Adolescent Psychoanalysis

(Extensively revised 10/18/08)

Cogito ergo Cogito

I think therefore I think

Chapter 11

Part 1

 

(from 9/18/08 – 10/18/08)

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Prologue:

“I need not say much about other schools which have branched off from our psycho-analysis.  The fact that they have done so cannot be used either for or against the validity of psycho-analytic theories. You have only to think of the strong emotional factors that make it hard for many people to fit themselves in which others or to subordinate  themselves, and of the greater difficulty justly insisted on by the dictum “Quot capita tot sensus”. (More usually given in the form) When the differences of opinion have gone beyond a certain point, the most sensible thing was to part and thereafter to proceed along our different ways-especially when the theoretical divergence involved a change in practical procedure.  Suppose, for instance, that an analyst attaches little value to the influence of the patients personal past and looks for the causation of neuroses exclusively in present-day motives and in expectations of the future.  In that case he will also neglect the analysis of childhood; he will have to adopt an entirely different technique and will have to make up for the omission of the events from the analysis of childhood by increasing his didactic influence and by directly indicating certain particular aims in life.  We for our part will then say: “this may be a school of wisdom; but it is no longer analysis.”  Or someone else may arrive at the view that the experience of anxiety at birth sows the seed of all later neurotic disturbances. It may thereupon seem to him legitimate to restrict analysis to the consequences of this single impression and to promise therapeutic success from a treatment lasting from 3-4 months.  As you will observe, I have chosen  two examples which start from diametrically opposite premises.  It is an almost universal characteristic of these “secessionist movements” that each of them takes hold of one fragment out of the wealth of themes in psycho-analysis and makes itself independent on the basis of seizure-selecting the instinct from mastery, for instance, or ethical conflict, or the importance of the mother, or genitality, and so on.  If it appears to you that secessions of this sort are already more numerous than to-day in the history of psycho-analysis than in other intellectual movements, I am not sure that I should agree with you.  If it is the case, the responsibility must be laid on the intimate relations which exist in psycho-analysis between theoretic views and therapeutic treatment.  Mere differences of opinion would be tolerable for far longer.  People like accusing us psycho-analysts of intolerance.  The only manifestation of this ugly characteristic has been precisely our parting from those who think differently from us.  No other harm has been done to them.  On the contrary, they have fallen on their feet, and are better off than they were before.  For by their separation they have unusually freed themselves of one of the burdens which weigh us down-the odium of infantile sexuality, perhaps, or the absurdity of symbolism-and are regarded by their environment as passably respectable, which is still not true of those of use who are left behind.  Moreover, apart from one notable exception, it was they who excluded themselves.”  S. Freud. New Introductory Lectures on Psychoanalysis, V 22, pp 143-144

 

I would like to establish an algebraic model of psycho-analysis which will form the basis of much more of both this chapter and this book. To construct this model, I will utilize  mathematical equations.  

 

The first equation, which is defective, as will be later explained, will be used as a starting place:

S + T = I

S = Statement/truth, T = Theory, and I = Interpretation

The implications of this model are broad and require careful study. This equation and it’s implications, are extremely relevant to the psycho-analytic treatment of adolescents and others.

 

Let us briefly discuss an imagined psycho-analysis. The analysand’s statement, S, is presumed to be complete, accurate (either consciously, unconsciously, or both) and not a lie.  This presumption is mandatory for this equation, albeit defective, to make any sense at all.  If S were known to be incomplete or inaccurate, the ‘truth’, then, would not be known, removing any meaning from the initial equation as our analyst uses it. The best that could then be is that T = I, a decidedly useless, circular equation, except to our analyst.  Our analyst must hold the belief  that the ‘truth’ (S) of the patient is identical to our analyst’s theory of this particular patient, a theory that he has been taught long before meeting our analysand.  The meeting of our analyst with other analysands will sound very similar.

 

The meaning of this ‘truth’ is derived from our analyst’s theoretical school, which is always busy, probably unintentionally, finding what it already knew. (see Freud V. 12, pg 111-112) 

 

Some colleagues of mine, for example, say that they don’t use ‘questions’ and, further, ‘didn’t like them’.  That is to say that their understanding of S is pre-determined. No matter, had these colleagues used ‘questions’ or any other methods to understand statement S, the ‘completion’ would be derived based on looking for material to support the theories known to be true by these analysts.  S, therefore, in this example, becomes inconsequential and irrelevant to an unbiased, observant outsider, but meaningful and supportive of our analyst’s theories. This is so in that S is the product of the intention to fulfill T. In that sense, S is T.  Now our equation is this: T = I.  Theory equals Interpretation.

 

One of the problems of Theories used in this way, T = I, is that these theories have migrated directly into the consulting room, where they don’t belong. Theories in the consulting room often or always transmute themselves from theories into psycho-analytic facts and psycho-analytic truths. Theory becomes practice.
 “In making the selections, if he follows his expectations he is in danger of never finding anything but what he already knows.” Freud. 

 

I can speak with authority on this topic. I spent many years in the distant past doing exactly what Freud admonished against. I repeatedly found what I already knew to be present.  Finding what I already knew never felt that way. I was constantly making ‘new’ and exciting ‘discoveries’  which unbeknownst to me, were both not ‘new’ but old and repetitive and theoretical.  I didn’t for a moment, however, during that time of my life, feel I was hearing what I needed to hear.  In fact, to the contrary, what I would ‘hear’ repeatedly confirmed the correctness of theories that I had learned.  The fact that I would find what I already knew which supported theories that I had been taught, further convinced me of their and my correctness.

 

Further, I knew that I was a great service to my patients. Interpreting the meaning of these ‘truths’, I ‘knew’ that I was helping the patient with what I ‘knew’ to be the ultimately true and correct way of practicing psycho-analysis. Some of my adult  patients improved.  I will examine what I believe to be the source of this improvement later in this book.

 

Adolescents, however, rarely improved. They did, however, learn and create new and exciting ways of convincing their parents that they were ‘healthy’ or better and needed to leave treatment, post haste. I, of course, debated the adolescent’s diagnosis of their condition. It was popular with my theoretical colleagues to argue forcefully and in the extreme against such departures. For example,  I would explain that their child was probably suicidal and that their life would be worthless but for this mandatory treatment. If that didn’t work, colleagues of my school could be called in for second opinions, which, as one might guess, agreed with me.  One can only imagine the carnage that surrounded this whole procedure.  Initially, the parents were steadfast and kept their adolescent in treatment. ‘Treatment,’ itself, became a  farce.  Treatment became an argument between myself, the adolescent, and their parents. Eventually the adolescent would wear down their parents, and treatment would end.  

 

Colleagues and I would often discuss, literally, how the failure of other analysts to follow our theories and practices was disastrous for their patients, and could, in the worst cases, amount to actual   murder. By ‘murder’ I mean DEATH. For example, Dr. Ralph Greenson, a prominent Los Angeles Psycho-analyst, who died some years ago, was supposedly the analyst of Marilyn Monroe. The discussion with my colleagues was that he might as well have handed Ms. Monroe a gun on the weekend of her death, since his suggestion that she ‘take a drive by the ocean’ ‘clearly killed’ her. Even though this story only rises to the status of ‘gossip’ and may be totally baseless, it was looked at by both myself and my colleagues, as the ‘truth’.  He had ‘killed’ her. Further, and obviously, the thought was that had she been in treatment with an analyst from our school, she would be alive today. (Of course, one can imagine how this type of zealotry and zeal worked with adolescents- it didn’t and doesn’t)

 

In addition to many other defects, such theoretical beliefs drastically limit the flexibility that we must have to at least try to understand our adolescent patients, as well as others. On the other hand, however, the practice and theories that I have described, lent a great deal of security and certainty to myself and ciolleagues.  Both I and they ‘knew’ the truth.

 

The nature of theories is that they are just that, theories, not absolute ‘truths.’. To me, however, theories that I knew, I knew to be the absolute ‘truth’ and as such, had to be used in practice. I was very secure in that I knew that my views were the correct views and certainly not the terribly incorrect views of other analysts who didn’t have the benefit of the real ‘truth’ and utilized the ‘false’ theories of other schools of psycho-analysis.

 

The ‘truth’ also contains the methods that are needed for the defense of that ‘truth’. The ‘truth’ needs to be defended against attack. Our ‘truth’, if allowed to be successfully attacked, would be destroyed. Our group would have dissolved. This destruction, or fundamental change in our theories, was not acceptable. Some defenses of our  ‘truth’ were the standard array of defenses (here ‘offenses’) known to us  all—denial, splitting, verbal and occasional physical assault, omnipotence, projection, etc. Identification of these defenses or offences were couched in terms which were consistent with our ‘truth’.  If our ‘truth’, for example, sprang from theories about very early childhood, then defense of such a ‘truth’ would be aimed at that period of time.  ‘Envy’, is a defense or offense, which has been and is seen by all of us, both in our practice and elsewhere. Once we had the mind-set that envy originates in very early childhood, our interpretations of envy were couched in terms consistent  with our theories of pathological infancy. With this mind-set, interpretations to both this patient and others were very likely to be fixed and similar, and aimed at infancy.

 

We have a closed circle in that finding pathological envy is inevitable, inasmuch as the theory is that infantile envy exists and forms a very substantial part of Kleinian Theory of envy and infancy. Therefore, as with other theories, ‘finding’ evidence of pathological, infantile envy  will result in an interpretation of infantile envy ( S + T = I.  S itself is irrelevant since T will modify S to fit T and therefore I = T). Often this interpretation results, particularly in adolescents, in a defense by the patient of themselves, usually understood by the analyst as further evidence of the truth of his interpretation. We analysts spoke to  patients about very early life experiences as though these experiences of infancy were alive and well in adulthood and understandable in adulthood language.  However “For Disorders of thought it is obvious that some problem of this kind has arisen in the infants life and has not been solved.  Yet, it is but a short step from this point to the absurdity of attributing to the infant ideas, thoughts, and concepts about what the grown up calls a “feeling”….” (Bion. Learning from Experience, page 103, footnote 12.2.2)  During the time that I speak of, there was either no Bion (which there was) or if there was a Bion no one heard or understood his caution.  We talked to adults as if they were infants, drawing comparisons of adult feelings to their ‘equivalent’ infantile ‘adult’ feelings, even though no such thing existed.

 

An adolescent patient said to me:  “I envy my father because he has my mother”.  Utilizing the above criteria, the theories that explain the ‘true’ meaning of this statement are numerous. First, there is the presumption that the statement is concretely true and complete, and that the definitions of the words in the statement are known.  From that point of view, no investigation is required, such as what are the meanings of the words ‘envy’, ‘father’, ‘has’, and ‘mother’, to this patient. In the above model, the truth is already known.  For example, were one a Kleinian, this equation might go this way: being a Kleinian (although this same set of defects applies to virtually all schools of psycho-analysis) material suggestive of early infantile mental  and pathological phenomenon are likely ‘found’. . Such a statement, for example, could reflect an example of envy, envy of the father, the marital couple, envy of the analyst and his wife, envy and destructive impulses towards the interpretations of the analyst, an envious hatred filled assault on his mother, envy of the fathers potency, etc.. Of course the presumption here is that fundamentally, ‘envy’ equals ‘envy’. ‘Envy’ is not a question, not four letters that have an unknown meaning, etc., but an absolutely known entity with meaning known to be attached to a certain, very early point of defective infantile development.

 

A useful example is this. The patient in this story is me and therefore I will use myself as the subject.  As I have said before, I am no author, have not written much of anything, and but for the last 5 years or so, felt I had nothing to say of any usefulness in writing to others. I did the ordinary things, however including the occasional lecture, many supervisions, directed Linden Center, and had an active practice. Let us assume, for the sake of this discussion, that I am in analysis now (which I am not). Further, let us assume that since I am so interested in writing this book, which I am, I talk about it frequently in my analysis.  Depending on my analysts theoretical point of view, these discussions of mine regarding this book could easily be seen in a variety of ways. In the world of psychopathology, they could be seen as discussions which show grandiose and omnipotent gestures on my part of pretending to be what I am not: showing that there is no need to prepare and be trained as a writer, that babies do not need to be inside the mother, but can just pop out willy-nilly, fully prepared for life, and that I really hated the fact that I needed a mother, but have gotten by that problem by becoming my own mother, complete with my own uterus, womb, breasts, milk, etc., and anointed myself a great writer.

 

My statements in the circumstance I envision, would not need to be investigated further since their ‘meaning’ would be clear and already ‘match’ with crucial ‘ultimate truths’ of certain analytic theories. My statements, illustrating certain theories which lead to the interpretations which I have listed above.  In one form or another, my writing this book could easily be seen by my analyst as a sign that I was ill.  Could actual analysis be of use to me?  Undoubtedly so. (In giving this example, I have no intent of claiming to be healthy, which would be a questionable conclusion, in any event.  I do omnipotently think I am not severely ill, however.  Nor is it my intent to say anything about this book’s quality or accuracy or usefulness, although all three are superior (sic). In this particular analytic school virtually all material is considered a sign of primitive mental illness and as having it’s origin in very early life. 

 

For the most part, most of us would not consider trying to analyze a dream without the initial presumption that the manifest content of a dream usually and concretely tells us nothing directly about the dream or it’s meaning to the dreamer.  So we seek the ‘meaning(s)’, of elements of the dream. We would rarely dream (sic) of attempting to interpret a dream without associations. Unfortunately, however, fettered by our S + T = I (beliefs), we likely would ‘investigate’ this dream based on T.  Hence, we would end up with both understandings of the dream and interpretations of the dream in the same way we ‘analyze’ supposedly awake statements.  The associations themselves would be found to satisfy T, and hence would be irrelevant to some and gospel to another.

 

Having determined the ‘meaning’ of the statement S, which in fact is T, the rest of the session is usually determined. For example, any patient response can be met and defeated by the defenses of the known to be correct interpretation/understanding. For example, should the patient say that an interpretation by the analyst is correct and that the patient’s secret is out, this could be looked at as the patient trying to destroy the truth of the analyst by a sycophantic agreement with the analyst.  Such a statement would likely not be seen, for example, as a complement to the analyst, which it might be.

 

Should a patient, differently than above, disagree with the interpretation, his disagreement is known to be defensive.  Should the patient simply think that the analyst is wrong, there is no place for a disagreement to be regarded as a disagreement.  For example, he may feel that the analyst’s interpretation is distinctly incorrect and that he is tired of the same old interpretations that he often considers to be wrong.  His disagreement will not be taken as a disagreement but as an assault, which of course, confirms the correctness of the interpretation.  In this scenario a Cigar is never a Cigar.

 

Once again, from an adolescent’s point of view, this scenario is untenable.  Furthermore, although they may not say as much, a little or a lot of Cigar=Cigar is a welcome relief.

 

One of the issues that has bothered me extensively in the writing of this book is this.  I could easily imagine the reader concluding that I had departed my subject.  For example, in part of the remainder of this chapter, chapter 11, I refer to mathematical equations.  This may seem to be at best far afield from the psycho-analytic treatment of adolescents.  Yet that is not true.  In my view statements are easily made, but rarely justified.  My intention regarding the analysis of adolescents is to state views I have developed or rediscovered and to justify them.  This latter task, while fascinating to me, is also difficult for me and probably creates a heavy load on the reader.  Please remember that the inspiration for the extensive research that has lead to this book was for me to try to ascertain what particular techniques, practices, etc., that I used to enable me to analyze adolescents.  I analyze ‘rides’ not ‘distances.’

 

In writing this chapter, I emphasize over and over again, hopefully in non-repetitive and boring ways, the danger to psycho-analysis of theories in the consulting room.  As I have said before, my education, supervision, analysis, etc., were Kleinian. My clinical life has been divided into two major parts: The Kleinian years; and the years thereafter, this latter part being the longest.

 

For the longest time, the issue that bothered me most with my work was related to Kleinian psycho-analytic practice, which I practiced, and which I equated with Kleinian meta-psychology.  One of the reasons that this equation was made by me, was that in Los Angeles at that time those two topics were in fact melded into one: Theory = Practice.  Nevertheless, if one were disillusioned by one (Kleinian practice), and Kleinian Practice = Kleinian Theory, that then meant one was disillusioned by the other. T=P. The two, T and P were inextricably married.

 

This marriage was not an awareness, however, that I made at that time. At that time, what I felt to be true was that Kleinian clinical practice, based on a great deal of experience, was to me misguided and became an anathema to me. As Freud said above, I had focused on infantile mental life and decided that that focus explained everything about patients, including adolescents. It obviously doesn’t any more than Freudian Analysis, Self-psychology, and Intersubjectivism explain all about anything.

 

In the meantime, however, particularly during the writing of this book, I gained what I think is a much clearer understanding of my feelings back then. It has been made clearer and clearer to me that I had made what today is a serious logical mistake, although I don’t think that I could have seen that error then.  For the Kleinians, and this is the crux of the matter, and other psycho-analytic schools, theory and practice are the same. But theory and practice  must be teased apart so that the usefulness of either can be extracted and be able to be discussed, learned from, and used.

 

The confusion and misuse of Theory as Practice by virtually all schools of psycho-analysis is obviously a problem of monumental proportions to the adolescent. Theories are hated in as much as they rarely have anything to do with the adolescent themselves.   The analysis of adolesents in this light is virtually always impossible.

 

The analysis of adolescents without a common language is also impossible.  If L (language) is added to the initial equation, the result is as follows. (‘Common language’ here does not mean the ‘same’ language, but one that is developed, keeping both the language of the adolescent and the analyst in mind.  One does not need to be a drug talking, sex talking adolescent for analysts to talk to adolescents about those subjects).

 (L x S)+ T = I x L

L=Language        S= Statement     T= Theory        I= Interpretation

If L or correspondence of L’s is not present, L = 0 and our equation once again is T = T, in the consulting room.

 

If a psycho-analyst were an honest broker, the correct “I” (interpretation) would be a statement/question such as ‘I don’t understand, could you try to show/teach me again’ (that is, could you help me make something more than 0 out of I?). There is something about such questioning, however said, which is considered an anathema to most of us.  We are supposed to know so we tell the adolescent that we do know, via an interpretation that has absolutely nothing to do with anything except that it may be a regurgitation of some lesson learned somewhere. Adolescents might call it ‘psychobabble’ or a sign of insanity. We must remember that most adolescents are certain that we are crazy or lost in ‘crazy’ theories.  The equation of sums of theory (wrong)( -1 ) with practice (wrong) (-1 ), and not understanding or even trying to understand the language ( -1 ), is far greater than the mathematical sum of -3.  Psycho-analysts, were they thinking this way, would charitably score us as a minus 3. Adolescents would not be nearly as kind.

 

Betty is a 16 yo girl, almost 17, going on 13.  Working with her presents a number of unique challenges, one being that she also thinks she is ‘young’ for her age, but varies widely in how she can be talked with—-sometimes older, sometimes younger, etc.  This session is the young version of her.

“By the way what’s the deal with the cat?” I asked.

“Um, she took it away from me and I got mad and now the cat doesn’t like me any more, but yet it’ll come up to me and want me to pet it every once and a while and then when I go up to it, it doesn’t want me too.  It’s bipolar.” She said.

“So you have a cat that needs some lithium or something like that?” I said.

“And the only reason I try and pet it; is because it is the only cat in the house, so.” She said.

“So what, she[mom] tells you not too, but you go ahead and do it.” I said.

“Sort of; like I’ll pet it and then she’ll tell me not to any more after I have already pissed it off.” She said.

“So if the cat gets pissed off with you?” I said.

“I mean but sometimes it’s fine; I’ll sit there and pet it and it will be fine and then it will snap.” She said.

“When it snaps what does it do?” I asked.

“Start’s hissing.” She said.

“Does it ever bite you?” I asked.

“No, if it did I’d frickign throw it like a football.” She said.

“Now, that’s kind of what happened before right?” I said.

“And I like animals too. Well, I didn’t mean too throw it, I like; there was a box, it had a whole bunch of blankets and I was trying to hold it and my mom got pissed at me so I put it back in and I like tossed it in whatever and I didn’t like throw it. Whatever. I don’t think it has to do with that; cause animals, it has nothing to do with fricking hitting them once.  If you hit them once ok whatever, they get over it.  But something to do with something else.  I think the cat’s racist; because she’s black and I’m white; and she only only likes my mom because my mom feeds her.” She said.

“A rascist cat.  Never heard of one before.” I said.

“My mother thinks that I walk all over her, like with the cat.” I said.

“I don’t remember that. I don’t walk all over her at all, I always ask her can I do this can I do that and I whatever.  In the past yeah; but now no.” She said.

“How do you do at home when she says no, you ask her about something you want to do and she says no.” I said.

“Then I just take it as ok maybe later. She sucks, because I went straight from Colorado and I was home for like almost two weeks and then I came here.  It’s not like I even got a chance to even see if I could come home from Colorado and do good. So, I don’t now.  It’s frustrating.  I just want to go home. Uh, I’m frustrated you know.  Want some Cheese It’s?” She said

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