CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

Friday, April 12, 2013

Closed Forever

“Closed forever,” the sign reads on the door of the big Barnes and Noble on the corner.  One day, the store is packed with people looking for bargains among the bare shelves and the  rummaged-through pile of esoteric cookbooks. The next, the windows are covered and a sign on a flimsy piece of computer paper taped to the door announces, “Closed Forever.” 

Something aggressive announces itself as well.  Perhaps the sign was created, by a now out-of-work disgruntled employee -- the last to leave. The one who was given the assignment to turn off the heat and the lights, to lock the door for the very last time and oh, by the way, to post a sign saying we have gone out of business.

In fact, isn’t that the more traditional wording in such circumstances?  Something handwritten like: 

“Going Out of Business. Thank You to all of Our Customers who have Supported us through the years!” 

Even if the closing store is part of a national chain,  the reading of this traditional type of sign  invokes feelings of sadness, compassion, and regret.  One is saddened that  the business could not withstand the economic downturn; one feels compassion towards the employees who toiled there but now face financial hardship; one regrets that one did not patronize the establishment more.  

“Closed Forever,” however, invokes a different response.  A sign without punctuation, it seemingly takes no emotional position on the matter. It is a sign that does not say a proper good-bye or explain anything.  It is final, it has the last word, it offers no engagement with the reader.  It does not acknowledge our years of shared interactions and memories.

One feels like a spouse who comes home to a quiet house to find her partner’s closet and bureau empty and an heirloom once cherished together missing. Only a hastily written note on the entryway table, “Gone Forever” is left behind.

Forever is a rigid word that nothing can follow.  Its permanence ironically signalling the impermanence of things. Perhaps the author of the note was angrily commenting on the impermanence of our times.  What exactly is closed forever?

Paper books?
Shopping in brick and mortar stores?
Neighborhood haunts?
Places to kill time browsing picture books between appointments?
Sensory experiences of discovery and pleasure that come from whiling away hours among rows upon rows of books?

Therapists have long known that saying, “goodbye” is hard.  How endings occur reveal much about the leaver and the left behind.  There are good endings that celebrate what has been shared before.  There are endings that fizzle away subtly -- both parties tacitly agreeing to pretend not to notice that they are no longer how they once were.  Then, there is the door slam, the angry rupture like the one down the street at the bookstore.  Its “Closed Forever” signaling the ever foreclosing of closure. (This post originally appeared on 1/11/12 at sallyrudoy.com)

Several days after the closing of the store and the posting of the aforementioned sign, Barnes and Noble finally put up a formal, "Going Out of Business" sign on a window.  Curiously, they left up the "Closed Forever" sign on the front door.

Saturday, November 24, 2012

A Petition to Myself

By Sally Rudoy

I would like to secede from myself, please.  I petition to withdraw from the anxious, obsessional conglomerate that at times rules my actions and mood.  Let me respectfully and peacefully depart from the parts of myself that I think are not serving my best interests and with whom I share little save for a body and a name.  Frankly,  they really are “not-me.”  In this, I am like Texas and, if some online news organizations are to believed,  like Alabama, Florida, Georgia, Louisiana, North Carolina and Tennessee. We all share secession fever.

Self governance is difficult when parts of yourself are at war.  Just ask Abraham Lincoln.  Things would be so much easier if my dependent, fearful self would not block the initiatives of my independent, bolder self.  So what if Miss Nervous Nellie kept me from jumping from an ungodly height  into the inviting coolness of the quarry below last summer?  Sometimes, you have to go over a cliff -- fiscal, personal, or otherwise  to move things forward.

Now, some may say that a house divided against itself cannot stand.  Well, you will get no argument from me there.  Where we disagree is what to do about it.  You may say it is important for divergent parts of the self to work things out, to compromise, to find a way to live in relative integration and understanding.  I say let those divisive parts divide. 

If I can secede from myself, I promise I will be neighborly. The border between my free and unfettered parts and the hand-wringers across the way will be firm but cordial.

I wish, like Texas, I could get a reasonable response to my petition from the President. I am afraid, however, that even if I could garner the  25,000 digital petition signatures necessary, it would be an uphill battle.   I will not let myself withdraw from myself without a fight.

Monday, May 21, 2012

Gay rights and gays wronged

By Eric Sherman, LCSW

It's enough to give you wedding whiplash.

First, North Carolina voters overwhelmingly approved a constitutional amendment prohibiting same-sex marriage. The next day, President Obama made history supporting the right of gay couples to say two simple words North Carolinians (and those in most other states) will not allow: "I do." The NAACP soon followed suit, coincidentally the same day that New York City Council Speaker (and possibly future mayor) Christine Quinn married her long-term partner. 

At the same time, not to seem enlightened, a Mississippi state lawmaker cited the Bible in calling for gays to be put to death. The esteemed gentleman from Mississippi probably also does not believe in evolution, which is ironic because he is proof that some Homo sapiens have not evolved beyond Neanderthal man. (Relax, senator -- I said Homo sapien.).

As the (wedding) march toward equality picks up speed, each step forward brings a lurch back. The gyrations have more than just political and social implications. They have profound impact on millions of gay men and women who are alternately given the message that they have finally been accepted as equals, and then reminded just how threatening they are to many in society.

 As a psychoanalytic psychotherapist who specializes in working with the LGBT community, I am amazed at the range of individuals I see and their relationship to their sexual orientation. Men and women, single and in loving relationships, for whom being gay is no more an issue than being left-handed or tall. Then there are the ones who break my heart. A man who was disowned by his parents when he came out to them. A couple afraid to hold hands in public for fear of being beaten. A woman who remained in an unhappy heterosexual marriage afraid she might lose custody of her children if she left her husband for her female lover.

In 1973, when I was 11 years old, the psychiatric community finally eliminated homosexuality as a mental illness, like schizophrenia, from its diagnostic manual. Four years later, the singer Anita Bryant made national headlines crusading against homosexuality, calling gay people child molesters bent on recruiting children to their sinful lifestyle. She, too, cited the Bible and her religious faith.

No doubt there will be more setbacks on the road to marriage equality. But with polls consistently showing an overwhelming majority of young people supporting it, it's only a matter of time. It is unlikely, however, that homophobia will be eradicated altogether. Fear of otherness is a powerful motivator. Yet time marches on.

Saturday, February 11, 2012

What Puppy Husbandry has Taught me about Psychoanalysis and Winnicott

by Sally Rudoy

I guess you can teach an old dog new tricks. In this case, I am the old dog. The new trick is a profounder, deep-rooted understanding of the psychoanalytic concepts I have been immersed in for years. My rediscovery of psychoanalysis’ brilliant take on the workings of the human unconscious has emerged not within the patient/analyst dyad but in my relationship with an animal. Sometimes you have to wander outside the familiar milieus of consulting room and conference hall to gain fresh insights into what you think you already know. For me, I wandered into the world of puppy husbandry.

The kids were launched. The nest was empty. Life was an uncomplicated and spontaneous mix of work and personal pursuits. Yet, as I saw that I had more years behind me than were in front of me, I knew there was at least one thing missing. I wanted to raise a puppy from scratch.

I was set on a rescue dog. As many have pointed out, therapists rescue others to rescue themselves. Years before I had good luck with an older black lab mix shelter dog named Maggie. For my new puppy I was determined to branch out to some other mutt combination. Psychoanalysis teaches us that people are drawn repeatedly to early objects. Thus, after researching many different breeds and visiting various shelters, I impulsively adopted a black lab mix who was a doppelgänger for her predecessor.

I struggled with what to name the new puppy. Ultimately, in a Lacanian sense of inevitability, I shuffled a few letters around and rhymed her , Moxie. "Hmmmm," I hear my former analyst murmuring triumphantly, "Moxie, Maggie, Ma...Ma...Ma...Mama, Mother!!"

From the moment this 3-month bundle of cuteness entered my life my understanding of Winnicott's notion of maternal preoccupation deepened. I monitored, prepared for, and obsessed about Moxie's house training. The rhythm of my days was organized around her toileting, sleeping, and eating behaviors. I suspect this must have happened when my human children were infants. But then I was, well...too preoccupied to notice. With little Moxie, I could stand in the spaces between my obsessive puppy-caring self and my cynical, observing self. The latter liked to remind the former to get a life.

A dog is the ultimate blank screen upon which pet owners can project their inner worlds. They are furry containers of disavowed affects, self and other representations, and unspeakable wishes. In the local dog park I observe my fellow pet owners as keenly as I keep an anxious eye out, plastic bag in hand, for Moxie's productions. I hear all sorts of attributions in the confines of that human-canine space. Standouts are:

· “Binky is uncomfortable around that pit bull"

· “Smudge has finally decided to embrace his life here”

· “Henry is anxious to get home”

· “Contessa is ambivalent about her new food regimen”

· “Do you think Parsnip’s rhinestone collar makes her look like a slut?“

· And, from one under-employed owner of a hyper beag-a-doodle, “Antoine needs a job!” *

For my part, depending on the day, I experience Moxie as having loving, hateful, or indifferent feelings towards me. At times, as she follows my every move, I see rapture, an idealizing transference, if you will, in her intense brown eyes. At others, I "know" she is just playing me with those same brown eyes to get an extra treat. However, now that she has entered puppy adolescence, I am convinced she is determined to show me who’s the boss. And, it ain’t me. In the middle of the night, I fret, “Where oh where did I go wrong?”

Sometimes insights come from unfamiliar and unexpected places. Raising Moxie has taught me plenty about psychoanalysis and the human mind. While animal behaviorists might say that when she looks at me she is calculating, “What’s that nice lady got in her hand and can I eat it?,” I sense so much emotion, so much intention, so much kinship, and attachment. I realize, paraphrasing Winnicott, that for me there is no such thing as a puppy. Only a puppy and her pet owner -- an interlinked couple of mutual and symbiotic connection.

* The names of the dogs have been changed for confidentiality (but believe me, they are not far off)

Tuesday, January 3, 2012

Are you a perfectionist?

I know a woman who feels she must get everything right. Margaret agonizes over work projects, convinced she will never please her boss. She spends a fortune buying the best of everything, yet still questions her choices. She throws parties and has a miserable time trying to assure that everyone is having fun. No matter what she accomplishes, how much time she spends in the gym, how carefully she prepares a meal, it's never quite enough. Margaret is smart, successful and popular.

She's also unhappy.

She is not alone. We live in a society that teaches us to do more, be more, have more -- now. Perfection is just around the corner, so if your life isn't exactly the way you want, you must be doing something wrong. Just look at the current Republican presidential race, in which candidates are embraced then discarded if they take a single position that doesn't jibe perfectly with right-wing expectations. As the old advertising slogan asks, "Who says you can't have it all?"

Well, anyone with a modicum of common sense. And yet, sometimes without even realizing it, people labor under the false belief that if they just try hard enough, they can always get things precisely right. What a burden! Perfectionists tend to be insecure and overly critical -- certainly of themselves, but also of others. (Some perfectionists, however, are not equal-opportunity critics -- they hold themselves up to impossible standards, while giving everyone else a free pass.)

In truth, perfectionism exists on a spectrum. To one degree or another, we all sometimes demand just a little too much of ourselves, at least in certain areas. Up to a point, this can be healthy. A little perfectionism sets high standards that force us to grow. The problem is when taken to an extreme -- when it becomes the person's predominant way of functioning.

Except for fleeting moments, perfection is impossible to achieve. No one (and no thing) can be absolutely perfect. We all have flaws and anything we do could probably always be improved upon. An accurate self-assessment allows us to accept our imperfections and to decide what might be worth striving for.

True perfectionists have a hard time doing this. Deep down, they are convinced there is something fundamentally wrong with them, and so all the praise and success in the world isn't enough. Since they drive themselves, they may, like Margaret, accomplish a great deal, but they take little pleasure in their accomplishments, much less in the process of getting there. Sometimes, they can be self-destructive; since they are always ready to fail based on excessive internal demands, they may procrastinate or miss deadlines obsessing over details. Ironically, they then prove their fear -- that they are somehow fundamentally flawed.

Perfectionists can come across as controlling -- of themselves, of situations, and of others -- since they fear being out of control. They torment themselves into knots of second- guessing, often suffering from anxiety, depression and difficulty sleeping. They have a hard time seeing beyond the black-and-white extremes of absolute success or abysmal failure.

It can be challenging to work with a perfectionist in psychotherapy. They want lots of tasks, guidelines, answers and homework. Even when they do gain an important new insight, they may quickly ask, "Okay, so now how do I fix that?", without taking a moment to even consider the complexity of what they have just learned.

Since they can be impatient about the time the process takes, and the fact there are no easy answers, psychoanalysis initially can be challenging. Starting sessions can sometimes feel torturous, since they believe they must come up with the one most important thing to say in order for the session to have value.

Yet the same analytic process of taking pleasure in finding unknown aspects of oneself in spontaneous interaction with the therapist can be precisely what the doctor ordered. In demanding perfection from themselves and/or the therapist, they unwittingly sweep the analyst into their world. Without realizing it, the therapist may feel the need to be brilliant, despairing that they are failing the patient when really they are feeling precisely what it is like to be that individual. If the analyst can take a step back and realize this, she can find some way to interest the patient in just why things must be done perfectly, what the costs are, and the possible alternatives.

These alternatives include accepting oneself as we are, even as we continuously push for further growth, to test the limits of our potentials. Perfection is a necessary -- even healthy -- illusion. It is the demand that everything be perfect that truly makes a person miserable.

-- Eric Sherman, LCSW

Saturday, December 17, 2011

Sexual Abuse -- New Statistics, New Hope

The numbers are staggering.

According to a just-released government survey, nearly one-third of women report they had been victims of sexual violence — rape, beating or stalking — at some point in their lives. Additionally, one in seven men had experienced severe violence at the hands of an intimate partner and 1-to-2% had been raped.

The high numbers surprised even some experts. They point to a problem in our society that is poorly addressed and that has profound implications for its victims.

Not surprisingly, the report showed that people who survive sexual violence suffer from physical and psychological problems, including diabetes, chronic pain, difficulty sleeping, increased risk of smoking, depression and Post-Traumatic Stress Disorder.

Part of the toll comes from the fact that rape is not only an act of sexual violation, but of power and control exercised over a helpless victim. The survivor must contend not just with being brutalized physically (often by someone he or she trusted), but also with the violation to her or his sense of self integrity and safety. The experience can be overwhelming, particularly when it stirs up memories of earlier examples of vulnerability, betrayal and shame going back to childhood.

In my practice, I have worked with many such individuals. Some report anxieties and inhibitions around sex, as well as guilt, anxiety, anger and mood swings. It can take a toll on their sense of confidence and trust, and on their ability to grow close in intimate relationships. Because of shame ("What will people think of me?"; "Maybe it was my fault") many do not talk about what happened to them. Some are afraid that to speak about it — even in therapy — would leave them once again feeling trapped with the very overwhelming feelings and memories they are trying to avoid.

Unfortunately, denial rarely works. In order to shut down anything associated with the experience, the person numbs her or himself (sometimes with alcohol, food or cigarettes), reliving what happened in flashbacks or through persistent fears and hypervigilance. They are always mobilized and on the lookout for danger. Some isolate from friends and loved ones. Without being able to deal with what happened, the trauma lives on within them, and gets created with others around them.

Since my practice includes men who have been physically and sexually abused — many, but not all of them gay — I wanted to address the special challenges they face. Both male and female survivors have to battle stigma and shame, but a man who is overpowered is often deemed weak and unable to fight back. There is a great hesitation to report crimes for fear of how the police and others will react, whether they are gay or straight. Much of the abuse takes place in romantic or sexual relationships, which can lead to guilt, stigma and self blame. Women who know their attackers often struggle with this as well, although in somewhat different ways.

Regardless of the circumstances, a goal of therapy is to create a sense of safety that allows the patient to feel she or he can talk about what had happened without being judged or overwhelmed by their feelings and memories. The therapist is careful to move at a pace that feels comfortable to the patient, in a way that is respectful of her or his need to feel in control.

The ability to speak the unspeakable before a carrying, nonjudgmental other can help relieve shame and give the person a sense of control and understanding. To the degree that the experience stirs up pain from the past, the ability to shed new light on earlier experiences — and to see how they connect to the person's current reactions and coping skills — can be profoundly healing and self-esteem enhancing. Ultimately, the person can move from feeling like a victim to a survivor who might actually grow stronger from the experience.

-- Eric Sherman, LCSW

Sunday, November 13, 2011

Learning for Penn State: the Legacy of Childhood Sexual Abuse

Much has been written about the recent news out of Penn State. Throughout the country, people were disturbed by the magnitude of the sexual abuse allegations, and the negligent way that coach Joe Paterno and the administration swept aside this serious matter.

The news brought home a dynamic of childhood sexual trauma with which many survivors and fellow professionals are familiar. In fact, a number of former abuse victims in my practice again felt violated by the news that unfolded throughout the week, including the way the beloved father-figure Paterno had further betrayed the children involved by not acting on the charges more seriously. (The insensitivity of Penn State students who violently rallied on behalf of Paterno as if he, and not the boys involved, was the victim also upset some.)

It is sadly ironic that the name Paterno sounds so much like paternal. When a young person is abused, frequently a parent (or both) who should have known instead adds to the victim's trauma. Whether consciously or not, they ignore signs (including of the child's distress) that something is amiss. Worse, they may disbelieve or even blame the child, perhaps re-creating a dynamic from their own childhood. (Victims of child abuse frequently marry abusive partners to whom they cling.)

The results can be devastating. Sexual trauma -- including various forms of seduction and boundary violation -- can overwhelm the child's ability to make sense out of what has happened, leaving him or her feeling frightened, overwhelmed, and guilt-ridden. Without the support of protective parents, the child feels doubly isolated and betrayed. He or she may blame themselves for whatever small degree they enjoyed the attention. Incest and other forms of child abuse generally take place in dysfunctional and chaotic households where children feel unseen and unprotected. The attention of a seductive father can be the only form of love the child knows, leaving her to blame herself for what had happened. ("I must have wanted it.") When one or both parents reinforce this message, the child is left burdened by a sense of guilt and shame too massive to process.

And so the victim frequently employs something called dissociation to try to maintain some form of self integrity. Dissociation is a coping mechanism designed to help an overwhelmed individual cope with trauma -- although at great cost. Threatening experiences and feelings are split off from the person's conscious awareness and are experienced as if not part of the self. The unconscious is acting like a surgeon, sacrificing a cancerous limb to protect the rest of the body -- except the person is not aware of what they are missing. In severe cases, called Dissociative Identity Disorder (formerly Multiple Personality Disorder), the parts of the self associated with the trauma become autonomous personalities that take over the person's consciousness.

However, dissociation need not be so pervasive. An adult can function quite competently in the world, yet be afraid of sex, for instance, since sexual feelings cannot be tolerated due to their link to the original trauma. Or he or she may be unaware of their own anger, dating back to the original betrayal. These people present as compliant adults terrified of aggression or confrontation. Without being able to get in touch with their own healthy assertion, they attract demanding others who use them and leave them confused -- precisely the original trauma from childhood the person was trying to avoid.

This is one explanation why trauma survivors often unwittingly reenact painful situations in the present. What cannot be integrated and understood can only be lived out over and over again, seeming to reconfirm for the adult that life is in fact terribly dangerous, that they are bad and worthless and sure to be betrayed.

For such adults, psychotherapy -- particularly a psychodynamic approach -- can be a vital part of the healing process. Therapy helps the individual understand and incorporate parts of themselves that have been left behind. The analyst -- another parent-like authority figure -- creates a safe environment to inevitably reawaken the patient's hope and dread of being both recognized and helped, but also once again seduced and betrayed. It involves more than simply recovering memories, but rebuilding trust. This involves the adult being able to experience and integrate what had previously been dissociated. Rather than simply reenacting the trauma in adulthood, the person finally begins to see themselves in a new light and moves on in their lives in ways they never would have imagined.

If some good comes from the Penn State tragedy, perhaps the discussion about sexual abuse and adult responsibility may increase awareness and make it that much easier for others to come forward and get the help they need.

-- Eric Sherman, LCSW