Back to my Roots
Those who follow this space closely know I have recently published my first book-length manuscript, Holding and Holding Back, which explores some of the more creative ways we can potentially use Artificial Intelligence in the practice of psychotherapy. That project was a challenging undertaking and one that drew me away, in some ways, from the kinds of clinical phenomena I prefer to write about. As such, I thought I would get back to something more personal in the sense of both being rooted in the kinds of things that have always gotten me excited about therapy and their being two of the core texts I have carried with me throughout my years as a clinician. My hope is that it will also be a bit of a palette cleanser as I get back to talking about technique rather than tools.
The two texts I want to focus on this week are personal favorites, which seem to have carried some influence on the Boston psychoanalytic scene. Given that my own book has seemed to generate some amount of new traffic outside of Massachusetts, it seems only right to dedicate some time and space to two books that have been so influential on my own work and perhaps do not have as wide a readership as they should enjoy or have faded a bit into relative obscurity.
Both harken back to my time at Lesley and were taken from syllabi in clinical supervision courses that were taught there. Part of the joy of being in that environment was the fact that many of the faculty, especially the adjuncts who taught the courses related to clinical skill development, had a real appreciation for psychoanalytic work, without that being the central commitment of the program itself. There was something about being in that space which felt quite orienting. It contributed to a kind of belief that I was gaining access to some of the more arcane knowledge this field has to offer and that my judgement and sensitivity in the consulting room was being shaped by serious clinical minds.
The first book is Judith Viorst’s Necessary Losses. Coming to this text by way of an interest locally in the work of the Boston psychoanalyst Paul Russell (an enigma to the generations that came after his passing and know of him by reputation alone) the text served as a jumping off point for one of Russell’s many unpublished lectures he gave concerning ideas about the repetition compulsion, which came by way of his work with Loewald. The transcript of the talk identifies it as a response to a previous talk by Viorst and pins the date of the talk in March of 1988, just a few years after Viorst’s book became a bit of a sensation.
Viorst is still a popular writer to be sure and continues to maintain enough of an audience. The book has sold some 4 million copies, according to some light research done on my end, which is especially extraordinary given the content. The book is a meditation on the role of grief throughout the life span, as told through the lens of psychoanalytic thinking and Viorst’s considerable gifts for prose. Weaving anecdotal story-telling and precise clinical insight (Viorst was a poet and children’s author who eventually took up an interest in psychoanalysis) the book makes the argument that the essence of human development is not about what we gain, but what we lose as we journey through life. The human psyche is enriched and evolves via the recognition of what it must give up along the way to becoming whatever life might be demanding of us. This is not just formulated via the way we typically talk about grief as being related to the loss of one’s own life or the life of a loved one, but positions grief as a recurring developmental phenomenon that must be mastered in order for something else to be gained.
Viorst’s book takes this question up through a logical chronological structure, beginning in infancy and following through to death. She notes how life starts for all of us with a separation that must be grieved, the loss of the comfort of the maternal womb and the onset of the recognition that we will have needs that will go from being fully and immediately met, to sometimes delayed, to suddenly unmet and finding ourselves left—as a consequence—needing to develop the capacity for self-soothing. Life begins with loss and how well we are assisted in navigating that transition sets the path for how we will continue to experience various losses as they reemerge throughout the life span. We lose the illusions of union that mark infancy; the sense of innocence and omnipotence which is the marker of childhood; the dizzying number of losses that come with the difficulties of adolescence and our beginning to organize who we are and what kind of impact we might have on this world (and vice versa).
Viorst’s book renders poetically—and with a good deal of humor—an idea that has become central to psychoanalytic thinking following works like Mourning and Melancholia and the attention paid to loss as a developmental necessity for growth in writers like Winnicott and Loewald. Our ability to organize grief and allow ourselves the ability to experience the recognition of loss that comes along with any of life’s transitions is what informs our ability to navigate any of those transitions in a manner that might not fully destroy us or the people around us. This book is the reason that, should a client stay on with me long enough, the work I do almost inevitably turns to some discussion about the losses we don’t always recognize and an understanding that grief is not just a necessary part of living and growing up, but is similarly a necessary part of any good therapy. All change requires mourning and grieving what we are letting go. In the language of psychoanalysis, this means the relinquishing of defenses that served some person in helping to keep us sane through many of life’s difficulties. We all come to therapy claiming this to be something we want, but it can be an arduous and grueling task, one our bodies and our psyches do not always get immediately on board with. How we work through that matters, and Viorst’s book can help enhance our sensitivity to where and in what ways this phenomenon might be showing up.
The other text I want to highlight is, I think, one that carries even more regional interest, and I would be curious to know what the actual reach of the book has been to other parts of the country and other psychoanalytic spaces. I know its author does not toil away in complete anonymity, but given the practical utility of the book I am about to name, my guess is that—even then—they don’t fully get the recognition they deserve.
The book in question is Modes of Therapeutic Action by the Boston analyst Martha Stark. Stark occupies an interesting place, in that you won’t see her name cited in the papers published in the big psychoanalytic journals, but she also isn’t in quite the same ball park as someone like a Nancy McWilliams in terms of churning out well-known and broadly circulated educational and instructional psychoanalytic texts (though she probably skews more towards the McWilliams territory).
Modes of Therapeutic Action has a fascinating structure. The book is broken up into 28 short chapters, which are themselves then broken down into even more manageable chunks, often just 2-3 pages long. The book is an attempt at making sense of the various relational dynamics and structures that arise in the therapeutic context, with Stark writing from a perspective that has the benefit of coming after Mitchell’s work in consolidating the contemporary relational movement and its interest in a comparative psychoanalysis.
In the text, Stark offers the language of thinking about psychoanalysis as operating from one-, one-and-a-half-, and two-person psychologies, a shorthand which has continued to be maintained in psychoanalytic circles. These markers, respectively, designate something like analysis that is largely interpretive, analysis that uses the relationship without necessarily naming the therapist’s role, and the authentic relationship of bringing the clinician’s experience of the client to bear on the analytic act in a genuine way. Stark offers a lot of novel language for categorizing the various ways these dynamics can play out: “Afference and Efference”, “The Patient’s Need for Restitution”, and “Displacive Identification” are just some of the subheading names. And for anyone even slightly familiar with Stark’s thinking, there is a short section on the patient’s “relentless hope”.
It’s a remarkable text. Great for developing therapists who want to begin to explore their capacity for seeing various kinds of transference-countertransference dynamics playing out in the therapeutic encounter, and especially useful in guiding clinical intuition in terms of when and how to apply the different therapeutic stances she names. For the more seasoned therapist, the structure of the book makes it really wonderful for being able to pick it up and flip through a short section when there is time, quickly giving life to any of a handful of concepts that show up often in the work that we do. It is worth reading in full, but is also perhaps more rewarding than any other text I own for just keeping it on a nearby shelf in the event of an unexpected cancellation or other open clinical hour.
For those who don’t know these books, I hope it inspires you to seek them out. I look forward to getting back to writing more about the kind of conceptual insights they contain. My suspicion is that, given the recent passing of the influential interpersonal analyst Irwin Hoffman (a major proponent of the idea of a two-person psychology), I will be venturing back into the interpersonal space I often explore through Levenson, Bromberg, and writers of that ilk. I look forward to what some of that might bring and hope I am able to bring it to life in this space in the way these two wonderful writers do in these indelible works.
