A Note on Harold Searles on Counter-Transference

Having, as you will see here, paid my debts to Harold Searles for his fascinating and often useful work on schizophrenia (and before that his essay on "The Patient as Therapist to His Analyst"), I must now register a complaint that his book Countertransference and Related Subjects: Selected Papers (International Universities Press, 1979), ix+625pp. is misleading from the outset. That is, the book is badly named: only on p.373 do we get first discussion of counter-transference, and it is not developed in any useful detail but remains superficial. The rest of the book virtually ignores any serious discussion of countertransference and is instead an assorted collection of articles, most having to do with schizophrenia. It should therefore have appeared under the title Collected Papers on Schizophrenia Vol. II, as a complement to the other volume bearing that title. 

Having been an academic editor for twenty years now for presses and journals in two languages and three countries, I am perhaps more critical, and less forgiving, than some. I find it serves nobody well when publishers allow authors to throw everything into a book without any attempt even so much as to organize the chapters coherently. Those chapters then ramble on with excessive detail and clinical illustrations that run for so many pages as to lose their point very quickly. In short, this book should have been at least 25% shorter than it is. (The editor who gave me my first editorial job in 2002 said "We pay you for one thing only: to be ruthless!" There is always room to cut--sensibly and intelligently, without blindly hacking away--and myriad opportunities to put things more compactly and cogently.) 

That said, there are little nuggets here and there one must dig out, as here:

Finding Your Own Psychotic Elements:

I liked early on in the book when Searles noes that at the end of a successful treatment of schizophrenia or psychosis, the patient has achieved individuation and ego integration to whatever possible degree, but, Searles says, the psychotherapist has also gained something: he is much closer to, and on much easier terms with, his own psychotic elements, and, in future, will not have to travel so far or so hard to experience them in the next case that comes along. 

This is a point he reiterates at the very end of the book (pp. 596ff.) with brief reference to Harry Stack Sullivan, noting that if the psychotherapist has reflected philosophically on the fact that the differences between 'sanity' and 'insanity' are not so great he will, in Sullivan's famous words, be able comfortably to see and accept that "we are all much more simply human than otherwise" and thus the psychotic person is not some strange 'other' we must race to rescue and 'fix.' 

What Might Psychosis Have to Teach Us?

It still seems sadly common to deride psychotic disorders as a descent into utterly meaningless gibberish and irrational gestures ('word salad' etc.) but I simply cannot believe that to be the case all the time. And so with Searles, in this book as in his other one, I think he is onto something significant when he claims that "Schizophrenia is, in a sense, the shadow cast by the emotional deficiencies of our culture" (26). 

Even more strongly, Searles speaks of his schizophrenic patient thus: "because he, perforce--not by choice--has been living on the sidelines of humanity he is in a position to tell us some important things which we have been too immersed in 'normal' living to see" (p.26). This accords very much with what patients have felt and described to me, too--like they are coming back to report on things nobody wants to hear but which they regard (and I agree) as being vitally important to think about by way of acknowledging the suffering and isolation at the heart of the human condition, and the oft-unfulfilled longing for communion and connection. 

The Rewards: 

I was heartened to read that Searles reports feeling "unclean" with guilt, and "perverse" in his fascination with his patient's delusions and hallucinations--until he allowed himself to see them as high art, as products of a highly creative mind. I was also impressed (albeit uneasily) the first time delusions and hallucinations were described to me in very careful and exacting detail, feeling like I was watching a painter very deliberately decide on which brush, colour, and location on the canvas for each stroke and detail.

Having overcome his guilt, in the end Searles sees "one of the endlessly rewarding, exciting aspects of this work" to be found precisely in the unpredictability and singularity of each individual. I fully agree! 

A Caution Against Cures:

Searles, however, is at pains in his lengthy chapter on "The Dedicated Physician" not to go about putting pressure on patients to achieve the sense of satisfaction the psychotherapist needs in watching patients get better. As he elsewhere noted, and others have as well, pressure to be 'cured' can in fact be highly suspect and unhelpful--and may arise from omnipotent and sometimes sadistic elements in the psychotherapist's mind. Searles notes how often the overly zealous and over-eager therapist infantilizes the patient by his insistence on a cure, by his omnipotent desire to help which robs the patient of his autonomy. Sometimes you do this to avoid having a competitor or even superior in the patient, whose health or strength is suddenly greater than yours. 

Regardless of your motive, he says you must not imprison the patient with your desire to see him cured. In this he joins with Nina Coltart, Adam Phillips, and others in swearing off the idea of 'cure,' and I am glad to learn from them on this score, as I also have from Searles, albeit not as much as one might expect in a book of 625 pages!

In Praise of Frieda Fromm-Reichmann

Gail Hornstein's lovely biography of Frieda Fromm-Reichmann convinced me that I must also read the latter's Principles of Intensive Psychotherapy, which I have now profitably done. In reading this latter work, I had constantly to remind myself that it was written in the 1950s (she died in April 1957)! It was astonishing to me at every turn how much of contemporary practice and current concerns she anticipated and was already engaged in. I will say more about this later. Let us begin with To Redeem One Person is to Redeem the World: the Life of Frieda Fromm-Reichmann for it is a moving, elegant, and gracious study of the life of someone who remains too little known even today. 

This biography, whose compelling title is Talmudic in origin, takes us to the beginnings of Fromm-Reichmann's life in Germany where we get some crucial insights into her early family dynamics that seem--so Hornstein suggests several times, and convincingly--to have played no small part in shaping her career choice and actual clinical practice. Fromm-Reichmann was the sort of person who seems almost effortlessly to have put the needs of others ahead of herself. 

After her move to America, she finds in Chestnut Lodge in Maryland what seems an almost Providential appointment so well suited for her unique gifts and limitations. It is hard, in reading of the uniquely free, creative, unrestrictive environment around the Lodge in the interwar and immediate postwar years, to restrain at least a touch of nostalgia for what seems a less straitened time before the orthodoxies of a strict Freudianism, or later a strict behaviorism and cognitive-behaviorism, set in. 

When I picked up Hornstein's biography I expected that Frieda's marriage to her very famous first (and only) husband, Erich Fromm, would occupy more of the stage than it does. At least in Hornstein's telling the marriage--much of it lived in different countries--seems to have come rather quietly to a relatively mutual and amicable end, and Frieda does not seem to have bothered herself with romantic partners again, though Erich of course did at least twice more. (Erich has been the subject of at least three biographies that I know of. I think the Lawrence Friedman one, The Lives of Erich Fromm: Love's Prophet, excellent.)

I cannot do justice to the rest of the Hornstein biography so I will not try here. Let me instead reiterate my warmest recommendation that you read it. You will not be disappointed. I know I will leave it on my shelf in order to be able to come back to its riches and delights at some point in the future. 

Let us now turn to Principles of Intensive Psychotherapy, which is--quite frankly--far better written than I expected. Fromm-Reichmann's style is not at all what is sometimes derided as Teutonic prose: leaden, verbose, impenetrable, abstruse. Quite the contrary: she is succinct (more so in the first half of the book, admittedly), cogent, and constantly supplying practical illustrations and applications based on her own long clinical career. 

In addition, while clearly downplaying her own personality and unique contributions, one nonetheless gains throughout the book a considerable glimpse into the person of Frieda Fromm-Reichmann, and it is an attractive one. In fact, several times I thought of Peter Rudnytsky's observation about another clear, practical, cogent, and wonderful clinician I admire hugely--viz., Nina Coltart, whom I discussed here at length. Of Coltart he noted that

In reading the work of a psychoanalytic author, there is one question that I think we should ask ourselves above all others: would I want to be in analysis with this person? Is this someone I would trust to probe the innermost recesses of my psyche and with whom I would be likely to have a genuinely therapeutic experience?

One feels something quite similar in reading about Fromm-Reichmann, and with Rudnytsky one can also answer these questions in the affirmative. 

It seems that much of her Principles reflects and retains her very considerable debts to, and her desire for expanding the insights of, Harry Stack Sullivan, which is no small thing for he is often confined to a footnote in recounting the history and intellectual development of psychoanalytic theory. In this regard, FFR and HSS alike rise and fall together. 

They are clearly yoked in this book, and by the end of its brief introduction it is clear that FFR is a strong proponent of HSS's interpersonal theory. Indeed, upon finishing her thoughts here mine immediately turned to Winnicott: "there's no such thing as a baby!" With DWW, HSS, and FFR, one could thus insist "there's no such thing as a solitary patient who does not come into one's consulting room trailing a long line of entanglements with parents, siblings, authority figures and others." And this patient's interpersonal challenges will, of course, show up in the transference and counter-transference. 

Anticipating by many decades the contemporary research that has shown, time and time again, how crucial the therapeutic alliance is to the success or failure of therapy, Fromm-Reichmann opens her book by insisting that "the first prerequisite for successful psychotherapy is...respect...[for] the mental patient" (xi). Such patients come, she notes, seeking not just insight, but also symptom relief and possibly personality change of some sort. 

FFR made her bones, as it were, and her name treating psychotics and schizophrenics especially. From this she makes a striking comparison I've not heard before but whose logic makes sense to me: When it comes to the question of dreams, she notes that they "and psychotic productions are actually analogous" (xiii). We will return to the question of dreams late in the book, noted below. 

If it was Yalom who made famous and widespread the recognition of the importance of paying attention to the here-and-now in the psychotherapeutic relationship, it was FFS who anticipated him by decades: already by p.4 of Principles she is insisting that we must pay serious and regular attention to "the reality of the actual experience between therapist and patient in its own right."

This takes us to her second chapter, explicitly focused on the role of the "doctor" in the therapeutic relationship. Here she issues a welcome and forthright reminder that no therapist or doctor worth his or her salt will be trying to impress a patient with his technical brilliance or intellectual prowess or theoretical genius, all of which she regards as displays of "irrational authority" (17) that will set therapy back, not advance it. (In a similar way and for similar reasons, at the end of the book, she stoutly insists that the doctor should not give advice for that infantilizes the patient.)

Much as I have more recently heard the great Adam Phillips regularly remind us (especially in his Unforbidden Pleasures), FFS was, in the 1950s, insisting that the therapist must resist "fantasies of omniscience" and illusions of "perfectionism" (18). This must go hand-in-hand with the humble admission of mistakes, which we now know, thanks to decades of research after her death, is a key part of sustaining and repairing the therapeutic alliance. (On the question of the alliance I have recently found Jeremy Safran's book Negotiating the Therapeutic Alliance: A Relational Treatment Guide very insightful and helpful.) Such admission of therapeutic mistakes, Fromm-Reichmann helpfully reminds us, really must be done "in a matter-of-fact and nonmasochistic manner" (20). Therapists, confessing missteps, do not need to lose control of their own masochism and turn themselves into penitential flagellants!

Chapter three is where I detected what I take to be the clearest and closest influence of her sometime husband, Erich Fromm. She notes here that the therapist must be free enough to stand above and at some remove from the pressures of conventional thinking and "authoritarian values" and their demands for obedient conformity. They must also help their patients do the same thing if that is what the patient wants. To do so, she continues a little later, requires in the therapist "mature love" based on "stable self-respect." 

Chapter V, "The Initial Interview," begins by reminding us (again, decades ahead of this becoming a commonplace!) that "psychotherapy is a mutual enterprise, if not a mutual adventure" (45). In other words, Fromm-Reichmann is quietly moving beyond what is often called the one-person psychology of classical analytic approaches into the two-person and inter-personal approaches that would not really become mainstream, at least in America, until forty years after her death. 

Again, in the 1950s FFR was ahead of the modern fixation on having goals for therapy, which she explicitly addresses a number of times. For her these seem to have been very important for she was operating--as a striking footnote on p.61 called me up short to see--in an era before the Diagnostic and Statistical Manual of the American Psychiatric Association had been invented--much less ballooned to the massive thing it is today (about which its sometime editor, Allen Frances, has had some critical things to say in Saving Normal). Later (p.143) FFR notes the importance--which seems standard today--of regular review of treatment plans to avoid therapeutic drift. 

Returning, late in the book, to the topic of dreams Fromm-Reichmann again says several very useful and striking things, starting with: "Dreams are frequently used by the sleeper as a means of conveying something to the therapist which the patient has been incapable of conveying while awake" (163). More strongly still, she goes on to note that "the mental operations of the sleeper frequently excel in wisdom and insight those which he is capable of accomplishing while he is awake" (169). (I know this to be true from the very first dream I had back in the fall of 1994 immediately upon entering into psychoanalysis. Fromm-Reichmann, a little later, notes that you should always pay attention to the first dream in therapy for it often indicates the central struggle of the patient's life, and its theme will recur in therapy.)

She goes on, in the same practical and hands-on way she uses throughout the book, to offer an approach to dreams which very much accords with my own as both patient and therapist: the challenge of interpretation. Here she says that "the greatest source of help in this endeavor is the patient's own associations to his dreams." This, as an analysand, I found invariably helpful to decoding most--but not all--parts of dreams that would otherwise have been rather recondite in meaning. 

If there are--and frequently this is the case--parts of dreams that prove elusive to association and interpretation alike, she recommends a useful tip: have the patient tell the dream a second time, and this time, as therapist, pay very close attention to any alterations in the second re-telling for such alterations are very likely "deserving of the therapist's special attention." In the end, it is not necessary, she says, to interpret every detail of every dream. 

Overall, Principles of Intensive Psychotherapy holds up astonishingly well. Yes, the language (almost always "the doctor" or "the psychiatrist") is sometimes stilted and perhaps overly formal, and not all the details in her chapter on interpretation and its techniques would be widely practiced today. But overall a book that has now been in print for over sixty years remains fresh and challenging, reflective of the wisdom of an extraordinary woman whose therapeutic endeavors with some of psychiatry's sickest patients would prove redemptive indeed. Let that be counted unto her as righteousness, and may her memory continue to be blessed. 

Robert Abzug on Rollo May

It is always melancholy for me when I reach the end of an exceptionally good book, but my consolation is that if I leave it on my shelf long enough, I can come back to it again in a few years time and enjoy its riches anew. This I will do with a fascinating biography that was melancholy for me in a second way: it took me back to a time when there seemed to be a closer, richer relationship between psychology and theology (as well as existentialist philosophy) than obtains in most places today. 

That relationship was lived by Rollo May, whom I first encountered almost thirty years ago as an undergraduate in psychology with a strong interest in theology, especially in its mid-century existentialist manifestations which I had explored in the last year of high-school when a generous French teacher (who very much saw himself as a soixante-huitard and thus indulged his contempt for rules and routine) gave me the entire semester off from class provided I show up on the last day in June after having written him a final paper on existentialism. This I gladly did, and so availed myself of the opportunity to read a lot of Paul Tillich--in English--and then Sartre and Camus in French. 

The following year, as an undergraduate, I read at least one of May's books as I recall: Love and Will. (I also read Will and Spirit: A Contemplative Psychology by his half-brother, the psychiatrist Gerald May.)

May is now the subject of Robert Abzug's brand new book, Psyche and Soul in America: The Spiritual Odyssey of Rollo May (Oxford University Press, 2021), 432pp. 

I finished this biography about a month ago on a lovely early summer evening on my patio. It is superbly written and a real treat to read. Abzug has an extremely deft touch in knowing how much detail to give about May's fascinating life and how much contextualization the reader needs without in either case overwhelming one with an excess of details. One would expect no less of so seasoned a scholar who is now professor emeritus of history at the University of Texas at Austin. 

Following standard practice, I e-mailed Dr Abzug some questions and was delighted when he agreed to my request for an interview about his new book, His thoughts are below. 

AD: Tell us about your background

RA: I grew up in a suburb of NY City, went to Harvard as an undergraduate and then to Berkeley for graduate school, both degrees in history. I was raised and remain a reform Jew by belief and tradition, though of course writing about May (and before that about 19th-century Protestant reformers) deepened my sense of the power of Christian faith and influence.

AD: What led you to writing Psyche and Soul in America: the Spiritual Odyssey of Rollo May?

RA: I tell the story of meeting Rollo in the Preface of the book, but the short answer is 1) After having taken Erik Erikson’s course on the life-cycle in college, I began to have an increasing curiosity about psychology and psychotherapy, one that had already been reflected in my first two books but only as a non-jargony use of what I would call a psychological aesthetic. 

Also, while in graduate school, had taken an external seminar in the latest psychoanalytic developments at the San Francisco Psychoanalytic Institute. And, of course, being in the Bay Area between 1967-1977, I was in a culture awash with therapeutic visions of the world. That said, it was only the accident of meeting Rollo that I became interested in writing about May and, for that matter, seeing some of the history of psychotherapy and religion through the lens of his life. Of course, the experience of knowing him and his world of friends and concerns for the last eight years of his life proved richer than I could  have imagined.

AD: I first read May in the 90s as an undergrad in psychology who also had an interest in theology, especially the existentialists like Paul Tillich. Tell us a bit about the long-term and hugely important relationship Tillich and May had. 

RA: The early 1930s were key in setting May’s future. First, while still in Europe as a missionary teacher, he encountered, and I would say “converted,” to psychoanalysis by taking a seminar in Vienna with Alfred Adler. That put a certain shape on his spiritual quest but didn’t end it, and when he returned to the U.S. he enrolled at Union Theological Seminary in New York. 

Tillich meanwhile had just escaped arrest by the Nazis by being invited to teach at Union, which he started to do in 1934. He and Rollo met early on in that year, and it began a relationship that was intellectual, spiritual, deeply personal, and lasted for the rest of Tillich’s life (he died in 1965). That relationship is certainly a central theme of Psyche and Soul in America. The mentorship of Tillich for May is clear, but it was something of a two way street. That is best indicated by the fact that Hannah Tillich asked May to deliver the eulogy at his first burial in East Hampton, NY, where the Tillichs had a summer home, and his reburial at the park named in his honor in New Harmony, Indiana.  

AD: May was also influenced by Freud, Adler, and Rank. But Adler seems to have been especially important. Tell us a bit about his relationship to and influence upon May. 

RA: Paul Tillich and Alfred Adler came into May’s life at a crucial period in his life, where his spiritual searching needed greater guidance and inspiration. Adler certainly had a life-changing influence on May, giving him a new way of envisioning the world and the possibility of a new profession. 

But Adler died in 1937, only four years after May met him and aside from a few friendly and important encounters in New York, the two didn’t really have the same sort of relationship as May did with Tillich. Nonetheless Adler’s ideas formed a compelling basis for his exploration of Freud, Jung, and Rank. 

But May told me that in the end he found other first generation analysts and later American neo-Freudians like Harry Stack Sullivan and Erich Fromm more powerful than Adler in their sense of complexity of the human condition and intellectual reach.

AD: You note (p.54) that May for "remained all his life wedded to obsessive self-scrutiny." That certainly comes through in your biography down to the last years of his life. What lay behind such an obsession?

I was about to say, “that’s a question for his analyst,” but let me give you two answers. First of all, I think his sense of spiritual devotion, which as it developed was truly a relationship with Tillich’s “God beyond God,” one which a therapist might call, insufficiently, OCD, made him investigate and judge his every action. This compulsion was historically not unusual among what Max Weber called “religious virtuosi,” and May was certainly of that breed. 

But I think more important was that he had the genius to build a theory of therapy based in many ways on his somewhat perhaps narcissistic but very productive contemplation of self. In short, these ongoing themes that provoked incessant self-questioning were in fact the well from which he drew much of his best work.

 AD: Part of May's project, you write (p.114), was "marrying the insights of psychoanalysis with the eternal quests of religion in a manner meaningful to the modern reader." Given how popular his books were, it seems he was successful in this endeavor in one way, but I'm wondering in another way about the kind of reception his books received in the professional psychoanalytic community. Did you come across reviews of and reactions to his works by psychoanalysts, and if so can you give us an idea of what they were?

RA: From almost the beginning, he saw as his mission in life the spiritual counseling of individuals, whether in the first instance through religion and later through psychotherapy, but perhaps most of all by educating an interested public through his writings. This was true when he first started publishing books that implicitly or explicitly saw a crucial interaction between the spiritual and the therapeutic (The Art of Counseling of 1939 and The Springs of Creative Living from 1940), the latter being a main selection of the Religious Book Club. It remained true even after he shed the theological trappings of Protestantism for a spiritualized existentialism.

Much of the answer to your question about his impact on therapists and reviews of his books is as much the ever-changing nature of psychology, psychiatry, and psychoanalysis as it does with the specific contents of one May book or another.  

AD: In early 1940 or 1941, you write (p.135), May began an analysis with Erich Fromm. I've been re-reading Fromm for the last two years and amazed at how well some of his insights stand up three quarters of a century after his English-speaking debut. Tell us a bit about the influence of Fromm on May that you see.

Another very interesting question.

I think there was some influence, though some of the most important ideas about the world and culture were transformed in May’s work from neo-Marxist thought to existential thinking, for instance living in a culture where not so much through the transformation of society but rather the resistance of self an authentic sense of the world might emerge. 

Nonetheless, there can be no question that Fromm influenced May, especially in those early years of analysis before the post-tuberculosis restart of the analysis. And certainly, by reading Fromm’s Escape from Freedom, he got a new and materialist view of an idea that he was already familiar with from reading the late Victorians and conversing with Tillich: the notion that both faith and community had been in decay for some time and that these trends had deleterious effects on the ability of individuals to “be” themselves. In that general sense, May joined with Fromm and others of the postwar era—David Riesman, William H. Whyte, John Kenneth Galbraith, and others—each in their own way critiquing the conformity, consumerist values, and general weakening of individual autonomy.

AD: I sometimes wonder if the existentialist movement in theology and psychology alike has been largely left behind, but then you trace out the burgeoning relationship between an older Rollo May and a then-young and upcoming Irvin Yalom, who is still with us after an astonishingly prolific career. Tell us a bit about that influence of May on Yalom.

RA: As Irvin Yalom has said many times, it was his reading of May’s Existence (a collection of essays from European therapists) introducing an existential framework to psychoanalysis and psychotherapy that inspired him to follow a psychiatric and analytic path. Later, when they got to know each other, I believe each helped the other in imagining the possibilities of existential psychology. However, there were differences. Yalom was a doctor, taught at a prestigious university medical school, pioneered group psychotherapy, was a self-declared atheist, and was a successful novelist. Rollo May was many things but none of those. In short, while they came together on existentialism, their careers and commitments were strikingly different.

AD: May's relationship to Christianity waxed and waned over the decades--from being a pastor and preacher early on to falling away it seems and then to returning to attending church later in life as an Episcopalian (p.331). Where, in the end, do you see May's life in relationship to Christianity?

RA: I think it is fair to say that past the early 1950s, at which point the formal church was no longer part of his life, he nonetheless lived a life imbued with the values he gained within the Protestant church culture and retained an abstract but real sense of what he called “infinitude.” His attendance at the Episcopal church in Tiburon in the 1980s had more  

AD: For those new to May and wondering where to begin, do you have, say, your top three favorites of his writings? What would you recommend beginning with for those who want to discover May today?

RA: My top three for getting to know May’s work would be Man’s Search for Himself (1953), Love and Will (1969), and The Courage to Create (1975), which is short, fits creativity into a vision of society, and as usual is clearly and compellingly written. And I would also suggest reading May’s introductory chapters in Existence (1958), an edited introduction to the possibilities of merging psychotherapy with existential thought. These are marvelous explanations of the power of existentialism. I might add that since the book’s publication, I have received any number of emails, some quite lengthy attesting to the influence May’s ideas had on their lives, and the three I recommended were ones that most often came up in our exchanges.

AD: Having finished this biography, what are you at work on now--new works in the pipeline?

I am still catching my breath but have thought about a short book based upon some lectures I have given recently about the practice of spiritual life in America, both in and out of formal denominations and traditional ritual practice. One element I wish to explore is the impact of religious and cultural pluralism on individual and group spiritual practice.

AD: Sum up your hopes for the book, and who especially should read it.

RA: Most of all, I hope to restore Rollo May’s place in the history of public intellectual life and, indeed, allowing readers to grasp the significance of his work to contemporary society and thought and inspire to engage with his ideas. As a biographer, I have also tried to write as “intimate” a biography as the sources allowed in order to provide readers with an account of May’s life that conjoins the public and private, as well as the unconscious and conscious—that is, brings an understanding that the origins of significant public lives lie in unique and often less than ideal sojourns. 

As for a readership, my hope is that psychologists open to a broader view of their profession as well as all who in one way or another were affected by May’s writings would profit from it. Yet, I also hope that those too young to know of Rollo May first-hand but who are in need of a broader and deeper sense of life somehow find the book and seek out May’s own attempts to offer roads to a richer life.