience with her previous analyst that was forfeited when her analyst’s needs came to the forefront, usurping analytic space.
Samantha and I played out these themes during our work. Think of the rocking chair incident when Samantha, feeling vulnerable and fragile, was traumatically startled and terrified by the slightest movement of my rocking chair. Her father would have screamed at her for feeling so vulnerable and scared. At that moment, I was able to feel her terror and spoke ever so gently and calmly to talk her down from the terrorizing ledge of fear and distrust.
We made our way through episode after episode of terror, of her feeling endangered, unprotected, and all alone. Despite the traumatic imposition of her parents’ agenda, Samantha nevertheless was resiliently able to maintain some sense of an authentic self along with a considerable determination to develop and further realize what was experienced as authentic to her. Processing and repairing traumatic ruptures both within and outside the analytic relationship contributed to a growing sense of competence and self-regulation, as well as a sense that others could be helpful rather than just a source of further shame and upset. Our close tracking of her experience, emphasizing affects, meanings, intentions, and goals, contributed to her extricating herself from the parental attributions and to articulating and consolidating a more cohesive narrative of her authentic self, all occurring first and foremost within, but not by any means limited to, the analytic relationship in which she could gradually experience being seen and known by the analyst. Ever so gradually, Samantha began to feel that she could count on me, and that she was no longer alone. She grew in confidence. With determination, she worked hard in her writing and teaching career, eventually becoming recognized and successful.
The affect tone of underlying anxiety receded and was replaced by an increasing affect tone of excitement from feeling like a “doer doing”—a sense of competence in “mastering the environment.” The analytic ambiance over time became us “doing” the work together with lightness and humor, and with enjoyment of each other and of her, and our, accomplishments, all of which increased intimacy and satisfaction - the pathways of human relatedness and intimacy and mastering the environment. In the last session presented, this patient/analyst ambiance enabled us to competently and quickly address reflectively, and to rebalance when the old anxiety ’’will I be enough?” was activated, as it was when she anticipated the new job.
As she continued to consolidate a more cohesive, positive sense of an authentic self - or, in other words, as she became more fully her own person - Samantha gradually desired a fuller relationship in the analysis with the entrance of more of my subjectivity, which was now no longer terrifying to her. Our subsequent experiences of sharing moments of enlivening experience and heightened moments of surprise, humor, and mutual admiration was based on, as she expressed it, “a level playing field.” With the increased sharing of our subjective experiences with one another, analysis became one person relating to another (subject-to-subject relating). Now, liking and affection could be mutually experienced and expressed both verbally and through physical touch where sensuality, not sexuality, was in the forefront. Hugs and handshakes, initiated by Samantha, were potent affective communications. Each had a distinctive meaning and fit the occasion, serving to regulate the closeness between us as well as increasing her sense of personal agency, an experience of being a “doer doing.” These verbal and physical expressions of affection emanated from a hard-won sense of safety and self-assuredness that stood in contrast to the previous traumatic childhood and analytic transgressions. The sensual/sexual thread (a very important distinction; Lichtenberg, 2008) varied from a softness and tenderness in speaking, in “being with,” to a more overt description that highlighted affirmation and mutual feelings of sexual attraction that could now be expressed within an arena of trust and safety. Humor and playfulness increased and substantially contributed to a patient/analyst ambiance of lightness, enjoyment, and loving connection. Overall, her originally high threshold for experiencing positive emotions was lowered and her low threshold for negative affects was raised. Over the past year, I realized that we had developed a special greeting when I picked Samantha up in the waiting room early in the morning: I loudly and heartily express “SAMANTHA.” and, in resonance, Samantha exclaims “JIM.” an ambiance that is emblematic of our mutual enjoyment of each other. The world, self and other, had become safer, enlivened, and enlivening.