A Cat in the Clinical Hour
Rituals of frame
A Sufi story tells of a cat that belongs to one of the Sufi masters rubbing against seated meditators, interrupting their focus. The solution becomes to tie the cat up during meditation. But the cat lives a long time, and the Sufi master dies. Younger monks continue to tie up the cat during meditation, and by the time the cat dies people have forgotten why the cat was tied up in the first place, and so buy another cat to tie it up for meditation (Shah, 1988).
This story highlights the dynamics of ritual, community memory, and the actual restraining of a cat - dynamics at the heart of this paper. I am exploring the impact of a cat I restrained during a patient’s clinical hour and the way this touched pre-oedipal issues in the transference/countertransference, as well as providing a symbolic bridge through cultural hatreds of racism filled with malevolence and violence.
Among the rituals of psychoanalysis and psychotherapy, the clinical hour is one of the most significant and enduring. The hour is framed by time and walls, by the couch and chairs in which people sit, by objects in the room, as well as silences and words within that hour. The frame of the clinical hour is of importance because it provides a space where the outside is separated from the inside, so the inside can better be attended to.
Yet, inside and outside are never completely separate, and the intrusions become as important as the frame itself. The clinical hour is intruded upon when airplanes fly overhead, family members die or become ill, lawns are mowed, hurricanes strike, the patient brings in ice-cream and the analyst’s own mind wanders. The traditional clinical hour was first and foremost a ritual of words, with nonverbal communication translated into words. But now intrusions and enactments, actions and objects, can be seen as communications in their own right, rather than resistance disrupting the course of a therapeutic process. The analyst is no longer merely abstaining, remaining neutral to avoid gratifying instinctive drives, but can be an active participant. In the early years of the psychoanalytic relational movement, Stephen Mitchell observed the move away from word interpretations exclusively, towards the inclusion of objects and actions, to be rooted in a shift of
A cat in the clinical hour 133 understanding humans as meaning-generating animals rather than primarily drive regulated (1993).
But if the ritual frame of the clinical hour becomes one where intrusions are valued as much as words, where enactments are intrinsic to the process, a greater responsibility is required of the analyst to question what is occurring for the symbolic and metaphorical meaning it holds.
Ava and I
Enactment intrusions wove into my work with Ava from the beginning when my mind began a pattern of shutting down. Within minutes of our meeting, Ava asked if I was Christian. It is not my usual practice to answer personal questions without understanding where the questions come from, but it seemed Ava spoke of how we needed to connect, wanting a clear, spoken link. 1 flashed through ways to respond as if 1 had to give a complete and factual answer. 1 no longer described myself as Christian, but what roots did 1 have if they were not Christian? I answered ‘yes’. Ava then asked if I was ‘saved by the blood of Jesus Christ’. ‘As a child,’ I said. But suddenly anxious at this representation of myself, I rushed on to say I did not work as any sort of Christian counsellor. ‘Whatever’, Ava said, waving her hand through the air. ‘1 can see you’re not black and 1 hope you’re not prejudiced, but if you and I don’t share Christianity, I don’t know how this can work.’
Screaming fights and the taut, angry silence between her parents punctuated Ava’s childhood. Her father worked two, often three jobs. He also engaged in public affairs with multiple women in the community. When she discovered the affairs, Ava’s mother refused to clean or cook, often never leaving the house. Little Ava cleaned and cooked. In the evenings when her father came home, he praised her for this, while her mother hated and envied her, striking her physically as well as verbally. For comfort, Ava compulsively ate. When, as an adult, she got into a twelve-step recovery programme, her father’s gifts of money stopped, but his gifts of food continued.
Ava’s mother got a companion cat. Perhaps the green eyes of the cat mirrored the envy and hate of Ava’s mother because Ava felt terrified of that cat. Seeing Ava’s terror, her mother kept the cat in the kitchen or living room whenever she wanted Ava to remain in her room. On those days Ava could not cook or clean. Sometimes she did not attend school because the cat waited outside her door. Ava felt convinced the cat would attack, unsheathe its claws and maul her face. The more frightened she became, the more her mother laughed.
In the first years of our process together, Ava bought her own home, lost the weight she was trying to lose and was awarded a prestigious financially remunerative honour over thousands of other nurses in the hospital where she worked. But then Ava became flooded by an inner certainty that she had trespassed in some way. She had achieved what other nurses had not, what her mother had not. All eyes were on her. It felt to Ava as if she had violated a rule, the rule that she existed to serve others, to help others, and could not triumph in such a visible way. Envy attacks by other nurses reinforced Ava’s terror, a terror that quickly became a rage, often directed at me.
‘You white people will kill us,’ she yelled. And if 1 tried to explore her statement with something as simple as, ‘You sound angry with me,’ she yelled louder, saying that I took what she said far too personally, that all white people took things too personally. Didn’t I see this was not about me?
While 1 knew Ava’s rage was about her and her mother, about daring visibility and rejection, and I knew her rage was connected to a history of injustice that was much larger than either one of us, 1 was the person in the room, the white person Ava yelled at. 1 often felt speechless with my own rage, as if our analytical third became a pure rage.
The analytic third is a way to conceptualize how neither Ava nor 1 exist as separate psychological entities in the clinical hour. Like mother and infant, our individualities and inter-subjectivities entwine, shape, and create each other. This follows Green’s (1975) ‘analytic object’ and Ogden’s (1994) view that the third is formed in the clinical setting, asymmetrically, privileging the unconscious of the patient (ibid).
Rage devoured the connection between Ava and 1. Rage thinly veiled our mutual terror of destruction. My mind went numb again and again. When 1 could sluggishly think, 1 wondered: Was Ava terrifyingly close to her experience as a child? Was this a forbidden oedipal triumph? Were the intergenera-tional traumas of slavery and invisibility rising up to shake her from within?
Ava said she drove over to the white area of town to mail letters and buy groceries because the post offices and stores were better. Cleaner. She said a white patient at work called security because she was black and did not do as he asked. He was not even her patient, just saw her in the hall and thought she should roll him over in his bed. ‘Your people are something else,’ Ava said. She told me black patients were rushed out of the hospital even if they had high blood pressure or other health risks, while white patients were treated with more care. ‘Nothing to do about it,’ Ava said. ‘Your people are trying to kill us off.’
At times I felt defensive, responsible by the colour of my skin, a defensiveness Ava saw and struck at. ‘Do you have bars on your windows?’ she asked one time. Tn my area of town, we all have bars. If we didn’t, we’d be robbed for sure.’ And much in the same factual manner, 1 answered Ava’s questions about Christianity, I told her she had the money to buy a house in my neighbourhood, that black people and Latinos and Asians all lived there.
‘I have to be with my people,’ Ava said.
The psychological legacies of slavery, colonisation, and empire haunt those of us in the United States. Ron Eyerman (2001) refers to the collective experience of African Americans as ‘cultural trauma’, a term capturing its historical and violent roots. And Farhad Dalal (2006) challenges the more common psychological approach to racism in which ‘political rage is understood as a displacement of the “real” internal and personal rage.’ Dalal expands psychoanalytic explanations to wonder, ‘It is at the very least curious that the self-loathing is only understood as a defence, and not as a symptom of living in a racist context’ (2006, p. 17, italics in original).
1 felt more and more helpless as Ava began to self-destruct. She ate compulsively, gaining back sixty pounds she had lost. She married a man she barely knew, an unemployed preacher. He wrecked a car she bought him. Two cars. Three. He had affairs, one with her sister-in-law. Then he began to harm her physically, threatening to burn her house, turning the wheel of her car into oncoming traffic as he drove her to work. Worried about her survival, I suggested marriage therapy. He did not attend the sessions. 1 suggested divorce, and we argued. ‘What about all the other divorced people in your church,’ I said. ‘They’re black. Are they going to hell? Your mother wasn’t strong enough to leave. You are’. To which Ava replied: ‘You white people all get divorced too easily. You want us black people to be like you. My mother stayed with my father and 1 can’t be better than her. Besides, the Bible doesn’t allow divorce’.
Ava and I meet dogs and a cat
Seven years after her marriage, Ava got her divorce. A year after her divorce and thirteen years into our process together, I built out an office at the back of my house, leaving the midrise where I had worked. The rain slowed construction and the walk to my office was incomplete, little more than a trail of mud over which I arranged wood planks. Half an hour into Ava’s session, 1 found her in her car, shaking. She pointed to the mud puddles and planks, screaming, tears running down her face.
You didn’t think I would walk up that! You don’t know me - you couldn’t think that! I went up that other walk, the finished one, and you left your house door unlocked. You white people all leave your doors unlocked and you have so many dogs. You white people will hurt someone with your dogs. You white people in your white neighbourhoods have no idea how people live. You will kill us.
Did the planks over the walk to my office symbolise intergenerational traumas of slaves who walked on planks to care for rice in the region? Did my dogs raise traumatic memories of black people who were hunted by dogs? Perhaps my office door at the back of the house touched the way black people were only allowed access to white people’s houses through back doors? Or was an office in my home too close, too personal for Ava? But 1 could ask no questions because Ava stopped coming to sessions and returned no calls. 1 felt helpless. Distraught.
In Ritual and Spontaneity in the Psychoanalytic Process (1998), Irwin Hoffman explores tensions between an analyst’s feeling of connection to patients and the training and expertise. For Hoffman, these tensions cannot be resolved, but are to be attended to through dynamics of psychoanalytic ritual and personal participation.
To the extent that the analyst conceives of himself or herself merely as offering a service based upon technical expertise, doing analysis can be a relatively comfortable way to make a living. To the extent, however, that the analyst conceives of his or her role, correctly in my view, as combining technical expertise with a special quality of love and affirmation, one that derives part of its power from the inheritance of the mantel of clerical authority, the occupation can be a source of some unspoken and usually disclaimed embarrassment (p. xix).
I felt 1 had failed Ava. Whatever else had occurred, when she met my dogs, she experienced violation. Animals provided tenderness in the harsh environment of my own childhood, and it did not occur to me she would walk into the midst of my dogs and they would frighten her.
Richard Tan’s writing on Racism and Similarity (1993) outlines ways both therapist and patient can hide from issues of difference, in particular racial difference, by taking refuge in similarities. This entrenches the dyad in a paranoid-schizoid manner because they become hidden and disassociated from themselves as well as one another. And from the start, Ava and 1 appeared to enter this dynamic, disassociating our differences in an effort to connect. I often thought of the two of us as sisters in the transference/ countertransference: born the same year, both in helping professions, our roots in Christianity, she eating too much in stress and 1 eating too little, she giving generously and myself more a miser. And in spite of rage erupting into consciousness, by the time Ava met my dogs, I had become so heavily committed to minimizing our differences, 1 did not create a frame within which she felt safe enough to risk.
After six long months, Ava reconnected. She had just assaulted a coworker. ‘Management made me go to a therapist for anger’, she said. ‘That one cost less money and I wanted her to work, but she said things I already know’.
In the interim, in addition to the four rescue dogs Ava bumped into inside my house, I had adopted a local family of feral cats. One of the cats became ill, so 1 kept it in my back office for recovery, away from the consulting room. The cat lay quiet for weeks but then began to use the curtain as a lever to lift the door, push it open and enter the consulting room. Remembering Ava’s fear of cats, and her terror when meeting my dogs - no longer blinded by a haze of similarity - 1 locked the cat into the bathroom for Ava’s sessions, where the door could be dead-bolted. Ava refused to enter the office until the cat was locked away. ‘You know, if that cat gets loose, I will leave and never come back,’ she said. Scratches covered my arms from restraining the cat. I wrote signs on the bathroom door: Closed for Cat. I hired a contractor
A cat in the clinical hour 137 and got a new deadbolt for the back office so the cat could no longer use the curtain as a lever.
Ava spoke of the cat every session: that it was my cat and I locked it behind a door. She began to calm down, bringing in a video of two children playing with a muddy puppy in a bathtub, crying as she played it for me: ‘It’s like a baby. I never knew pets were so much like children’. And although Ava still spoke of race, it was no longer as angrily. Rather, she explained her culture and experience, trying to help me understand. She began to lose the weight she had gained and changed her home church to one with women pastors as well as men. ‘The Prozac I’ve taken all these years must finally be working’, Ava said and smiled. ‘I even have compassion for your animal craziness’.
And when I asked about using our work together in papers I write, Ava told me she would be honoured if her struggle could be of use to others. Yet I felt uncomfortable, wondering if I once again entered some enactment of similarity. I asked again. She agreed again. I asked a third time, and Ava became angry: ‘No, girlfriend. You have your writing and your animal craziness. That’s you, girlfriend. It’s not me. And you keep asking me the same question over and over. That’s your issue, not mine.’
A cat as part of the frame
There is great anxiety deconstructing familiar narratives. The race is a familiar narrative. When Ava chose to work with me, she demonstrated her willingness to engage difference and race, issues that cannot easily be separated from dynamics of early maternal attachment as cultural, family, and gender expectations are absorbed with the gleam in our parents’ eyes.
Harriet Kimble Wrye and Judith K. Welles explore these dynamics in The Narration of Desire: Erotic Transferences and Countertransferences (1994). For Wrye and Welles, pre-oedipal, nonverbal issues are often brought into treatment in the form of representative objects of the patient’s body. Such objects are symbolic of a defect felt by the patient, a defect felt to be present from the earliest history (ibid). The concrete quality of these enactments feels necessary to the patients because words cannot adequately convey the experience:
Typically the patient was unable to carry on in the analytic mode, was unable to talk about feeling, and felt compelled instead to action. Something primitive, preverbal and maybe even terrible was going on (Wrye and Welles, 1994, p. 22).
Work with Ava was filled with concrete transference/countertransference enactments, from our first discussion of Christianity and my mind’s pattern of shutting down, to her bringing me clothes catalogues so I would ‘dress better’, and spilling chocolate chip ice cream in the waiting room. Ava struggled to verbalize her sense of defect in a way I could understand.
Carl Jung (Jung and Baynes, 1921) understood any true symbol to be the best possible description of a relatively unknown fact. That is, by the time a symbol is fully captured in words, fully made conscious and known, it no longer operates as a symbol that bridges the conscious and unconscious, because it exists primarily in the realm of conscious knowledge (ibid). Such a view brings into question the primacy of words, a precursor to the relational school’s work on enactments when a mix of transference/countertransference is acted into without conscious awareness. As Donnel Stern says, ‘enacted experience is unformulated experience’ (2004, p. 212). Much like Jung’s view of the symbol, within the enactment are myriad hints or possibilities as to what it means, where it comes from, what it is about. And by the time the enacted experience is formed into an accessible, useful interpretation, it is no longer filled with as much raw potential or unconscious dread.
Whatever else it was, the symbol/enactment of the cat I restrained during the clinical hour became much more than a cat for both Ava and me. The cat’s tiny mewing and soft weight of its body echoed the sounds and feel of an infant, connecting it to pre-oedipal issues - messy, demanding instincts that raged, hungered, desired. In addition, Ava’s mother had once used a cat as an extension of herself to torture Ava. The cat symbolized division. Alienation. The cat symbolized hate. Wrye and Welles (1994) observe that ‘patients who are most terrified of experiencing primitive body sensation and longing associate them to a loss of control’ (p. 105). In this way, the cat symbolized restraint, my restraining of myself - my rage and desire to merge - and by transference extension, Ava’s mother’s restraint. The cat came to represent both the Winnicottian version of hate (1986), which developmentally based hate the child learns to recognize as coexisting with love, and a bridge through the cultural hatreds of racism filled with malevolence and violence. But perhaps most significantly, the cat symbolized my capacity to keep Ava in mind as different from myself. I could prepare a ritual frame for our clinical hour together where inside and outside were separate enough for Ava to risk vulnerability and self-reflection, to find her own meaning.
There is no longer an easy division between words and actions in the clinical hour. The choice to speak or not speak is as much an action as my choice to lock up the cat. 1 will never fully know what the cat has meant to Ava, but it has served as a link between us, and with that link are new/old questions.
In the story told by the Sufi masters, the cat was once restrained because it disrupted meditation. Then the community memory eclipsed the purpose of restraining the cat. The ritual became hollowed out. Empty.
It seems to me that those of us engaged in the work of psychoanalysis and psychotherapy are often at the brink of such hollow rituals. To understand that restraining the cat was of use to Ava is one thing but believing that restraining the cat will continue to be of use to Ava is quite another, and no less damaging than my desire to ignore our differences and focus on similarity.
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