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CONCEPTUAL BIO
I have been waiting for hyperlink
to be invented—to make it possible to bring my work together with
a few clicks.
People who
know me as a sex therapist are unaware of my work as an analytic therapist,
and vice versa. Within the analytic community, my contributions
to ego analysis have been misidentified as ego psychology.
My analytic
genealogy, for those who are still interested in such things, goes back
to Otto Fenichel (Rado-Fenichel-Windholz-Weiss), especially as he
presented his position in Problems of Psychoanalytic Technique
in 1941. Crucial to this position is the distinction between id
analysis and ego analysis.
I cobbled
together my own analytic training since at that time psychologists were
excluded from the Institutes. My analyst, Joe Weiss, is a training
analyst and founder of Control Mastery therapy, which, if you look
at it really closely has detectable links to ego analysis, although
mainly on the theoretical level. In practice it resembles id
analysis more than ego analysis.
At that
time, like most therapists, I was doing intensive, long-term analytic
therapy. However, unlike most therapists at that time I also was
developing an approach to brief therapy, partly because I had been
trained and then hired at a brief therapy clinic, but also because
Weiss's approach works with the moment and so can easily be interrupted.
At that
time I was developing the distinction between ego analysis and id analysis,
both in the literature (two long papers in the International
Journal of Psychoanalysis), which began a correspondence with
some major figures in the field, most notably Merton Gill, and in
conducting the final seminar in the clinical training series in
Department at UC Berkeley (Theories of Therapy), and a similar seminar
at the Wright Institute.
I also was
published in an entirely different venue, the Berkeley Barb,
a popular Berkeley counterculture paper (I think the "Barb" was to puncture
the establishment). It was a long interview with me, covering
two issues. I used the example of "frigidity" as one of
the best illustrations of an id analytic concept, laying out the
ego analytic alternative. The Barb liked it because
it seemed to puncture the analytic establishment.
That led
to a call from a woman attempting to work as a surrogate, on her own,
after reading Masters and Johnson's description of that work. She
was having trouble and needed a consultant. The Barb
interview made me look like a possible resource. I organized
a group to study her cases, eventually called the Berkeley Sex Therapy
Group. I had some ideas about how ego analysis could be applied
here, but it was still unclear whether we had a workable approach. Then
we were suddenly caught in a media blitz, with Masters and Johnson,
Helen Kaplan, and us getting national and international attention.
Just as
suddenly we were deluged with patients. Should we tell them, sorry but
we're not sure we can help? These were desperate men. About
a third had been through long-term therapies, and another third
were currently in therapy. The remaining third would never have
entered conventional therapy. We couldn't turn them away, and
with this volume of patients we had an opportunity to develop an
approach that worked and that created what my colleague Martin Williams
called a "new laboratory" for the study of sex and sex problems.
I also spent
time in St. Louis to find out what Masters and Johnson were actually
doing (at one point being listed on the staff of one of their workshops,
assigned to put what they do in a conceptual frame). I found
that their approach looked very different in practice from the impression
their publications create. Unlike anyone else in the field
they were surprisingly ego analytic. Beyond that, their approach
to sex was truly revolutionary, although, like Freud's recognition
of bypassed guilt and shame (see ego analysis), it has been all
too easy to assimilate to the commonsense notions it so radically
revised. For a thorough presentation of this perspective, see
"What the Sex Therapies Tell us About Sex," in Kleindiest (Ed), New
Perspectives in Sex Therapy, Brunner/Routledge, 2001, pp. 5-28.
Of course,
we also saw a lot of couples in sex therapy, but the foundation of our
approach was worked out in Individual Sex Therapy, which actually
was a couple therapy, with the couple being a male patient and a
female body-work therapist. At the time this scandalized many
therapists, naturally enough, since they envisioned the usual male
dominant, female sex-object scenario (others, with the same scenario
in mind, applauded us). It was too hard an idea to grasp that
trying to fit this scenario was what our patients were suffering
from. How people responded to our program was yet another
"laboratory." The crowning absurdity was the charge that men
who could "perform" with a "surrogate" might still have a problem
with a "real" woman, as if to have a successful experience under
any circumstances would not be enormously relieving—or at the very
least a valuable clue. For an illustrative vignette, see On Performance-Anxiety
Anxiety.
Of course,
I also saw the usual range of couples and individual patients as well,
but this focus in one area. especially one as both as vexed and
as revealing as sex, gave me and my colleagues, most notably Martin
Williams and Susan Greene, the opportunity to unearth some truths
about sex and sex therapy that would have been hard to come by any
other way. My definitive presentation of this approach was
published in 1984 in The Journal of Sex Research and received
the Hugo Beigel award as the article-of-the-year.
It is always
assumed that this work made me an expert on male sexuality, but much
of the focus was on the body-work therapist's reactions (as clues
to the patient's problem). When I mentioned in a meeting that
we were doing an intensive relationship therapy, one therapist said
she didn't see how I could think of the patient and body-work therapist
as having a relationship. Our patients typically had the same
problem—in fact that was their problem: they didn't
think they were having a relationship with the body-work therapist.
(Of course, that's true of most patients in therapy. They don't
think they are having a relationship with the therapist. Recognizing
it is called the analysis of the transference.)
This work
also gave me a chance to more fully develop the ego-analytic model. Here,
in a nutshell, is what I came to.
Think of
cognitive therapy. It is our negative self-talk (self-reproaches,
self-hate) that generates our symptoms, rather than the reverse. Another
way to say this is that we feel overly responsible for what we feel
and do (which typically has the effect of our denying responsibility). This
makes it hard to grasp reality, much as in the extreme case, in primitive
times, we thought that our feeling were put into us by witchcraft
and also that our feelings could cause plagues and
other disasters. A book about this might be
called "How We Dismiss Reality," or, to be more specific, How We Disniss Sexual Reality.
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