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From libido to love: relational psychoanalysis and the redemption of sexuality.

The author presents a case which posits the profound growth potential of relational psychoanalysis when it is grounded in a thoroughly Christian world view. Prefacing the case of Graciella, is a brief overview of pertinent relational and Christian concepts. The movements of this psychoanalysis are then interpreted as composed of three transference cadences: Abandonment and the longing for nurture; Rejection and the plea for acceptance, and Destruction and the survival of the object. Graciella's maturation toward intersubjective relationships, educational and career achievements, and spiritual and artistic formation are chronicled. Verbatim patient interactions as well as patient dreams, poetry and journal entries lend poignancy to the narration.

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Rare in these days of managed care and "drive-thru" sanctification is the opportunity to practice a psychotherapy that even modestly resembles a discipling journey. Rarer still, is the likelihood of finding a patient willing to commit to this kind of journey and to do so wholeheartedly. It is of one such journey, a fortuitous confluence of both journey guide and soujourner, that I write.

As journey guide, I have studied the ancient maps of our souls contained in holy writ. Unchanging in accuracy, they have been my continual reference points as I with regularity deliberate over, and update the therapeutic journey to which I invite my patients. Practicing a distinctively Christian relational psychoanalysis has, for me, most closely paralleled the two-tiered pathway to the healing of human suffering that Scripture charts: an addressing of the human mind and heart in all of its complexity and conflict, superimposed on an even more foundational call to relationship, first with God and then with our neighbor. It is relationality that lies at the heart of our Christian experience. Relational psychoanalysis asserts, in agreement with Scripture, that we are born to relate. Furthermore, it elaborates in ways that elucidate and extend Scriptural principles, how relational dynamics propel the establishment, maintenance, enactment and repair of human struggles.

Relational Psychoanalysis: Overview

The compatibility of relational psychoanalysis and Christianity is no accident. Complementing the Freudian emphasis on the quest for "truth" in the face of human denial and defense, object relations theorists such as W. R. D. Fairbairn and D. W. Winnicott (who were both raised in devoutly Christian homes), added to Freud's emphasis on "truth" (Word), the emphasis on "relationship" (Spirit) to dramatically alter Freud's Enlightenment-based and "hydraulically-driven" version of the human psyche (Hoffman, 2004). (1) Fairbairn and Winnicott asserted that the earliest mother/infant relationship established the seeds of brokenness [i.e. "fallenness"]. Relational patterns, (which today are being researched, catalogued, and validated through infant observation [Beebe & Lachmann, 1988; Main & Hesse, 1992; Sander, 1977, etc.]) are encoded, setting the child on a course which ensures the transmission of the "sins of the fathers." These patterns, Fairbairn (1952) theorized, become maintained in order to provide some semblance, though destructive, of attachment to one's primary caregiver.

It is to these patterns that relational psychoanalysis addresses itself. Recognizing the patient's internal warfare between old patterns and new ways of being, the analyst allows himself/herself to be pulled into the battlefield in a process called enactment. Militating against the notion that there is only one broken person in the consultation room (Searles, 1979), relational psychoanalysis as a "two-person psychology" (Aron, 1996), and in keeping with a truly Christian view of human depravity, holds that the "old nature" (Christian rendering) of the analyst initially pulls him/her into the patient's and his or her own "fallen" relational patterns (Mitchell, 1988; Aron, 1996) and that this can be, if understood, a redemptive occurrence. For it is in the tracing and understanding of these patterns, that light is shed on previously unconscious, even unformulated (Stern, 2003) relational dynamics, setting the stage for repair (mourning, forgiveness, restitution, etc.) through a new type of relationship with the analyst and subsequently for redemptive expansion.

Relational Psychoanalysis: Specific Case Foci

I will be demonstrating such a healing journey as it has unfolded in the on-going psychoanalytic treatment of Graciella. Graciella, a 45-year-old Costa Rican woman, had been born out of wedlock and was subsequently abandoned by her mother at the age of six. Her father of Canadian descent rejected her for her Costa Rican appearance, one which did not measure up either to her brother's fair complexion, or to that of her Canadian siblings, unknown to her, that he as a bigamist secretly kept in Canada while residing in Costa Rica.

The case will unfold around three major transferential patterns, which although presented in sequential fashion, were hardly so. The first phase of therapy focused on the relational dynamic which primarily occurred with the mother, i.e., a maternal transference, revolving around abandonment and the longing for nurture. The second phase of therapy moved toward a paternal transference which predominantly centered on rejection and the plea for acceptance. The final phase enacted the destruction and survival of the object (the analyst), a Winnicottian concept to be discussed below, with its progression from rage to redemptive and creative growth.

Graciella was raised in an environment charged with a pervasive and unmodulated sexuality that was dissociated from intimate relationship. The resultant state of sexual hyperarousal led at the behavioral level to her investment in erotic pursuits and fantasies, a means of enlivenment that served simultaneously as a replacement for the nurture of which she was deprived (a defense against actual intimacy), and more importantly, as a connection to parents who had substituted this dissociated sexuality for true intimacy. At the affective level, Graciella demonstrated the response patterns characteristic of a survivor of psychological trauma marked by the survivor's oscillation between states of affective numbing and agonizing hyperarousal (van der Kolk & Greenberg, 1987). In her states of unmodulated hyperarousal, Graciella would experience excruciating anxiety, an anxiety that would precipitate necessary and repetitive withdrawals and emotional numbing (Davies & Frawley, 1994, p. 30).

A concurrent damage plagued Graciella as well. She had come to believe that she had no intrinsic value, but that she could be valuable to others by discovering and offering what would bring them pleasure. In short, she became an object to be used in order to "feel loved."

In the clinical material to follow, sexuality's redemption through its modulation and reintegration into the framework of intimate relationship, as well as its more nuanced expression through other outlets, emerges as the telos of Graciella's treatment. This redemption commences as she both longs for and comes to experience an intimacy with me that evolves far beyond eros. This evolution also impacts her relationship with God. Graciella's vitality, once predominantly restricted to sexuality, wonderfully bursts into her pursuit of artistic and academic achievements.

This "redemption of sexuality," while referring specifically to the case of Graciella, also lies at the core of the relational shift in psychoanalysis. Relational psychoanalysis has emancipated sexuality from its dissociated state in classical psychoanalysis, and has, mirroring the intent of God, brought it back into its rightful place within the scope of relationship. My supreme desire in this article is to chronicle both Graciella's emancipation, and the redemption of psychoanalysis from the shroud of godlessness that has hung over its rich contributions, familiarizing a new generation of Christian professionals with the metamorphosis of psychoanalytic work. Through God's sovereign influence via the writings of theorists steeped in the Judeo-Christian narrative, relational psychoanalysis practiced within a Christian world-view has become, for me, the place where Spirit and truth, transcendence and immanence, law and grace meet in the context of life-changing relationship.

CASE: HISTORY AND DEMOGRAPHICS

Graciella presented for therapy nearly six years ago, motivated by a persistent and worsening depression. Her first marriage at 15 had produced one child. Her second marriage only lasted four months. She was now 36, newly remarried and desirous of making her current marriage work. Graciella was employed as a clerical worker for a company of dubious reputation. I was quickly impressed with her intelligence as well as her exceptional capacity for abstract, analytical and creative thinking. Therapy began at a frequency of once a week for the first year, and increased into a three times a week psychoanalytic treatment at a reduced fee.

Born in Costa Rica, Graciella grew up in a family touched by sexuality in its worst expressions. Mother, as Graciella discovered through contacting relatives during the course of her treatment, had more than likely made the acquaintance of Graciella's father during her time as supervising "madame" at a brothel. Graciella's sister related how she would run Graciella to mother's red light district location in order for mother to nurse her. Graciella's ten siblings were born from various fathers, though her favorite, a sister, was also a child of the Canadian, blond-haired father who had won the affections of her mother. Unfortunately, this sister not only received her father's fair complexion, but contracted a venereal disease during birth which is more than likely responsible for the psychosis that appeared in adulthood, and has rendered her permanently disabled. Destructive sexual behavior also claimed the life of Graciella's brother, Juan, who having lived a promiscuous lifestyle, died of AIDS in his twenties.

Mother, in spite of her chequered history, was deeply loved by Graciella. Her most striking memories of Mom were her laughter, her jokes told with great panache and sexual innuendo, and her perfectly executed, sensual dancing. Graciella recalled that mother wanted her to feel that they "were the most connected people in the world." Not surprisingly, mother's abandonment of Graciella at the age of six was utterly devastating. Following a few weeks of glorious car rides with Mom to visit relatives, Mom suddenly disappeared. Graciella was told after the fact that she had gone to the USA to make more money to send back to the family in Costa Rica. She was assured by the grandmother with whom she was left, that Mom would return soon. Time and again, Graciella remembers sitting by the bus stop, having been told that mother would be back that day, only to walk back home alone and disappointed. However, at the age of ten, mother did come through for Graciella, and brought her to New York. And so, speaking little English, Graciella arrived in Brooklyn, finally reunited with her mother and sister.

ABANDONMENT AND THE LONGING FOR NURTURE

The early scenario of abandonment by mother, with its sequelae of displacement, rejection and deep loneliness, as well as the fundamental character of their relationship which predated mother's departure, dominated the first segment of my work with Graciella. The growing bond between Graciella and myself afforded us times of profound closeness, and progressively deepened the admiration that I had for this woman who not only survived, but had retained such a will to "go on being."

Predictably, Graciella oscillated between expressions of deep gratitude for the care she was receiving and a terror that I would prematurely end the therapy. She would fluctuate, at times with dizzying rapidity, between allowing a child-like dependence and tenderness between us, and a longing, even a demand, for a more sexualized connection, enacting the relating modeled by her family. Graciella had unfortunately been well taught by her family. From early sexual molestation both as victim and perpetrator, Graciella progressed to an active and unregulated dating life which culminated in her marriage at the age of 15. This relationship produced several abortions, for which my patient experienced severe guilt. During her first and second marriages, a pattern of extra-marital affairs continued until the point that she became a Christian.

As our work deepened, Graciella began to work through this entrenched pattern of connection via a sexuality that superseded fully orbed relating. In the early stage of this work, Graciella recalled the following dream which depicted the shifts that often would occur in the transference.
My dream began as I heard the bathroom overflowing and went in to check
it. The neighbor was using his plunger, and it had backed into my house.
I was sick and needed to use the bathroom, so I went to check the
downstairs one, and it was overflowing as well. My mother appears and is
trying to take care of me, but follows me into the bathroom, which I
thought was ridiculous. I started defecating and vomiting diarrhea. Mom
disappears but Marie was at the door for my appointment. I apologized
for the house and my sickness. Marie was radiant, and it did not phase
her. We went to my bedroom where we were having our session. I can't
recall the conversation, but it involved my feeling sad. Marie got up
slowly and sat beside me on the bed. She put lotion on my face and began
to rub it in a comforting way. I felt her closeness and couldn't believe
she was touching me, let alone putting lotion on my face. I closed my
eyes and rested in the moment. We were interrupted by someone coming
in--family members. Marie went down to say hi and came back up, but
there were two girls there now. Marie helped me to get rid of them. She
then asked me to lie down on the bed face down and relax. It felt as
though she was beginning to give me a massage. The next thing that
happened caught me by surprise. Marie lay on top of me and began to make
sexual movements. She told me that I did not know what she fought
against in her past. She then took on a very sexual look, and became
playful and flirtatious. I did not want anyone in the house to think
that this was the kind of counseling relationship we had. Marie was not
sticking to the hour, either, which I also found to be outside of our
norm. She left, but not without a "lover's" glance.


Dreams are powerful tools in psychoanalysis for helping a patient see his/her dynamics. We spent a good deal of time processing the symbols and the action in the dream, because they so clearly depicted the sexual riptides that we were experiencing. The dream begins by presenting Graciella's history which she experienced as sordid, overwhelming and filthy. She could not find a place to dispose of this filth which had now entered her. The accuracy of the dream is striking. The problem did not start with her, but with a man who had his own filth--a reflection of her father and of her family's dynamics. Her mother was of no help, and she experienced her as having no boundaries.

My entry into the dream reflects the point at which Graciella came for help. Her "filth" and chaos did not bother me. I was a good maternal figure who listened to her sadness, soothed her, and comforted her. But we become interrupted. Family members-which symbolized parts of Graciella that were intent on maintaining old patterns (parts that we identified as "self-states") disrupted the tenderness. I returned as a therapist with the dynamics of her family of origin. Graciella needed to feel close to me. However, at this point she could not sustain experiencing me as a new, good object. I needed to be someone to whom she could relate. Her dream depicts us as becoming related, not through our mutual respect and care, but through traumatic history and sexual desire.

The processing of such painful material was difficult for Graciella. To support her working through of such painful feelings, Graciella began to create both paintings and sculptures that reflected her self-states, (see Bromberg, 2001) which had evolved in successive stages of her life. The first of these was a miniature clay model of herself as an eight-year-old girl, bewildered, rejected and alone. Many more self-portraits were to follow, as well as numerous paintings and sculptures depicting my relating to her. Many were showcased in a room in her home. There, she would both create art, and maintain via these transitional objects (Winnicott, 1971) an unfettered connection to me that included both nurturing and sexualized fantasies. The transitional objects which enhanced Graciella's work with me also transformed her creative energy as she discovered a previously unknown artistic capability.

My primary therapeutic aim at this time was to help Graciella modulate her sexual arousal, while providing in our relationship a new way of relating. I facilitated her understanding of her emerging sexual feelings of which she felt ashamed, but did not enact her longings for touch, and thus derail the experience of nurturing intimacy that she needed. Graciella became aware that her room full of transitional objects, while providing sure and instantaneous connection, simultaneously served as a defense against disclosing her needs with me. She astutely captured this understanding in a journal entry:
I am overflowing with aliveness for the things I love. Ironically, most
of these things I love are so inanimate and require no people
challenges. None are relational. They feed my isolation. Today this
isolation is good. Beneficial. But to the extent that I continue to
choose to be alone with "my toys", then they become my crutch instead of
my walking on my own two feet toward relational healing.


Her now conscious awareness facilitated processing this lacuna in our relationship. A verbatim excerpt demonstrates how these dynamics emerged in session.

[Graciella is having a phone session from home, and is curled up in bed speaking. She is having difficulty expressing the sexual and angry feelings that are emerging.]
Graciella: "I'm feeling anxious. Maybe I'm too relaxed about the
 sessions?"
Marie: "Do you know what's making you anxious?"
G: "I don't want to talk about ... (Long pause) I want to chill. I am
 saddened by so many things. You're so close but so far. In my room I
 feel so close to you."
M: "Why can't you feel close to me when you're with me?"
G: "In my room I can speak candidly with you. I can touch the clay, the
 picture."
M: "Why do you feel safer a half a city away with images of me, rather
 than with me?"
G: "The phone is in my ear."
M: "Pillow talk?"
G: "Probably." (Long silence ensues.)
M: "What happened? Did you get uncomfortable when I said pillow talk?"
G: "Yes."
M: "Why did you get uncomfortable?"
G: "It's sexual."
M: "Is there a concern that those feelings will get mixed, and that if
 you talk about sexual feelings, it's bad?"
G: "I'm speechless."
M: "I know this is difficult.
G: "It's so frustrating."
M: "You're very afraid to talk about your strong need for closeness, and
 about your anger that you're not getting it in a certain way."
G: "Sometimes I've been able to turn the frustration into positive
 energy."
M: "Is there only room for positive Graciella.?"
G: "You don't like the other parts of me."
M: "I enjoy certain times with you more than others. But to not like
 certain parts means to not like you. You're a whole, and I'm not
 comfortable saying that."
G: I think I don't like me at those times. The world wants happy,
 compliant Graciella."
M: "The world may be that way, but that's not how that is here."
G: "Is time up?"
M: "Yes."
G: "I love you, and I like you."
M: "Do you think I like you?"
G: "Sometimes!" (Laughter.)


REJECTION AND THE PLEA FOR ACCEPTANCE

It was inevitable that the depth of Graciella's longings would lead to her feelings of rejection by me. It was one thing for mother to care for her, and need to go away; it was another to have had a father that utterly rejected her. And it is the move from the feelings of longing for nurture to anger at rejection that signaled the shift from what was a primarily maternal transference to a paternal one. The mood became darker in sessions. Anger and pain were always seething just below the surface. Father had a history of problems with money, both in not supporting his family, and in being financially incompetent. He suffered from physical ailments as well. This period with Graciella mirrored the connection with father, being replete with conflicts over payment of the fee, as well as increased debilitating physical difficulties

The oscillation that took place during these times is best understood through a brief review of Heinrich Racker's elaboration of the concept of counter-transference. Racker (1968) an Argentinian psychoanalyst, theorized that there are two kinds of countertransferences which emerge in treatment. The first is a complementary countertransference. Here, the analyst is nudged into the role of a significant other in the person's life, experiencing and potentially enacting that person's feelings and behaviors. The second kind of countertransference is concordant. The patient assumes the role of a significant other, and the analyst is made to feel what the patient had to go through at some point in her life. Often, the most difficult and painful enactments are of this type. For healing to occur, the analyst must bear the experience of pain that the patient felt, that is, he/she must become a "faithful high priest."

It was this second type of countertransference, the concordant type, that dominated the second period of the analysis. Graciella would begin most sessions describing some form of physical difficulty or painful condition. No amount of exploration seemed to help. In frustration, I at times would offer suggestions which invariably were ineffectual. She would fall into silences that were excruciating. I could not connect. I could not help. My deep desire to comfort and care was dismissed. I did not understand why she was rejecting me. From time to time Graciella would let me know that it was the pain of the sexual need that was producing the alienation, a need I could not meet. I was the child that was cast aside, as she had been, for not being what father wanted her to be. She, in contrast, experienced me in a reverse dynamic: I became the rejecting father because I could not give her the acknowledgment she was craving. I distanced, became mechanical and resorted to interpretation when I could no longer bear the intense pain in the room. I keenly felt the enormity and the agony of the rejection that Graciella had borne, not just from father, but in the many settings to which she was a stranger, different, "other."

Many tears of mourning were shed during this period. When I was able to connect the enactment between us to the enormity of the rejection that she experienced first with her father, then with others, she would sob with groans that were heart-wrenching. On one occasion, the experience of being breathless was connected to feeling smashed like a tin can. The memory came back to her that Dad had hundreds of smashed tin cans under his sink as a money making scheme. And she felt like one of them.

There were times that the mourning, rage and ensuing silence built up to such an intensity, that the atmosphere became almost unbearable. Graciella felt that if I could not accept her felt need, and in some way compensate for the incalculable deprivation she had experienced, she could not survive, and I knew that any move toward the kind of gratification that she longed for would annihilate the therapy. During this time in an attempt to help me understand the agony she was experiencing, Graciella spoke of the tragedy of the Lady of Shallot, having been intrigued both by the painting and by Tennyson's poem. She described her identification with the Lady of Shallot. She, Graciella, had caught a glimpse of Lancelot (the ideal of love and relationship) on his way to Camelot; she was doomed to die for pursuing him. As we processed the story, what became evident is that the death of the Lady of Shallot was tied to her search for the ideal. The Lady of Shallot did not die when she came out of the tower, nor when she passed the village people. It was only when she came past the first house in Camelot that the curse materialized. I asked her if she knew the story about Camelot. She didn't. At this point, in an attempt to access a child-like side of Graciella, I sang to her:
 The rain shall never fall till after sunset
 By nine the morning mist must disappear;
 I'm sure that there is not, a more congenial spot
 For happy ever-aftering than here in Camelot.


This song opened the space for Graciella to verbalize more lingering pangs of mourning for a father who could never be replaced. While sharing her anger at me for not providing "Camelot," she wrestled anew with the reality that seeking for the ideal would not only cause her to miss attainable joys, but like the Lady of Shallot, would invariably lead to a death-filled existence.

There were, however, times of respite during this period, enabled by a deep-lying therapeutic alliance. Graciella and I knew that we cared for each other and sessions could become very warm and connected. Graciella was changing. During this time, as if to reassure me that she was growing, she wrote this piece of poetry:
Sometimes one at a time, sometimes a bunch at a time, the leaves fell
baring each branch. From evergreen and at attention, alert and proud and
alive, to a skeleton of dull brown and gloom. Then when dry and thirsty,
surrounded by winter's cold, the pruning came. Painful clippings
apparently dead, they went some as whispers, others as rolling thunder.
And now, little buds of green-promises of a new spring.


With art, Graciella was able to transform the pain in her relationship with her sensual mother into something redemptive. With Dad, it was words. Dad had not done much for Graciella, but he had exposed her to classical books, which from her earliest days she loved. Graciella now sought to identify with me through words. She writes:
Today I went to the bookstore looking for something. I longed to find
something to connect with Marie. I went there and totally looked past
the art section. I read over a million titles in the self-help area. My
eyes roamed, searching without really knowing. I considered Nietzsche,
something on Klein and an author/doctor with the last name of Gray. I
looked through many "Ws" And then I saw it. Winnicott--an upside down
"M"!! And I felt life spring back to me. At that precise moment I felt a
desire to fight back. Not because I know enough about Winnicott. But
because I know enough about Marie. I know enough about me and my hunger
for discovery and help and healing


DESTRUCTION AND SURVIVAL OF THE OBJECT

Graciella's introduction to Winnicott's works would prove to be pivotal in the work that lay ahead. Not only would she refer on many occasions to his creativity and aliveness, which she as well wanted, but she more consistently grasped and experienced a holding environment with me, with its regression to dependence.

Through the painful stages of the first four years of therapy, Graciella had grown. Her menial job with a disreputable firm was traded up for an administrative position with an internationally respected company. The home that they once rented was purchased. She began to take care of her body, faithfully working out at a swimming pool. And she began to develop her mind, enrolling in college and making perfect grades in a psychology program, while writing, sculpting and taking art lessons on the side.

Graciella's relationship with God changed as well. When treatment began, church had been successful in providing a prohibition against her sexual acting-out, but it had not addressed the underlying problem. Instead, church was a sort of Camelot, with God as King Arthur, who magically made things happen, and the pastor as Lancelot, whose attention and approval she desired. Worship would bring about, at times, a level of excitement that for Graciella became linked to her familiar ways of connection.

As Graciella grew in understanding herself, she recognized that her church experience, while initially benefiting her, was now sustaining childhood patterns. And so, along with her husband, she began to search for churches that would help her grow. Her God representation was changing as well. He no longer was the taskmaster; He was a caring Father whom she was with great hesitation willing to know.

The growth that was taking place could be summed up in relational psychoanalytic terms by saying that I had served Graciella as both a good enough and a bad enough object. As a good enough object, I provided a holding environment that permitted her to be known and feel loved in a new way. However, as a bad-enough object, I, in spite of my best efforts, participated in enactments (2) of old patterns, which we would examine, and for which I could ask forgiveness and correct--an experience unknown in her childhood.

There was however, an on-going enactment which, in retrospect, I feared to address. I believe it was this enactment that was preventing her from relinquishing me as the hoped-for Lancelot in her life, and investing more fully in relationships outside of therapy, most significantly with her husband. Relational psychoanalysis, in contrast to many other therapies, does not see impasses like this, as primarily derived from a problem of will. Even an impasse is a relational event. According to Fairbairn, we cling to the relationships with our caretakers. Through enacting parent/child patterns, we experience the illusion of connection with them. For Fairbairn (1952), nothing short of "exorcism" of a clinical sort, rids us of this bondage to the sins of our parents. Simply thinking differently, at best, only begins the process.

Relational psychoanalysis affirms that the patient often becomes the best supervisor to the analyst. And so it was with Graciella's help that I came to see the problem. The following is one more verbatim session excerpt in which Graciella leads me to what can be of help to her.

[Graciella began the session by talking about her physical ailments and her anger at her husband's problems. She went on to talk about two recurring dreams. The themes are always the same. In the first, she enters a house. The entrance is narrow, and she has to crawl in. The ceiling is low and she feels like there is not enough air. The second recurring dream depicts her in a large home that she is renting. There are many rooms, which although they are rightfully hers to enjoy, she is not able to since the owner has completely furnished them and everything belongs to someone else.]
M: Pretty relevant.
G: Yah, I guess. The space ... no space.
M: Well, I don't just see it about geographic space. Is there a way of
 looking at it as it relates to your life?
G: I'm just angry.
M: About?
G: I'm angry at you. I'm angry at the whole situation; I can't go
 through this anymore. I want to stop so I can get caught up (said in
 little girl voice.)
M: You're feeling trapped just like in the dream.
G: I don't have the money. I always get angry at you about that.
M: The other dream also shows that there's a house, your house, and
 there are resources. But you don't have access to your resources.
 Hard to understand.
G: One good thing that always comes out of this is that I get angry
 enough to do something, so that's what I'm hoping for: to be
 resourceful. For myself. To wake up. This is the way I have been for
 45 years. Just barely making ends meet. It doesn't matter how much I
 make. I am always in a state of poverty.
M: You used to be more content living at poverty level.
G: Yah, so what is that?
M: What I'm saying is, it's growth.
G: This brings up feelings for me. But it's just like Amway. You're
 supposed to like dream. They had us look at boats and houses. I was
 frustrated and hated my lifestyle. I was always envious.
M: What was being offered to you was a mirage.
G: Yah, and that's the difference. I see the picture here. I understand.
 But it seems like ... oh" "my God, I don't want to get stuck here.
 It's like I'm helpless, I can't do anything. It's scary. I don't want
 to feel in this much physical pain all the time. My whole body is
 like ... Aagh.
M: Do you think your tension and pain might be related to holding back
 your anger? You were angry at your usband and you shut it down. The
 next day your body was shot. You're angry at me today.
G: I know, I noticed. Right away. I felt it right away. How can I stay
 mad at him? He wants to do better. He drove me to the doctor because
 I needed a shot. So I didn't work today. (Pauses and looks at me
 waiting for a reprimand). Are you going to yell at me?
M: Is that what you are wanting?
G: No.
M: Is that what you are expecting?
G: Yah.
M: So there's a way in which you told me this with the expectation that
 I would become upset with you. That may also be what you're wanting.


What Graciella was attempting to communicate to me, was that I needed to allow the anger that festered between us to erupt so that she could own her resources and be able to separate from me, and consequently from her parental internal objects to whom she had been clinging. These internal parents were familiar, but held her in poverty and physical pain as she has lived out her identification with them.

D. W. Winnicott spoke of this patient need to destroy the analyst who functions merely as a projection of the self. In his classic work on object usage, he hypothesizes that the analyst, (like Christ) must endure destruction, but not be destroyed by the patient, nor retaliate. Upon witnessing the analyst's survival, the patient is now able to see that analyst and patient are separate, each having their own resources and desires. The patient can then love the analyst and others for who they are, not just as a mirror of the patient's own desires. Winnicott (1963b) reflects:
Correct provision is never enough ... In the end the patient uses the
analyst's failures, often quite small ones, perhaps maneuvered by the
patient ... The operative factor is that the patient now hates the
analyst for the failure that originally came as an environmental factor,
outside the infant's area of omnipotent control, but that is now staged
in the transference. So in the end we succeed by failing--failing the
patient's way. This is a long distance from the simple theory of cure by
corrective experience (p. 258).


This is the crux of the enactment that had taken place. Graciella negotiated a very nominal fee at the beginning of treatment. As her income increased, I expected that her fee would increase. Any mention of changes either in frequency or fee produced an immediate expectation of rejection on her part. Because of my own fear of her rejection, and my discomfort with the anger that would certainly emerge, I avoided raising her fee to an appropriate amount. In so doing, I treated her as the poverty-stricken and incapable child of her parents. I became resentful of being used. I, in effect, became the used little girl who tried to be so good that I remained valued; for fear that she would become the rejecting parent. On her side, as long as I stayed in the role of the all-giving parent, she could remain a helpless child. However, if I raised the fee, she would experience me as the rejecting parent who dismissed her need and used her, only adding to the feeling of rejection in the sexual realm.

I decided that I needed to give her the space to become angry, and trust that we would both survive. As Winnicott cautioned, survival is never certain. One evening, I broached the topic of a progressively increasing fee structure. We attempted to process it, but her withdrawal was immediate. Withdrawal, silence, tears and rage continued for many weeks. The sexual issues reemerged and Graciella, unable to experience me as acknowledging her need sexually or monetarily, decided to reduce the frequency of sessions to once a month. I prevailed upon her to come every other week, so that I could attempt to help her through this difficult time. Graciella's rage and hurt continued unmollified. She demanded to take back her sculptures which had been in my office for safe-keeping, leaving me with only one precious doll, the little girl of 8 years of age.

It took many months to begin to work through Graciella's agony. She wrote profusely, attempting to articulate the pain that she was feeling. This period was agonizing for me as well: I was navigating in a storm that was potentially annihilating. I believe that what was most important for me to feel during this time, was the "My God, my God, why hast Thou forsaken me" that Graciella experienced, the utter abandonment that she must have felt at six when, for reasons of money, her mother abruptly disappeared. These feelings, though not in magnitude but in kind, were all too familiar to me, my own memories of rejection and abandonment looming perilously close.

Slowly, signs of survival were to be seen. Within the year, Graciella left the administrative position which had become monotonous to her, and assumed a position as counselor and legal aide at a Crisis Pregnancy center, her first position in a helping profession. Through this experience, and the validation of her superior performance, she set her sights on becoming a professional psychologist. Her physical ailments began to diminish. Also during this time of infrequent appointments, and frankly in order for me to clearly demonstrate that no retaliation was taking place, I passed on to her information about a writing contest. She entered and won. Her first short story was published.

Graciella's treatment is on-going. In recent months, her relationship with her husband though a continued source of frustration, has showed signs of hope. While he struggles with his own issues, Graciella has begun to appreciate the husband she has, and relinquish the charm that Camelot has had for her. Their sexual relationship reflects a new intimacy and excitement about their lives. As counselor, when Graciella is threatened with feelings of rejection, she is more able to resource the love of God, and His redemptive calling on her life and calm her anxiety. Sessions, which are back to once weekly, often include sharing at a spiritual level, and praying together. Our sessions are often playful, but we still weave in and out of moments of agony, though the once intractable sexual preoccupation is rarely present.

CONCLUSION

In Graciella's life, and in psychoanalysis, relationship is at the heart of all that is meaningful. For Graciella, sexuality had occupied that position. But the same had been true for psychoanalysis. The shift from libido to love, first introduced into psychoanalysis through theorists touched by the Judeo-Christian narrative, has transformed and immensely enriched psychoanalysis. And given the opportunity, relational psychoanalysis has the potential to, in turn, immensely enrich Christian counseling.

There is perhaps no better way to conclude this presentation than to offer a final dream from Graciella, cataloguing the shift from her first dream in which I was a sexual object to her. In this dream, the new type of loving relationship that has been birthed becomes evident.
The event seemed to be a company event. It took place at a very nice
hotel. The hall was decorated at its best. Marie and Lowell [my husband,
also a psychologist who in reality shares a suite with me] were the main
guests and entertainers. Both of them sang. Marie was dressed
beautifully in an evening dress. It was black with rhinestone trim Her
air was up in one part of the dream, and down in another. We both knew
each other in the dream as we do now--as well as Lowell. But because
this was a professional engagement we greeted each other (Marie and I)
as acquaintances--business acquaintances. I was in a side lounge area.
Marie was in the main area but came to where I was. We made some small
talk. Her hair was down. We chatted and then she moved on. I could
already hear Lowell singing in the main hall, but I couldn't see him. I
heard Marie join him singing. It sounded pleasant to my ears, but she
was in the background. Then Marie started singing a solo. It must have
been named "Graciella," for I heard the name several times as she sang.
I stood still and knew she was singing it for me and I knew that she
knew this and that she knew I was listening. She was singing it for me,
and ... I felt so much love.


REFERENCES

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Davies, J. & Frawley, M. (1994). Treating the adult suvrivor of childhood sexual abuse. New York: Basic Books.

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AUTHOR

Hoffman, Marie. Address: 7540 Windsor Dr., Ste. 105, Allen-town, PA 18195. Title: Co-Director, Brookhaven Center for Counseling ad Development. Degree: PhD, Clinical psychology, Union Institute. Post doctoral Studies: New York University. Specializations: Relational psychoanalysis.

MARIE HOFFMAN

Brookhaven Center for Counseling and Development

Allentown, PA

Correspondence concerning this article may be sent to Marie Hoffman, PhD, 7540 Windsor Dr., Suite 105, Allentown, PA 18195. Email: brookhavencenter@aol.com.

(1) The reader is referred to my previous study on the Calvinist and Wesleyan roots of Fairbairn's and Winnicott's writings and their implications for contemporary psychoanalysis.

(2) For a thorough understanding of "enactment", see Hirsch (1998); Aron (1996). Relational psychoanalysis holds that we cannot help becoming mutual participants in patterns that are a product of life experiences in both analyst and patient. It is the recognition and repair of these patterns that is most therapeutic.
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Date:Mar 22, 2007
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