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On Play and Enjoyment and Laughter in Psychotherapy

  As Arthur Leonoff commented in his necrology for Dr Louise Carignan, who was my psychoanalyst for seven years, she had a very memorable and infectious laugh. I don't remember what provoked it on one particular afternoon while I was lying on her couch, but the memory of that laugh has stayed with me more than twenty years later. It helped me realize that psychoanalysis and psychotherapy were not solely about solemnly entering into deep, dark waters of trauma, but should allow for occasions of laughter and enjoyment. 

This is a theme I first found in the great Nina Coltart, about whom I wrote here at some length, reflecting my longstanding gratitude to her. Her book Slouching Towards Bethlehem was what inspired me to seek out Dr Carignan in the first place, and in that book she stoutly and rightly insists that patient and therapist should be able to find humour in situations and therefore to laugh together.

More recently, I have been hugely indebted to Adam Phillips, including his recent book The Cure for Psychoanalysis. It is in that book (about which more another time) that he reminds me of what Winnicott (whose biography Phillips wrote more than thirty years ago now) said about the role of playing and enjoying in psychotherapy. 

Though I wrote earlier this year a few jottings on D.W. Winnicott on the fiftieth anniversary of his death, I had not then quite managed to finish Playing and Reality, which I now have thanks to Phillips drawing on it in his recent book, where he says that "what appeals to me about Winnicott is his wish to enjoy the patient's company." Just so. 

Reading DWW is always such a wonderful experience. You never have to worry about being bamboozled by theory or assaulted by polemics, or confused by turgid and abstruse sentences. I really do have the feeling, through Phillips' portrait and others I have read over the years, that you could indeed see DWW making and enjoying a cup of tea with his patients. This still comes through even today in his writing, many of whose basic insights seem to age really well. (I have recently found some of his writings in Through Paediatrics to Psychoanalysis on the possible meaning of adolescent stealing helpful to thinking through a very difficult case I am involved with clinically.) 

In Playing and Reality, DWW stoutly opens his third chapter by insisting: "Psychotherapy has to do with two people playing together." He goes on to say that if the patient is incapable of playing, then this must be the primary clinical task: to help them get to the point where they can play. In other words, modifying a famous Freudian saying, I would say "Where inhibition was, there shall playing be!" Or--if you will indulge me one more--modifying an equally famous saying of Ferenczi, the patient is not cured by playing but is cured when s/he can play (and do so, presumably, on his or her own). 

Later in the chapter, DWW says that health can be defined by the extent to which one is capable of playing, and that such playing "is itself a therapy." But in a clinical setting, there is a particular type of playing: "the playing has to be spontaneous and not compliant or acquiescent if psychotherapy is to be done." It cannot be coerced, in other words, but creative (a word DWW makes much of throughout this book) and always free. 

This, of course, requires certain things from the therapist, and here DWW is again equally direct: "If the therapist cannot play, then he is not suitable for the work." Therapists can also wreck the play of therapy, DWW warns, if they behave like experts who understand all the possible configurations of a game and act from this position of presumed omniscience instead of being at one with the patient in not knowing in advance how the game will play out. 

This, we know from several sources, is very much how DWW was with his patients, not just because he reports this to us, and his wife also noted this in a moving and important essay she wrote after his death, but also from some of his analysands including, perhaps most famously, Marion Milner, who charmingly recounts of DWW that was "on excellent terms with his primary process"! 

It is of course common today for therapists to have websites on which they advertise their philosophy of treatment, location, fees, etc. But in all my perusing of these, I have never once come across anybody who says that "Psychotherapy has to do with two people playing together." Imagine having that on a banner atop your website, or framed on your waiting room wall! 

Nor have I seen any self-descriptions by therapists today that they are on excellent terms with their primary process! Their websites sometimes groan under the weight of degrees and credentials, yes, and additional certification and training in whatever the acronym du jour is--certainly. But to advertise oneself as being on excellent terms with one's primary process?

If we cannot be playful and find the work enjoyable, and laugh at ourselves and with our patients, then it seems hardly likely that we will be able to keep at it for long or to do it very well. Thank God we have the witness of Donald Winnicott even fifty years after his death to save us from such ponderousness and to remind us of playing and enjoying not just outside our consulting rooms but within them. 

Frieda Fromm-Reichmann's Life

I have been reading and re-reading Erich Fromm again for more than a year now, after having first read some of his works in the 1990s. Some of my notes from my ongoing reading of him may be found here. 

Quite all of a sudden last week I realized I knew nothing of his first wife, and so I ordered, and have happily begun, Gail Hornstein's biography, To Redeem One Person is to Redeem the World: the Life of Frieda Fromm-Reichmann.

Normally I would wait until I have finished a book to comment on it--and I shall be writing about this book upon its completion--but it is such a lovely and even thrilling book that I wanted to recommend it straightaway. Hornstein's elegant introduction alone is worthy of her subject, who rapidly emerges as a fascinating figure indeed. 

In particular, Fromm-Reichmann was able to restore to health several schizophrenics, whom orthodox Freudian analysis at the time thought untreatable, least of all by unmodified analytic technique. (Even today, alas, some people, far from Freud, nonetheless also think schizophrenics largely untreatable by any therapeutic technique except perhaps heavy use of psychotropics.) In this there are parallels between some of Fromm-Reichmann's unusual clinical successes and those of others I have read such as R.D. Laing and more recently Christopher Bollas, especially his When the Sun Bursts: the Enigma of Schizophrenia. Such stores always fascinate and inspire me, serving as a reminder not to assume in advance that anyone is beyond reach.  

Diana Fosha on the Transforming Power of Affect

David Arute contacted me on Facebook and initiated a lovely discussion about numerous things. He heads (with his wife) his own psychotherapy clinic outside of Chicago, where they are doing some very interesting work indeed. You can read all about that here. I mention this to give him credit for introducing me to Diana Fosha and her book The Transforming Power of Affect: A Model for Accelerated Change, published by Basic Books more than 20 years ago now. 

I confess that until this conversation I had never even heard of Fosha, but I am grateful to have had that ignorance now challenged, and to have been introduced to her book, which I have read with great interest. My interest grew even stronger upon reading of her background and some of her key theoretical influences. 

Fosha was born in Romania but trained in the US, including time learning with and from Habib Davanloo, whose books I have and have been meaning to read for coming on a year now, without finding the time. Davanloo was a pioneer in a intensive short-term dynamic psychotherapy, an approach that Patricia Coughlin (whose books I also have, but have not had time yet to read) has continued to make known. It is an approach that fascinates me, and once I get around to reading those books, will have plenty to say about it on here! 

As I noted not too long ago, the idea that analytic therapy has to take years is a relatively late development. The very first generation around Freud specialized in short courses of therapy, so the desire to return to those today is not entirely or even primarily born of the usual horrid capitalist demands for brevity and "efficiency." 

I must say this book hooked me with the first lines of an unlikely page: the acknowledgements, where Fosha begins by acknowledging her debts to the great D.W. Winnicott, whose thought I have been drawing on more and more for the past few years, most especially in my essay here on Hating the Church. (In the next breath she acknowledges Davanloo's influence.)

After these, she mentions David Malan, whom I have also marked to read, in my continuing exploration of short therapy; and then, inter alia, Paul Wachtel, whose Therapeutic Communication, Second Edition: Knowing What to Say When I actually have finished reading but not yet posted my thoughts about. 

So, to Fosha then. Having started to read Bowlby, Winnicott, and attachment and object relations theory more than twenty years ago now, I found that her first five chapters were well written if somewhat underwhelming--a refresher for me, but valuable introductory material for those without the theoretical background.  

There were two outstanding insights in this section.

First, I especially appreciated Fosha--after reviewing the literature on defense mechanisms (including Anna Freud's well-known treatment of them)--arguing that defenses should be understood not just as negative barriers (I build a wall to protect myself against anxiety or trauma), but as also leaving a positive residue, which goes some way to explaining their power and hold over us: the wall reduces my sense of anxiety and allows me to feel a bit better, a bit less anxious, perhaps even good about myself. Anything that plays such a pivotal and powerful dual role--protecting me and allowing me to feel if not good then at least less anxious--is very likely going to become deeply rooted in most of us. 

In that sense we must not condemn defenses even if we now see that they are maladaptive and unhelpful. Once more I'm put in mind here of Auden's poem "In Memory of Sigmund Freud," and these verses especially: 

but he would have us remember most of all 
to be enthusiastic over the night,
     not only for the sense of wonder
   it alone has to offer, but also
because it needs our love. With large sad eyes
its delectable creatures look up and beg
     us dumbly to ask them to follow:
   they are exiles who long for the future
that lives in our power, they too would rejoice
if allowed to serve enlightenment like him.

The second insight here is a familiar one to readers of Yalom: Fosha's very strong emphasis on the here-and-now of therapy, on the moment-by-moment affective experience going on in patient and therapist, and between them. This is well captured at the end of chapter six, when she says that "what we discover...is that when dynamically understood, the structure of the sweeping patterns of a lifetime resemble the moment-to-moment dynamic shifts of the current relationship with the therapist" (136). 

Earlier in chapter six, this has become the explicit focus as Fosha argues that the clinician needs to be closely attentive to those micro ruptures and alterations in affect that take place within the session moment by moment. She highlights some of the differences between resilience and resistance in dealing with psychic conflict and anxiety. 

Anxiety, in turn, is linked with affect and attachment, these latter two attempting abatement and regulation of the former. But we must not, Fosha seems to be saying, focus only on anxiety and defenses. There is also a "desire to grow, connect, and feel authentic" (109). The therapeutic task, of course, is to create the environment and conditions where this may happen more fully. 

In chapter seven, Fosha focuses on the patient's love and compassion, and what may have happened to those if they were thwarted, rejected, mocked, or insufficiently received by their intended objects. She notes--as I have seen Harold Searles and others do--that the patient does not just have a need to be healed, but also to able to offer healing to others, including the therapist: "when...empathy is directed toward the therapist, it is extremely important that she acknowledge it" (145), especially in those patients whose empathy more easily and generously extends to others than to themselves. 

A little later on (152-53) this discussion about empathy leads to an interesting analogy: is there such a thing as an unprovoked bear attack? You might think you did everything right to avoid provoking the bear, but it is the bear, not you, who decides whether he is feeling provoked or not! The same is true for the patient, who decides whether he finds you, as therapist, empathic and understanding, warm and accepting, or not. 

Chapter 8's reflections on meta-therapeutic processing includes this useful reminder given to public speakers: tell your audience what you are going to do, do it, and then tell them what you've done. In a similar way, the therapist facilitates the therapeutic environment, names the experience, and then with the patient explores his or her experience of the therapy. This experience of reflecting on one's own experience, Fosha says, is "strongly related to resilience and psychic health" (163), an insight she draws in part from the work of such as Peter Fonagy. Practiced long and well enough, these experiences can lead to a level of emotional mastery whose marks may often persist long after treatment has ended. 

In reflecting on and working through the suffering and losses of one's past, mourning arises and will be greatly aided, Fosha says, by the therapist making manifest and making use of "her own grief and sadness for what the patient has had to endure" (169). Later on she notes that therapy is off to a good start after the "sacred" first session if it is clearly established that "the patient feels safe and the therapist brave" (213) by being willing to become emotionally vulnerable with and for the patient. 

How Are We Doing? 

Much as Yalom suggests, Fosha also later notes that the very first session should not end without the patient "spending some time processing the patient's reaction to being and talking with the therapist" (238). As she elsewhere notes, this should be an entirely open conversation about good and bad: "We try to help the patient verbalize the experience of closeness and distance. Talking about what is happening--good and bad--intensifies the sense of closeness" (220). Here Fosha notes she explicitly departs from a more "traditional" analytic approach that eschews focus on positive transference in favour of the negative. Nothing should be off the table, allowing her to suggest these two questions are central:
  • How do you feel here with me?
  • What is your sense of me? (Or: how do you experience me?)
If the answers to those questions are genuinely positive, then here as elsewhere Fosha says the therapist must not, because of "ill-placed modesty" downplay the discussion of those positive interactions: rather the courage you need, mentioned above, must be brought to bear here for this discussion about positive feelings and interactions is just as therapeutically important, allowing both patient and therapist to ask themselves "could it be that I'm not bad?" (221).

On the Working Alliance:

Next drawing on research into the centrality of the working alliance as crucial to the success of therapy, Fosha notes that therapist's must regularly, consciously, and deliberately engage in "empathic prizing," showing the patient how much their experience is valued and validated (223), both the suffering but also their positive strengths and gifts. The therapist must offer encouragement to keep going, showing a hopeful way forward; and must also offer positive feedback and commendation for whatever progress or successes the patient enjoys, especially calling out and lauding any actions by the patient toward self-care and affirmation. 

Sometimes doing this is a both-and exercise, Fosha suggests: the praise may often be met by a defensive downplaying by the patient, and the therapist's empathy should call both dynamics out, validating the need for the defenses while also encouraging the further taking of risks in precisely this area. 

When it comes to the therapist's feedback and even more his or her self-disclosure, Fosha has an interesting take, noting that especially for those "patients [who] have rarely felt that they have an impact on the significant others of their early life," knowing they are having an impact on the therapist can be transformative (230). This is also true when it comes to acknowledging errors by and limitations of the therapist, and any vulnerabilities. Fosha uses a striking phrase here, noting how the therapist's "self-disclosure [can] counteract therapeutic omnipotence" (231) as well as strengthen the patient's belief that he or she has valuable contributions to make to the welfare of the other. For patients whose relational style is that of learned helplessness, rising to the challenge of helping another can be an important lesson to learn. For patients (and therapists, I might add!) whose relational style tends towards the very intellectual or even quasi-schizoid, asking these sorts of questions, and offering these sorts of reflections, can prove to be "the ultimate corrective emotional experience" (243). 

Working with Defenses:

Noting that explicit challenges to defenses are a hallmark of Davanloo's work and all who come after him in the short-term dynamic psychotherapies, Fosha differentiates between "soft" and "entrenched" defenses, noting that the latter require some form of "restructuring" (247). (In addition to challenging defenses, all these approaches also share another goal and technique: the learning to bear previously unbearable affect in the here-and-now of the working alliance.) Her approach here is refreshingly straightforward: "using empathy," simply begin by talking about the role of defenses with the patient, offering "nonjudgmental feedback to the patient of what it is like to be on the receiving end of his defenses," thereby allowing him or her to become aware of the impact those defenses have on others. 

After this an appreciative reframing of the defenses can take place. But before this, some patients can respond by trying to do too much too fast, overcoming defenses almost by sheer willpower in a given moment, which may lead to frustration. It is important for the therapist to call out this self-pressure and allow it to deflate. 

As work with defenses proceeds, other relational patterns may emerge to be worked on, reflecting patterns in the patient's wider life outside the consulting room. From here the work may proceed to a recasting of the narrative of the patient's life. Specifity and detail are often key here, Fosha says, not least in getting through intellectualization defenses: the more a patient can remember and describe about an experience the more he is likely to be close to what he felt about it, too. 

In Honour of D.W. Winnicott on the 50th Anniversary of His Death

Last week marked the 50th anniversary of the death of D.W. Winnicott. It seems with each passing year I find myself reading more of him, and benefiting in deeper ways from his many rich and often unusual insights. (I have an essay coming out this week that draws on him.) So I wanted to repost these reflections from last November so that we may continue to honour him in the best possible way: by reading him. 

Before you do that, you could do worse than to start here with this moving and fascinating reflection from his wife on how DWW understood death and wrote about the prospect of his own death. I have read it three times now and continue to learn different facets of him and of their marriage. His prayer "Oh God! May I be alive when I die" is one that repays careful reflection. (I will, in fact, have an essay about it coming out probably next month.) 

I recently noted an essay of D.W. Winnicott that I found very insightful. Now the BBC has published excerpts from various talks by, and about, Winnicott. It is a charming retrospective and will only take 10 minutes of your time. Have a listen here. 

I have not read all of Winnicott by any means, but my debts to him are noted in the above-linked piece and in other essays here (discussing his thrilling 1947 essay "Hate in the Counter-Transference") and here. 

For those who have the money and inclination, Oxford University Press recently published the entire opera omnia. 

For those who might find it useful, let me recommend a few individual books by and about him. There are many more, of course, but these are the ones I have read and in some cases re-read several times. 

For biographies, there are two I have read (and others I have not but hope to). The first is by Adam Phillips, titled simply Winnicott. It is one of Phillips' earliest publications, and is a relatively simple and straightforward book without some of the literary flourishes so common in his more recent books. 

The second is by Dodi Goldman, In Search of the Real: The Origins and Originality of D.W. Winnicott, published in 1989. It's somewhat more intellectually expansive than Phillips but generally complementary to his book. 

The Chicago Psychoanalytic Institute had a library sale a year or two back, and I was very glad to get my hands on Through Paediatrics to Psycho-Analysis: Collected Papers. That is a very rich collection despite the somewhat off-putting title. 

Next to this, his Playing and Reality is perhaps one of his most noteworthy books.

Winnicott's Home Is Where We Start From is somewhat mixed, but there are some good essays in there. 

Additionally, I'm only part-way through Psycho-Analytic Explorations, but it has many good essays in it, especially those on the uses of silence.

Though a bit dated now, Judith Hughes' Reshaping the Psychoanalytic Domain: The Work of Melanie Klein, W.R.D. Fairbairn, and D.W. Winnicott is useful for the wider context, and for showing the very important relationships between all three who, each in their own way and also together, form so much of the British object-relations tradition. I am always happy to see Fairbairn get some attention after his decades of more or less solitary Scottish labours in Edinburgh, far from the London scene where Winnicott and so many others made their name. Fairbairn's early essay on schizoid personalities remains one of the most illuminating things I have read on that score. 

Finally, I have started, but not yet finished, Stephen Parker's Winnicott and Religion. So far it's rather good, though not earth-shattering. Winnicott seems to have been comfortable, in that rather vague and pragmatic British way, being part of the Church of England though he was not especially demonstrative of it, least of all in his writings. 

On this score, one final book on my list to read: Ann Belford Ulanov Finding Space: Winnicott, God, and Psychic Reality. I confess to never having heard of Ulanov (a New York-based Jungian analyst and academic) until almost exactly a year ago when I interviewed Pia Sophia Chaudhari about her recent and fascinating book, Dynamis of Healing:  You may read that interview here. 

On the Radical History of Psychoanalytic Liberation: An Interview with Daniel José Gaztambide

To immerse yourself, as I did over the Christmas break, in Daniel José Gaztambide's new book, A People's History of Psychoanalysis: from Freud to Liberation Psychology is a thrilling experience indeed. It is a deeply fascinating book uncovering all sorts of links and connections, possibilities and prospects, some realized, some thwarted, some both. Above all, I walked away with a rejuvenated sense that the original psychoanalytical movement was indeed much more socially radical in its vision and hopes than many of its successor personages and institutions were and are, with their turgid, hide-bound bourgeois orthodoxies that have made so much of psychoanalysis and psychology alike the preserve of respectable middle-class white people. I also found a kindred spirit in the author who ranges clearly and comfortably over the borderlands between psychoanalysis and theology, seeing in both a vision of social liberation far more radical than reactionary apologists for both disciplines often realize. 

I contacted the author by e-mail about his book, and here are his thoughts:

AD: Tell us a bit about your background

DJG: I’m originally from San Juan, Puerto Rico, born and raised in the Hato Rey sector of the metro area. My father is a “Brown” Puerto Rican man, and my mother was a White Cuban refugee from the Cuban Revolution. They were both heavily involved in our church community, Un Ministerio Sanador por Una Iglesia Sanadora, “A Healing Ministry by a Healing Church,” where my mother worked closely with our pastors. Our church, which had a orientation of healing and restoration toward the community, was very psychologically minded. 

My mother would read me books on psychoanalytic diagnosis, including from a theological perspective. Although she barely had a middle school education, she, along with my pastors, were the first to introduce me to psychoanalysis. I bring that up because one of the first things I encountered when I came stateside was this strange idea that psychoanalysis, in its essence, was too “Western,” classist, racist, sexist, and culturally incongruent with the worldviews of global south and colonized peoples. Not so under the mango tree of my childhood, the roof of my church, or the care of my community. Psyche, per Freud’s use of the work seele, was the soul if not it’s expression. 

But aside from being introduced to psychoanalysis at an early age, was the function of psychoanalysis—to put the unspeakable into words. And there were many things that were unspeakable in Puerto Rico, because de eso no se habla, “we don’t speak about it.” And the Puerto Rican was wrapped in many silences—around race and the meaning of my father’s Brown body and my White body, around class and the brutal inequality of the colony, around sexuality and the invisibility of women’s sexuality, and LGBTQ people as human. How is it, for example, that Puerto Ricans are “three harmoniously integrated races” yet Blackness is perpetually erased? Putting those questions and unspoken realities into words, in the clinic and the streets, are the impetus of my work. In some ways, my existence.

AD: What led to the writing of A People's History of Psychoanalysis: from Freud to Liberation Psychology?

DJG: The first seeds of this work started in my time at Union Theological Seminary in NYC. I was in the Masters program, which was an academic as opposed to a ministry-oriented degree, studying the intersections of psychoanalysis and liberation theology and psychology. I had been introduced to Paulo Freire’s work, the Brazilian educator and contributor to critical pedagogy and one of the inspirations behind Ignacio Martin-Baro’s book, Liberation Psychology, and was in the seminar library trying to find Jessica Benjamin’s book Bonds of Love. I had noticed all of these parallels around intersubjectivity, the teacher/student and therapist/patient relationship, and social justice, and thought that might be the beginnings of a project integrating psychoanalysis and Liberation Psychology.

I literally stumbled over a stool! And that stumbling brought me eye level with a copy of Elizabeth Danto’s Freud's Free Clinics: Psychoanalysis and Social Justice 1918-1938, Reading that work along with Sander Gilman, and realizing that the first generation of psychoanalysis was predominantly left-oriented Jews marginalized as racial others within the turn-of-century European world, blew my mind. Maybe, I thought, there were more than parallels between psychoanalysis and Liberation Psychology.

Later, when I was a doctoral student in clinical psychology at Rutgers, I was connected to Dr. Danto via an adjunct lecturer and later professor at the Silberman School of Social Work at Hunter College. She was my supervisor there, so I had an opportunity to explore these themes in-depth as I was beginning to write the papers that would inspire the book. It was liberating in a way, to find a story of Freud not at this impenetrable “guru,” a bastion of White male European enlightenment, but as a man negotiating the complexities of race, class, gender, and sexuality—as a matter of survival.

As I was reading about Freud’s cultural context, I discovered a number of contemporaries of both Freire and Erich Fromm who noted the ongoing dialogues between the two of them. Freire’s and others’ account of how Ivan Illich connected Freire and Fromm in Mexico City was powerful to me. In particular the moment when Fromm remarks that Freire’s critical pedagogy was essentially a historical-socio-cultural psychoanalysis. Noting Freire’s repeating citation of Fromm’s books was striking, as it was the first suggest that, actually, psychoanalysis and Liberation Psychology did not just have certain parallels. One actually flowed into and gave roots to the other. Learning how Fromm had originally studied with Otto Fenichel, another leftist psychoanalyst from the second generation who wrote quite cogently about race and class, became the first tributary connecting Liberation Psychology to psychoanalysis. First of many others.

Once, I was sitting with Doris Chang, a mentor and colleague who is more Cognitive-Behavioral, for lunch. As I was sharing all these connections I was discovering she got excited telling me that “It sounds like you’re writing a people’s history of psychoanalysis!” A la Howard Zinn. That was the “aha” moment. The rest, pun intended, is history.

AD: I loved your passage from Freire about how it is not a matter of thinking for the oppressed, but with them. (pp.xxviii-xxix). And yet how quickly did much of psychoanalysis in this country especially seem to revert to a model of "doctor knows best," setting up the kind of over-under relationship between analyst and analysand. This, as you show, was especially contrary to what Ferenczi in particular was attempting. Tell us a bit about his contributions to a psychotherapy of the people, and why that seems to have had a hard time taking root in the USA.

DJG: Ah, this gets at the other tributaries flowing from psychoanalysis to Liberation Psychology! One of the things Fromm did, both prior to and after his coming to America and then Mexico, was read and aggressively defend Ferenczi against the character assassination that took place after his and Freud’s death.

Let me make a few general comments—Freud and Ferenczi, both in their personal correspondence and their writing, talked very openly and cogently about race and class. People often write about how Freud dissociated himself from Jewishness, especially in bringing up race in his writings. That is not true. The story is much more complicated and tragic than that. Freud and Ferenczi were very aware of their Jewishness in an anti-Semitic world, and very aware of how anti-Semitism intersected with anti-Blackness and capitalist exploitation—dynamics which found their way into psychoanalytic theory. 

Ferenczi’s first writings on introspection and internalization were not primarily about parental object-relations, but about the internalization of social class. In particular, the sense of guilt that accompanies “moving up” in the world, and the precarity that even the position you now reached can be easily lost, tumbling you back down to “the bottom.” Similarly, some scholars note that Freud did not interact with any Black people on his infamous visit to the U.S. And yet, Ferenczi and Freud wrote to each other—Do you notice how they treat Black people in America the way they treat us Jews in Europe? How can that be, if they didn’t interact with, or see any African-Americans during their stay? 

If we understand that what is fundamental to anti-Blackness is not only the projection of aggression and animality, but the erasure of Black people’s humanity—especially the capacity to have a mind—then the analogy they drew is obvious. As if to say, “Do you see how Black people are erased in America, the way that we Jews are erased in Europe?”

Freud and Ferenczi shared a theory of how society becomes internalized within the individual, and how those who are framed as enemies of society—working class gentile Whites, for example—can be turned into the very vehicles of society’s violence. How they theorized the internalization of oppression is key and foundation, including to Liberation Psychology. When these dynamics entered the analytic session, that is where they began to part.

Ferenczi considered the possibility that he, no matter how warm or empathic as an analyst, could eventually “commit an act of murder” toward the patient that enacted their original trauma. Thus, he inaugurated a whole new way of thinking in which the analyst is not just a passive recipient of parental, cultural, or societal projections, but an active participant with them. If the analyst could be open to the patient, and think through this repetition not for them, but with them, and take ownership of their contribution, then a real sense of trust could develop--specifically, a trust in the analyst’s mind. 

Fromm, in reading and learning from Ferenczi, was one source transmitting this very same ethic to Freire, who more fully expanded on how this process was not only healing, but emancipatory, bringing the social world itself into view. After all, Ferenczi wrote to Freud on how in their analyses they discover the real conditions of society, as they are mirrored in the individual.

This idea, that the analyst could be vulnerable and open up their mind to the patient, was anathema to Freud. Although we know he was capable of being very warm and caring toward his patients, he was allergic to the thought of real vulnerability with them. We know, for example, that he found patients’ maternal transference to him to be disorganizing. Freud, a caring mother? Perish the thought! This belied an ambivalence toward vulnerability, but everything else associated with it in the social unconscious—femininity, homosexuality, Jewishness and Blackness.

Ferenczi, and Lacan himself recognized this to an extent, representing the best of what psychoanalysis could be—a process of open exploration where the patient, perhaps for the first time, could interrogate their relationship to the Other including the analyst, and discover new limits within which their freedom could be actualized. Not freedom in the sense of “liberty,” or participation in the market, but the freedom to choose in a new way. Freud, Ferenczi, and Lacan exemplify this ethic at different points—Thou art that. 

America wasn’t having any of that! The refrain from American analysts was always, yeah, but aren’t we supposed to educate the client? Give them a new moral framework? Make them good citizens of society? No, said Freud, Ferenczi, and Lacan. Not if that means imposing the analyst’s will as a vehicle for the will of society. They would have been in agreement, I think, with Martin Luther King’s address to the American Psychological Association. Not adjustment to an unequal society that pathologizes “maladjustment,” but the pursuit of “creative maladjustment” should be the north star of our field.

In brief, the ego psychological turn toward adaptation to an “average expectable environment,” the destruction of the psychoanalytic left and trauma of the Holocaust, the pressure in American medicine at the time toward assimilation to Whiteness, and the “Red Scare” all created conditions that turned Freud’s ambivalence toward Whiteness and Blackness into a disciplinary boundary. American psychoanalysis became White. Whiteness and toxic forms of masculinity, as ideologies that stress invulnerability, perfection, and autonomy, do not mesh well with a psychoanalytic stance that stresses vulnerability, humility, and our fundamental connectedness to each other, and the Other’s desire. 

In that sense, Freud and Ferenczi died twice.

AD: The 1918 Budapest congress is, you show in detail, a pivotal moment in the move of psychoanalysis out "into the streets" as it were. Tell us a bit about those developments at and after the congress.

DJG: Absolutely critical. There were a number of intersecting issues here. One was the aftermath of the First World War, and the exigencies of social democracy in rebuilding devastated economies and communities. The other was the proliferation of technical approaches to psychoanalysis, adapting treatment to working with war veterans and multiply traumatized working people. In essence, the war pushed psychoanalysis to define and re-define itself.

On the one hand you had folks like Ernst Simmel, who used “cathartic” technique in ways reminiscent of contemporary exposure therapy, and Ferenczi who, under Freud’s supervision, employed techniques we would today recognize as behavioral activation, exposure and response prevention. Both found that far from “corrupting” the psychoanalytic process, such “active” interventions—active not because the analyst was active, but because the patient engaged in new activity—freed up unconscious material that could be processed in the transference. Freud himself recognized you could only talk about a phobia for so long. Eventually, the resistance against approaching the phobia needed to be addressed--often through what was essentially “homework.”

This conference blew the doors open on a whole new world of technical experimentation which included brief psychotherapy. Also on Freud’s mind was how social democratic states could support psychoanalytic treatment to make it accessible for all. His “psychotherapy for the people,” can be read a “psychotherapy for all.” Public policy, clinical technique, theory, and social justice intersected in fascinating ways in Freud’s speech. Much of this innovation, however, was functionally destroyed by the “Aryanization” of the psychoanalytic free clinics, the Americanization of psychoanalysis—White supremacy on both sides of the Atlantic—and Freud and the other early analysts attempts at survival. In the end, Freud and others chose to “Whitewash” psychoanalysis, betraying the spirit of the theories they had developed, while enacting the very problems they were trying to solve.

Psychoanalysis went from a discourse that challenged social oppression, into becoming its vehicle.

AD: I have several beloved colleagues who describe themselves as Adlerians, and I have always understood Adler to have been much more focused on socioeconomic questions than those in Freud's early circles were often said to be. Yet he is absent in your narrative, as are Melanie Klein (echoes of whom I hear on p.153 in your treatment of splitting objects) and most of the British object-relations and "Middle" schools. Have your researches come across any significant contributions by Adler and British-based analysts to a liberation psychology?

DJG: To be clear—there’s no question about many other veins, tributaries, and roots connecting psychoanalysis to a social justice perspective. That would not only include Adlerians, but also Black psychoanalysts in America who developed new and revolutionary ways of thinking about race, psychoanalysis, and social justice--for example, Margaret Lawrence, one of the first African-American women to graduate from Columbia Psychoanalytic as an analyst. My project with this book focused on the "connective tissue," in both people and ideas, connecting psychoanalysis and Liberation Psychology, from Freud to Martin-Baro. Another project might explore other tributaries connecting psychoanalysis and social justice, whether they touch on Liberation Psychology or not.

This doesn't mean that Adler, Winnicott, A. Freud, or Klein aren't incredibly useful for thinking about these issues, only that they were not the focus of this book. There is some writing, for example, connecting Winnicott and Anna Freud's work in particular with the welfare state during and after WWII. Winnicott's discussion deprivation and delinquency, A. Freud's exploration of defenses, both took place in a context when British children were being literally deprived and their defenses literally bombed by the Nazis.

On the one hand, the theoretical constructs are incredibly relevant--not just parents but societies should provide a facilitating, "holding" environment. However, what Winnicott, A. Freud, Klein, or Fairbairn for that matter did not elucidate is how the broader societal environment, war or not, is not facilitating or holding for working class, immigrant, or ethnic minority populations. One's holding environment can be built upon another's depriving environment.

Neil Altman, for example, has drawn on Kleinian theories of the paranoid-schizoid position to talk about race, class, and splitting. James W. Jones has used Fairbairn and Winnicott to talk about transformative versus oppressive forms of religion.

AD: Your reading of Future of an Illusion brings out, as you say, a "complex, nuanced, proto-postcolonial psychoanalysis of oppressor and oppressed" (p.73) and thus begins laying the groundwork for a liberation psychology. This is not a reading of Future I have anywhere encountered before. Tell us how you came to it, and whether Freud's reputed hostility to "religion" made it more difficult for people to appreciate his liberating potential?

DJG: I've probably read Future of an Illusion ten times throughout undergrad, Masters, Doctoral school, and beyond! There's a bit of a game of telephone at play here--if the general consensus is that this is Freud's "religion book," and that the singular thesis is "religion is an illusion," you can wear that consensus as a lens and find that book and that thesis. But once I had made Freire, Fanon, and Martin-Baro a steady part of my literary diet, and being exposed to Danto's very different take on Freud and psychoanalysis, it's almost like I read Future of an Illusion for the first time. 

Once you read, for example, that for Freud society includes "control the forces of nature and extract its wealth for the satisfaction of human needs, and, on the other hand, all the regulations necessary in order to adjust the relations of men to one another and especially the distribution of the available wealth" (p. 6), that these two functions are interrelated, that "an individual man can himself come to function as wealth in relation to another one," that institutions "aim not only at effecting a certain distribution of wealth but at maintaining that distribution" (p. 7) you simply can't unread that! 

If, as Marx said, the "critique of religion is the beginning of critique," and that the critique of religion leads to the critique of ideology, then Freud is in good company here. My fantasy is Freud might have read Marx and not credited him! This is what is at stake in talking about religion.

To your point--most psychoanalytic critiques of Freud on religion have not picked up on the relationship he draws between religion, race, and the ideological apparatus that protects capitalism. Freud essentially is saying, "Religion is an illusion that fixes our desire on another world in heaven, in exchange for our exploitation. Maybe we don't need oppression and can create the Kingdom of God on Earth." The response, essentially, has been, "Yeah, but good religion gives us meaning, helps us get in touch with primary process and beta elements, access transitional space, have a corrective experience with a benevolent God," etc, etc.

It's not, mind you, that religion doesn't do those things. It's that the critique is almost never placed in the context of political economy--save of course, works like Carrette's Religion and Critical Psychology: Religious Experience in the Knowledge Economy. What would it be like for the psychoanalytic study of religion to "return to Freud" not only as a critique of patriarchal, idolatrous religion (per Jonte-Pace and Jones's great works), but as a specifically White and capital-informed idolatrous form of religion? Freud is clear on this--he's critiquing religion, but specifically White Christian Civilization, and how it upholds the political economy. 

In that sense, it's less about Freud's hostility to religion, and more about the desire to recuperate religion as a technology of self-actualization, which fits within a capitalist, White Supremacist mode of production. Freud and the Liberation Theologians would, interestingly, agree--this form of religion promises us mana in heaven, rugged individualism on earth, and "socialism" for the pharaohs, pharisees, and caesars of the world.

AD: Towards the end of ch.4 you note the ambivalence of Freud's legacy and recognize that while anti-Semitism and anti-Marxism blunted and destroyed the more "radical" inclinations to social justice, Freud himself also undermined the liberating program of psychoanalysis by reverting to being (in Fromm's view, as you show, which I think correct) an authoritarian figure demanding loyalty and subservient disciples. As a result, the tradition has both "emancipatory possibilities and bourgeois anti-Blackness." Tell us a bit more about that latter reality in light of "black psychoanalysis from Harlem to Algeria," the subject of your fourth chapter.

DJG: Absolutely. I think Claudia Tate's classic "Freud and his negro: Psychoanalysis as ally and enemy to African Americans" was really instrumental to my thinking here. She talks about a racist joke Freud would often repeat, "12 o'clock and no negro," referring to one of his American patients. With this joke, Tate argued, Freud evoked the anxiety provoking associations between Jewishness and Blackness on the one hand, and their contradistinction with Whiteness as the standard of the human. He evokes the association, in order to then cut it, finally collapsing it into the antagonism of Black and White. In so doing, he performatively assimilated Jewishness into Whiteness. The joke was a portable "Ellis Island" through which he could become White. 

Psychoanalysis in many respects is a theory about such transformations and displacements. While Jewishness could become Whiteness, this required Blackness to remain the fundamental antagonism facilitating this becoming as such. Blackness, in Freud, was as much a metaphor for the Unconscious, the uncanny double, and primitivity. If the work of analysis is to make the "unconscious," the "unheimlich," conscious and heimlich, and if, as Annie Lee Jones has recently written, Freud considered the preconscious between both as akin to a mischling, or mixed, "half-breed" race, then the traumatic project of at least one form of analysis becomes obvious. 

What Fenichel, Ferenczi, and others began to realize--and I think Freud began to approximate this in Moses and Monotheism--is that the call of Whiteness, "turn White or disappear," need not be the only way. What does psychoanalysis entail when you are the abject defined as non-Human, cast into a "zone of non-Being" that makes being for others possible? 

This is what Fanon wrestled with in his critique and use of psychoanalysis.  For Fanon, ultimately, to make conscious the very desire to make the Black subject become White, insofar as this betrayed a different formula, "turn White and disappear." To look beyond two options which are equally unattainable, to weep between "nothingness and infinity," means to take a leap. A leap into the abyss. A leap without faith or the possibility of arrival. A leap, which, by its radical vulnerability, introduces "invention into existence."

To put it succinctly, what becomes emancipatory about psychoanalysis for Fanon is that it leads us to question the contingencies that rule over our lives. "If you become White, then you will live," and "If you remain Black/Brown/Jewish, then you will die." But the psychoanalytic lens leads Fanon to notice that the Black subject is bound within an "omnipresent death," which renders such "If/Then" contingencies absolutely barren. Whether you become White or not, you are always already not-Human. If there is no "If/Then," then the only term that matters is "I," as in "I want," "I love," "I am," irrespective of the outcome. 

Black Theology, and here I'm thinking of James Cones' The Cross and the Lynching Tree, captures this ethic. Jesus on the cross does not look up at God, wink, and say, "We got this. I know this is part of the plan." No. Instead he says: "My God, my God, why have you forsaken me?" which gives way to a final act of surrender, "Into your arms I commend my spirit." Jesus dies. He is pierced on the side, even though he is already dead. And though dead, rose on the third day. No matter the heavy hand of empire, no matter its brutality and erasure, death has no hold over us. And why did Jesus endure that pain? Because he loved, irrespective of the outcome. 

When you're existence is a perpetual twilight, to demand that one "hopes" for tomorrow becomes an act of violence. The Fanonian ethic, psychoanalytically inflected, simply wants tomorrow, fights for it, demands it, takes a leap for it, regardless of whether it arrives. That is a level of vulnerability Freud flirted with and shied away from. A vulnerability that got Ferenczi buried. A vulnerability that made love not an assurance, but a possibility, for Fanon.

AD: David Pavón-Cuéllar's Marxism and Psychoanalysis: In or Against Psychology is rather scathing in its view that much, perhaps most, of American psychology has hopelessly sold out any interest in social justice to become a totally bourgeois institution concerned with protecting its own power and prestige. Do you see figures in American psychology today who would not be guilty of such a thing, who would be, in your terms, active in or at least supportive of liberation psychology?

DJG: Yes and no. On the one hand, there are those who truly take a consistently decolonial perspective in their work. On the other, to put it bluntly, are those who simply want a more diverse elite. Let me be clear--this not about people being perfect, or some unreachable notion of ideological purity. 

There is a very dangerous alliance between a White liberal desire for a performance of diversity and social justice, and a very specific, professional-managerial group of people from marginalized backgrounds who use that desire to climb up institutional structures, and then kick the ladder behind them. To paraphrase the late activist and podcaster Michael Brooks, a world in which White liberals can simply say "I acknowledge my privilege, now can I keep my money?" is a world that leaves rampant inequality virtually untouched.

The answer, of course, isn't just more ladders, but seriously questioning and deconstructing--here I mean literally tearing down--structures of power. 

If the best possible world we can imagine is one in which Puerto Rico is still a colony under the U.S. in which those Puerto Ricans who are wealthy and White--or can pass, or are light enough--can have, but the overwhelming majority have-not, with egregiously high levels of unemployment and underemployment, poverty, community violence, food insecurity, ecological precarity, and so on, but hey, here's Daniel Gaztambide. He made it, and so can you if you work hard enough and have resilience, optimism, and grit! The silent signifier here is, of course, and if you didn't make it, what's wrong with you? 

That is an extremely dystopian and fatalistic reality. We don't have to jockey with one another for position and status. When we do, the only ones who suffer are ourselves and our communities. When we are divided in this way, our mind shuts down, focused on the question of "Who am I?" and "Where am I in the hierarchy?" It would be great if the outcome was the realization that the hierarchy itself is itself. But more often than not, we become obsessed with climbing the very hierarchy that hurts us. No sense of solidarity is possible.

This brings us to Asad Haider's discussion of "insurgent universality," which I read through Liberation Theology's preferential option for the oppressed. It's not that I, being Puerto Rican, have access to some essence or special knowledge that should be privileged. It's that when I look at my experience, and my community's experience, of colonization I realize, wait a minute, Europeans came to Puerto Rico looking to conquer and accrue wealth. 

The indigenous Taino people and African people kidnapped from Africa fought back, furiously and at times creating free nation states. When free Black people, enslaved Black people, and the growing multiracial population all realized that the creole White and Spaniard class were full of shit, they rebelled. In each of these instances, the colonized constructed and weaponized notions of race and Whiteness to cripple slave rebellions and worker uprisings. Stories like these, although particular to Puerto Rico, have been enacted in some fashion throughout history. The history of the United States is a case in point.

It is not that I have to discover some hidden particularity to set against universality. Nor that I need to "surrender" my particularity in favor of an abstract universal. It is that within my particular story lies a universal story. When I state, for example, that I stand for the liberation of Puerto Ricans, built into that statement is the specificity of Afro-Puerto Ricans, of LGBTQ Puerto Rican Women, of working class Puerto Ricans. How is the Puerto Rican struggle, then, not also at the same time a workers struggle? A Black struggle? A struggle for women's rights? A struggle for trans revolution? My debt is both to Haider, and historically to the work of the Combahee River Collective. It was the ethic I heard in the halls of Union Theological Seminary: we are not free if we are not all free. And all must of necessity, the center the fight against anti-Blackness in said struggle. To learn from Freud's hubris, in a way.

If mentalization, simply put, is our ability to reflect on 1) the thoughts, feelings, and behaviors of the other in context, and 2) recognize the opacity and unknowability of the other, then political mentalization is our ability to reflect on self and other in a political context. As Freire argued, when we conscientize, we become able to read to the world. Because language also fails us, we begin to ascertain the world's indecipherable otherness. We begin to dream a new world that is not promised and is fundamentally unknown. We simply, in dreaming, want and demand a better one.

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

My hope is people will get a different take on what psychoanalysis fundamentally is, and how it can inform how we think about power and politics in and outside the consulting room. 

I would say primarily graduate students, as my graduate school experience is really where the book came from. But also those interested in how the relationships between psyche and politics was conceived, from Freud to Martin-Baro.

AD: Having finished the book, what projects are in the pipeline now?

DJG: Currently writing a lot about anti-Blackness in psychotherapy, and racial identity among Puerto Ricans. I'm working on a treatment guide on working with race in complex trauma and personality disorder treatment, which is more of a clinical application of the ideas in A People's History of Psychoanalysis.

The Ethical Visions of Psychotherapy

I have just finished a short but fascinating book by K.R. Smith, The Ethics Visions of Psychotherapy (Routledge, 2020), 112pp. Imagine, if you will, Charles Taylor teamed up with Alasdair MacIntyre and Smith to write this book. It explores crucial philosophical issues that Taylor and MacIntyre have been rightly celebrated for over the last several decades, but which mainstream psychology and psychotherapy have all but totally ignored. Smith unpacks those issues, and the costs of their neglect, and the promises and prospects of exploring them in the years ahead by and for psychotherapists. To do all this in short, accessible, polemic-free book is a masterful achievement. It is the sort of book that belongs on the bibliography of every introductory psychology and psychotherapy course. 

Here is the publisher's blurb:

The standard view of psychotherapy as a treatment for mental disorders can obscure how therapy functions as a social practice that promotes conceptions of human well-being. Building on the philosophy of Charles Taylor, Smith examines the link between therapy and ethics, and the roots of therapeutic aims in modern Western ideas about living well.

This is one of two complementary volumes (the other being Therapeutic Ethics in Context and in Dialogue). This volume explores the links between therapeutic aims and conceptions of well-being. It examines several cognitive-behavioral and psychoanalytic therapies to illustrate how they can be distinguished by their divergent ethics. Smith argues that because research utilizing standard measures of efficacy shows little difference between the therapies, the assessment of their relative merits must include evaluation of their distinct ethical visions.

A key text for upper level undergraduates, postgraduate students, and professionals in the fields of psychotherapy, psychoanalysis, theoretical psychology, and philosophy of mind.

I will have more to say about the book in due course, when I also hope to have heard back from Smith with some questions I sent to him for an interview on here. Stay tuned!

Louis Cozolino on the Making of a Therapist

I don't remember exactly how I came across Louis Cozolino's The Making of a Therapist: A Practical Guide for the Inner Journey, but I am very glad and grateful that I did. He has written an extremely useful book in a cogent and accessible fashion. I would be very tempted to use it if I ever teach a course on, say, introductions to counselling and therapy. 

He begins by noting that would-be therapists need to be encouraged not to "stay above the neck" in how they relate to their patients: "the more fearless we become in the exploration of our inner worlds, the greater our self-knowledge and our ability to help our clients" (xvi). Such inner exploration is necessary because that world is a crucial tool: "the private personal world of the therapist is, in fact, one of our most important tools" (xviii). The fact that this is so little taught today, Cozolino says, is a great loss to all concerned. And we mustn't resist doing this, for, as he says a little later, "to accept our clients, we have to first learn to accept ourselves. This can be the biggest challenge of all" (15).  

His first chapter reiterates what I have seen so often, and recently written about, in Nina Coltart: the therapist, for much of the time, must live with not knowing, not being certain, not having clear ideas of what is going on. This is not to be shunned or feared. 

Arranging the Consulting Room:

Chapter II has some very practical tips on getting centred in order to get started. He says that one must pay attention to one's consulting room and its set-up to ensure a comfortable, calm, mindful environment for you as well as your patient. I wrote rather at length about such matters here. He says it's best not to have chairs directly facing one another, and to give people options for sitting, asking them from time to time about how they feel being in the consulting room with you. He also says there's nothing wrong with modifying arrangements if people need or request it.

Communicating:

As you are going about your day, schedule yourself to allow for breaks and to ensure you are not rushing. Equally or even more important: do not rush to fill in gaps, but allow for silence. When you do talk, keep it simple and short. This good advice, much confirmed by my recent supervisors, led me to adapt something I heard in another context:

  • Be blunt
  • Be brief
  • Be quiet. 

Maintaining the Tension:

Good therapy, Cozolino says, is always going to find itself stretched between several poles:

  • Nurture and Challenge
  • Comfort and Stress
  • Affect and Cognition

In addition, it should have the goal of increased affect regulation and the creation of new narratives about the self. 

Treatment Plans:

These will flow out of your theoretical orientation, he says, and are constructed backwards, from goals to interventions. Keep them clear, straightforward, and open to revision in dialogue with your patient.

Notes: 

Keep them very short and say nothing critical that you would not want the patient to read.

Loving Defenses, Patiently:

What Cozolino writes about appreciating the role of resistance and defenses puts me in mind of Auden's poem "In Memory of Sigmund Freud," which I love, especially these lines:

he would have us remember most of all 
to be enthusiastic over the night,
     not only for the sense of wonder
   it alone has to offer, but also

because it needs our love. With large sad eyes
its delectable creatures look up and beg
     us dumbly to ask them to follow:
   they are exiles who long for the future

that lives in our power, they too would rejoice
if allowed to serve enlightenment like him.

One thing I have realized over the past year is that we must come even to love the defenses for they once served a useful purpose that has since become maladaptive. Cozolino says that if patients see your appreciation of their defenses, they "will be more wiling to explore alternative ways of being" (76). All this will be slow-going with, he says, some "backsliding." 

Resistances, too, have their rewards, not least because they often point quite clearly and directly to what is most painful and difficult that might hitherto have been closed off to and hidden from us. This may also be true of conflicts in the therapy. Don't be defensive about defenses, about conflicts, about resistances. That will serve nothing and nobody. To launch a frontal attack on defenses is to ensure they deepen. 

Negative Therapeutic Reaction and the Death Drive:

Cozolino has clearly been influenced by the psychodynamic traditions, but he wears them very lightly. He raises "the very success of therapy" will unsettle some people and cause regression, or even destruction and early departure. All this is, he says, a "common occurrence" (119). (Freud certainly saw it, not least in Beyond the Pleasure Principle.)

Counter-Transference and the Desire to Sack:

Cozolino offers some helpful advice in sorting out the desire to fire or sack a patient. This may be legitimate--you are a bad fit, or lack the skills for this particular disorder, or are in an impasse. But it might also be caused by the patient who needs to try to get you to fire him or her, creating, yet again, their past experience of abandonment. This requires careful discernment on your part, and perhaps some supervision if necessary.

In his ninth chapter, he introduces the very useful image and concept of shuttling. This is "up into your head, and down into your body" as you monitor counter-transference reactions. You shuttle from mind to body, and then from you to your patient and back again. He offers very concrete guidance here, saying you should do this if you've felt disconnected, or been tuned out, confused by what the patients is said, or fearful or anxious. He often shares the results of these shuttlings, especially if a particular strong feeling or image surfaces. Sometimes these can provoke really stunning responses; at other times they miss their mark. In any case, he allows the patient to "accept, reject, modify, or ignore" the results of the shuttling, saying that if it is rejected, just let it go because hanging on to it will not serve any purpose.

Dreams: The Royal Road to Whose Unconscious?

Cozolino has a brief section on the use of dreams, noting that patient's dreams are of course useful and important, but so are the therapist's. He gives a compelling example of how one dream of his enabled him to pick up on a deeply buried part of his patient's life, endlessly denied, and eventually nudge this trauma out into the open.

Wordiness Should Make You Wary:

Patients will try to recreate other relationships in the therapeutic relationship. One such will be the excessively wordy person who appears to be describing things--even feelings, or traumatic memories--in great, and greatly wordy, detail. This can be a trap and so Cozolino says we must not "mistake a barrage of words for openness and vulnerability" (143). 

The Vocation and its Enjoyment:

Cozolino ends this excellent book where he began, saying that your self-acceptance (and self-care, which he stresses in the penultimate chapter) will be key to your flourishing in the vocation of therapy, which must not be allowed to become all drudgery but should be an occasion (as Coltart and before her Winnicott above all said) where patient and therapist can enjoy one another (at least some of the time).