You say you want a resolution

Ah, New Year's. A time of fresh starts and grand resolutions. This is the year you lose weight, look for a new job, learn Swahili, and, in general, get your life in order.

And so you eat plentifully during the holidays, assured that your diet doesn't begin until January 1. You join a gym, and for a few days you actually go, waiting your turn for the elliptical machines with the other easily-winded New Year's resolvers.

Then one morning your alarm goes off, and you hit the snooze button. Once, twice, three times. It's okay, you'll go to the gym after work. But then after work becomes tomorrow morning, which becomes the next week, and there you are, soothing your guilt and shame with a pint of marshmallow chocolate chip ice cream, a spoon, and -- who are we kidding -- no bowl. I say this as a person who was spent plenty of time with my face in front of the freezer vowing just one more scoop and that's it.

This blog post will not offer 10 easy tips for making your resolutions stick. If it were that simple, you would have made the changes years ago, or on any of the other 364 days of the year. What gets people into trouble is the well-meaning naivete with which they make sweeping promises, ignoring their own ambivalence (and their track record).

Each of us has fears and resistances to letting go of bad habits. The devil we know is less frightening than the devil we don't. What if we were to put in the strenuous effort of changing, and we failed? Or if our greatest fears about ourselves proved true? By not really trying, we keep things safe and in our control. There are no unpleasant surprises, even if that means we are unhappy.

For instance, procrastinating on projects and then rushing to do a sloppy job confirms that we are not capable enough for a promotion. That's the unhappy part. But what if we put in our all from the start, and it's still not good enough? That might feel devastating. Better to procrastinate and feel like a failure by our own doing rather than have it irrevocably proven by really trying and missing the mark. All of this happens unconsciously, out of our awareness, which is why it's so confounding. Procrastinating keeps alive the hope that we will still be recognized as unique and talented -- a desire that was not often met as a child -- if we would only stop putting things off.

Which brings us to what psychoanalysts call "secondary gain." Without realizing it, there's something we are getting out of even the most self-destructive traits. I have a friend who is forever sick with ill-defined illnesses and body aches. She bounces from physician, to specialist, to chiropractor, complaining loudly of her misery. Is she happy? No. But, without realizing it, she's getting plenty of attention she feels is lacking in her life. The person who continuously overeats or drinks to excess may be using food or substances to fill an emptiness, or to avoid experiencing other difficult feelings.

Until we look at the unconscious obstacles we put up to dismantling our personality armor, we're likely to continue repeating the same New Year's resolutions -- with the same outcome -- year after year. Still want to make a resolution? Resolve to spend some time truly understanding the complexities of what makes you tick. This is no easy task, but it can be an exciting one. You might want to make an appointment with a psychoanalytic psychotherapist to help in this process.

And then resolve to try to keep that appointment.

Happy new year!
--Eric Sherman, LCSW

What's a Lunar eclipse have to do with psychoanalysis anyway?

I keep thinking about the recent full lunar eclipse that occurred at the same time as the winter solstice. This one was especially noteworthy because it was the first time since 1638 that such a confluence of events occurred (that’s 372 years ago!) What I keep thinking about doesn’t have to do with the astronomical factors involved in such an event nor with how beautiful the moon looks cast in an eerie shade of orange. What I keep thinking about is the terror such an event caused in the hearts of our ancestors all those many eons ago. Even more I think about all those poor women who lost their lives as they were offered up for sacrifice in order to appease what was believed to be an angry god. It’s amazing how our ancestors’ lack of knowledge as to what caused this event didn’t keep them from “knowing” how to fix it!

Apparently no one was sitting around at night, seeing this phenomena unfold, saying to themselves and others,

“Hey, look at that! I wonder what’s going on? Everyone ok? Anyone hurt? No? Good, let’s keep an eye on this and see what happens.”

Rather, I imagine what was thought was something like,

“Hey, look at that! I don’t know why that’s happening and worse yet, it seems to be happening outside of my control. That makes me feel small and vulnerable and that makes me anxious! In order to make myself feel better, I’m going to make up a story about why this is happening. Of course, since I’m making this up, it will consist primarily of projections of my own internal world. I know; this will be about having done something to piss off my parents, better known as the ruling gods. (Given that I’m working on getting to the depressive position I will try to make amends but I can’t help but also express my hostility.) I’ve got it; the gods want us to offer them sacrifices of young innocent women, yeah, I’m sure that’s what gods like! “ And so, into the fire those women went giving the gods what they wanted, at least according to the men in charge.

The importance psychoanalysis places on the power of the internal narrative--that’s what keeps occurring to me as I think about the lunar eclipse. How attached, how enamored we become of our story, the one we told ourselves in order to survive what we couldn’t understand or control. How well it serves our anxieties and how poorly it serves our ability to be in the present moment. For the last several days I have found myself listening to my patients struggle with their internal voices, conflicts, and longings. I hear my own drama calling out to me as I move through my day.

When I think of the olden days, I picture tapping those ancients on the shoulder and telling them that it’s safe. They haven’t done anything wrong. They don’t have to “pay” for their misdeeds. The universe doesn’t keep score.

Then I wish I knew the magic words to tell my patients (and myself). I want to tell them that their life is in the present. That yes, we are vulnerable in that present to things we don’t want or control but that we fare so much better when we don’t make up stories or give ourselves things to do that create the illusion that we are protected. I would like them to know that we can be anxious or sad or frustrated and remain thoughtful, curious and still. And that although it is a flawed present, incapable of righting the wrongs done to them, although it is limited in providing them with the antidotes to their early pain, capable of even more disappointments and things that can’t be controlled, it is nowhere as painful, anxiety-producing and limiting as an endless search for what is no longer available.

In the end, I realize that the tap on my patients’ shoulder can’t be so much in what I tell them, as much as in how I am with them. I can invite them into a world that doesn’t shame them for their fears and longings; where there are no forces that need to see pain as proof of one’s devotion We can sit together and observe when it is that their moon disappears, noting, but not necessarily acting on the commands embedded within their ancient story and hoping that in my joining them on their journey we will write a new and more fruitful story, one more firmly rooted in the present. My hope is that we will keep the casualties to a minimum.

By Irwin Badin

HBO’s IN TREATMENT: Can good drama be good therapy?

Recently, I participated in a terrific discussion group about this season’s HBO series, IN TREATMENT. The group was held in NYC and was led by two analysts from William Alanson White Institute, Claire Basescu and Don Greif. For our final meeting, Claire and Don asked us to respond to questions that addressed whether the show was a good portrayal of therapy. Below are the questions and my responses. Please share your views on these questions.

Did your view of IN TREATMENT as a showcase for therapy change over the season?

I think this season of IN TREATMENT provided great drama and wonderful personal stories. However, a showcase for therapy it was not. My perception about its showcase worth changed over the season. It gradually became less and less so as the personal flaws of both therapists were exposed. While I thought Paul improved somewhat once he was in treatment with Adele, he seemed too restless, angry, and tortured in his own life.

For many prospective patients, I could see this feeding into one potential stereotype about therapy: that the doctor will be crazier than the patient. People considering going into therapy might wonder, “are these my choices: on the one hand, someone who will need me more than I need him and will be working out his own issues with me; or, on the other, a steely, at times robotic, person who adheres so rigidly to her theory, that she misses the unique needs of each patient. And, because of her allegiance to a 1-person view of analysis, does not take ownership of the problems she herself creates?”

What Positive and Negative images of the profession does the show present or reveal?

Negative Images:

• Therapists will answer my questions with questions
• The doctor is crazier than the patient (see above)
• I will be shamed
• Therapy is a game of “gotcha” if I am avoidant/resistant

Positive Images:

• I can say anything in a therapist office: swear, rail, talk about sex
• Therapy may be about connecting to your true, creative, lively self
• Wow, dreams do mean something and can help me understand myself (Paul’s dream)
• There is an unconscious: many of my thoughts, feelings, behaviors and relationship choices may be out of my awareness. Now, because of this show, I am curious about finding out more about my unconscious.
• My confusing behavior and repetitive patterns can be untangled as they are replayed in transference.
• Therapists are humans too (but with training)
• I can have some very attractive person focused exclusively on me for 45 minutes!

Are you proud to be identified with the therapists in the show?

No. I was prouder in the last 2 seasons. Not this one though. Several of the treatments might be considered “failures.” Also, the doctor may be crazier than the patient (see above).

What misunderstandings and/or correct understandings about therapy do you think people might glean from the show?

Possible misunderstandings:

Therapists will know better than me about me. They will tell me what I am thinking and feeling and why. Therapy is an exchange between a flawed “me” and an objective other.

Correct understandings:

Therapy can be a very intimate and emotionally charged experience. Therapists really think and feel so much about their patients outside the consulting room. Therapy is only as good as the human being who provides it. Ultimately, no matter what the theory, my problems will be viewed through the subjectivity of the therapist. Finding a “good fit” with someone is important.

Is the show a good vehicle for exploring clinical process & technique?

Yes. I think it is a terrific vehicle. It illuminates so much about: the frame, boundaries, dual relationships, the transference/countertransference matrix, enactment, different meta-theoretical approaches to interpretation, resistance, the classical and contemporary views of neutrality and abstinence, dream interpretation, termination, psychopathology and character disorders.

And, of course, it highlights the importance of a therapist’s own analysis so that the doctor is not perceived as crazier than the patient (see above).

Sally Rudoy, LCSW

Who's afraid of the big gay wolf?

With a vote that had seemed impossible just a week ago, Congress did the unthinkable yesterday:

The right thing.

Repealing Don't Ask, Don't Know (DADT) should have been a no-brainer. The president, the Pentagon, most lawmakers, the majority of the public, and the Secretary of Defense all supported the repeal. Even 70% of surveyed servicemembers believed it would have no negative impact on their units. But thanks to the voices of fear, it practically didn't happen.

Openly gay soldiers will be a dangerous distraction to the troops, endangering their lives!, warned Sen. John "I never said I was a maverick" McCain and Marine Corps Gen. James F. Amos. Apparently, now that they don't have to be closeted, McCain and Amos expect gay soldiers to hit the trenches in Bob Mackie gowns, making it impossible for our well-trained heterosexual boys to keep their eyes on incoming fire.

Does anyone else find that kind of hysterical homophobia a little, well, queer?

But there it was only a few weeks earlier, in a court hearing involving California's anti-same-sex-marriage law, Proposition 8. In that case, the group ProtectMarriage.com sounded the alarms, warning that allowing gay people to marry would threaten the very foundation of (the apparently fragile) institution of holy matrimony. Ironically, the same argument has been put forth by the likes of McCain, Newt Gingrich and Bill O'Reilly, who have five divorces and numerous affairs between them.

What lies beneath the fear of all things gay? Like all fears and prejudices, what really unnerves people may be deeper than meets the eye.

As a rule, people tend to rail against unpalatable aspects of themselves that they see in others. Someone who is afraid that they may be gay unconsciously tries to eradicate this threat from within by seeing the danger as coming from others. By clamping down on gay people they attempt to eradicate disturbing aspects of themselves. Many of the harshest critics of homosexuality turn out to be gay themselves -- like politician Larry Craig, who was caught in a compromising position in an airport men's room, and "Conversion Therapy" psychologist George Rekers, who believes homosexuality is sinful and was photographed with a male prostitute earlier this year.

Sadly, homosexuality is frequently associated with weakness, and male homosexuality with femininity. For men who feel insecure in their masculinity, gay men pose a particular threat. These heterosexuals try to prove (to themselves) that they are "real men" by beating up on other men.. Explaining why resistance to repealing DADT was particularly prevalent among Marines, Gen. James T. Conway responded, "We recruit a certain type of young American, a pretty macho guy or gal." Someone should tell Gen. Conway that us less-macho guys stopped calling women "gals" decades ago.

Finally, sexuality is a fertile breeding ground for anxiety. Sex represents both the ultimate vulnerability, as well as all that is wild and out of control. Erotic passions attract shame like a (Spanish) fly to a flame. As a society, we talk about sex constantly and often quite crudely (hello "The View"). We spend a fortune on products intended to improve our performance as if our sense of self was as flaccid as our erections. We are obsessed with sex -- we just don't have any. Gay people -- who often seem more sexually uninhibited -- can be a lightning rod for many erotic insecurities.

We all grow up in a heterosexual society that values sameness and conformity. To one degree or another, we are all at least a little homophobic, just as we are all a little racist. Prejudice is particularly insidious where it is most subtle, and therefore easy to hide out of view. Also this month, in the midst of the debates about DADT and same-sex marriage, a study in the journal Pediatrics showed that gay, lesbian and bisexual teenagers in the United States are far more likely to be harshly punished by schools and courts than their straight peers. This was true even though they are less likely to engage in serious misdeeds.

With the surprising repeal of DADT, perhaps homophobia has been dealt a serious blow.

But somehow I doubt it.

-- Eric Sherman, LCSW

PTSD: Post-Thanksgiving stress disorder?

Your critical mother was in rare form, simultaneously carving up the turkey and slicing through your self-confidence like so much pumpkin pie. ("I'm just saying how much nicer you would look if you wore a little makeup and lost a few pounds, dear.") By the end of the meal, you had regressed from being a seemingly confident adult to an insecure, acne prone teenager.

All things considered, the turkey got off easy.

There's nothing like the holiday season to re-creating old family dramas. Yet many people are surprised that the scars from childhood remain so raw. What can be most unnerving is the realization that you, too, do your part in the drama, arriving late to (unconsciously) annoy mother, or arguing back in some misguided attempt to finally convince her of your worth, or to prove how she has wronged you for decades. Hasn't enough time gone by to forget about all that?

But time alone will not put the past behind you. Without realizing it, you may be holding onto your pain -- and often re-create it in the present -- in a misguided attempt to protect yourself from further trauma.

When your earliest needs and unique individuality are met with hostility or neglect, you are too young to know how to process this experience. Overwhelmed, a part of you shuts down in self protection. Unable to make sense of what has happened, you go through life on guard for the trauma to happen again. You continue to see yourself as not quite good enough, sure to be rejected. Unconsciously, you choose people who reject you and remind you of the past precisely because they are so familiar, and thereby oddly comforting in their predictability.

When a critical boss reminds you of mother, or your defiant daughter stirs up your fear of not being good enough, you may feel thrown back to being a helpless child. It happens so reflexively, so unconsciously, you may not even realize it. And you certainly may not be able to make the connection to the past that would help make sense of your strong reaction.

Instead, you become your critical mother by yelling at your defiant daughter, which only causes her to ignore you -- making you to feel more rejected. At work, you procrastinate and miss a deadline, unwittingly contributing to your boss' ire. You berate yourself for your imperfections, thus becoming both critical mother and incompetent child within yourself.

The only way to move on from the past is to better understand how it continues to affect the present. Psychoanalysis encourages you to re-examine your childhood not to get stuck in it (as many people fear) but to get unstuck from it. Only then can you mourn what you didn't get, and find recognition and fulfillment in the present.

Mother may always be critical. By exorcising her voice from within you -- or, more realistically, by incorporating it with other, more gentle voices -- you are less likely to be activated by her in the present.

Which just might make the holidays a little more bearable.

Condolences and contradictions -- an unnecessary death

Jumping off the gw bridge sorry

When Tyler Clementi plunged into the Hudson River hours after posting those chilling words on his Facebook page, the Rutgers University freshman became the latest in a string of suicides of gay teenagers taunted by their peers.

Forty-one years after the Stonewall Riots launched the gay rights movement, nine out of ten LGBT students report experiencing harassment and nearly two-thirds of them feel unsafe in school. The incongruities are astounding -- young people are coming out far earlier then ever, yet suicide related to homosexuality remains the second leading cause of death among youth. Five states and the District of Colombia allow same-sex marriage, yet several more outlaw gay people from adopting or becoming foster parents because of the "risk" they pose to unplaceable children. And talented young students with the rest of their lives to look forward to jump off the George Washington Bridge.

The more things change, the more homophobia remains ingrained.

More than three decades after the DSM belatedly removed homosexuality as an illness, I still sometimes treat men and women of all ages tormented by their same-sex attraction -- successful businesspeople terrified of being outed on the job; gay parents worried they could be reported for child abuse if they show their children too much affection in public; adults and adolescents disowned by family or sent to counselors not to treat their depression but to change their sexual orientation. I also see many lesbians, gay men and bisexual patients who are out, open and proud.

A couple of years ago, I taught a course in Gender and Sexuality for CPPNJ. Several candidates wanted to know what caused homosexuality. Could childhood sexual abuse make someone gay? I asked the class why no one wanted to know what caused heterosexuality. Could sexual abuse make someone straight? When we are sitting with heterosexual patients, do we ever think to wonder about how their sexual orientation affects them?

We should. The difference between homosexuality and heterosexuality is not that one is normal and the other not, it is that one is the unquestioned norm and the other can be a frightening threat. We are all raised in a heterosexual society almost always by heterosexual parents (although that too is changing).

Less than a week before Tyler Clementi's suicide, Atlanta mega-preacher Eddie Long was accused of forcing young male church members to have sex with him. Not surprisingly, Long has famously decried homosexuality. What terrifies people within themselves can cause them to rail against others with the same issues. If they can try to eradicate it in others, they don't have to deal with it in themselves. Of course, what is disowned is often acted out, with real consequences on real people.

Rest in peace, Tyler.

-- Eric Sherman, LCSW

Narcissism Is Us

The recent spectacle of a lunatic Florida minister holding the world hostage by threatening to burn Korans remains disturbing on many levels. Admittedly, "lunatic" may not be a proper diagnostic term; so far as I know, the committee working on DSM-V is not considering Lunatic Personality Disorder as a new entry. (Given all that is going on in this country, perhaps it should.)

I won't speculate about what specific diagnosis might best describe the good Pastor. I do think it's fair to say he is just a wee bit narcissistic. And that our culture of ever-mushrooming opportunities to draw attention to oneself is helping to raise narcissism to new levels.

It's not hard to imagine the delight of Terry Jones, the once-insignificant minister whose tantrum-like media stunt would have been ignored in times past. How powerful this Napoleonic man must have felt as the President, the Secretary of State, the Vatican and, mind-bogglingly, Angelina Jolie (speaking of narcissists), made imploring statements and phone calls to him.

Of course Jones is not the only dangerous narcissist whose hunger for power and attention are currently indulged in our multimedia times. Take Glenn Beck and Sarah Palin -- please. They maniacally tweet and organize marches as testaments to their self-importance. The more attention they get, the more they want, and the more the media gives them.

These are extreme cases, of course. But the popularity of Reality TV, Facebook, Twitter, YouTube, and ever-present blogs has helped fuel even garden-variety narcissism. (The irony that I am blogging right now is not lost on me. Please ignore the man behind the curtain.)

These days, every mundane thing people do is posted, chronicled and video taped on the Internet, clouding the boundaries between what's truly important and what's just nonsense. Everyone wants -- and can presumably now have -- their fifteen minutes of fame, but why settle for only a quarter-hour? Not when you can bounce from reality show to magazine covers to celebrity rehab and three more reality shows -- simply for behaving badly.

"Attention must be paid," said Willie Loman's wife about her defeated husband in "Death of a Salesman." Loman was a tragic figure, an empty man who turned to suicide when he could no longer prop up his battered ego. Narcissism is about just that -- a desperate attempt to shore up a fragile sense of self by inflating one's importance. Grandiosity temporarily masks insecurity.

The problem is, it doesn't work. Each conquest ultimately leaves the person feeling more deflated, needing more of a boost to his or her self-esteem. Narcissism breeds more narcissism. As Glenn Beck's ratings continue to slip, I suspect his rants will only intensify. I shudder to think about what the Florida minister will do next.

All of us have some narcissistic characteristics; sometimes they are actually healthy. Mental health comes not from being flawless (isn't that the misguided goal of the narcissist to begin with?), but from being more aware of and comfortable with our vulnerabilities.

Humility can tamper hubris; self-awareness can replace self-aggrandizement. These are some of the goals of psychoanalytic treatment. Unlike other therapeutic modalities that do not address the underlying causes of suffering, psychoanalysts are uniquely trained to work with the fragility that fuels unhealthy narcissism. When we engage the frightened adult-child behind the blustery bully, both sides of the personality feel attended to. Shame can give away to genuine confidence.

And that is something worth posting on a Facebook page.

-- Eric Sherman, LCSW

Flunking Dr. Phil: In Praise of Introspection

Americans like our self-awareness like we like our food -- fast, and in bite-sized McNuggets. We pop pills and turn to self help books and TV "experts" to prop up or moods and pep up our orgasms. Yet we feel more impotent than ever.

How did we become a culture that reveres Dr. Phil yet reviles Dr. Freud?

When smiley-faced emoticons have replaced genuine emotions, and instant messaging trumps introspection, the ability to know oneself has fallen upon hard times. Given how overwhelmed so many people feel, the desire for easy answers is understandable. The idea of looking inside can be frightening when what's inside feels dark and shameful. That's what's so tantalizing about therapies that promise symptom relief without having to look at how the problems got there in the first place.

Yet in their rush to avoid introspection, many people end up feeling more stuck and confused. People who put "positive energy" into the universe (the mantra de jure) with little result end up doubting themselves more. They never understand what's beneath their negative thinking. Someone who cleans up the mess in their house only to re-create it days later is unaware that the mess symbolizes how they feel inside. Part of them unconsciously needs to create mess for many complex reasons. The deep-seated feelings they are trying to get away from are now simply expressed through new obsessions, addictions and phobias.

To borrow a motto from the 1970s, a mind is a terrible thing to waste. Concrete techniques to change destructive thought patterns and behaviors can be very helpful -- I use them in my practice all the time. But without also understanding what the mind is struggling to express and not express at the same time, the root of what causes self-destructive actions never becomes unearthed. Shame, fear and confusion often linger.

Psychoanalysis offers more than just a Band-Aid for multilayered wounds -- although it often does provide immediate relief for disturbing symptoms. Psychoanalytic psychotherapy does something more deep and lasting. It takes you on a journey of self-awareness.

There are potentialities existing within us all. Psychoanalysis is about excavating our pasts, but also about unearthing new ways to be with oneself and others going forward. It is deeply personal and deeply practical. Understanding the genesis of our problems, and recognizing how we unwittingly contribute to their perpetuation in the present, allows us to feel more in control of our lives.

I sometimes catch a glance of Dr. Phil on my gym's large-screen TV. I watch him only in small doses, and with the volume down. Then I look away and see where my mind takes me. It's a nice work out.
-- Eric Sherman, LCSW

Talking about Talk Therapy

Recently, a cover story in the New York Times Magazine, “My Life in Therapy,” by Daphne Merkin (August 8, 2010) generated an onslaught of responses in print and the blogosphere that, I believe, anyone passionate about psychoanalysis should be aware of and concerned about. http://www.nytimes.com/2010/08/08/magazine/08Psychoanalysis-t.html?pagewanted=all

In the article, Merkin details her 40-year history in psychoanalysis with various psychiatrists. The piece reads like a tell-all revenge fantasy against her former analysts. Her portrayal of the analysts is cartoonish in its presentation. Several analysts are silent and withholding. Others are bungling, authoritarian, and arrogant. Merkin’s sarcastic tone throughout clues the reader that she believes the doctor is crazier than the patient.

Her article is an indictment against these individuals in specific and against psychoanalysis in general. She believes neither served her well, yet she returned again and again to “classical” analysis for treatment of her depression.

As I was reading the piece I had a building sense of dread that the author was painting an inaccurate portrait of psychoanalysis that would proliferate rather than dispel old stereotypes. Beyond a chronological detailing of how each therapist, in turn, failed her, she weaves in rudimentary explanations of drive theory and ego psychology.

She has little curiosity about developments in psychoanalytic theory and practice over the last several decades. Nor does she explore other therapy modalities. This created quite an outpouring, as you can imagine, from blog and letter writers from the CBT community.

Many of the letters to the editor and blog entries confirmed my dread. Responses ranged from assertions that psychoanalysis is dead and discredited to judgments that psychoanalytic patients, indeed anyone who seeks therapy, are whiny navel-gazers.

However, there were also postings from current and former patients who responded that psychoanalysis had saved and enriched their lives or had put a stop to self-defeating patterns. Many analysts wrote in to invite Merkin, The New York Times, and its readers to learn more about the process and efficacy of contemporary psychoanalysis.

Psychoanalysis is a powerfully effective therapy. And, we need to get the word out. Recently a peer-reviewed journal article asserted that “talk therapy” works and keeps on working after sessions stop. Check out:

http://www.scientificamerican.com/article.cfm?id=talk-therapy-off-couch-into-lab

Researcher, Jonathan Shedler, has published articles that can be downloaded from his website. I recommend:

https://portfolio.du.edu/pc/port?portfolio=jshedler

The Efficacy of Psychodynamic Psychotherapy (American Psychologist, 2010)

That was Then, This is Now: An Introduction to Contemporary Psychodynamic Therapy

Analysts are wonderful listeners and profound change agents in the privacy of the consulting room. Now they must be excellent talkers and changers in the larger world as well. We need to present an accurate picture of what psychoanalysis is and how it helps people. Merkin will soon be enlarging her article into a book. We have our work cut out for us.

Sally Rudoy, LCSW

"Altar-ing" perceptions: On working with gay couples and individuals.

June is flying by -- the month when thousands of (heterosexual) Americans marry. June is also Gay Pride Month, when thousands more Americans still can't.

Imagine a fictitious gay couple, Tom and Jeff. They have been together for 17 years -- longer than either of their divorced parents. Imagine they are in couples therapy the day after attending the (heterosexual) wedding of Tom's niece in Pennsylvania, a state (like most) that does not recognize their not-quite-equal civil union from New Jersey.

In the session, Jeff complains about Tom's driving on the way home from the ceremony. "All I did was ask him to slow down a little and not be so aggressive," he tells the therapist. "He was driving like a madman."

"I was not," Tom snaps back. "You were very critical and harsh."

The therapist acknowledges Jeff's frustration and concern about Tom's driving, and encourages him to consider other ways to articulate his feelings. She comments on how the couple's disagreements sometimes devolve into power struggles, and offers advice on how they each might better communicate and express their needs. Tom and Jeff move on to another topic, and the therapist is satisfied that she has replied in a useful manner, based upon her work with many (heterosexual) couples and her own experience with a husband sometimes prone to aggressive driving.

In assuming that Tom and Jeff are like all the couples she has seen, however, the therapist has failed to realize that their relationship faces unique obstacles. Their fight was not simply a power struggle, but also expressed the hurt, shame and anger from feeling marginalized at the wedding.

Tom and Jeff need an opportunity to talk about how dejected they felt watching other couples slow-dance. Or how they both blanched when Tom's mother introduced them to others: "Tom, you remember your cousin Janet! And this is her husband, Paul. Janet and Paul, this is Tom and his, um... Jeff."

Most gay couples (and individuals) must deal with this sense of difference and even shame at times in their lives. In fact, the therapist would be wise to wonder if these feelings ever come up with her, a straight married woman. She may have been avoiding her own fears of not knowing enough, of being judged as different or inadequate. Had she been able to recognize her countertransference, she might have marveled at how similar she was feeling to them as an unacceptable other. She may have found a way to turn her discomfort into empathy.

Of course, gay, lesbian, and bisexual therapists would have their own countertransference reactions to this couple based on their own life experiences. Subtle expressions of homophobia are inevitable regardless of the analyst's sexual orientation. From a psychoanalytic standpoint, the goal is not to exorcise our countertransference, but to find ways to recognize and utilize it.

As analysts, we have a responsibility to become aware of our own beliefs and assumptions as they surface with patients. Additionally, I believe we have a personal and professional obligation to advocate for fairness for all people. Our commitment to alleviate suffering does not end at the consultation room door. Making marriage equal is no panacea, of course. But working for it is a good start.

-- Eric Sherman, LCSW

Eric Sherman is the author of Notes from the Margins: The Gay Analyst's Subjectivity in the Treatment Setting (The Analytic Press).

To find out more about supporting same-sex marriage, visit the websites of Human Rights Campaign (www.hrc.org) and Garden State Equality (gardenstateequality.org).

Common Psychoanalytic Myths: Part 2

Here is another installment in our look at a few common myths about what psychoanalysts and their patients actually do during sessions. We invite your comments and the sharing of your own myths.

MYTH #2

Will I have to spend all my time in a psychoanalytic therapy talking about sex?

FACT

Your question reflects two concerns you might have about psychoanalysis. One is that you will “have to” do something that you may not want to do – in this case talking about a subject that your analyst feels is most important. The second is the concern that your sex life will be the focal point of inquiry.

Tackling concern one: Many people new to analysis imagine their therapist will be an authority figure who will set the agenda for what is discussed. Many worry that they will be criticized, judged, or made to feel embarrassed. Although an expert in human psychology, the analyst’s view of the therapy process is collaborative and accepting. The analyst creates a climate where what is most meaningful and salient to the patient can be explored in a manner that is safe and respectful.

Concern two addresses the stereotype that psychoanalysts believe that sex is at the root of all problems. During the repressed Victorian era when Freud was developing psychoanalysis, he indeed encountered many patients with debilitating symptoms related to sex. He called sexual energy, libido -- a drive from the most unruly, uncivilized parts of ourselves.

Over time, with the benefit of many years of study and clinical evidence, analysts have also observed other causes for emotional difficulties such as ingrained patterns of being in relationships, vestiges of traumas, cultural and environmental influences, and individual genetic and body endowments. All of these and more are possible topics of discussion in an analytic therapy.

The thought that sexual matters may be discussed can be anxiety provoking. However, reflecting on the role of sex in one’s life is important. An essential aspect of the human experience, sex impacts our perception of ourselves, our relationship with others, and the choices we make in all arenas of life. So, analysts will invite you, when appropriate, to talk about sex. To never talk about it would be to bypass understanding yourself fully and omit tapping into a resource for happiness and positive change. Psychoanalytic therapists provide the confidential, private, and safe space for such exploration.

Sally Rudoy, LCSW

Can This Relationship Be Saved?

If you're anything like me (and for your sake, I hope you're not), you were a little unsettled by the recent separation of Al and Tipper Gore. If Washington's charmed couple could come undone after four decades, whose relationship is safe?

Who knows what happened that, seemingly out of the blue, what worked for the Gores for 40 years suddenly no longer did. Was it an affair? A slow drifting apart? After more than 14,000 days spent together, could Tipper no longer stand the toilet seat being left up one more minute?

Anyone who has ever done couples therapy (or been in a couple) knows that needs and interests that were once compatible can shift over time. We certainly hope they do. A relationship that doesn't change becomes stagnant. What marks a successful couple from an unhappy one is not whether the partners fight or how often, but how well they complement each other -- and how they navigate things when they don't.

Often, the very characteristics that attract us to our mates can pull us apart over time. The way he was so carefree and spontaneous now feels childish and irresponsible. "Why does he 'yes me’ whenever I ask him to do anything -- but then not do it?" The way she hung on our every word now seems suffocating. "Can't she give me a little space when I ask for it?"

We were so happy at first. What changed?

Undoubtedly many things. Here's one that a couples therapist, working from a psychoanalytic perspective, might consider. Without realizing it, we (unconsciously) choose a mate who embodies undeveloped aspects of our own personalities. His spontaneity excites us because we get anxious taking risks. We are afraid of our unmet dependency needs, and so are drawn to her seemingly unflinching trust. His ying is her yang. He introduces us to the world of freedom, she to safety and commitment. So far so good. But so long as our partner expresses a part of us we cannot tolerate, we become jealous of him for what we think we don't have. What we loved in them now frightens us. How come he gets to go out and have fun when we are always stuck with the kids? Ying and Yang remain split, and conflict brews. So long as she is the needy one, he never has to confront his own neediness, and she her fear of being alone.

Couples therapy helps each partner take back what the other is burdened holding for both of them. He begins to see that he has always been afraid to depend upon others for fear he will be abandoned. In fact, by ignoring her whenever she makes a demand, he in essence abandons her before she can reject him. Similarly, by choosing a critical, distant man, she has married someone just like the father who ignores her and shuts down her confident, fun-loving side.

As they work through these issues together in therapy, he can finally risk being more vulnerable with her, and she can discover her own strengths and capabilities. Each can feel safe learning from the other rather than railing against them. Differences can complement and enhance, not threaten. Not only does the relationship grow stronger, so do both individuals, as they get in touch with parts of themselves that were hidden within them all along.

-- Eric Sherman, LCSW

The New Jersey Couples Therapy Training Program (NJCTTP), a division of the Center for Psychotherapy and Psychoanalysis of New Jersey, offers a unique multitheoretical training program for mental health professionals, from both family systems and diverse psychoanalytic points of view. For more information, visit http://cppnj.org/njcttp.php.

Common Psychoanalytic Myths

Woody Allen has famously been called the “poster child” of psychoanalysis. Ironic isn’t it that the comedian/filmmaker has become the recognized face of psychoanalysis? Well, perhaps not. Psychoanalysis -- what it is and what happens during sessions has historically been the butt of jokes in culture, film and literature. Here we tackle a few myths about what psychoanalysts and their patients actually do during sessions. We hope to dispel, elaborate, or corroborate those familiar myths. We invite your comments and the sharing of your own myths.

MYTH

Psychoanalysts encourage patients to re-hash their troubled childhoods over and over

FACT

While analysts do encourage exploration of the patient’s experiences in childhood, parental and family relationships, cultural background, and traumas, they are not the exclusive focus of attention. What all analysts share in common is a profound respect for the unconscious: the contents of mind that operate out of awareness but influence and direct our thoughts, feelings, behaviors, and relationships. It is usually problems and disturbing patterns in these areas that bring people to treatment.

Analysts help patients become acquainted with the unconscious so as to have more freedom to make choices about their lives. Talking about childhood experiences and parents is one route to uncovering the invisible influences. But also, we examine how the patient functions in the world today and the perennial obstacles that stanglehold the person from achieving goals. Tuning into what is going on in the mind, body, and action in the present moment is a valuable source of information. Recent dreams, fantasies, everyday actions and reactions provide rich clues to where difficulties originate.

One of the most powerful ways the unconscious is revealed is in the very current, very alive relationship of analyst and patient. Once trust has been established, analysts invite the patient to collaborate on how the dynamics evolving between them may replicate difficulties in other relationships. The therapy room becomes an “in vivo” laboratory for the study of the unconscious with the goal of untangling the patient from past and present constraints.

Sally Rudoy, LCSW

All the rage

April 15 was particularly taxing this year, what with having to survive another round of Tea Party protests steeped in anger. The sound and the fury that ratcheted through the country after Congress passed health care reform has subsided a bit, but it is clearly still simmering. As psychoanalysts, trained to understand the complex workings of the mind, how do we comprehend the fear and loathing?

From a psychological lens, change frequently stirs anxiety. The bigger the change, the greater the uncertainty. Even when there is much to be gained, it's easy to fixate on all that might be lost. We see this in individuals as well as in the larger social system. There's something safe and familiar about the status quo, even when it isn't working. Change becomes equated with danger, and a fight-or-flight mechanism takes over.

Much has been written about how the Tea Party movement is dominated by white men terrified about the country's changing demographics -- especially about a powerful African-American in the White House. Psychoanalyst Neil Altman has written that those who are different frighten us with their foreignness. Through a process called projective identification, they become convenient receptacles for disturbing aspects of our own psyches. In this mechanism, parts of ourselves we cannot tolerate are unconsciously projected into somebody else, and then railed against. We can then cling to an image of ourselves as all good, devoid of malice or aggression, since these aspects are now found in others. We are not dangerous, angry and out of control, black people are.

Although many minority groups have served this function throughout history (including Jews in Nazi Germany), African-Americans are convenient receptacles for our disowned dark sides because their skin color is, in fact, darker. Black-and-white thinking -- literally -- has a temporary advantage of creating order in a dangerous world. With an us-versus-them mentality, at least we know where we stand. The problem is, where we stand is actually shakier than before since now the world is even more threatening, and the messier parts of ourselves more dangerous than ever.

Prejudice is endemic to the human condition. To rise above it we first have to locate ourselves in it. By staring at our own fears and prejudices -- by tolerating our own dark sides -- we become more human in the process.

-- Eric Sherman, LCSW

Shutter Island

Say what you will about how psychoanalysis is outdated, but how could we make a good horror movie without the stock characters of the Freudian unconscious? The suffocating mother, the castrating father, the lover who steals one's soul - Martin Scorcese's new movie "Shutter Island" is cast from The Interpretation of Dreams. The only cliche it avoids, that famous cigar, finds ample substitution in cigarettes and even these, it turns out, may be poisonous. "Beam me up, Melanie Klein," I was thinking.

It's a poignant time for a movie that ultimately argues for depth psychotherapy of the very ill and uninsured. As health care reform succumbs to the sexy argument that we should get by with less care, third party payors don't reimburse for insight. If medication can make you feel better in thirty days, that's good enough. No wonder Shutter Island is set in the 1950s, when mental hospitals could still provide psychotherapy.


Stop here is you want to be surprised by the plot twist in the movie. Because on Shutter Island, the battle between the risks of insight and those of social conformity is stark and dangerous. Can a clinician help Teddy, a man lost in a delusion of his heroism, face his unbearable trauma before the men in the white coats take over? The harsh technique of institutional psychotherapy -- a Nazi doctor armed with insinuation, contempt, and a hypodermic -- has not reached the protagonist. Time is up. "When you see a monster," the doctor intones, "you must stop it." Instead, Teddy's illusions are finally breached by his analyst's willingness to surrender his authority and become his patient's loyal sidekick in his fantasy.

There is plenty to appreciate in this movie is you are an analyst sacrificing the rock-hard stability of a one-person psychology to dive into the shifting tide of a relational treatment. No wonder a hurricane is needed to shake protocol in the movie. Our institutions loathe the uncertainty and expense of human understanding and depend on the security of the empirical. Yet, in the novel from which "Shutter Island" is adapted, Teddy's belief in his delusion falters at the moment he notices his doctor's eyes are not implacable, but weary. It is the uncertainty of human connection that makes its occurrence such a potent force for change.

These are the moments we clinicians treasure: the dawning idea that the rules one has lived by belong to a time long past. The moment is tragic, too. It brings not only relief but regret for all one has misunderstood. Knowing more is seldom an easy thing, a truth with dramatic effect in the movie. Teddy says, "which is worse: to live as a monster or to die as a good man?"

How Betty White can save your life

As a lonely pre-adolescent, I often found comfort perched in front of the warmly-glowing television set my mother insisted would make me blind. (She also warned I would poke my eye out with an umbrella. It's a miracle I became a psychoanalyst rather than an optometrist.)

TV gave me hope. If Mary Tyler Moore could make it after all every Saturday night, then maybe so could I.

And so I think it is wonderful that one of the hottest actresses in Hollywood these days is Mary's former costar, Betty White -- an octogenarian with a zest for life and a delicious ability to poke fun of herself. So many people have lost that sense of joy and playfulness. I'm amazed by how many 20- and 30-somethings are already having midlife crises, terrified of growing older.

Over the years, I've worked with a surprising number of healthy people of all ages gripped by a fear of dying. As we explore this together in therapy, we often find that what they are really afraid of is living. They have experienced so much disappointment whenever they have gotten their hopes up, they are wary to embrace life more passionately. So they procrastinate, avoid and worry. The misery they know is safer than the uncertainty they don't. Ironically, they are petrified of a death they are already living.

That's where psychoanalysis comes in. Finding meaning and richer ways of living by understanding oneself from the inside out is the goal of psychodynamic psychotherapy.
Psychoanalysis is unique among therapeutic approaches in that it does more than simply alleviate symptoms and teach coping skills. (Although it does that too.) It helps get to the deep-seeded patterns that cause suffering by helping people understand how, unconsciously, they contribute to the very unhappiness they are trying to avoid. Psychoanalysis gives a sense that one could be a more active contributor to one's life. It generates a precious ability to be curious, creative, open to new possibilities -- to embrace the very uncertainties that so many people feel overwhelmed by.

In short, psychoanalysis creates laughing, loving, teasing Betty Whites, eager to live life with relish.

You'd have to be blind not to see that.

-- Eric Sherman, LCSW

The Dis-Connect: “I’m sobbing right now, can I call you back in 10?"

Time was once when my office was a quiet private sanctuary where the patient and I could delve, without intrusion, into solving the difficulties in the patient’s life. Lately, the therapy room is abuzz with the chimes and digitized melodies of cell phones. Text message alerts and phone calls from patients’ circle of family, friends, and colleagues arrive with regularity during therapy sessions.

And when they do, there is a moment of decision-making for the patient as he or she feels the familiar tug to look and respond to the insistent vibration of the phone. Do I allow this interruption during my time of self-reflection? For just this one hour, can I hold the external world at bay while I explore my internal experience? Are the demands of the texter/caller more urgent than what I am doing right now?

There may be legitimate reasons to take the call immediately, whether the patient is a parent worried that the school is calling about a sick child, a business person waiting for a piece of information from a boss who expects 24/7 availability, or a teenager concerned about not being left out of the social network. However, there is a pause as they consider what to do when the outside world calls.

Psychoanalysts strive to maintain the boundaries of the therapy frame. We attempt to help patients put difficult feelings into words not action. Most analysts would ask their patients not to eat or do jumping jacks, say, during a session but attend instead to feelings and thoughts.

Somehow, perhaps because technology has become such a part of my own life, I have let the distracting chirps and ring-tones enter my office unanalyzed. My phone is always off during the therapy hour so I can focus exclusively on my patients’ struggles. It’s time I ask them to focus with me. I’ve decided to take a page from theaters everywhere: “Ladies and Gentlemen, Please turn off your cell phones!”

Sally Rudoy

Welcome to our Blog

Dear Readers,

Welcome to our Blog. We are very excited to launch this new interactive component to our website. We hope you will join us in our discussion of Psychoanalysis and Psychoanalytic therapy, what it is and how it has evolved from the time of Freud.

Psychoanalysis has gone through a revolution in the last several decades into an approach that is alive, active, integrative, and very different from some of the old stereotypes of the past. On this site we will be blogging about Psychoanalysis, Psychoanalytic therapy and a Psychoanalytic sensibility based on contemporary practice and theory. There are a number of ways in which we talk, think and feel about the world that are influenced by unconscious processes within ourselves and in relationship with others. These processes manifest in a variety of thoughts and behaviors, some in sync with what we want and some conflicted. In all cases, the Psychoanalytic sensibility provides us with vital information to process our experiences and as a result learn new and important things about ourselves and those closest to us, enhancing our experiences and relationships.

We will be writing about various aspects of life, art and therapy in an effort to put voice to what we believe is an essential and powerful life tool. Please feel free to share your point of view, ask questions or simply comment. We look forward to the dialogue, sharing with you and hearing from you about what gives life meaning. The unexamined life may still be worth living, but may not be as lively as when explored.

- Sandra Sinicropi