Intersubjective similarity and intersubjective dissimilarity

Every therapeutic dyad includes interactivity between elements of “intersubjective similarity’’ and “intersubjective dissimilarity.” To an extent, some of these elements are easily identifiable and known to both subjects in the therapeutic dyad - for example: gender, external appearance, religion, profession, and education. Other elements are known to only one of the parties - either the therapist or the patient. And, in addition, there are elements of difference and similarity between patient and therapist that go unidentified and are unknown to both. These latter unknown and unconscious zones are the most susceptible to projections, splitting, and dissociation. The influence of these zones on the therapeutic process is not accessible to analysis, processing, recognition, or understanding unless the therapist undergoes processing and analysis.

When we ask ourselves whether the dimensions of similarity and dissimilarity in the therapeutic dyad may produce blind spots in the therapy, we might assume that dissimilarity, due to the negative feelings it often provokes, is more likely to lead to blind spots. I believe that in cases of similarity the risk of blind spots is even greater. It is particularly high where unprocessed parts of the therapist encounter unprocessed parts of the patient. This is reflected in the following vignette.

Case study

Majda, a young, traditional Muslim, intelligent and impressive, was referred for therapy to my Tel Aviv clinic in Israel. She lived in a Muslim community with her husband and children, was good looking, elegant, and very successful, both professionally and financially, as a lawyer. Majda grew up in a middle-class family and is the oldest of three siblings. She perceives her family as warm and close, yet at an early age she used to take on roles in which she supported the family. Her younger sister was born with cerebral palsy following a complication at birth and Majda has always treated her as no one else in the family has been able to.

She turned to therapy due to anxiety attacks and physical symptoms which, following a long process of medical check-ups, were understood as being mental in origin. Her physical condition and her anxiety almost entirely prevented her from engaging in her work, or from being a dedicated mother and daughter. This functional change also seriously affected her self-perception. While she used to feel capable of taking up any challenge, she was weak now, depressed, dependent, helpless, and scared. She came to therapy wanting to return to her former self.

In therapy, Majda spoke about her relations with her family, her parenting, and about other significant relationships. In all of these, close or more remote, she would somehow zoom in on the people who were in need and come to their help in a total way, whether the support required was emotional, technical, or financial. Majda habitually ignored signs that told her to stop her boundless giving, much like she often ignored the red light in her car when it warned she was running out of fuel: Again and again, she would find herself stuck on the road with an empty tank. Majda had a grandiose, omnipotent perception of herself, denying and refusing to accept herself as a person with needs and limitations. Her family had always treated her as an all-powerful savior, and she conformed to this perception. In our therapeutic work we understood and interpreted the anxiety attacks as both body and mind telling her she was under unreasonable strain. For many years she had been setting aside her own intuitions about her limitations, and, just like her car, she found herself stuck now that her strength was exhausted and her mental “tank” had run dry.

When overnight her anxiety attacks stopped her in her tracks, during therapy she found herself having to rehabilitate and rebuild herself in a more balanced manner, with a self-perception that included split-off and dissociated parts. This involved a process of mourning as she had to come to terms with both physical and mental constraints. Gradually, Majda grew stronger, and became able, both at work and in her personal relationships, to function and focus herself, while also protecting her boundaries and looking after her resources and strength.

The religious and cultural differences between Majda, an Arab-Israeli Muslim woman, and me, a Jewish Israeli woman of European descent, were often present and mentioned in our meetings. In many senses, Majda’s life involved a lot of back and forth between her Islamic culture and the local Jewish one. She lived in both worlds in parallel: she was familiar with both cultures, spoke both “languages,” and was competent and natural in switching between them. This too was how our therapeutic conversation went. Her great familiarity with and understanding of my Jewish culture enabled her to explain her own language and culture to me in my language. In the course of the therapeutic process and my deepening acquaintance with Majda and her life, I learned about a world view, about family and social relations and norms, in a neighboring and yet remote culture.

Her personality and her culture, as they came through in her stories, and the complexity of her life as a Muslim woman in a Jewish state, impressed me. In one such story she described an intrusive, humiliating security check at the airport on her return from a working trip in Europe. This incident, and ones like it, did not make her angry; she felt only sadness and understanding: “I understand them. The ones who do the terrorism are the Arabs.” In spite of the political and security situation, and of the natural human tendency to feel fear of the other and the unfamiliar, she felt sympathy and identification with Israeli-Jewish culture. She sought to raise her children with an openness to the other culture: she created opportunities for them to meet with Jewish people, took them to after-school activities or summer camps with Jews - but she expressed her frustration because in spite of her attempts “they are afraid of Jews.” I wondered what about her own fear? What about her anger?

In the countertransference I felt sympathy, closeness, and compassion for her and her people. I felt uneasy about belonging to an occupying nation. I had to contain within myself my feelings of guilt and helplessness regarding the political situation. Time and again we had to keep the political and security situation from entering the clinic. But we felt that in the small bubble of the clinic and our personal encounter we were managing to create a coexistence marked by communication, acceptance, and understanding.

At this point I would like to zoom in on an event which occurred in Majda’s past, and which is related to the present discussion as well as the way the therapeutic process evolved. In her twenties, Majda had been present at an horrifying terror attack when two Muslim suicide terrorists - one on either side of her - had blown themselves up. She was surrounded by the bodies of the killed and injured while she herself, miraculously, was unscathed. Soon enraged bystanders moved in on the scene and started yelling “Death to the Arabs!” She observed how a young man near her was identified as an Arab, immediately captured, and taken away. Majda froze. She realized that she would be in danger once they realized she was an

Arab. Thus, from having been in mortal danger due to her own Arab fellow citizens, the danger now, within minutes, was coming from the enraged, violent, Jewish crowd. Rescue teams arriving at the scene asked her to help, but Majda was afraid to open her mouth and reveal her accent. The security forces interpreted her silence as a sign of a panic attack, which attracted more attention and increased her fear and helplessness. As she remembered it, it took a long time until she managed to extricate herself from the scene and escape to the safety of her home. This extremely traumatic event clarifies the impossibility of life within conditions of violent conflict in which there exists a confusion of dangers and identities, and internal chaos suffused with fear of death. Experiencing and witnessing, in therapy, Majda’s trauma, confronted me with my own trauma. Many years earlier, I had been present during a terror event and found myself in mortal danger. It was a miracle that I emerged unharmed. This event had a major impact on my life. The terror attacks we had experienced were similar: We both survived them, and they occurred during the same period and in geographic proximity. Two women, two nations, two traumas in a therapeutic space that has to hold the dissimilarity and the similarity as they intermingle, creating an indigestible compound.

While the therapy was making good progress, with Majda growing impressively stronger both physically and mentally, we were coming closer in time to Israel’s Memorial Day for the Fallen Soldiers and Victims of Terrorism. Reality entered the clinic when it turned out that our weekly session coincided with the time when the siren would be going off to mark the remembrance services in cemeteries throughout the country. On this day, every year, I attend a ceremony at the graves of close friends who lost their lives. It is an almost sacred day of mourning for me. I mused, to myself, on the coincidence, literally, of Majda’s weekly meeting and the ceremony. For the first time since Majda began her therapy, I found myself reflecting on what we knew yet hadn't thought about. I began to feel emotions connected to the strangeness between us and additional meanings concerning the fact that we belong to different peoples who are locked in an ongoing, bloody conflict. These feelings are hard to contain in a relationship marked by the intimacy we had both been trying to build and maintain. So far we had kept such feelings at arm’s length. I tried to imagine how it would feel not to go to the annual ceremony and instead be there for Majda at our usual hour. How would that be? What do the sound of the siren and the ceremony mean to her, and what do they mean to me?

Memorial Day brought to the surface a more complete acknowledgment; both of us knew it, but had apparently not thought about it, in Bollas’s (1987) terms. I chose to go to the ceremony and make space for my own mourning. I wrote to her that I had to move the meeting, and offered her some alternative times in the same week. Majda replied she was technically unable to make it on any of these times. She also cancelled the two next meetings in the subsequent two weeks, again giving practical reasons. She did not answer my phone calls, and three weeks after Memorial Day she stopped responding to my text messages. For some months I continued trying to contact her, to suggest we should resume contact and pick up the therapy, but she remained silent. And so Memorial Day for the Fallen Soldiers and Victims of Terrorism turned out to be the day on which this therapy came to an end, and with it the personal and intimate coexistence between us.

My world view, personality, and personal and professional values all led me to have an open attitude of acceptance toward Majda and her difference and her dissimilarity. In this therapy, like in others, my own subjectivity and difference were present from the start. I believe that she sought therapy with a Jewish therapist who was different from her in order, among other things, to examine the dynamic she knew so well from her frequent transitions between cultures and languages. Questions of belonging versus being different were part of her intrapsychic world, just as they were part of her everyday reality.

Looking at the earlier-mentioned dimensions, there were many elements of dissimilarity and similarity in the clinic between me and Majda: they marked the therapy and largely affected it. We were from different cultural, ethnic-religious, and linguistic backgrounds. We were alike in being women who combined motherhood with a career. We were situated at the two poles of the Israeli-Palestinian conflict but shared an approach to coexistence, which we tried to achieve when we met in the clinic. We were both women who knew what it meant to devote oneself to the other. Each of us had been through a traumatic experience in which our lives were in danger, and each of us had miraculously survived.

What was the political and social context to our relationship? Something emerged between me and Majda that gave room to dissimilarity, to difference, to social-political tension, and allowed for an attempt to enter a process of healing. Ziv (2012) coined the term “the political third,” which represents a joint creation of patient and therapist. What, then, was the

“political third” between Majda and me? Ziv also mentioned the constant presence of an ethics of suspicion. In what way did the dialectic of fear in the political-social-national context make itself known in the relations between Majda and me? Majda and my political third included closeness and a wish for healing and reparation, but there was also the fear of death, the fact of our belonging to two peoples between whom there is hate, trauma, and violence, which stayed denied and untouched. Much like in many other aspects of her life, where she denied the constraints of her body and mind, maintaining a grandiose self and an illusive experience of self-competence, Majda felt she could deny the complex social-political context of her life both as a Muslim woman in Israel and in the therapeutic dyad. An additional dialectic that marked the therapeutic discourse is one that both Freud (1919) and Kristeva (1991) mentioned, namely the elusive dynamic of taking an emotional position vis-à-vis the other, which includes both a need to identify with her or him, and a fear, or even rejection, of her or him.

Majda’s shifts between cultures and languages served as a way of protecting herself from the experience of being a stranger, which had become linked in her mind to both national and personal trauma. Schecter (1980) theoretically linked trauma and experiences of strangeness. He argued that when an infant encounters trauma, having no other way of dealing with the event, it freezes. Shecter calls this freezing and dissociation in reaction to a traumatic event the “shock of strangeness.” Simultaneously, a repertoire of adaptive interpersonal strategies develops. This comes to help in avoiding contact with the terrible experience of strangeness in the infant’s contact with himself and with others.

The therapeutic situation at hand included two terror-related traumas and two experiences of cultural-religious strangeness. Majda’s and my ability to contain the meaning of these traumas and the resulting experience of psychic strangeness was naturally limited. In this way, an experience of cultural-religious strangeness, similarity in trauma, and psychic strangeness in the meaning of the trauma became entangled.

On Israel’s Memorial Day, which closely precedes Independence Day -days during which the Israeli-Palestinian conflict becomes especially prominent on the public agenda - both our psyches enacted the dissociated split-off parts, which we had not seen or felt. Memorial Day confronted us with the need to integrate split-off parts of acceptance and fear, of appreciation and rage, of familiarity and similarity, on the one hand.

and strangeness, on the other. The traumatic event Majda experienced was marked by a dramatic inversion of the roles of enemy and attacker: Those who were supposed to protect her (the Israeli security forces and the bystanders) turned, in her experience, into dangerous attackers themselves. Unconsciously, perhaps, the transformation of the dangerous attacker was reproduced at the precarious moment of Memorial Day, when she became aware of the fear that, from being a person who protected her and was her familiar partner, I might turn into an attacker.

Dissociated and split-off parts, both Majda’s and mine, led to something that the therapeutic relationship could not hold. My cancelling the meeting that would have coincided with the Memorial Day siren caused her to feel there was something our relationship could not hold. Why couldn’t I meet her on that day? She might have become anxious about what she imagined had happened inside me, or maybe she herself felt incapable of meeting me on such a day. It was too hard to get a sense of our “political third.’’ When it made itself felt in the therapy, the wish to escape arose, maybe in order not to spoil the idyllic experience Majda needed. And so, like in the case of her reaction during the terror attack, when she felt her life was endangered, with me too she reacted with silence. This might have been the result of an unconscious experience of feeling that dangerous emotions might upset a balance of denials to which she had learned to stick, and which continued in our relationship too.

That the therapy came to an abrupt end on a day which connotes the very essence of mourning, the very core of political conflict and of trauma for both Palestinians and Jews alike, is an enactment. Enactment, too, represents a special moment of encounter between therapist and patient, when transference and countertransference processes become blurred and contact between the patient’s and the therapist’s unconscious worlds occurs. This mutual and shared dissociation is what enactment is about: a split-off self-state of the patient encounters a split-off self-state of the therapist (not-me parts). These dissociated and split-off parts were entailed by the dimensions of similarity and dissimilarity. It was a cultural strangeness and distance in the political-social-religious context that became linked to similarity in the dissociation resulting from parallel traumas, the depth of whose meaning neither one of us could have held.

My own understanding of my dissociative parts and split-off self-states emerged as a result of the sudden ending of the therapy and continued to evolve while writing this paper. I hope that this important therapeutic process can be resumed and completed if and when Majda returns to the therapy, when I can be in touch with those threatening, split-off self-parts. My ability to hold these parts will make movement possible and undo the freezing, so that we can then come to hold together the threatening emotions which in our joint illusion became part of the others, the strangers. A continued process could integrate Majda’s denied and split-off parts around the social-political-security experience and other denied and split-off parts in her mind and in her daily life, which were responsible for the anxiety attacks and mental-functional crisis which she initially came for therapy.

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