Adolescent Psychoanalysis

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

Chapter 12

From There to Now (cont)

Part 4

(Extensively Revised 2/22/09)

In the midst of the fighting, The American Psychoanalytic Association concluded that the Los Angeles Psychoanalytic Institute needed help.  Who could argue.  Remember, however, the American Psychoanalytic was characterized to us Kleinian Candidates by Senior Kleinians, as a powerful enemy of Klein—which some or many Traditional American members certainly were. Obviously some weren’t.

The American requested that a contingent of Senior Faculty and Candidates from the Los Angeles Institute visit the Denver Institute for some help.   Somehow I was included in this group by the administration of the LA Institute, who were stridently Anti-Kleinian and fervently Pro-Traditional American.  All that being true, I shouldn’t have been picked. Nevertheless, at least one candidate (me) or more (I’m not sure), as well as a number of Senior Training Analysts, mostly Traditional Americans and a few Kleinians, traveled to the Denver Institute, ostensibly to receive help.

That meeting had a profound effect on me in spite of its beginning. At the outset of the meeting, with all of the Los Angeles contingent plus members and candidates of the Denver Institute present, was a talk by Joan Flemming, M.D., the Director of the Denver institute and esteemed member of the American Psychoanalytic Association, and at that time either the sitting or past president of the American Psychoanalytic Association.  In this talk, she spoke about the fighting in the LA Institute.  She utilized her fists, banging together, as a model of the fighting in Los Angeles, how destructive it was, and how it must stop. Her fists banged together! I was chagrined.  Denver?  For this? I could bang my own fists in Los Angeles.  Those moments, however, were the end of my disappointment with the Denver meeting.

After that the attendees were given a tour of the Hospital used both as a psychiatric hospital and as the base of the Denver Institute.  I can’t remember the name of the man who took me on a tour.  He was a senior candidate.

(As a side note, one of the big issues in Los Angeles was who was and who wasn’t analyzable. The Kleinians’ view was that many more patients were analyzable than thought to be so by the Traditional group.  This issue was one of the many between the Kleinians and ‘Traditional Americans’. Therefore, as stated above, as a Kleinian, it became necessary to hide both the “very ill” patients and the Kleinian treatment they received, from the ‘Traditional Americans.’ Discovery of such by them was thought to lead to dire consequences.  This particular thought was probably true.)

On my tour in Denver I passed by a hospital room, peered in through a window in the door, and saw a patient in a locked, padded room.   This patient, additionally, was in a straight jacket and lying on the floor.  There was no furniture.  The Candidate volunteered that this was his patient.

I asked my escort what sort of treatment this patient was receiving.  Psycho-analysis was the answer. I was shocked.  “Do you have to hide this patient?”, I asked, although the physical arrangement of the hospital/institute would have made such ‘hiding’ impossible.  What did other analysts think of this case?  What about Dr. Flemming?  What did she think? He said that all of the analysts there were very supportive of him and his psycho-analytic treatment of this patient, as was his supervisor.  In Denver, they were analyzing patients that would make the “too ill” patients, according to the Traditional Americans being treated by Kleinians in Los Angeles, look like pictures of incredible mental health.

This issue of what we were arguing over in Los Angeles, analyzability, by comparison to Denver, was a joke.  Further, this woman was not the only very ill patient who was being analyzed at the Denver Institute.  “Did you have to lie to the American?” I asked.  “Would they agree that such an ill patient could be deemed analyzable?”  His answers were that “no”, he didn’t have to lie and “yes” the American had no trouble with this case.

I was both amazed and saddened.  The members and candidates didn’t fight, didn’t seem to be bothered by formulations of analyzability, or the formulations of different theoreticians in psycho-analysis.  To this day, I don’t know if they were simply victims of a loss of common sense, or that they understood more thoroughly than we in Los Angeles what analyzability meant.   The evidence pointed obviously to the latter. Most importantly, they worked together.  No “hidden” patients. No hidden treatments or interpretations.  Although I had long lamented the failure of the groups in the LA Institute to share their considerable knowledge and work together, here such a situation existed.  Apparently no lying about cases for starters.

(I should add that such a union was attempted in the 40’s by Anna Freud and Melanie Klein.  There was to be an Institute which had three parts: Freudian, Kleinian and Middle Group.  This never came to pass, apparently because both sides felt that they were so far apart that such a union would be useless. And, of course, there was the ongoing debate between Anna Freud and Melanie Klein over who was really the most Freudian. I find a great irony in this in that much of Klein’s work, although sometimes, in my view, put in a unique and difficult language, was both similar to and a clear development of the work of S. Freud. “Mourning and Melancholia” and the proceeding paper on Narcissism (Freud Standard Edition vol. X1V ) are examples. Klein’s contributions defining very early primitive defenses, the paranoid-schizoid position and the depressive position were seminal. Her development of the concept of projective identification was crucial.  Although there were undoubtedly many more influences on Klein, it is difficult not to imagine her being heavily influenced by Freud, part of this influence being the above mentioned papers.  The analysis of adolescents must use the con-tributions of Freud, Klein and later Bion couldn’t be more relevant.  I should remind the reader that what I mean by the latter statement, is the appropriate use of the work of these great thinkers)

The last great benefit from this meeting for me was that I became a fast friend of Dr. Flemming.  During this Denver meeting I made an appointment with her to discuss what I had seen.  How could what I had seen exist?  And what about the American?  It was clear immediately that I could talk to her about each of these questions and I asked a great deal more.  We talked of the American, their standards, the fighting in Los Angeles, the apparent absence of fighting in Denver, etc.  She was a great person.

We wrote back to each other fairly frequently and talked on the phone occasionally.  I could talk to her about issues. I think one of the things that attracted me to her so much was that she was a revered member of the American Psychoanalytic Association and could and would talk about most anything and wasn’t constricted at all by the “isms” that littered the landscape.   If she were an example of the American, it clearly was different and better than I had believed.  I don’t know if she was.  Sadly, she died some years ago.

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

Chapter 12

From There to Now (cont)

Part 3

(Extensively Revised 2/17/09)

In the session at the end of Chapter 12, part 3, to put it mildly, Mary had little or no protection from anyone, least of all her father. The concept of “protection”, however, is far too narrow.  Mary neither had that, ‘protection’, nor ‘rearing’. Lest one think that I confuse analysis with raising a child, there remains clear similarities.   If one were to consider what happens in a good analysis to contain in an analytic way an unusual but usual form of rearing, that might not be far off the point. A great teacher of mine told the story of a seminar he conducted.  The question at hand was what to do with the young woman, lying on his couch, an analytic patient.  She had just been told that her husband, whom she deeply loved, had been killed in an automobile accident the day before. To put it mildly, she was deeply in pain, distraught, and feeling utterly hopeless, and sobbing.  The specific question that he raised to other analysts in this group was this:  should one reach down and put a hand on her shoulder by way of condolence?  Many answers were offered, most of which included the touch of condolence.  The answer, according to the teacher, was that one wouldn’t touch her.  Why?  This was analysis.  Was this cold, a sign of indifference?  Hardly.  All one had to do was to know this man.  He was, of course, right.  But, lest anyone be deceived, there could be no doubt that his sadness was conveyed to his patient, without speech or touch.  He is a great analyst.  He is a Kleinian.

The virtues that I have itemized are those I feel must be present in our work for it to have a chance of success.  Protection or its absence comes in many forms, many expected, many not.  One of our duties as analysts is to protect our adolescent patients from us, our theories, our own ends, our inappropriate actions,  etc.. Adolescents don’t come to analysis to learn about our lives, participate in our lives, to be used by us, manipulated by us, etc. If my analyst and his wife were the beginning and end of my ‘protected’, principled analytic training, it is difficult to imagine that I could possibly have turned out at all well. That we cannot absolutely protect adolescents from either themselves or others or ourselves is a truism.  However, we can do our best to analyze our adolescent patients according to their present, not ours, and protect them from, at least, ourselves, by doing good work which amongst other things is not corrupt or usurious, or grandiose or omnipotent. The ends do not justify the means. We must to analyze their ‘ride’, not teach ours.

In spite of some shortcomings in my analytic training, the sum total certainly was and is very useful to me.  Portions of my analytic training, to be sure, did not represent generally recognized principles of psychoanalytic training.   Some of my experiences in analysis were clearly different from the norm, but hardly all bad.   Both in real time, and particularly in retrospect, I learned and experienced many facets if psycho-analysis. Reading about an experience is simply not the same as having the experience.  Reading about corruption is clearly different than experiencing corruption.  Experiencing, perhaps impossibly, the life of adolescents, is crucial. No books are available. Perhaps one could say it is a state of mind.

As I have written about before and will later, perhaps a portion of my experiences in analytic training played a major part in my identification with adolescents. Learning from experience or identifying with experience or sorting out experiences for their value or using experience to learn good from bad, etc., is the essence of useful experience.

Certainly not all the Traditional Americans nor the Kleinians were or are corrupt.  The vast majority were not.  Further, there was a great deal of excellent teaching and supervision by Analysts from both sides of the debate.  My analysis, in ways that I can’t explain, seemed to have a very productive side and then changed, for the worse.  Where what I experienced as actual analysis was, perhaps lasting 4-5 years, the latter 2-3 couldn’t have been more different.  Moral values of the analyst emerged—not mine.  My analyst’s moralistic and theoretical views became the guideposts of my analysis.  In that sense, at that time, my analysis had ended. 

I would like to call the readers attention to one of the major problems in analyzing an adolescent is to analyze them, not with the moralistic or theoretical values of us. However different they may be or at least seem to be, our task is to explore theirs.  There has to be some reason why high school reunions, for most of us, are so important.  There is something about that time that marks an important place and time to revisit.  There seem to be many reasons why this is counterintuitive. Perhaps for many of us this was a time of great turmoil and pain, and joy, yet seductive. I suppose that for all of us to consider ourselves as a part time adolescent might be very useful, especially since it seems to be clearly true.

Adolescents require particular care for the sake of their personal development—principled, respectful, non-corrupt, non-manipulative, non-collusive, not demanding, not based on theoretical principles, and particularly non-moralistic, which must contain the means to find unknown ends, in spite of adolescents sometimes difficult or very difficult behavior and thoughts. Their fantasies and actions, which according to Freud are not all that different from grown adults, must be available to analysis.  We adults may suffer more repression than our younger brethren, but the fantasies remain. The same is true of Candidates and Members at an institute and Institutes themselves.  The same understanding and virtues must apply, as they do to adolescents.  Moralistic values, absolutely ‘correct’ wisdom can’t be, if possible, allowed.  Unfortunately, as the saying goes, we shouldn’t hold our breath.

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

Chapter 12

From ‘Then’ to ‘Now’

Part 1

(Extensively Revised 2/4/09)

Writing this chapter is necessary for me. I intend to get from ‘There’ to ‘Now”,’ 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 of me, and their importance, will have to remain a mystery. 

What I mean by ‘necessary’ is a feeling of my own that I hope my experiences with respect to psychoanalysis, psychoanalytic training, analytic institutes, AND, in my experience, analytic and theoretical arrogance, may be of some use to others in my position as well as to the others in the general field of psychoanalysis and psychoanalytic training.  These and other issues are of particular relevance to the analysis of adolescents.

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 a large part of it’s meaning.

Out of deference to some people I mention, many of whom are still living, I will use some pseudonyms in place of actual names. Names may be changed; the account will not. Some places will be changed, others not. Events will not be changed.

The beginning of ‘Then” —1971

My background prior to entering my Psychiatric Residency at UCLA was very ordinary. Approximately 1 year into my Residency at the UCLA NPI, I knew that I wanted to be a Psychoanalyst and to be trained at the Los Angeles Psychoanalytic Society and Institute.  Why the latter, I do not know, since there was one other choice, the Southern California Institute.  During my Residency, I began to meet a wide variety of new people, both fellow residents, senior members of the Faculty and Senior members of the Los Angeles Institute. Amongst the latter, I became acquainted with two well-known and brilliant analysts, who were both Kleinians.  They captivated me.   The theories and work of Melanie Klein seemed to offer all the answers that anyone would need to be an analyst, especially a very good one.

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’ (the name selected by some members of the Institute to represent the ‘Freudian’ group (see below) and the American Psychoanalytic Association, and the International Psychoanalytic Association (less the latter)) were provided to us junior 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, you ‘see it and believe ‘it’.  Further, such ‘beliefs’ lead to the search to find further evidence to support the truth of the ‘Beliefs’.  ‘Beliefs’ lead to further ‘beliefs’. And so forth.

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.

This fighting, which had been bad before and had lead to a split, was escalating again.  Same people, same fighting, different banners. The fighting between the “Traditional Americans” and the Kleinians was fierce.  The Kleinians were accused of being heretics, not analysts, etc.  Teaching assignments for Kleinians were reduced.  At one point, the Kleinians, considering all of the above, were considered non-analysts and there was an attempt to move candidates from ‘unacceptable’ (Kleinian) analysts  to acceptable analysts. Not a pretty picture.

This fighting knew no limits short of actual physical assault. There was subterfuge, lying, manipulating, etc., all the stuff of a good soap opera or gossip magazine, by both sides.  However, it wasn’t a soap opera.  It was serious fighting about a serious topic—Psychoanalysis—even though the fighting was terribly misguided.

For example, if one were a Kleinian candidate, the decided underdog in the ‘fight’, there were a number of unwritten rules that this Candidate must follow.  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, for their part, were a group of ‘true believers’, who knew deeply that they were ‘right’. I was a ‘true believer’. They were fiercely opposed by the Traditional Americans, another and larger group of ‘true believers’. They too also bore the banner of holding the ‘ultimate truth’. The Kleinians were under siege. The Traditional Americans felt they were being assaulted by the Kleinians, and vice versa.  

The Kleinians, to counteract this problem, undertook a number of maneuvers.  As said above, from a Candidates point of view, you didn’t talk ‘Kleinian’ except in ‘safe’ places.  There needed to be, so it was felt, probably accurately, 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. 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 with Kleinian techniques, hide the ‘truth’ of the patient from the ‘Traditional American’ supervisors, hide the actual elements of treatment as it was actually done from the ‘Traditional American’ supervisor, and then to construct all the elements just mentioned in both written and spoken in a form thought to be acceptable to the Supervising Analyst and the American Psychoanalytic Association.

If nothing else, in Los Angeles at least, one learned a set of skills that, to put it mildly, often violated nearly all agreed upon, ordinary ethical principles of Psychoanalysis and the rest of life. These skills might prove useful elsewhere in other professions, however.   Maybe a crook, a politician, a Wall Street Banker, other government officials, etc., would have signed on for the training.

(I actually think, counter-intuitively, that I got a great deal out of this melodramatic aspect of my training.   However, at the same time, many aspects of my training and my analysis were ordinary.  Other aspects were absent and/or distorted.  Learning about Freud, for example, was badly marred.  Perhaps everyone was too busy with more important issues to worry about that).

For example, I was told by my analyst, that the Los Angeles Institute was going to be informed by him that I had finished my ‘training’ analysis.  I was four years into my analysis at that time and not even close to being finished with my analysis. At that time, the Los Angeles Institute had a rule that limited the number of candidates that could be analyzed by any one training analyst, at one time. I believe the number was four. Hence, my ‘finishing’ meant that my analyst could take on another candidate, since my ‘position’ opened up. He, of course, filled it.  Sadly, he and I believed this to be the appropriate action at that time. At this time, ‘Now’, this and many other actions were performed that were obviously corrupt and bore no relationship to actual training or any other kind of psychoanalysis.  If you wanted more Kleinians you needed to have Kleinian training analysts available so that an analysis with a Kleinian training analysts could take place. The more Kleinians, the merrier.

The ‘Lawsuit’ was one of the next major events related directly to this edition of the fighting. 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. A much more detailed account of this fighting can be read in Dr. Bail’s paper “Psychoanalysis and the Fisher King” about which I will have more to say later.

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 are moral, ethical, professional, principled, etc.,  and for those standards to be used consistently.   Collusion cannot be allowed. To that end and others respects, adolescents need our protection, in spite their overt and covert protestations. About the time that we advertently or inadvertently manipulate or collude with our adolescent patients, we have stripped them of any possibility of being psychoanalyzed.  Psycho-something, yes.  Psychoanalysis—no.  We, as analysts, should know the difference.  If we can’t identify manipulation, not allow manipulation, not manipulate, then we should find another occupation.  Corruption should be easy for us to find and eliminate.  It obviously wasn’t. We cannot hide behind the shield of innocent ‘true’ believer-ship.  Manipulation is manipulation.  We all know that.