Leading and Following

Chapter 16

Part 4

Tuesday

“This isn’t as comfortable as I thought it would be.” She said.

“The chair? Laying that way?” I asked.

“Yeah. Not at all.” She said.

“Speaking of comfort. Just out of curiosity, what do you think the purpose of the cause you are pursuing to try to get at me? To get under my skin? Make me uncomfortable. I’m not sure what it is.” I said.

“I don’t know. I think I like to piss people off. I’m really into shock value. I like to do things. I like to test people. See how much I can do before they snap.” She said.

“Why do you think? You like to test people. You push them until they push away. What’s the point?” I asked.

“What’s funny is that, you’re going to laugh at me, but this is like the only way I can put it. Jim Morrison was the same way. He was fuck’in crazy but he was a genius. But he was fuck’in crazy.” She said.

“Morrison?” I asked.

“He just would do… Do you know anything about him?” She asked.

“A little.” I said.

“You know, he would do the most insane things for shock value. To see how much he could do to you before you would go away. To see if you would ‘go all the way.’ The only the person of course who would do that, was his wife. He would do shit like that. He would do crazy shit to see if you’d walk away, and he’s dead. She said.

“How do you tell? If you are doing that, ‘going all the way’, being dead, to see if they’ll ‘go all the away’. If you’re dead, how would you know if they’d have snapped”. I said.

“How are you ever going to tell? Good question” She said.

“If he’s going to be there, because you’re going to keep doing things. Okay, so you do one more, and he’s still there. Was your triple threat suicide attempt like that? And if so, who was to go ‘all the way? Or ‘snap’” I asked.

“Why do you think he’s fuck’in dead? Dude. That’s my point. It’s not the healthiest thing. Look it’s 6 feet under at 28. Should have died 3 years later.” She said.

“27?” I said.

“Nice.” She said.

“Just to show you…” I said.

“What? No one here gets out alive?” She said.

“That is your plan. Push things until your dead?. And I’m dead” I asked

“We’re the Jim Morrison of…” I said.

“No we’re not. That’s just the only way I could put it. You know he used to walk around after Jimmy and Janis were gone, he’d say, ‘you’re looking at number 3.’ He would just do stupid shit like that. Like chasing Nico around, from the Velvet Underground. When they went to New York. He slept with her too. He would chase her around and around the courtyard and shit like that.” She said.

“Velvet Underground?” I said.

“Yeah. I know you know them. You’re just being coy. John Kale, Lou Reed and Nico. He would do the same shit. He would do all this shit to people to try and push them away. To see how far they would go. I do the same thing. I’ve lost faith in people. I do that I think.” She said.

“They’ll fuck you over. Yeah. I’m hell bent on being right.” She said.

“Remember your ‘hope burns eternal’ hope. Do you think this would be an example—-you’re killing yourself. And you’re tough. Three what appear genuine serious suicide attempts: one tree and two bags of tyelenol. Were they that, suicide attempts, or you just trying to see, even though you’re dead, who would still be around” I asked.

“Yeah. Exactly. Hope does burn eternal. I will continue to push away and I will continue to hope.” She said.

End

Chapter 16

Part 3

Monday

“Got your dog to lick me. What next? You just can’t get rid of me now. It’s almost like that boyfriend that your whole family likes and wants you to marry, but you are so over it. Wait, you’re a man.” She said.

“So what’s a man got to do with this? Maybe I’m the boy?” I asked.

“No, I’m sorry. The girlfriend that everybody likes, your mother wants you to marry and all that. You liked her before but now you’re getting sick of her.” She said.

“Alright. I’m either the man or the boy, both of whom want to get rid of you. And what’s with ‘I’m sorry”?” I asked.

“I don’t know. You listen too closely. I’m the girl because I’m latching onto your dog now.” She said.

“Okay, but the dog is a girl”… “ I said, confused.

“Think of it as a metaphor. Like the chick you can’t get rid of.” She said.

“No, no. I understand that. I’m still trying to figure out who’s whom.” I said.

“I don’t think you’re the boyfriend. It’s just… how do I…. I give up. You’re dumb.” She said frustrated.

I laugh.

“I’m struggling to not be dumb.” I said.

“You clearly struggle with that a lot.” She said.

“Okay. You walk in saying that I can’t get rid of you. That’s what you say. Then you go on to say like the boyfriend the whole family likes, blah, blah, blah. And then ‘I’m a man”. So I’m thinking, I’m the boyfriend that everybody likes…” I said.

“No, no. I am.” She corrected.

“Okay, and I’m the girl.” I said.

“I guess?” She said.

“Okay.” I said.

“You know, I can’t get rid of her, kind of thing?” She said.

“Okay, so you can’t get rid of me.” I said.

“No, I can’t, you can’t…” She said.

“No hold on, be patient here.” I said, laughing.

She laughed.

“I’m still having trouble figuring out who’s who here. You can see why it would be confusing to me can’t you?” I asked.

“Yes. No, actually I can’t. It’s not that hard a concept to grasp. You got the concept of the guy whose got this girlfriend and at first he likes her and he takes her home. The whole family loves her and he gets sick of her.” She said.

“So he takes her home, but he… ” I said.

“Let me guess. You like some guy and he wants to get rid of you, but his family really likes you. And—call me wild and crazy, but your also worried that I want to get rid of you.” I said.

“Aren’t you a fucking genius. Duh.” She said

“Yeah and everybody loves this chick. ‘Oh are you going to marry her?’ She’s the greatest girl in the world. Have you ever seen the movie “How to Lose a Guy in 10 Days?”” She asked.

“No.” I said.

“It’s fuck’in hysterical. It’s like she does all these things that she’s not supposed to do, all in 10 days. The mother loves her and she’s calling the mother without his knowledge. You know what I mean? They’re all in cahoots together and then he’s like, ‘wait. I don’t like you anymore.” She said.

“Getting back to this concrete deal. I’m like the guy, you’re like the girl. My whole family’s saying this is wonderful, you’re going to marry her aren’t you. And you want to marry me. And then you try to get rid of me by being in cahoots with the mother who wants me to marry you but is helping you to get rid of him. And for good measure, I can’t stand you.” I said.

“No! I am the person that the guy can’t stand.” She said.

“That’s what I just said. I’m the guy and I can’t stand you. I said.

“Yes, and your whole family likes me.” She said.

“Okay. So I kind of had it right the first time around and you didn’t.” I said.

“Maybe I was just confused. No.” She said.

“Well there you go. So I used to be really entranced with you. But now I’m thinking, you’re out of here. You’d need a roadmap to follow all these changes.” I said.

“That’s what I’m talking about! You always reading into things! I could have been like it’s really pretty today, and you’d be, ‘what’s different about today?’ You would have made a whole session about it! This is your fault!” She said.

“Wait. Did you walk in the door out of the blue saying, ‘you know what? I remind me of a girl that I used to really like, but no more. I’m trying to get rid of you and …” I said.

“I was joking around. Your dog hated me and all of a sudden, Zoom made her hop up on the couch and I made friends with her. And now you’re screwed. I was just joking!” She said.

“Alright” I said.

“My god! Were you always like this? What did your parents do with you when you were a kid? ‘Oh, how was school today? Did you have a fun time on your field trip?’ ‘well, define fun.’ Fuck’in hell.” She said.

“Define field trip” I joked.

“Yeah, define field trip. Why do you think they call them ‘field trips’? Jesus Christ! You must have been obnoxious.” She said.

I laughed.

“Did your parents put bullets in their heads? Are they still living? Jump off buildings?” She said.

“They’re both severely handicapped. Because of all the bullets and so forth.” I said.

She laughed.

“Did they have a celebration when you turned 18? ‘Yes, we don’t have to answer his questions anymore!’ Oh, I’m sorry, am I making you feel bad?” She asked.

“Nope.” I said.

She laughed.

“I know that is a major goal of yours. Which you have not met.” I said.

“I have not met. But I will. I’m very tired. I didn’t fuck’in sleep last night. 2:30 in the morning. Jessica, I feel bad. She never sleeps. She’s always working. I was going in there to ask for a benadryl. Then I realized she had to call you in order to get that. I was thinking that wouldn’t be too bad, I could piss him off. I could get something out of this. But I like Jessica or else you’d be up at 2 am every day of the week.

“Boy is that confusing. Your goal is to disturb me, but then you don’t want to bother Jessica, both because of her and me. Very nice. What am I to think? And then today, whatever relationship that may or may not have to being nice to me, I’m either your boyfriend, a boyfriend who wants to get rid of you but is stuck with you, the girlfriend or pretty much any other person that I could be”, I said.

She laughed.

End of Session

Chapter 16

Part 2

(revised 6/3/10)

Agent of Whom?

A supervisee was presenting material from sessions with an adolescent at Linden Center. The 17 yo boy complained, according to the supervisee, that there were too many rules at Linden Center, many of which were ‘unfair’. The supervisee, who had been following the material very well, stopped following and started leading, abruptly. “Of course there are more rules. This is a treatment center into which you have gotten yourself and has to have more rules in order to help you”. I was surprised, to say the least, and asked the psychologist why he had taken that position with his patient. He said, “well, I am an agent of Linden Center. They pay me”. It was easy enough to point out to him that he was not hired to be an agent of Linden Center, but of his patient. He was somewhat shaken, but could easily see the point I was making.

This same principle applies to all patients, especially adolescents. Treating an adolescent, when the analyst is agent of third parties, i.e. parents, hospital clinicians, outside clinicians, friends, AA sponsors, educational reports, written hospital records, and the Department of Mental Health assessment, etc. makes analysis difficult at best, impossible at worst. This is usually a difficult situation, but one must be the agent of the child, participating ‘appropriately’ with outside agencies, and trying to cleanse one’s mind of the content of those meetings.

The same principal of agency, applies to the ‘history’ of the patient. If the analyst is an agent of the patient’s ‘history’ he will serve that master and will be in a position to analyze the ‘history’ of the patient, not the patient. The same principle applies to psychoanalytic theories. If the analyst is the agent of a set of psychoanalytic theories, the theories, not the patient, will be the available object of analyses. The theories will be the object of the analyst, and will become the new ‘patient’.

The concept, ‘history’, presents many other problems. I cite one of the many in particular. The patient’s ‘history’, at best, is heresay, no matter who is saying it. Descriptions of an event usually say a great deal more about the observer than the event. Cluttering the landscape with elements of the mind of the observer is obviously a cluttering that inaccurately, but for coincidence, says little or nothing about the actual patient. The account presented by the patient is also ‘hearsay’, but is the ‘truth’ of the patient, which changes frequently.

The account presented by the patient purports to represent exactly the meaning attempting to be conveyed by the patient. If the patient ‘leads’, what he presents can be considered his version of himself, and the analyst can be the agent of understanding or integrating those elements of the patients account. If the patient ‘follows’, his associations will reflect those of the analyst’s beliefs and desires.

This account presented by the patient of and by the patient is analyzable. This is the stuff of psychoanalysis. Another function of this process is that it forms memories in the mind of the analyst, ideally unconscious. Elements of these memories are derived from the sessions and nowhere else. These ‘memories’ are fragments of thoughts that may emerge spontaneously, in the present or future, in the mind of the analyst and in the actual analysis, stimulated by the associations of the patient. These may be usable in giving further meaning to the adolescent’s associations and memories. They represent the analysts equivalent of Freud’s Basic Rule for the patient, that of ‘free association’. The analyst as well as the patient must be able to free associate in analytic sessions. They must be able as well to think about these associations lest meaning be derived from these associations. These thought or feeling fragments are free associations of the unconscious of the analyst drawn to consciousness by the associations of the patient.

Ideally the material of the session should be ‘forgotten’ by the analyst so that he may continue his analytic work. This is particularly true of adolescents. The material with adolescents is particularly changeable and often very charged. By charged I mean that the material is often laden with ideas that are ego-dystonic to most analysts. These ideas may be particularly obstructive to the analyst, if allowed to be dwelled upon. Nevertheless, all of us know that there is no way for us to cleanse our minds of all conscious memories, and desires and hopes for ‘cure’. One major source of aid to the analyst, perhaps the only source available, is the analyst’s own analysis. The best we can do is be well analyzed and try hard, knowing that we will ultimately fail.

All this being said, below I will present a series of sessions from a 16 year old adolescent girl. What, retrospectively, turned out to be the case, is that these sessions seemed to fit together in what seemed to be a sequential order. This week of sessions, again retrospectively, had the quality of being one long session, one seemingly building on the previous and leading to the next, very unusual in my experience. The sessions of this week also contained the first direct mention of sexuality.

Leading and Following

Chapter 16

Part 1

Sergio Contardi: Journal of European Psychoanalysis: “Psychoanalysis can be defined as a practice of listening. Freud himself defined this listening as floating or “evenly suspended,” that is, a listening aimed not at unveiling the hidden meaning of what the patient says, but rather at grasping and freeing a new signification.”

A supervisee recently presented a case. She was explaining a story told to her by an adolescent patient. She seemed to be following her patient, a 16 year old very hardened inner city girl, asking questions that clarified the material that was presented. The material, gradually expanding, became more and more sexually and violently explicit. The therapist became more and more agitated by this material, initially internally, then suddenly explained to the patient ‘that the patient should understand that the dangerous behaviors she was engaging in could have severe consequences on her—pregnancy, AIDS, death, etc.’ The session went immediately awry and an argument ensued.

The therapist’s statements abruptly changed her position from follower to leader (in this instance, angry educator). Up to this point, the material offered by the patient was being followed by the therapist and the patient was the leader. By ‘leader’ I mean the person, the patient, presenting the material. By ‘follower’ I mean the therapist who was following the patient’s material about which she is curious, seeking clarifications and NOT directing the material in any particular direction. The session now became a debate between the patient and the therapist. “I know, I know” the patient said (referring to her dangerous activities). “Then why don’t you do something about it?” said the therapist. The flow of the material had changed dramatically. Instead of the material continuing to expand, as it had been, it shifted and stopped. The patient had been leading and was now debating with the therapist, who became the ‘leader’. Both insisted that they were the leader. Both were ‘right’, according to them.

This shrinking away from the curiosity needed to elucidate the adolescent’s way of thinking, his meanings, is a great problem for many of us. So much of what many adolescents think radically deviates from standards we have all developed as we have grown and matured into adulthood. The temptation to cease ‘Following’ the oftentimes seemingly inscrutable or unacceptable associations (including but not limited to verbal free associations) and begin ‘Leading’ (teaching truths known to be the ‘truth’ by the analyst) is immense. I have intentionally titled this chapter “Leading and Following”, to call attention to these phenomena. It is my intent that the material both before and after this paragraph, will illuminate the importance I attach to these practices.

The material of the adolescents must lead us to clarify their associations. This practice is as old as psychoanalysis and one of Freud’s seminal contributions. The Basic Rule for the patient: “say whatever comes to mind, without censorship”; for the analyst: ‘without memory or desire, listen to these associations, and determine their meaning, if possible’. If free associations form a basic foundation of psychoanalysis, they are of even greater importance in the analysis of adolescents. The ‘free’ associations of adolescents are ‘freer’ than those of adults. It is not that the ‘meanings’ of associations in adult patients are fixed, patient to patient. It is that for a variety of reasons (age, experience, brain structure, social influence, etc.) the associations of most adolescents are often ‘wider’, less coherent, less ‘rational’, less arithmetic, etc. Therefore, determining the ‘meanings’ of associations of adolescents is usually more or vastly more difficult than the same determinations in adults.

If an English speaking analyst were to try to analyze a French speaking patient, the first task would be to learn to speak French. In this situation should the analyst be unable to learn French, there could be no analysis (unless the analyst spoke very loudly and much more slowly—a technique many Americans use in exactly this situation). The same situation often applies to adolescents. One must learn, on an ongoing basis, ‘Adolesentese’, comparable to the English speaking analyst having to learn French, with the caveat that French has a certain stability, while ‘Adolesentese’ doesn’t. In the latter, the meaning of words change and can be added or deleted at a moments notice. As a simple reminder, the meaning of ‘talking’ today can mean ‘hanging out’ tomorrow and ‘hooking up’ the day after. The meaning of ‘hooking up’ today can be ‘meeting’, such as at the mall. Tomorrow, ‘hooking up’ may mean having sex (the current meaning of ‘hooking up’).

From the position of the analyst, ‘Clarification’ of these associations, therefore ‘understanding’ of the adolescent, is an ongoing process, from the very beginning to the absolute end of the analysis. By ‘clarification’ I mean methods which often, but not always, take the form of ‘free’ listening and seeing and feeling, illuminated by ‘curiosity’. “Psychoanalysis can be defined as a practice of listening. Freud himself defined this listening as floating or “evenly suspended,” that is, a listening aimed not at unveiling the hidden meaning of what the patient says, but rather at grasping and freeing a new signification.” (Dr. Sergio Contardi: “Journal of European Psychoanalysis” (citation incomplete)).

In this model, ideally, ‘an association’, inspires ‘curiosity’ in the analyst leading to a necessarily incomplete ‘clarification’ in the analyst, which spawns curiosity, and curiosity expressed to the patient, inspires a new association. And so forth. All these elements, ‘association’, ‘clarification’, ‘curiosity’, and ‘expression’ are interactive processes, not objects nor facts. The sum of these processes–“Grasping and freeing a new signification”– constitutes learning.

For this process to have any particular use, the analyst must think or learn something new, usually about his patient, so that his clarifications can show the patient something new about himself, a new ‘signification’. If the analyst learns or thinks nothing new, he can grasp and free nothing. If that is the case, the analyst will only find what he is looking for, that which supports what he has previously determined to be true. That being the case, all due credit to Kant, the analyst either believes that he knows ‘the thing in itself’ of the patient, or that all patients are identical.

Many, if not most adolescents, react very badly to ‘classical’ interpretations, unless these interpretations are very firmly grounded in the material at hand, don’t interrupt the flow of the material, and are made in a fashion useful to the patient. By useful, I mean in terms of language, expression, etc., that can be ‘digested’ by the patient.

‘Adolescentese’, albeit difficult to learn, is the language of choice. Ordinary epistemological standards usually don’t apply. Insistence on adult standards and measurements of thinking, e.g., ‘rationally justified true beliefs’, is usually both impractical and foolish. ‘Adolescentese’, for example, is highly idiosyncratic and changeable and seemingly or actually irrational. My experience is that at least trying to learn this ‘language’ carries a good deal of weight with most adolescents. We usually get credit for trying. Nevertheless, obviously, we are not adolescents and pretending to be one usually often causes serious problems. For example, the question of ‘who is the patient?’ arises. There is something to be said for being an adult, behaving like one, etc. The adolescent, in the last analysis, didn’t come to see a peer, which can be done in numerous ways, but an adult who doesn’t expect them to be one.

There are a number of major benefits that flow from the use ‘Adolescentese’ communication technique. If one is asking an adolescent, using their language, if they can tell more about their thought, there is usually little cause for a debate. Everyone, or nearly everyone, adolescents included, likes to talk about what they say, their truth. Challenging their truths as opposed to trying to discern and understand them, should be left to debaters. Debating should be left to debaters. Accumulating associations, clarifying and understanding them, and communicating curiosity and understanding, is our work. Particularly with adolescents, making judgments and debating truths should be left to others.

There is another and perhaps greater advantage to this practice. The material is simply rarely artificially narrowed, or limited by theories. A ‘classic’ interpretation, no matter how close it may be to the truth, is always wrong (Kant—“thing in itself”), and breaks the continuity of the material of the session and spawns arguments, or worse, sycophants. Saying ‘always wrong’ is not a comment on the quality of the theory that forms the basis of a classic interpretation. It is, however, a comment on the fact that no interpretation can be any better than close (yet another example of the usefulness of Kant and ‘the thing in itself’). The material it purports to illuminate is, at best an ‘emanation’ from the ‘thing in itself’—the actual personality of the adolescent. That being the case, realistic modesty about ‘interpretations’ and their worth or accuracy has a great deal to be said for it.

Along Came Andrea

Chapter 15

Part 2

The happenings that occurred both in the first part of this discussion with Andrea and the portions that followed, are difficult to understand, yet easy to write, if writing is analogous to transcribing a tape recording. The dialog was much like one would have in an ordinary conversation, but in an extraordinary venue, a sort of dialog in which I have participated many times. My way of talking with her was very much as I would in an analytic session.  By this I mean that I consider her statements to be free associations. My elucidation of these associations yielded further associations, both from the further ‘building’ of her my understanding of her and further associations and questions associated with these associations, etc. My elucidations (questions, clarifications, statements, etc.) are interpretations. (I intend to explain further the meaning, free association, interpretation and transference as used by me in the following 2 chapters. What I mean to her in the transference is not clear, whether I be father, confessor, idealized listener, etc.)

To grasp the drama of this conversation, the situation in which it took place and the staff who were present, must be kept in mind. This meeting included a number of people who had a great deal to say about Andrea’s treatment, including when Andrea would be discharged from the Linden Center Program. I, for obvious reasons, make it a point to stay out of such decisions as much as I possibly can, an example being date of discharge, for a variety of reasons. If I put myself in a position of ‘power’ over my patients, such as when they will be discharged, the obvious would happen.  Any ‘free’ associations would cease to be ‘free’, but constricted and contrived, consciously or not. Nevertheless, to deny my position, is, of course, laden with problems. Were my actions direct intrusions into such issues as discharge, communications with me, in the ways that I have outlined, would cease. Nevertheless, I should add that the patients at Linden Center ‘seem’ to believe this ‘truth’.  I think usually that their belief is not a matter of denial, projective, or splitting. They believe that the confidentiality they are promised actually exists and they usually have faith in that agreement.  That faith is well placed but for one caveat. They understand that should they actually set out to hurt either themselves or another, I am legally and ethically bound to break this confidentially.  This situation, fortunately, has only arisen a few times over many years.

Andrea’s saying what she did, to me in this meeting contradicted, dramatically, statements she had repeatedly made to staff, therapist, mother, etc., e.g. not drinking or using drugs at all on any home passes.  She knew that saying what she did could materially change the time of her discharge—but she went ahead and said it.    It did.

For me, this type of experience, this sort of conversation, even in front of groups, was and is, very common.  My discussion with Andrea continued.  The fact that it continued was not at all unusual.  What was different, dramatically so, is that as this conversation continued, I gradually developed a bizarre sensation that all of the large number of people in the room disappeared, were literally gone, save Andrea and I, and that Andrea and I were speaking in ‘private’.

(Wilfred Bion, in his book, Experience in Groups, specifically dealt with a topic close to that which I have referred.  Specifically, he cautioned against having individual psychotherapy in front of a group instead of group therapy, the group being the patient.  The type of group to which he referred was a ‘therapy’ group.  The group to which I refer is obviously not a ‘therapy’ group. However, in this circumstance, I was having ‘individual’ therapy in front of no group, yet another twist on the topic of Groups.

An esteemed colleague, to whom I told this story and who knows me quite well, suggested that what happened is that I listened very intensely, hearing and seeing only her. He went on to say that since not being listened to, was such an important issue to me in my upbringing, this may be related to how I listen. There may be some truth to the latter.  Nonetheless, for whatever reason, one of the skills I have been blessed with is the ability to listen very intently and think of nothing else but what I am hearing from and seeing of a patient.  When these latter conditions are not met, I ‘know’ that something has gone wrong, although I am often not sure what has happened.  I usually, but not always, settle on the fact that some extraneous issue with me is the culprit, which often seems to be the case.  Obviously, there are other possibilities

Andrea and I continued to talk of many things beyond the above, some of which were very personal and private to her, again as though no one else were present, as if only she and I were talking.  Many of the issues that she spoke of were unknown to everyone in the program—staff, teachers, therapists, etc.  We continued having a private meeting in public.  This dialog lead to many other topics, like those listed above.

I have had and continue to have many such experiences with a large number of adolescents like the one I had with Andrea, minus people disappearing. Some, certainly not all of them, occur in public, such as in a staff meeting, in the corridor, and in my office. Whether in public or private, however, virtually all lead to a very productive dialog.

Other, and by far most, similar experiences would usually occur in analytic sessions, with adolescents who were in analysis with me, both from Linden Center and elsewhere.  The results were very similar to examples I have and will give.