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VIGNETTES
(Or, All You Need to Know About Ego Analysis)
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THE CASE OF
THE MAGIC SPORTCOAT
The first
principle of ego analysis is about what creates a problem. It often looks
as if an experience is a problem because it is painful, self-defeating, or
frustrating. But an experience becomes a problem only when it is
reacted to anxiously or with self-condemnations. Such reactions make it
hard to minister to oneself about the experience or to fully process it.
In other words, what turns an experience into a problem is our reaction to
it. But this is often hard to recognize because the reaction just looks
like a reaction and not like what created the problem. Here are three
case vignettes that uniquely demonstrate this.
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A high school teacher
presented with what appeared to be anxiety about public speaking that led
to heavy sweating when talking to his classes. Embarrassed by the
damp areas under his arms, he took to wearing a sportcoat to cover
them. He was mystified to discover that when he did this it not only
concealed his sweating, he no longer felt anxious.
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Here is how this first principle
applies. What turns ordinary nervousness about public speaking into
anxiety is shame about being seen as nervous. When you have ways to
cover the signs of nervousness it soon wanes, just as happened in this
case. But when the nervousness can't be covered up, then shame
intensifies it. Some people are well aware of feeling ashamed of being
seen as nervous, although even they think of it as simply a reaction to being
nervous, not what turns nervousness into a problem. Shame locks in the
nightmare, making it difficult for it to be modified by real experience.
Often a problem seems so obvious one wouldn't think to look more closely at
the reaction to it. There was an instance of this in this same
case. He was stuck with having to wear a coat, and naturally wanted to
be free to not wear it. That seemed straightforward, but shame was
still in the picture.
To accept too quickly his wish to be free of the coat would have been to miss
his chance at an even greater freedom: to be able to feel comfortable
wearing the coat or even to feel lucky to have hit on this solution.
After all, it was a magic sportcoat in that it relieved him of what had been
a truly agonizing experience. He was being denied the pleasure he could
have gotten from his little secret, even though he would still have wanted to
find a better solution.
But to enjoy wearing the coat, he would have to have felt compassion for
himself about the painful embarrassment it relieved. As it was, he
expected me to think it was pathetic to have to resort to this coverup.
He was ashamed of having to be so "neurotic." To try to
convince him that wearing the coat was nothing to be ashamed of would have
been to miss that he was ashamed of feeling ashamed. This is the
inevitable infinite-regress effect that shame, guilt, and other forms of
self-hate create (shame about feeling ashamed, being self-critical about
being self-critical).
News
flash: Charlie
Kaufman, interviewed on Fresh Air, about his scripts for Adaptation,
John Malkovich, etc., 10/23/2008
I often went into meetings—one of the things the
Nick Cage character [in Adaptation] said that is true is: “I sweat in
meetings.” I was always really embarrassed about it, and then after I did Adaptation,
I figured, well, everyone is expecting that from me, you know, and so if I
sweat it doesn’t matter any more. So I could sweat without embarrassment, and
you know what happened; I stopped sweating in meetings. I mean, that was
really interesting.
This just in:
Carly Simon
used to have a debilitating stammer. Starting at age 6, whenever she tried to
pronounce certain words, her throat would close up, leaving her speechless.
Like a nightmare where you have to run, but have huge invisible weights
attached to your ankles.” Simon tried to hide her affliction, but inevitably
her classmates pounced on it. “There was merciless teasing. I was beaten into
states of self-hatred. I knew the answers in class and couldn’t raise my
hand. Hiding was my game.”
But a turning point came when she was 16 and her boyfriend at the time, a
Harvard freshman named Nick, put her at ease—with a simple gesture. “Nick
told me that not only was it something he didn’t love me in spite of, but,
matter of fact, because of. He thought it was ‘charming.’ Charming? That was
a completely alien thought to me. I had spent 10 years trying urgently to
hide it. Now it was sexy. All of a sudden I was exotic, different in a
positive way. I was eccentric, artistic.” Her stammer occasionally
resurfaces, but ever since her boyfriend erased her shame, it hasn’t been an
obstacle in her life.
[From
thedailybeast.com, June 2009]
In all three cases it is surprising that the symptom could so easily vanish
or at least be markedly limited. It is surprising, of course, because we
assume that these symptoms are deep seated, as of course they are. What we
don’t see is that they are frozen in place by self-hate (guilt, feeling
immature, neurotic, defective, weak, or bad).
The
implications of this recognition are not obvious right away. It can look like
Charlie Kaufman and Carly Simon just needed to get over being ashamed of
their hang-ups, to be more self-accepting. That is where all good
interpretations go to die. You then feel all the more neurotic for being
unable to be more self-accepting, ashamed of still feeling ashamed. There are
therapists who will say “You even feel self-critical about being
self-critical,” as if that is not to be expected, even inevitable.
Let’s
call these inner reflections: your reactions to your reactions,
thoughts about your thoughts, feelings about your feelings. They are hard to
notice because it’s the air we breathe. When a therapist avoids confronting a
patient with how he monopolizes the conversation, the rationale is that he is
narcissistically vulnerable—which makes a lot of sense, but it overlooks how
anyone would take this characterization as a slight. When you have this in
mind, you realize that, at least partly, the monologuing is compulsive
because the patient himself is ashamed of it, i.e., thinks its bad. So he
can’t enjoy it, which makes it a compulsion.
Similarly,
someone who is especially sensitive is sensitive about being sensitive which,
then, is what makes them sensitive. So the ego-analytic jargon for this is
that he is unable to be sensitive—meaning he can’t be on his own side about
it, inhabit it, be on good terms with it. Thus, we can say, in the same
paradoxical way that the narcissistic patient can’t be narcissistic, that is
fully, or with gusto. His way of hogging the spotlight is a defended
version. If he has free to really be that way, it would be contagious.
You wouldn’t even notice it.
When reflections are not taken into account you get the
streamlined version of psychoanalysis that we often see, in which it is no
more than connecting the present with the past. The idea is that you are
misinterpreting the present in terms of the past. You are supposed to learn
to tell the difference and to separate to two. That is the psychoanalysis
that got everybody discouraged about analyzing. It is a limited kind of
analysis, one that risks being merely intellectual. Of course, we all suffer
from holdovers from the past, but what gets missed in this simplified version
of analyzing is that what is heldover is the reflections. That’s most obvious
in cases of early abuse, as I discuss at great length in the file that
follows immediately after this one (On Entitlement to Feelings).
Just
as children are prone to feel they cause everything that happens to them, so
the most traumatic effect of early abuse is that it is taken as a sign of
badness. The child can easily feel to blame for being mistreated. So, what in
the present is misinterpreted in terms of the past is not that authorities or
intimates will be abusive, but the belief that you caused it will make it
difficult to recognize as abuse. This can be even more difficult if you are
told that your perception of abuse, at least of the subtle kind, is a
misperception. People who have been abused are sensitive to the subtle abuse
that others can’t see, but they don’t feel entitled to that sensitivity.
PERFORMANCE ANXIETY
To repeat: people typically
think that their problem/symptom/issue means that they are neurotic,
immature, crazy, bad, or weak. To a surprising extent this is the cause of
the problem, even though these look merely like reactions to it. Therapists
once thought that performance anxiety was merely a reaction to having a
sexual dysfunction, so they overlooked it. They thought, "If you have a
performance failure, of course it makes you anxious. It did not occur to them
that there is no such thing as a performance failure unless it makes
you anxious.
Not only that,
performance anxiety is not a problem if it does not makes you anxious.
Sexually dysfunctional patients not only are threatened by the problem, they
are threatened by their anxiety about it, and so are always battling their
anxiety. In fact, if you look closely enough, you find that performance
anxiety actually is performance-anxiety anxiety. This is the frontier,
leading edge, of the problem.
Everybody
wants us to be less self-critical, less self-judgmental, to live in the now.
And, apparently, you can get pretty far with enough mindfulness meditation. But
from the beginning Heidegger, Sartre, Fromm, Rollo May, et al., made us
judgmental about being judgmental.
Schopenhauer
said "We forfeit three-fourths of ourselves to be like other
people." Suppose it was four-fourths? How much of ourselves
would we need to "forfeit" for Schopenhauer to give in and decide
that wanting to be like other people is being ourselves?
The authenticity
movement (and the anti-establishment ethos of the seventies) was relatively
short-lived, I believe, because it was so condemnatory of self-condemnation
(conflict, self-doubt) and, correspondingly, of all the varieties of
immobilization. It made everyone more ashamed of such experiences. You
were supposed to be yourself, and your self never included insecurities and
vulnerabilities.
The term self-acceptance captures the
core of the problem. All it is is a judgment; it doesn’t mean
anything. Tillich said somewhere that you can’t accept yourself (that you can
only be accepted by someone else—probably a variation of the idea that you
can’t forgive yourself, i.e., forgiveness is mine saith the Lord).
This
introduces the second ego analytic principle, that trying to help people be
more self-accepting is of limited value unless they also are helped to empathize
with, be on good terms with, the ways they are not self-accepting. This
is what the authenticity movement consistently misses. People don't generally
appreciate how refreshing and relieving it can be to feel non-judgmental
about the experience of being self-judging, that is, of being non-self-accepting.
The
big insight of the authenticity movement is that we are much more self-hating
than we realize, much more prone to judge ourselves harshly, to be unable to
stop evaluating everything we do, think, and feel. Actually that insight is—or
would be—profoundly mind altering, but there is no way to appreciate its
profundity because we can’t help reacting to it judgmentally—feeling diminished
by it.
Much of our discomfort with ourselves gets by us because it seems so appropriate.
Of course the teacher was embarrassed, and of course, so was Charlie Kaufman.
Naturally, Carly Simon felt humiliated.
AN EMDR CASE
In one of the most
well-known EMDR cases, one that is on video, a woman dying of cancer is being
worked with while she is in her hospital bed, tubes up her nose, and the
rest. Her problem is that her husband could not stand seeing her in her
condition and left her. He eventually returned, but now every time he leaves
the house, she is afraid he will never come back. So she bought a gun,
with the idea that if he did abandon her again, she would shoot herself.
Almost unbelievably, the therapy succeeded. The eye-movement device is
a way to keep clients focused on their pain while developing the ability to
stay centered. That's hard to do because our pain-avoidance reflex
automatically blocks out pain. Typically our problem is our fear of the
pain.
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The EMDR therapist who worked
with this woman had
her hold in mind the
painful image of her husband, Charlie, walking out the door, never to
return. The therapist keeps having her come back to that image for as
long as she can stand it, again and again.
He says: "Let's go back to the image of Charlie leaving
you. Hold the thoughts, 'I'm worthless', and the feelings, like
loneliness. Hold those in mind and follow my finger."
At first it is just too painful for her to watch. She is to use hand
signals to indicate when she has lost or been unable to tolerate the image
of Charlie leaving. "Just follow my finger. I know it
hurts. Just notice it. Just let it go by. It's
scenery. Like on a train."
When she just can't stand it, she is told to blank out her mind, and then
to take a deep breath, and return to the image. "What do you get
now?" "I hurt from head to toe."
"Just stay with that hurt. Hold that hurt in mind and follow my
finger. Just let it come out. Let it go by. Just notice
it. Just watching the scenery." This sounds like trance
induction, but Shapiro claims that EMDR-induced brain waves are
"completely different" from trance brain waves.
I don't know how many sessions it took, but finally, the client says,
"It's gone. I don't have to hurt any more. It's
amazing."
The therapist still gently insists that she go back to the image.
"Let's go back to the original scene."
She then says: "If he wants to go, let him go. He's
backing down the driveway and I'm standing at the door. And I'm
saying, 'Bye Charlie, bye.' And he's smiling, I think. 'Have a
good time, Charlie, bye'."
"Oh, gosh," she says. " 'Bye, Charlie, bye.' I
could do it. I could do it. I'm gonna be strong. When I die
I'm going to die with dignity. And if he doesn't want to see that,
that's OK."
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This client's suffering had seemed direct and obvious. It just seemed
clear that she was grief stricken because she was facing death and her husband
was on the verge of abandoning her. It looked like there was little
anyone could do. But what emerges is that 1) she was phobic about the
pain; couldn't stand looking at it, and 2) she was humiliated by it; it made
her feel pathetic. "Now I can die with dignity."
She was not desensitized. What happened was that she was able to
contain the pain. And that also allowed these invisible layers to
emerge. Who would have thought there was a significant superego problem
here?
FOCUSING
Working with an
academician who had a writing block, Gendlin had him first focus on the
experience of being "stuck." He came up with
"contempt" (for being stuck). Then beneath that, it felt like
it would be awful if he didn't write his book.
Gendlin: "All right, go back to the feeling and say, 'OK, right,
it would be awful not to do this writing.' Then ask why that would be
awful."
This sounds at first like Gendlin is poised to rebut the client's awfulizing.
But look what he says next—to us—about George:
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George often goes past a
feeling without going down to it. This is where I usually help.
He knows that it is important to accept every feeling that comes, not argue
with it, not challenge it with peremptory demands that it explain
itself. You don't talk back to a feeling like an angry parent
demanding that the feeling justify itself. You don't say, 'What do
you mean, such-and-such would be awful? That's nonsense! Just
why would it be awful?' Instead you approach the feeling in an
accepting way.
"George
accepts his feelings, but he often goes by them too fast. The best
way is to go to the feeling and say quietly, "OK, fine, it's as you
say, it's thus-and-so. But why is that? And you gently stay
until it answers."
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Gendlin's cases can't be summarized neatly, like that George couldn't write
because he was afraid of competition, or because he felt guilty about
surpassing his father, or because he felt that no one would love him, or
because he was too driven and it felt depriving, or because he was afraid of
failure or of success.
Gendlin gets the client into the feelings about the problem. Like the
EMDR case. That can seem superficial, but I think it is more often true
than we realize that, like the suicidal woman with cancer, the client thinks
that it is the problem itself that causes pain, but the most profound relief
comes from relieving phobic reactions to the problem, panic about it, and
from negative self-judgments about it.
Ego analytic addition: This self-reflective factor can be made more
explicit and so provide more of a model for growth. The growth model of
EMDR makes the client passive, and even Gendlin's focussing does not give the
client much of a way to think about the processing. But the secret of
insight therapy lies in modifying reflection, by which I mean what
clients are telling themselves, their own theories, and how our
interventions affect them. That is also the insight central to cognitive therapy,
as I discuss in the file on CBT.
ID ANALYSIS
In Spleen
and Nostalgia, Chicago analyst John Gedo's 1997 memoir, he tells of an
exchange in his analysis with Maxwell Gitelson. Gedo says, "There
was no hiding behind good manners in the analytic setting," and so he
complained in some way about Gitelson's habit of "puffing on stinky
cigars while he worked." "Gitelson was wont to reply with
something like, 'Why do you think you want to knock the cigar out of my
mouth'?"
I should note, first, that what "psychoanalysis" means is always
changing, both over time and even geographically, not to mention the often
bitter schisms over what it means in any one Institute.
And, second, the "drive theory," a term popularized by Greenberg
& Mitchell, just means that wishes are seen as bottom-line explanations
("You really want to knock the cigar out of my mouth"). Which
often has the implication that it's bad and it's your fault. That angle
is now more commonly found among non-analytic therapists. Analytic therapists
are now more likely to find bottom-line explanations in the recovery of early
deprivations, now loosely labelled as the object relations approach (it's not
bad and it's not your fault.)
Third—and this is my main point—it is idle to make the postmodernist charge
that classical analysis was authoritarian and the Self Psychological charge
that it was unempathic. Obviously it was both and this was its
downfall, but this stance followed directly from the theoretical model.
Classical analysts often did not enjoy this role, what Stern called "the
austere and demanding practice of psychoanalysis."
Back to the vignette. Gitelson's apparently rambunctious style suggests
that he was not one of those who suffered from being austere and demanding.
No one nowadays would defend his approach, but therapists would differ in
what they objected to about it. What is most striking from the ego
analytic angle is Gitelson's airy lack of concern for what Gill and I call
"superego effects." This stems from the classical analyst's
idea that he was opposing repression. The patient was expected to
resist the unmasking effect of interpretations, and the analyst had to be
determined enough---or shall we say, macho enough—to persist undeterred
by patients who were often characterized as ridiculing or enraged. Not
only did he have to cultivate a thick hide, he had to be sublimely
indifferent to the accuracy of his interpretations.
The classical analyst was a "libidinal detective" as Sterba put it (in
Reminiscences of a Viennese Psychoanalyst), ferreting out hidden
wishes. Hence, Gitelson's "Why do you want ... ." He
would have had a sense of cutting to the heart of the matter, Gedo's
forbidden wish to knock the cigar out of the mouth of the father. To
say that such an interpretation is unempathic is putting it so mildly as to
miss the point. Looked at decades later, it was naive and staggeringly
irrelevant.
In fact it would almost be said jokingly, as in "Ha! Gotcha!"
Gitelson would have not conveyed anything like the grim sense of Gedo's
wanting to do him in. So, of course, Gitelson would not have gotten
into how Gedo, had he actually had such a wish, would have felt anxious and
guilty about it, afraid it was immature, crazy, or bad.
I doubt that Gitelson himself knew whether he was being condemnatory.
But he obviously was not encouraging Gedo to experience the wish, if it was
there, more fully. Nor was he bringing up Gedo's inability to express
this wish, if he had it, directly. Most classical interpretations had
to come across as admonishments.
There is a second vignette in Gedo's memoir that conveys the way he went on
to think id analytically. He describes Kohut's distress at my critical
review of his first book (which Kohut himself refers to in a very gentlemanly
way in his second book), saying that he, Gedo, offered to write a protest
letter to the editor (which was published, along with my rebuttal). He
declares that Kohut eagerly agreed, but then made a lot of suggestions, as if
he wanted to write the letter himself, or so it seemed to Gedo. Gedo
told him that it was too late, that he had already sent the letter. Gedo
reacts:
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This anecdote illustrates
how desperately Kohut needed to obtain the "self-object
relationship" he wanted from me. From my viewpoint, he wanted to
rob me of my ego boundaries, amd I was determined never to let that happen
again.
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Now first there is a lot of venom here, and Gedo did bear a lot of resentment
toward Kohut. But this approach to interpretation is so admonishing
that Gedo need not notice what he is using it to express. Second, like
Gitelson, and the typical classical analyst, he presumes that a hidden wish
constitutes the bottom-line explanation. The hidden wish is Kohut's
wanting to rob Gedo of his ego boundaries in order to make him into a
narcissistic object, a sycophant and acolyte—that is, to strip him, as it
were, of his individuality (shades of Transylvania).
Kohut wanted to defend himself, but could not, given the niceties of the
book-review world. Probably his fault, if it was a fault, was to not
feel free to make plain to Gedo that he just needed to borrow his name, or
maybe that he felt inadequate to do it (neither of them seemed up to the
task) and would be permanently indebted to Gedo if he would do it for him.
But
he does not consider, even to dismiss, the possibility that Kohut was being
inhibited about using Gedo, and that he needed to acknowledge that he felt
somewhat puritannical about such a request. The irony is—as it always
is in the id analytic model—that you get accused of what you actually can't
do, and worse than that, you get accused of what you accuse yourself of.
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