Aug 20 2008

Psycho-Analysts Ask—Conjunction Junction What’s Your Function? Part 3

Psycho-Analysts Ask—Conjunction Junction What’s Your Function?

Chapter 10

Part 3

New players, new solutions, old solutions, defensive about XXX residential treatment program, and worry about what mother thinks, which she never worried about before about something that sees trivial. And much more details about everything—friends, drugs, police, etc.

Session one day later.

“Hey” I said.

“Not everyone I know went to xxx (residential treatment)”, she laughed.

“Embarrassed about xxx (residential treatment)?” I asked.

“No. Like Trisha. We weren’t in the same grade but I would sleep over and we were the best friends.” She said.

“And she didn’t go to xxx?” I teased.

“I have people in my top 8 that didn’t go to xxx. “ She laughed

“Well so far you’ve mentioned 8 people and 7 of them were at xxx” I said.

“yeah. But not all.” She laughed.

“They call it a top 8 but you can make it a top 24. I have at top 12.” She explained.

“You told me it was a top 8” I said.”

“They call it a top 8. That’s just what they call it because you used to only be able to put 8 people on it. And then Tom, the person who created MySpace, he put it so that you could put 24. I wrote to him a lot at xxx.” She laughed.

“8 out of 24 or 12 or 500. Are you sure Mike didn’t design this by any chance?” I laughed.

“Mike, my therapist?” she said laughing. “no.”

“Sounds like Mike.” I said.

“No. You gotta be kidding. He couldn’t be ever that smart. Tom’s cool. You can ask him questions.” She said.

“How do you get to Tom?” I asked.

“You email him. It takes a while for him to get back to you. ‘cause he’s the creator of MySpace and everyone emails him.” She said.

Silence

“It’s so stupid! Oh. (silence). I hope he calls me! He’s losing me fast. Though maybe it’s the other way around. If he loves me as much as he says he does, or did, or I don’t know what you call it.” She said.

“Either he does, he doesn’t? What’s the other one?” I asked.

Silence.

“I don’t think I told you this. I got all of Ed’s crap together in my room, his pictures, his letters, his cologne, his flower thingies, all the things he gave me, and I put them in a bag and I’m going to give it to his aunt to give to him. And I’m going to put a note in there that says ‘if you don’t want your shit, then throw it away’. I threw away all of Tom’s shit because I hate thinking about him and I don’t care about him anymore. ‘I don’t really like thinking about you, but I thought I would give you the option of keeping the things or not. But then this is all shit anyway, right?’ and that’s the letter.” She said.

Sigh of frustration

“I don’t know, I don’t know man. I’m not calling him! I promised. If I don’t keep this promise, I’m gonna hurt myself so bad. I said that this weekend and what do I do? I call him. Maybe I’ll be too busy. I’m seeing some of my friends from xxx, I have the date, I have an orthodontist appointment.” She said.

“Maybe see Tricia. She does E. It’s really bad. She lives right across the street from me. Saturday, I snuck out and went to across the street to her house. She starts crying and keeps saying ‘I can’t believe you’re back, I can’t believe you’re back’. And I said I can’t believe I’m back either. So I go into her house and we’re sitting there talking. She just filled me in on all I’ve missed. Then we played the Ouija board, which was kinda creepy. “ She said.

Silence.

“How’d the Ouija board thing turn out?” I asked.

“I don’t know. It’s kinda creepy.” She said.

“Do you ask the Ouija board questions?” I asked.

“Yeah.” She answered.

“I’m going to take a shot in the dark about what kind of questions did you ask?” I asked.

“Yeah, it’s what you think. But also that I snuck out.” She said.

“Oh. Sneak out a big deal” I said.

“My mom would kill me. She doesn’t like her at all. I don’t know why. Yeah I do. Drugs and because she didn’t write me when I was at xxxxx. If I was on drugs, I wouldn’t want to write anybody there. I would write to anyone who wrote to me.” She said.

“Sounds to me you were forming a club, a xxxx veterans and newbie club, going to, have been at xxxxx, who you write to, etc..” I said.

“There is a club.” She said.

“Well, no. I have other friends. Like Jessica. She was with me on my 16th birthday when Tom broke up with me. I was sooo drunk, out of my mind, it wasn’t on my birthday, but technically it was because it was after midnight. So he broke up with me on my birthday. I was so completely gone, I was drunk. I was taking shots. Usually I can take 2 shots of Jack and I’m soo gone. I took 4. I couldn’t think, I was crying hysterically. She picked me and Wendy up and I got into the car and she said ‘are you guys drunk. You’re getting in my car, drunk? I can smell it (alcohol).’ She took us to her house. Just our luck we’re driving to Jessica’s house and check-point. Checkpoint! And she’s ‘oh shit, oh shit.’ What do we do? Stupid her and she turns around and the cops see us. And follows us. She turns into someone’s driveway. He pulls us over and says ‘what are you guys doing? Why did you turn?’ He can see me in the back crying hysterically. And Jen is like ‘we’re wanting for our friend here.’ He says ‘why, have you guys been drinking? Why is she crying?’ Jessica says, ‘it’s her birthday and her boyfriend broke up with her.’ He says ‘ you know what, I’m not going to give you a ticket. I’m going to go home and be with my family and I’m going to go to sleep and I’m going to have a good night.’ And then he got onto his bike and just left.” She said.

No responses yet

Aug 17 2008

Psycho-Analysts Ask—Conjunction Junction What’s Your Function? Part 2

Psycho-Analysts Ask—Conjunction Junction What’s Your Function?

Chapter 10

Part 2

Next session, one day later. Mary is obsessed, to put it mildly, with Ed. She is sounding more and more manic. Further, she is massively confused about most everything and everybody. This confusion is not seen at all by her. Everything she says, contradictions, confusions, etc, are not that to her. Everything she says is clear to her. As before, she is telling me her ‘truth’, which changes rapidly, which I keep trying to investigate, with questionable success. However, she keeps on talking (free associations) with little or no censorship, is attached to me, and has a very good sense of humor.

“He drives me crazy.” She said.

“Perhaps what your mom says is that we can have another member of the Borderline club. So you have you, your mom, and Ed.” I said

“Ed is not borderline.” She said.

“What is he? Just crazy?” I laughed.

“He’s very hard headed.” She said.

“So that’s really not a mental health diagnosis.” I said.

“That’s just Ed. (pause) I’m real hard-headed too. That’s the problem, we’re both really hard-headed” she said.

“Well that’s even worse, you’re a hard-headed borderline” I said. She laughs. “ Just out of curiosity, your mother the diagnostician, what does she mean by borderline?” I ask.

“I don’t know. I just try to ignore. She talks to Jessica about it. I just think ‘God, what’s Ed doing.’” She said.

“So your mom and the family just talking about how you are a borderline and you keep talking ‘Hard-headed Ed?’” I asked.

“Sometimes. Even in XXX residential treatment program with Mike, they would talk about borderline stuff and then they would say ‘isn’t that right Mary?’ and I’m just like ‘yeah’. They talk on and on and I’m like day-dreaming off. Eventually they be like ‘do you understand?’ I say yeah. ‘Can you explain a little bit?’ and I pick out a few words I picked up in the conversation and try to make some sense out of it” She said.

“So he was basically talking to himself?” I asked.

“I’m not sure if my mom was listening at all. I’ll have to asked her about it.” She said.

I laughed. “I always confuse people. Mike is the the liar who is slow and stupid and the ‘I want to keep you here until you’re 18 guy.” I said.

“Slow and dumb” she said.

I laughingly apologize. “A liar who’s slow and dumb, not stupid, who wants to keep people there until they’re 18”. I said.

“Yeah.” She said.

“Did you ever ask your mother for a diagnosis?” I ask laughing.

“For what? For me?” She asked.

“No, for Mike.” I said.

“No. But my aunt came for my first visit and she met him and he toured us around. When we were done, she said ‘he’s really slow.’ So they must think he’s really slow then.” She said.

“The psychiatrist was the …” I say.

She continues the sentence “the ADHD guy. He’s ADHD and he diagnosed half the school as ADHD. He made me nervous so I’d move around in his office all the time. He’d be like ‘Is your leg shaking? You might have ADHD.’ I’m not joking you. Every time I went into his office, he would diagnose me with ADHD. It’s like he would diagnose so many people with ADHD, that he would forget that he had already diagnosed me with ADHD. Every time I went into his office, I would be twiddling my thumbs, or shaking my legs and he would be like ‘you’re twiddling your thumbs, you’re shaking your legs. You might have ADHD.’ And I’d walk around that room. ‘Do you think you might have ADHD?’ Everytime I’d walk into his room.” She ex-plained.

“Had he already put you on medication?” I asked.

“Yeah. I think he forgot. He put me on Strattera. And then he’d be like “How’s Strattera doing?’ I forgot why he took me off of it. And then I’d come in and walk around and he was say ‘do you think you have ADHD?’ I’d say, yeah you put me on Strattera. He wanted to put me on Ritalin and my mom said no. He wanted to put me on Adderall and my mom said no. “ She said.

“Maybe for those people you don’t really give a diagnosis, unless it’s slow, lying.” I said.

“dumb” she interrupts.

“I thought slow and dumb went together, but not necessarily. “ I said.

Pause.

“Well yeah. He had me on his MySpace page. I don’t know if he took me off be-cause I took him off. He probably took me off too. I was trying to make a joke out of it, I emailed him and said ‘please call me, I promise I won’t hang up on you.” She said.

“And I said lol.” She said.

“’I don’t find any humor in that.’ He (Ed) said.” She said.

“I was like dude, what’s wrong with you?” She said.

“’Nothing. You’re just going to regret what you said later.’ he said.” She said.

He emailed it to me. MySpace email.” She said.

“Can you still MySpace email if you’re not on the friend’s page?” I asked.

“I didn’t take him off my friends list. I just took him off my top 8. He’s still on my 500 list of friends.” She said.

“If you’re on the top 8 list, what privileges do you get that are different than the other 500?” I asked.

“Nothing. Just letting people know that these are my best-friends. And then being #1 is a big deal. I’m his #1. He’s the only one on all of MySpace that has me as his #1, except for my mom. She has made it but she never went on it again.” She said.

“Is she on your top 8?” I asked.

“No” She said.

“Is she on your list of 500?” I asked.

“yeah. She’s on the 500. Who is? My cousin, Ed, was, my best friend Alicia who went to XXXX residential treatment, my friend Ashley, etc. (all friends from XXXX residential treatment) and Trisha who I’ve known since 11 years old” She said.

“So everyone is from XXXXX residential treatment. What happened to Trisha?” I asked.

end

No responses yet

Aug 11 2008

Psycho-Analysts Ask—Conjunction Junction What’s Your Function? Part 1

Please remember that the contents of this book by Dr. Ricker have to be read from the bottom of the blog. For example, Chapter 1 is at the bottom of the blog and is the first entry. Please, therefore, read upward from the bottom of the blog. In that way, you will be reading the chapters in their correct order.

Psycho-Analysts Ask—Conjunction Junction What’s Your Function?

Chapter 10

Part 1

(Chapter 10 has been removed, re-written, and re-posted. As well, clinical notes have been added. More notes from sessions with this patient will also be added shortly)

The ‘background’ of Psycho-analysts is complicated and extensive. This ‘background’ is crucial to our work. ‘Background’ is material in the back of our minds. Learned and forgotten. But of course, it is still there. A large part of this ‘background’ is knowledge of the many Psycho-analytic Theories that exist.

One set of theories that form this ‘background’ are those of Melanie Klein and Wilfred Bion.

Early mental life has a close relationship to adolescent mental life, both as a model and a fact. The study of primitive emotional life of infancy offers rich information in grasping the origins of the creation of the ‘ride’, of adolescents.

Bion emphasizes that a sequence of events regarding the evolution of a theory occurs. The first element is an empirically observed fact. In the instance of Melanie Klein, this observed fact is that there is an obvious relationship between an infant and its mother that far exceeds simple physical needs. Bion goes on to say that theories that derive from the observable, empirical facts, should yield empirical observations on the part of other psycho-analysts to confirm the theories so derived.

However I believe that this is an error on the part of Bion. One of the greatest road blocks to actual psycho-analysis is the search, conscious or unconscious, for proofs of theories. The biggest problem in this search is that when we search, we will find. Such ‘observations’ offer only the support of theories by other theories. Such support is infinitely available, but rarely proves anything except that a theory can be evolved to support another theory, and so forth.

“For as soon as any one deliberately concentrates his attention to a certain degree, he begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded, and in making this selection he will be following his expectations or inclinations. This, however, is precisely what must not be done. In making the selections, if he follows his expectations, he is in danger of never finding anything but what he already knows; and if he follows his inclinations will certainly falsify what he may perceive”. Freud, Standard Edition, Volume 12, pgs 111-112 Papers on Technique, “Recommendations to Physicians Practising Psycho-Analysis”)

­­­­­­­­The particular elements of Ms. Klein’s and Dr. Bion’s work that I wish to focus on are few: the work of both on Projective Identification; Ms. Klein’s concepts of what she calls the Paranoid Schizoid Position and the Depressive Position; and Dr. Bion’s Theory of Thinking—Second Thoughts.

The concept of Projective Identification, stemming from many factors, largely the empirical observation of the complex relationship between a mother and its infant, is extremely useful. Ms. Klein’s theory of Projective Identification basically represents her model to explain the beginning communications between an infant and its mother as well as the relief of the infant from intolerable pain and terror. The infant is born with no ability to think, to know anything about thoughts, etc. This state is envisioned by Ms. Klein to be one of terror and unspeakable pain for the infant. In order to relieve itself of these unbearable feelings the infant tries to reduce these by projecting these outward. The mother, if available emotionally, is able accept these projections. She is then able to convert these, later called Beta elements, the unthinkable, non-thoughts, laden with terror, into thoughts that can be thought about, abstracted, etc. and projected back into the infant (later called Alpha elements and Alpha processing).

Ms. Klein, trying to account for this relationship, created the concept of Projective Identification. This model is, of course, theoretical and not empirical but extremely useful. Her models’ went further to include the Parandoid-schizoid position, and the Depressive position These, according to Ms. Klein, are crucial parts of normal development, but also provide the opportunity for the development of pathological mental states. The Paranoid-Schizoid position advanced by Ms. Klein, posits that it is from this time of life that many primitive mental mechanisms develop. All of these are familiar to all of us. Whether Ms. Klein’s theories in this respect, are accurate, of course, remains in doubt. The existence of these very primitive mental mechanisms, however, does not.

Specifically, it is during this very, very early time of life that the first evidences of ‘normal’ Projective Identification occur. Those, put another way, are the first mechanisms of communication that arise. Projective Identification as adumbrated by Ms. Klein, is crucial in the development of ‘normal’ interpersonal relationships, providing the model of all subsequent such relationships. Further, she regards the failure to negotiate this period of life successfully, to be the source of many if not all of subsequent intra or inter emotional problems.

These primitive mechanisms, according to Klein and others, are mental mechanisms characteristic of very early life and re-emerge at various times of life. These primitive mechanisms are always present and active, sometimes overactive. They are primitive defenses against experiencing all manner of problems.

Much later, Bion, created an extremely useful model for the further understanding of Projective Identification and thinking. To teach about and illustrate his model, amongst many other concepts, Bion assigned a system of labels, all of which are familiar to us, but familiar to us in a different way than many things that are familiar to us. He used portions of the Greek alphabet as signifiers, these having no particular meaning to any of us.

Two of these, Alpha and Beta are used by Bion as follows:

1) Beta elements are considered as a type of non-thoughts, but with very special characteristics. They are unavailable for thinking or modification or abstraction. An example is frustration. In the sense of and example being discussed, ‘frustration’ is an unknowable ‘thing’, a ‘Beta’ element, which cannot be thought about which is un-modifiable and can lead to more frustration. This Beta/frustration element cannot be modified. The only relief that can be obtained of this ‘feeling’ is for it to be expelled.

2) Alpha elements and Alpha processing: Alpha elements, unsaturated thoughts are distinctly different from Beta elements. Alpha elements in conjunction with Alpha processing, are living thoughts. They seek satisfaction. They are able to abstract themselves. These thoughts are receptive to modification and are able to reflect, to interconnect, to be thought about, to modify other thoughts, etc. Further, they have a mechanism to think about thoughts. Such a process is present and is designated by Bion as Alpha processing.

This re-introjection of this now converted beta element provides the infant with its’ first experience of the ability to think, its’ first Alpha element and a mechanism for thinking (modifying, rearranging, abstracting, the ability to tolerate frustration about the thought along with the beginning ability to think). Development doesn’t always follow this mechanistic process. There are obviously many serious and potentially negative consequences associated with failures in this ‘process’. For example, the ‘mother’ may be unavailable emotionally. She may be unable to tolerate, receive and ‘process’ such projections. What will then be re-introjected into the infant will be ‘thoughts’ said to be ‘satisfying’, but which are not. This failure on the part of the environment may be blamed by the infant on themselves, leading to more projections. This state is called by Ms. Klein pathological Projective Identification.

Bion, much later, described a much more sophisticated model of how the process of primordial and more sophisticated thinking may develop. He envisions what has been called Beta elements as Preconceptions/Beta elements, genetically present. He envisions then the meeting of an ejected pre-conception/Beta element as meeting a realization in the mother that re-introjected into the infant and called a conception. Conceptions aided by Alpha processing may then develop into a concept and subsequently into a thought. Thoughts are stored in a ‘reticulum’, forming the concept of a ‘mind’.

Discussion

When we pass from adolescence to adulthood, our misunderstanding of adolescents starts and gradually becomes monumental. This transition is not thought to be the schism that it is, but gradual. Utilizing Melanie Klein’s concept of ‘splitting’, a massive split occurs between adolescence and adulthood. If this split isn’t recognized, there is no reason to try to grasp it, bridge it, etc. One doesn’t try to build a bridge over what appears to be flat land.

From Southern California to San Francisco there is a geological formation called the San Andreas Fault. This fault is the demarcation between two tectonic plates that of course are separate, but are moving in different directions, unfortunately for Californians. One unusual aspect of this fault is that the earth along this fault is mounded up in such a way that this fault can actually be seen—-seen clearly. One can fly an airplane along this fault and because of this mounded earth, see and follow it for hundreds of miles.

Most geological faults are not seeable. Even the existence of the vast majority of faults/splits are not known in spite of the vast array of modern techniques to find them. In Southern California, for example, nearly every earthquake, the extremely serious and damaging Northridge quake in 1992 for example, are caused by unknown faults.

These ‘faults’ are analogous to the demarcation between adults and adolescent. These splits are there, but usually unseen. Knowing that there is a ‘split‘, no matter how small or massive is no guarantee of anything. Knowing the San Andreas exists doesn’t mean that much can be done about it itself. However, awareness of its existence has proven to be and continues to be useful to a wide variety of people. We have scientists who study it, scientists who try to discover ways of getting advanced warning of a quake, new and better building codes, lessons on civilian preparedness, etc.

As with other ‘splits,’ we can work to find them. There are splits between adults and adolescents. Splits can be major or minor, minimal or monumental and always changing. The knowledge of their existence and attempts to find them, although guaranteeing us nothing, is crucial. There are splits between adolescents and adults. Adolescents show massive internal splitting. We learn ways to identify and discuss these divides. Some practitioners attempt to cross the split between adults and adolescents by becoming ‘fey’ adolescents. They often hope that this status will cause them to be included ‘in’ the world of the adolescent. For most adolescents, this a status that is seen through from miles away and is therapeutically is a disaster. Credibility and respect disappear immediately. Inclusion, if there ever was any, is replaced by exclusion.

Honesty seems to offer at least a leg up. For example, I am not Asian. If I acknowledge this fact, which is obvious to my Asian friends, the resulting relationship is different than if I were to pretend to be Asian. Pretending is the opposite of acknowledging. If I pretend to be an adolescent as opposed to acknowledging that I am not an adolescent, the resulting relationship with my patient, is dramatically different. If I try to live in the adolescent world as an adult dressed in adolescents clothing, I will be seen through immediately. Adolescents are both good at and very experienced at identifying phenomenon. To try such a maneuver, unless I am convinced that adolescents are stupid and easily duped, is foolish.

As with the mother, it is our job to understand them, not theirs to understand us. If one were to compare theoretical developments of thoughts and thinking in infantiles, to that of adolescents, then we would have to be prepared to relate to the adolescent as would a mother to their infant child. They project needs or ‘not’ needs, we try to both perceive, understand and modify them appropriately, without being ‘fake’ or colluding mothers.

These models are often used not as speculations or theories but as facts, empirically observable facts. For adolescents, this creates an insoluble impasse. While some of us see facts, adolescents see theories and arrogance, not being listened to and certainly not understood. ‘Normal Projective Identification‘ ceases to be present. Put differently, normal projective identification between the adolescent and adult analyst virtually ceases. Primitive Paranoid-Schizoid mechanisms carry the day. Splitting, projecting, enviousness, hatred, omniscient mechanisms become the rule, not the exception.

The re-emergence of these primitive mechanisms is fraught with difficulty for us, not consciously for them. The onslaught of these primitive mechanisms, for the adolescent, become the shamelessly ‘correct’ way of existence. For them, these are not primitive but advanced. They are their ‘being’. Telling an adolescent that it’s ‘being’ is a sign of sickness or defense is understandably insulting and non-sensical. Further complicating this situation, our communications to the adolescent or infant, do not rely only on words. Some not only try to talk the talk, but to walk the walk Movements, looks, postures, glances, facial movements, touches, clothing etc., are all potent methods of communication. Both adolescents and infants are particularly sensitive to these means of communication. Perhaps as a defensive secret code, adolescents develop their own idiosyncratic methods of communication including speech, activities, movements, clothing, etc.

These are additional sessions, 8 months later, of the 16 yo girl in chapter—The Whole Person

“Here’s my date!” she said joking.

We both laugh

“ This is the boy that’s not a Mormon, but family is?” I asked.

“Yeah.” She said.

“I’ve decided that if Ed and I ever went on a date, I would be like killed.” She said.

“You”. I asked.

“Yeah. I don’t know. I don’t know. I’d be really hurt. I know that sounds stupid. But I’ve decided I’m going to tell Sam that this is not a date. We’re just going out as friends. Instead of telling Ed that it’s a date, ‘cause remember I said I was going to post a bulletin so everyone could see, including Ed where I’m going to go. So I’m going to go to the movies with Eric and I can’t wait, or something like that. You know. So that Ed will get jealous. But it’s not a date. I’m not going to say that it’s a date.” She said.

“So who are you going to tell?” I asked.

“I’m gonna post in on my bulletin so that everyone who is my friend is going to see it.” She said.

“I’m so scared.” She said.

“Of?” I asked.

“Just… I don’t know. I’m going to be so pissed off if Ed doesn’t call me. If he called me at Gardner.. I thought he might call me at my house. But if he doesn’t, we know… this is so stupid.” She said frustrated.

“What’s so stupid?” I ask laughing.

“How am I starting stuff. Are you still confused about that because I am. At least I’m not the one who started stuff.” She said.

“Start?” I said.

“I’m not” she interrupted.

“You’re , what, still trying to figure out if there’s a possibility you are starting stuff and not know it?” I asked.

“No. He thinks I start stuff. Really I’m just speaking my mind rather than keep things from him, I should have just kept it from him.” She said.

“My mom says I’m to sensitive. She says its because I’m borderline and that borderline people notice everything and they take it in fast, I guess.” She said.

“Borderline?” I said jokingly.

“She’s been shoving that bipolar and borderline shit up my face ever since I was little. ‘She’s bipolar I can tell. I see her. I used to be when I was small’” She said in a nasally voice imitating imitating her talking to her mom. “Shut up, shut up, shut up.”

“So in other words from your mother’s point of view, this all has to do with you’re wacked?” I asked.

“Yeah. (pause) Well no. not. Maybe. She says that because I notice that he does not hold my hand anymore, shows that we (the borderline people) are very sensitive and we notice everything. But the fact that he acted the way he did, I have a reason to be mad at him.”

“He didn’t. he didn’t return my phone calls. He wasn’t holding my hand anymore. He didn’t say ‘I love you’ ever” she said very upset.

No responses yet

Next »