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 is a case that uniquely demonstrates this.

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.

         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).

PERFORMANCE ANXIETY
         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.                                                         

         This introduces the second ego analytic principle, that helping patients to be more self-accepting is of limited value unless they also are helped to accept the ways they are not self-accepting.  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 authenticity movement (Heidegger, Sartre, Fromm, Rollo May, 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.
         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 conventional approach treats shame like a fever---as a sign of some underlying problem (early shaming experiences, fear of showing off, narcissistic vulnerability) that needs to be treated, not something that primarily needs to be treated in itself.  The client's relationship to shame is taken for granted, just as our relationship to a fever is taken for granted.  Yet to be able to empathize with the feeling of shame relieves it.

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.

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."

          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:

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."

         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.

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:

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.

         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.