Adolescent Psychoanalysis

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“The Revolution Will Not Be Televised”  (Gill Scott Heron)

Chapter 12

From There to Here

Part 1

(Extensively revised 11/27/08)

Writing this chapter is necessary. I intend to get from ‘There’ to ‘Here,’ trying to describe the trip - The making of this Adolescent Analyst. The beginning of ‘There,’ arbitrarily starts as I start as a candidate in the Los Angeles Institute.  Obviously, no one’s life starts at age 29.  The first 29 years, and their importance, will have to remain a mystery.

Some parts of this chapter are controversial. To write about my experiences during this time, I cannot avoid personalities.  That is the controversial part.  However, minus the personalities and the people and the places, at least as experienced by me, my ‘There’ loses it’s meaning.

On the other hand, were I writing this, say 75 years from now, details, including names, would be required and be acceptable and not controversial.

So here I am.  It is not 75 years from now.  If it were, of course, I’d be long dead.  Dead, for me, equals no writing, barring some divine intervention.   In this instance, I prefer writing now.  I’m not betting on that intervention thing, either.

Out of deference to some people I mention, many of whom are still living, I will use pseudonyms. To add a bit of spice and mystery, I will not tell whose names are changed.  Names may be changed; the account is not.  Some places will be changed, others not.  As on the TV show, “Dragnet”, “the names (some) have been changed to protect the innocent (hardly all)”.

The beginning of ‘There’ —1971

Approximately 1 year into my Residency at the UCLA NPI, I knew that I wanted to be trained in Psycho-analysis at the Los Angeles Psychoanalytic Society and Institute. When I began, I met a wide variety of new people, both associates and senior members of the Institute.  Amongst those, I became acquainted with two well-known and brilliant analysts, who were both Kleinians.  They captivated me, especially with the work of Melanie Klein.  I was hooked.  The work of Klein made so much sense to me, that I took it on with a religious fervor.  One of my fellow UCLA residents and then good friend, who was also at that time at least, a fellow Kleinian, and I, ‘found’ evidence of Klein’s Paranoid-Schizoid and Depressive positions all over the place, especially in music.  We concluded, for example, that the much unfairly maligned John Denver and his song, “Poems, Prayers and Promises” illustrated dramatically what Klein must have met by the Depressive Position.

I should add an extremely important point.  All the information, initially at least, about the evils of the Traditional Americans (see below) and the American Psycho-analytic Association were provided to us Kleinians by senior Kleinians.  We all know the problem.  If you are taught the meaning of what you see, by someone you respect and believe, as well as why and it makes sense, unless you are a cynic, you ‘see’ ‘it’ and believe ‘it’.  Further, such ‘sightings’ lead to the search to find further evidence to support the ‘sightings’.  ‘Sightings’ lead to ‘sightings’.

Earlier fighting, years before, had lead to a split in the institute, resulting in the Los Angeles Institute and the Southern California Institute. The earlier fighting had nothing to do with the Kleinians, since there weren’t any, but about other issues. The fighting, which had been bad before, lead to a split, was escalating again.  The fighting between the “Traditional Americans” (don’t ask me where that term came from since I have no idea) and the Kleinians, was fierce.

This fighting knew no limits short of physical action. There was subterfuge, lying, manipulating, etc., all the stuff of a good soap opera or gossip magazine.  However, it wasn’t a soap opera.  It was serious fighting about a serious topic—Psychoanalysis.

For example, if one were a Kleinian, the decided underdog in the ‘fight’, there were a number of rules.  One would only ‘speak’ Kleinian in certain off grounds locations, certainly not in the institute itself, but for rare occasions. The general idea, correct or not, was that you could just as well get a gun and shoot yourself if you engaged in that form of ‘free speech’ in the wrong place, or with the wrong analyst.

The Kleinians were a group of ‘true believers’, who knew deeply that they were ‘right’. They were fiercely opposed by the Traditional Americans, another and larger group of ‘true believers’. The Kleinians were under siege. The Traditional Americans felt they were being assaulted by the Kleinians.  The Kleinians, to counteract this problem undertook a number of steps.  As said above, you didn’t talk ‘Kleinian’ except in ‘safe’ places.  There needed to be, so it was felt, careful presentations of clinical material in supervisions with ‘Traditional Americans’ lest the Candidate be found out to be part of the heretical Kleinian group.  What this lead to was Kleinian candidates out and out lying about cases to Traditional American Supervising Analysts.  The Kleinians were accused of taking into analysis any applicant, including those who suffered severe disorders of thought.  These were “un-analyzable patients”, according to the Traditional Americans. Hence, to ‘hide’ these patients’ histories and clinical material, was considered mandatory. (eventhough it turned out there was probably nothing to hide.)   This required intentional alteration of both historical and clinical material.  If you were a Kleinian, such behavior was said, by the Kleinians, to be the only way to survive.  It was quite a trick to treat a patient as a Kleinian, hide the ‘truth’ of the patient (assuming we knew it anyway—a very dubious assumption) from the supervisor, hide the actual elements of treatment as it was actually done from the supervisor, and then to construct all the elements just mentioned in both written and spoken form to be acceptable to the Supervising Analyst and the American Psychoanalytic Association.  (Think of a double agent who reports different information to two sets of supervisors; one to whom he pretends to follow and the other to whom he truly follows, for guidance and direction). If nothing else, one learned a set of skills that, to put it mildly, violated nearly all agreed upon, ordinary ethical principles of analysis, but might prove useful elsewhere.  Maybe a crook, a politician, etc., would have signed on for the training. I actually think, counter-intuitively, to contradict the above, the I got a great deal out of this melodramatic aspect of my training.   Like President Nixon, I am not a crook.

I was told (at least one point here for honesty) by my analyst, Dr. Smith, that the Institute was going to be informed that I had finished my ‘training’ analysis.  I was four years into my analysis at that time. Using the then operative Institute standards, that would mean that my analyst could take on another candidate, which both he and I believed to be appropriate.  If you want more Kleinians they need to have a training analysis with a Kleinian analyst. At the time, such a maneuver made great sense to me.

Nevertheless there is one point that cannot be overlooked or overstated.  ‘True Believers’, be they Kleinians, Traditional Americans, Kohutians, or the latest edition of ‘True Believers’, the Intersubjectivists, all share the same fundamental flaw.  They each held or hold, according to them, the ‘absolute’ truth, and will defend that ‘truth’ by any means necessary.   You’re either with your group or you’re not.   Debate can be carried out inside a group so long as the fundamental belief system of the group is not assailed.  Christianity, for example, can stand considerable debate within its ‘group’ about details of Christianity. Debates about the existence of Christ, on the other hand, are not an allowed debatable issue inside the Christian group.  If you want to be in the Christian group but don’t believe in Christ, you are not able to be contained by the group.  Ideas like ‘I am a Christian and want to be a Christian but believe that Christ doesn’t exist’ are intolerable to the group.  So it goes with psycho-analysis and psycho-analytic schools.  If you believe you believe.  If you don’t believe, you’re out.  Litmus tests abound.

Then there was the ‘Lawsuit’, related directly to this edition of the ‘fighting’.  I sometimes thought and think, that, minus fighting, the LA Institute had no particular reason to exist.  In fact, it does not still exist, although Los Angeles has a number of splinter institutes. The Los Angeles Institute and Southern California Institute no longer exist.

My analyst filed suit against the LA Institute seeking to enjoin them from limiting the number of training analyses that could be performed by any one training analyst. Further, the Kleinians wanted the length of time that an analysis could be considered a training analysis, not a personal analysis, to be shortened to a fixed number of years.  I want to emphasize that I was deeply involved in this fight and concurred with each of the elements of that fight that are written about both above and below. I was a ‘true believer’.

Some might say that I was too young to know better or should have been better protected. They are probably right. Any of us who are familiar with the intense emotional experience and dependence on our analyst that occurs in analysis, can easily understand that.

We can definitely say that about our adolescent analytic patients.   We owe them a set of principles that we find useful, professional, principled, and then use them—consistently. They must be moral at base.  Collusion cannot be allowed. In that and other respects, adolescents need our protection, in spite their seeming protestations. About the time that we advertently or inadvertently manipulate our adolescent patients, we have stripped them of any possibility of psychoanalysis, no matter what we say or how ‘noble’ our cause. We, as analysts, should know the difference.  If we can’t identify manipulation, not allow manipulation, not manipulate, then we should find another occupation.  We cannot hide behind the shield of innocent true believer-ship.  Manipulation is manipulation.  We all know that.

(Anonymous comments may be left by clicking the response button at the end of each section)

Cogito ergo Cogito

I think therefore I think

Chapter 11

Part 3

(Revised 11/9/08)

I am very unsure of the psycho-analytic ‘positive’ value of writing this brief history of Betty or any other adolescent, or, for that matter, of anyone.  I say that because such a ‘history’ is by definition ‘wrong’ and ‘misleading’. It is ‘wrong’ in the sense that it is based on heresay-heresay-heresay, interpretations of these events by a variety of people, the patient, other communicators, medical records, verbal communications, written communications, sensual communications, all of which are subject to infinite variations of humans and their understandings of most anything, etc.. Furthermore, and most importantly, we are psycho-analysts who realize that the meaning of virtually anything can only be determined by the essence of our work.  Were we mathematicians, we could add numbers and get the answer in the form of a sum, which we likely could agree upon.  An essential thesis of this book is that anything that is done to lead the analyst to stray from their duties as a psycho-analyst should be avoided as much as is possible, particularly with adolescents.  ‘History’ is an excellent example. I have quoted the following passage from Freud in a number of places, and it is particularly relevant yet again:
“It will been seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate every-thing that occurs to him without criticism or selection.  If the doctor behaves other wise, he is throwing away most of the advantage which results from the patient’s obeying the ‘fundamental rule of psychoanalysis”.  The rule of the doctor may be expressed;’ he should withhold all conscious influences from his capacity to attend and give himself over completely to his “unconscious memory., or, to put it purely in terms of technique:, he should simply listen, and not bother about whether he is keeping any thing in his mind., (what is achieved in this manner will be sufficient for all requirements during the treatment….” (Freud, Standard Edition, Volume 12, pgs 111-112 Papers on Technique, Recommendations to Physicians Practising Psy-cho-Analysis).
As a reminder, put as an equation, the result is
S1→ S2→S3 →S4  and so forth
Each S represents statements, ‘truths,’ made by the adolescent. Each “→” is very complicated and important.  Although these arrows may denote a connection, such as a computer to the internet, it is important to note that these arrows do not necessarily denote a connection to anything including the next S and so forth. These ‘connections’ may say nothing about the quality or specificity of a ‘connection’.  That is to say, except temporally, statements may connect, may not, or may not be known to connect or not to connect.
 At each S or →, questioning, clarifying, gestures, commenting, remembering, connecting, listening quietly, laughter, etc. may be found to attempt to define, at least somewhat, the meaning of or the truth of the statement or connection.
It must be born in mind that none of these statements or connections or investigations are based on any ‘theory or predisposition’. This topic is also written about extensively in the ‘Commentary’ section of Bion’s book “Second Thoughts” which furnishes extensive material illuminating this topic.
Nevertheless, in spite of my reservations, below is a brief ‘history’ of Betty. One last reservation is that the ‘history’ itself is of no use, except to provide confusion and non-analytic thinking in the analytic consulting room. (Sources used to write this ‘history’ include verbal and written records of previous psychiatrists, treatment centers, hospitals, family members, especially her adoptive mother, Departments of Mental Health Reports, and the patient)
Betty is a 16 year old girl.  Her history is very complicated.  Allegedly, she is the off-spring of a drug addicted mother, an adoptive mother, who was allegedly a drug user herself, an alcoholic father and stepfather, and a family whose determination that on a ‘good’ day Betty was and is only intolerable and indescribably bad on ‘bad’ days.  The definition of ‘good’ and ‘bad’ remains very unclear both to me and to Betty, although Betty’s attempts at making these distinctions are few and far between.  Betty’s denial of the impact of these various relationships, circumstances, and events ranges from some to virtually complete.
One of the issues that apparently happens frequently, which may give a flavor of how things appear to go in her family, is that her family’s assessment of her behavior on a ‘home’ pass may be both to Betty and the staff, ‘good’, and yet in a latter report to the staff/Betty about the same pass, ‘bad’.  During the first two sessions with her, contrary to many, many later sessions, Betty reported with considerable animation her anger at her mother, and that she, Betty, was ‘perfect’ and that how her treatment by her mother made no sense, except to demonstrate how ‘crazy’ she (mother) was.
This theme of ‘perfect’ arose then and consistently appeared as her analysis proceeded. I jokingly recommended during a ‘perfect episode’, that she get a T-shirt that said “Perfect Girl”, lest there be any doubt by an observer that she was indeed perfect.  This idea entranced her and she had an actual “Perfect Girl” T-Shirt made for her. As her analysis proceeded, the T-Shirt creations expanded considerably, much to her delight.  Some ‘shirt’ themes based on their magnitude grew into statues. Most of the later versions of these shirts were imaginary.
Many fairy tale characters attracted/attract her.  “Tinker Bell” is a favorite of hers, which emerged as a favorite only after months of analysis.  In fact, according to her, she apparently owns virtually all of the Tinker Bell paraphernalia, including lunch boxes, clothes, shoes, etc., etc.. Her omnipotent creation of this ‘fairyland world’ may amount to her only solution to the apparently ‘terror land’ in which she apparently does live. The names and concepts of these T-Shirt names have varied widely and have gone from little girl fantasies to a much broader and more ‘mature’ and seemingly less fantasy based.  Recent names have included “Miss Unreliable”, “Miss Smart”, “Miss Room Restriction”, “Miss Obnoxious”, etc..  At present there are 21 active descriptions.
Although 18, Betty usually looks 13-14, but often acts older, sometimes younger, and is particularly ‘cute’.  She is commonly regarded, so I am told, as the ‘cutest’ girl in her high school.  ‘Cuteness’, according to her, makes her very sought after by the boys.  In the meantime, she talks with me about her ‘relationships’ which she conducts according to her ‘relationship’ principles.  For example, she likes to tell her next prospect ‘everything’ about her and expects them to do the same.  Absent this, she wants to be rid of them.  I don’t know as yet what her definition of ‘everything’ is, although this topic has emerged many times in sessions with Betty.  Lest I give a misleading impression, Betty is very bright, does well in school, and will graduate next June.
Further complicating matters and seemingly contradictory, as will be seen in the session below.  There is a clear-cut vicious, sadistic anger harbored in Betty, of which she is apparently primarily unconscious, sometimes consciously, which expresses itself partially towards her mother’s cat.  There is a long history of problems between Betty and the family cat. Her mother is a veterinarian’s assistant. As such, she is apparently especially close to animals, and especially the family cat.  Allegedly, on one occasion that is mentioned by Betty in the session material below, Betty threw the cat into a cardboard box.  This incident created an immense amount of anger and distrust by mother of Betty, and revealed Betty’s hatred of the cat.
My reason for the exercise below, annotation, one which I repeat frequently, is to review what I supposedly ‘did do’ at least as it is represented by my written recollections of the content of the session.  Mistakes I make are my main target. Of course, realistically, my notes are incomplete and inaccurate. First of a long chain of inaccuracies is that the notes rely on my memory, which is at best suspect. That my writing of notes can in any way reflect numerous variables such as tone, movement, looks, interruptions, etc., etc.  This exercise seems to be quite useful, often educational and fun, although sometimes revealing just how wrong I am able to go.
I will annotate this session using the principles expressed above of S1→ S2→S3 →S4  and so forth.
1  “By the way what’s the deal with the cat?” I asked.
As always, I try to be as non-specific and non-narrowing in interpretations I make.  With adolescents, this is particularly important.  The ‘S’, (truth) of ‘cat’ to Betty, is not known by me.  Her mention of the ‘cat’ just prior to my question, lead to that question about ‘cat’.
2  “Um, she took it away from me and I got mad. 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 to.  It’s bipolar.” She said, laughing.
3  “So you have a cat that needs some lithium or something like that?” I said laughing.
At that point in time, as often, to cast what she says, her ‘truth’ at that moment, in a way not ‘matching’ the apparent emotional ‘valence’ or thrust of an interchange, usually badly damages the session.  Here, she is laughing about the cat.  Laughing along seems to be the appropriate matching and is natural, not forced.
4   “And the only reason I try and pet it; is because it is the only cat in the house,” She said.
5  “So what, your mother tells you not to, but you go ahead and do it?” I asked.
6  “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.
I missed the point somewhat, but as so often happens, a correction in an appropriate environment, usually follows with the ‘correct’ material.  I think she’s talking about what her mother tells her to do about many things; she’s still talking ‘cat’.
7   “if the cat gets pissed off with you, what happens?” I asked.
She has gotten me back on track.
8  “I mean sometimes it’s fine; I’ll sit there and pet it and it will be fine and then it will snap.” She said.
So now, the ‘definition’ of the ‘cat’ is expanding. It is now the pissed off, snapping, bi-polar thing called  ‘cat’.
9  “Snaps—(shrug)?” I asked.

10  “Start’s hissing.” She said.

The meaning of the concept ‘cat’ continues to expand:  snapping, pissed off, hissing, and bipolar thing called a ‘cat’.
11  “Does it ever bite you?” I asked.

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

The ‘cat’ is now a snapping, pissed off, hissing, bipolar, football suited to be thrown thing, called a ‘cat’.
13   “That’s kind of what happened before?” I said.
14   “And I like animals too. Well, I didn’t mean to throw it.  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 frick’in 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 likes my mom because my mom feeds her.” She said.
The definition of ‘cat’ to Betty is expanding exponentially: The ‘cat’ is now a snapping, pissed off, hissing, bipolar, football suited to be thrown, tossed, not thrown, to be hit once, racist thing called a ‘cat’, which is related to mother since the cat is black and Betty is Caucasian and fed by the mother.
16   “A racist cat.  Never heard of one before.” I said.
17   “My mother thinks that I walk all over her, like with the cat.” She said.
Now the ‘cat’ = mother.  Mother thinks that the Betty walks all over the cat and herself.
18   “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.
Paraphrased: I used to walk all over her in the past, but not now and besides, I don’t remember anyway.
19   “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.
20     “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.” She said.
21    “Want some Cheese It’s?” She said.
Back to T-Shirt Betty
For the sake of simplifying the S1→ S2→S3 →S4  …Sn model, I have, in this discussion, designated  “→” the investigator of, for example, S1 or as constructed,   an investigator/connector which leads to the following S.

The concept of ‘leading to the following S’ is extremely problematic.  With adolescents, as well as adults, we have no way of knowing what the following S may be unless we are lead there.  Should we presume we know the ‘next’ S and the pathway to it, the fabric of the analysis is shredded. That this is so results from the fact that we are providing pathways to an S, both of which are truly unknowable. We, in that instance, have fallen back on our theories in the consulting room—-a fatal mistake, especially in the analysis of adolescents.  Worse yet, If we ‘know’ the unknowable and yet lay out the ‘pathway’ to the unknowable, then insult is added to injury.  One more person who doesn’t listen, is full of theories and tries to apply them.

The ‘truth’, S1, of Betty’s ‘cat’ has meanings Betty has  attached to ‘cat’. As the investigation of these ‘truths”  (S’s) were investigated, it was found that ‘cat’ contained many qualities/meanings that one would not ordinarily associate with ‘cat’—e.g. fur, purring, playing, etc.  Or, if they seemed ordinary, these ‘ordinary’ cat elements had idiosyncratic meanings to Betty.  For example, ‘discovered’ elements of S1. etc., (cat hissing, getting pissed off, being racist , mother not wanting to have/take care of Betty, not wanting to feed her) are a partial list of elements of ‘cat’ meanings to Betty.  These ‘cat’ elements also show themselves to lead to actions and reactions between Betty and her mother.  For example, getting the cat to ‘hiss’, ‘get pissed off’, ‘assaulting the ‘cat’ in fact put into action Betty’s ‘cat’ feelings towards the intended object of these actions - her mother.  Hence, contained in S1, are both meanings and actions, which, in this instance, are both discoverable and of great importance.

(Revised 11/4/08)

 

Cogito ergo Cogito

I think therefore I think

Chapter 11

Part 2

 

 

In the case of analyzing adolescents, even if the error is made in considering Theory and Practice to be identical, the absence of any understanding of L (adolescent language) completely alters the psycho-analytic state of affairs.  Even if we, armed with theories in our consulting room, busily looking to ‘find’ S that ‘fits’ T, with adolescents, at least, if ‘adolescent speak’ is not spoken or attempted to be understood, the net result is this:

 

L_a=Adolescent  Language  S= Statement    T= Theory I= Interpretation

 L_a * S* T = I * L_a

If L_a = 0    Then the above equation is 0 = 0

 

 

We have anointed T with a variety of qualities that make it powerful. First and foremost, T (theory) in this model is not functioning as a theory should.  Theories are just that.  They are speculative and virtually always not empirically based. The ‘theories’ we use in terms of their justification cannot rise above the standard of a rationally justified true belief and virtually never even approach that standard of justification. (In a subsequent chapter, I will have a good deal more to say about epistemological justifications as they apply to our field). A rationally justified true belief is not necessarily a statement of fact.  It is still speculation.  Our theories about the functioning of the human mind are speculations, but often said to be facts.  When theories dictate practice, they cease to be theories and become facts, much as in an operating room, for example, where the administration of anesthesia is not a speculative theory, but a fact, a practice, born of scientific research, experimentation and use, and the results studied and evaluated.

 

In Physical Medicine there are methods for the evaluation of treatments, medications, etc. Attempts at validation of theories in physical medicine often include what are called ‘controlled double blind’ studies. So, for example, let us imagine that there is a theory that drug B will be beneficial to patients who suffer from disease F.  This theory could have been developed in many ways, but usually starts with what is called an individual or small group observation, otherwise known as a ‘case study’.  In our case, from these meager beginnings this, this individual case study seems to be corroborated by other practitioners who treat patients who suffer from F, and have used drug B.  We all know of the variables that can distort ‘corroboration’. For example, the desire to find something that really helps with disease F, a serious disease, can lead people to ‘find’ cures’ and people to corroborate these findings, even though the whole endeavor may be specious.

 

However, minor experience, theories, etc., may lead to an actual study to determine the usefulness or lack thereof or associated dangers of drug B.  At that point, a study is planned. One of the facets that is most important in such a study is to remove passions and desires of practitioners from the evaluation, as much as possible.  The purpose of this practice is not because people hate practitioners and want to cut them out of work. The purpose is, as much as possible, to make the study rely on ‘facts’, and not the passions and biases of the researchers. Adequate standards for investigation are the foundation of such a study.  Bad standards equal bad evaluations.  This harkens to the somewhat ribald saying regarding computers—-S… in, S… out.

 

However, once planned, procedures to evaluate drug B are first practiced on many forms of life other than humans.  If the drug passes those tests, many of which are often of dubious value, then testing is begun on humans.  People with and without disease F are randomly assigned to test groups.  People inside these groups, randomly divided in a ‘double blind’ fashion are give drugs or no drugs.  ‘Double Blind’ means that neither the evaluators, or patients, or controls know if the patient is given the drug or not, the amount given, etc.. The purpose of that process is another step designed to make evaluations as unbiased as possible. As a part of evaluation, humans are involved—often physicians.  They are expected to follow certain criteria in their evaluations. Once all this data are compiled, a ‘verdict’ regarding drug B is arrived at. Should the verdict be that this drug B, is useful in the treatment of disease F and doesn’t cause serious drug use ending side effects.  Based on all this, approval by the Federal Drug Administration is sought.

 

If approved by the FDA, drug B is put on the market.  It is at this time that the most information about drug B is brought to light.  Unfortunately, at this stage, to a large extent, the investigations are now back to individual practitioners doing ‘case studies’, with all the risks that go with such ‘studies’.  As before though, should there be ‘enough’ questions raised about drug B, a new round of testing as outlined above is undertaken.  And so forth.  Out of all of this what was a theory remains partially a theory, but is moved into the realm of ‘fact.’

 

Psycho-analytic theories should be a part of the experience and learning that rest in the ‘back’ of our minds.  Perhaps a reasonable analogy is that of the relationship of the skeleton to the body.  The role of our skeleton is obviously crucial.  Without the support of our skeleton there will be no person.  But, the skeleton is not the person. Our theories should be the supporting elements for us in Psycho-analysis.  There should be no confusion on this matter.  The skeleton is no more a person than a psycho-analytic theory is a fact.

 

A New Definition and Use of S

Let us return back to our equation and assume another alternative and define S differently.  This new definition of S is that S is a statement, the dimensions and meanings of which are not known either to the patient or the analyst.  Let us further assume, given the above, that the analyst has no theory that he wishes to promulgate. The technique used in analysis of adolescents follows Freud’s Fundamental Rule: “It will been seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate everything that occurs to him without criticism or selection.  If the doctor behaves other wise, he is throwing away most of the advantage which results from the patient’s obeying the ‘fundamental rule of psychoanalysis’.  The rule of the doctor may be expressed:  he should withhold all conscious influences from his capacity to attend and give himself over completely to his “unconscious memory”, or, to put it purely in terms of technique:, he should simply listen, and not bother about whether he is keeping any thing in his mind., (what is achieved in this manner will be sufficient for all requirements during the treatment….” (Freud, Standard Edition, Volume 12, pgs 111-112 Papers on Technique, Recommendations to Physicians Practicing Psycho-Analysis)

 

Put as an equation:

S_1-® S₂®_-S₃ ®_-…S_n    

Each S represents statements made by the adolescent. Each “®” represents a connection between statements.  These connections do not say anything about the quality or specificity of a ‘connection’.  That is to say, except temporally, statements may connect, may not, or may not be known to connect or not to connect.

At each S or ®, questioning, clarifying, gestures, commenting, remembering, connecting, listening quietly, etc., may occur.

 

None of these statements or connections or investigations are based on any theory or predisposition.

 

This is a brief portion of a session with a 16 yo boy illustrating these principles. 

1.     “I hate my father because he has my mother.” He said.

(Using our new definition of S, this statement actually, in and of itself, tells us nothing.  S = ?. However, the meaning of it may be found out, or not, by investigation.)

2.     “You say ‘has’?”  I asked.

3.      “Yeah, he is always keeping her away from things she usually does with me and my brother, like making dinner.”  He said.

4.      shrug’. (?) portrays the analyst.

5.      “He is the most self-centered person I have ever seen.  It’s all about him.” He said.

6.      “What’s with that?” I asked.

 7.     “He’s forever telling us that he had a hard childhood which makes him this way and that we just have to be understanding.” He said.

 8.     “Really.” I said.

 9.     “Yeah. What a crock of shit.  He is forever making up stories or just plain lying.  He won’t take           responsibility for anything”. He said.

10.    “I take it you’re not too fond of your father?” I asked.

11.    “You can say that again.” He said.

12.    “I take it you’re not particularly fond of your father.” I laughed.

13.    “That’s another thing.  He has no sense of humor. Everything with him is so serious and usually                 about one or another defect he has. Things at home are just dead serious” He said.

 

Were I to have used our initial model: S + T = I, the chances that we would have been completely diverted into our theory/facts would be very high. For example, this vignette fairly calls out Oedipal to the Freudian.  To the Kleinian, this vignette might well be a clear illustration of envy of the father, hatred of the mother, the desire to steal the mother for both personal gain and to deprive the father.  Intersubjectivist colleagues would be needed by me to fill in what Intersubjectivist theory/facts would be illustrated by this vignette.

 

Using our new equation/view, this vignette may be seen as follows:

1₁  “I hate my father because he has my mother” at least as investigated at this point in time, less any fact/rules, is quite different than any of us would expect.  “Has” does not have any sexual connotation. “Mother” is not a sexual being as one might expect, but someone who is stolen away by father, not for sex, but to serve him.  It is also clear that the mother is seen by my patient as a functionary.  It is not clear during this session if she is expected to function as a mother or as a servant.

2_i   “You say ‘has’?”  I asked.  I selected ‘has’ to ask for clarification.  Obviously, I could have selected other elements of the statement to seek to clarify.  ‘Has’ at that time and in subsequent thought seems correct.  “Has my mother”, if possible, is both a provocative and ‘meaningless’ statement, that requires clarification.

3_i “Yeah, he is always keeping her away from things she usually does with me and my brother, like making dinner.”  He said.  Probably in response to ‘has’. He goes on clarifying his views of his parents: He takes, she gives, both at the ‘seeming’ needs of the children

4_i    shrug’. (?) portrays the analyst. I find it particularly useful to keep my inquiries as open ended as possible.  My reason for this is that I don’t wish, if possible, to direct the patient to any statement by the nature of my inquiries. This action presents an interesting dilemma:  There is no doubt that this is a dyadic conversation, but one with a unique set of rules.  Further, there certainly are times when this is not the case.  For example, should there be a contradiction, I often specifically ask about that contradiction, in as non-directive way as possible.

5_i   “He is the most self-centered person I have ever seen.  It’s all about him.” He said.

6_l    “What’s with that?” I asked.  Again I’m curious what he means, but ask in as open-ended way as possible.

7_i    “He’s forever telling us that he had a hard childhood which makes him this way and that we just have to be understanding.” He said.  More about ‘father’.  I say ‘father’ because I really don’t know what he means.  He has told me a number of factors of the person he calls ‘father’, but is about all I can say.  What a ‘father’ or ‘mother’ is to him, I don’t know.

8   “Really.” I said.

9_i   “Yeah. What a crock of shit.  He is forever making up stories or just plain lying.  He won’t take responsibility for anything”. He said.  More elements of the personality of what he calls a ‘father’

10_i   “I take it you’re not too fond of your father?” I asked.  There are clearly times when a sense of humor is very useful with adolescents.  The best I can say as to why ‘then’ and why subsequently is that I don’t know.  Perhaps I could be let off the hook by saying that at that time it ‘felt’ right.  The patient obviously responded well

11_i  “You can say that again.” He said.  More humor.  Again a feeling.  No specific justification. 

12   “I take it you’re not particularly fond of your father.” I laughed.

13_i   “That’s another thing.  He has no sense of humor. Everything with him is so serious and usually about one or another defect he has. Things at home are just dead serious” He said.  Further response to humor and other material.

 

Summary:  my patient did not feel he was one of my theories; he knew that I took him seriously; interpretations that I made were not intrusive to him, but seemed to have the effect of furthering our analytic investigation; he discussed issues that are clearly important to him (although to me, at least, quite unclear); humorous interpretations seemed to facilitate psycho-analytic investigation; transference was clearly important, me apparently being an idealized version of whatever a ‘father’ is to him; and, finally, clearly he has a constructive and friendly relationship with me.