Risk of Over-Focus on One Spouse in Couple Therapy

Arthur C. Nielsen, MD, in his “A Roadmap for Couple Therapy” (Routledge, 2016), observes that “Another difficulty unique to couple treatment is that if the therapist spends too much time and too many consecutive sessions focusing on the symptoms or defenses of one spouse, he or she may feel (understandably) that the therapy has become too tilted against him or her.  In such cases, the therapist may have to sacrifice thematic continuity in order to sustain a neutral position and the therapeutic alliance.”  (p. 16)

This prompted me to think of my work with various couples, as well as some examples of couple therapy by colleagues when I have been the individual therapist for a client also in couple therapy.  There are a number of ways in which over-focusing on one spouse at the expense of the other, and of the relationship, can happen.  

One obvious way is when one spouse has an issue that actually does undermine the couple so much that it prevents the therapy from being balanced.  For example, if one spouse is abusing alcohol, and refuses to acknowledge or deal with it, that issue may become the focus of couple therapy until the drinker is willing to address it.  In such cases, I’ve told the couple that, once alcohol is no longer an obstacle to therapy, we will be focusing more equally on the issues presented by both spouses.  As the quip says, “Each person is 100% responsible for 50% of the problem.”  Of course, this can be a threat to the non-drinking spouse, who may see the partner’s drinking as the sole or main problem in their relationship;  “We’ll be fine if you’ll just stop drinking.”  But that’s not how it is.   

Infidelity, past and present, is another issue in which, for a time, the focus can be more on one person than the other.  Some marital therapists won’t work with a couple in which one spouse is engaged in a current infidelity—Sue Johnson won’t—while others therapists, for example, Esther Perel, will.  This is a complex topic.

Aside from alcohol abuse and infidelity, there can be more subtle ways in which the focus in couple therapy can be unbalanced toward one spouse.  A couple may have a narrative in which one spouse is responsible for most of their problems.  There are psychodynamic advantages for both the “guilty” spouse and the “victim” spouse in that narrative, and their collusion in it prevents them from honestly exploring the obstacles that each contributes to their relationship.  Such couples may welcome the therapist being more focused on one spouse than the other.  The challenge to the therapist is to recognize the dynamic and help each partner, and both together, explore how each person contributes, and how their collusion protects them from seeing what’s really happening.  I have seen cases in which the couple, already in collusion in the narrative that one spouse is the “guilty” party, draw the couple therapist into collusion with them in this narrative; undermining the therapy and creating what psychoanalytic therapists call an “enactment.”  Enactments can be very valuable, but only when we have identified that we are in them and are working through them with our clients.     

Nielsen says that the therapeutic relationship should be “Safe, but not too safe.”  I think he means that couple therapy must include issues that will be difficult for all parties; for each member of the couple as an individual, for the couple as a couple, and for the therapist.  If it doesn’t, the therapist ought to be asking why we can’t talk about what’s really going on here. 

System, Method and Experience in Psychotherapy and Consultation

Therapists and teachers often describe their approach to psychotherapy as a system or method, such as cognitive-behavioral or psychoanalytic.  Many other approaches, when you look into them, are some sort of inspired hybrid, such as Emotion-Focused Therapy, Internal Family Systems or Acceptance and Commitment Therapy.  My approach to therapy, like my approach to consultation with therapists, doesn’t rely on a system or a method, although it is methodical and systematic in its own way.  It places experience, and the observation of experience by client and therapist, first.  In my work with each client in psychotherapy, and each therapist in consultation, I am focused on exploring the experience of the client, the experience of the therapist, and the experience of the therapeutic pair.  This is a highly reflective process, and it includes the exploration of behavior and its meaning.  Psychologist George Kelly–a teacher of one of my teachers–said, “Experience is not what happens to us, it’s what we do with what happens to us.”

I had a very unusual introduction to psychotherapy, because of coincidences (or, if you prefer, luck, or grace) in my life.  While still an undergraduate at Goddard College, in Plainfield, Vermont, I met, and became an apprentice to, Eugene Eliasoph, MSW, LCSW, co-founder and co-director of the New Haven Center for Human Relations.  Gene was a therapist, psychodramatist and leader of therapy and personal growth groups.  For a year, II was able to participate in Gene’s groups, along with licensed therapists and Yale post-docs, and receive undergraduate credit for an off-campus field experience.  Goddard’s educational philosophy, influenced by John Dewey, prioritized experiential learning and the role of students in pursuing what they wanted to learn, on campus and off.  Even then, I was finding my own way.  

Psychodrama, for readers unfamiliar with it, is a way of exploring situations in our lives, in groups, by acting them out rather than talking about them.  The person whose situation is being explored is the “protagonist,” the leader is the “director,” and group members play the various people involved in the situation.  There is a role in psychodrama called “auxiliary ego,” which Gene often asked me to play.  The auxiliary ego, also called a “double,” is sent by the director to join with the protagonist (or other member of the psychodrama) and express what the person might be thinking or feeling, but not saying.  This was part of my introduction to psychotherapy.  The experience of the person I was doubling with was more important than any theory, method, concept or system.  My task wasn’t to label what the person was struggling with, or analyze how they were doing it, it was to find my way into the person’s experience and express it in a way that helped move the exploration forward.

In his other therapy and personal growth groups, Gene included me as a “model member,” who was there to learn and participate authentically.  Gene had a lot of knowledge and experience about facilitating therapeutic and personal learning in groups, and later became President of the American Society for Group Psychotherapy and Psychodrama.  His focus was always on the experience of the people he was working with, and he had a way of being and working with them that helped them feel encouraged and secure enough to explore issues that might otherwise have felt too vulnerable and disorienting to get into.  He had psychoanalytic training, at both Austin Riggs and William Alanson White, as well as psychodramatic training with J. L. Moreno, the creator of psychodrama; all of which informed his work.  But he also bought his own life experience to his work.  Among other experiences, as a soldier in W.W. II, he had been captured and escaped, and this contributed to a deeply existential view of human nature.  He had also been influenced by the writings of Harry Stack Sullivan, which he had studied at William Alanson White (which Sullivan had helped found), on the importance of interpersonal relationships.  Gene was also a jazz musician, as I was at the time–he on clarinet and me on guitar–and we shared a love of improvising together within a structure.  This is similar, in some ways, with the experience of psychodynamic psychotherapy (for a unique consideration of this dimension of therapy, see “The Musical Edge of Therapeutic Dialog,” by Steven Knoblauch, https://www.amazon.com/Musical-Edge-Therapeutic-Dialogue/dp/088163297X).     

I later came to understand part of Gene’s systematic approach in the psychoanalytic concept of the “frame” of psychotherapy.  The frame is the set of mutual roles and responsibilities of client and therapist, which creates a safe relational space, at least compared with most other relationships in our lives, within which clients can let down their guard and accept help in exploring intimate and difficult issues.

Later on in my academic and professional education, I was exposed to lots of theories, methods, and systems of therapy.  They all seemed to me to have some truth, mixed up with expressions of the personalities of the founders and their followers, and their attempts to achieve stature and the appearance of theoretical consistency.  This is a problem that started with Freud and continues to this day.  I’ve worked around it by studying neuropsychology and neurocognitive science, as well as spiritual psychology, and developing a model of how psychotherapy works.  That model, under continuous revision, is based on brain structure and function, neural networks and their interaction, the experience and behavior of multiple self-states, the social and economic dynamics of human communities past and present, the dynamics of identity and meaning, and how all those processes are instantiated in the client’s issues and the psychotherapeutic relationship.  (See my review of Pat Williams’ “Which You Are You?” https://psychatlarge.com/a-review-of-which-you-are-you-by-pat-williams/).  I call it an “expanded psychodynamic” model, and it easily incorporates what I find useful in psychoanalytic, cognitive, and other therapeutic approaches.  It enables me to be methodical and systematic without being confined within any method or system.

For more on consultation to refine therapists’ perceptions and skills, see my earlier blog post at https://psychatlarge.com/consultation-to-refine-therapists-perceptions-and-skills/


It Doesn’t Take A Sufi…

A young man in another state contacted me for online consultation, having learned that I’d written about Sufism, particularly Idries Shah’s work.  He was reading Shah’s books, and wanted to include this interest, as well as other issues in his life, in our discussion.  I made it clear that I am neither a Sufi nor a spiritual teacher of any kind, and that such information about spiritual psychology as I’d gathered over the years was not he same as being a qualified spiritual teacher.  We could try a consulting relationship as long as we had that straight.

It turned out that he had an intense desire to find “the truth,” and thought he could do that by reading Shah’s books by himself and finding the way to break through from where he was into that truth.  He seemed like a good guy to me, responsible to his customers and company in his work, striving to live a morally good life and treat other people well, and genuinely called to inquire within himself for the mystery of being.  However, he was very introverted both by nature and upbringing, having been restricted to his home while growing up by a parent with rigid religious beliefs and acute fear of the outside world.  Aside from his job, which he liked well enough, he spent most of his life by himself at home, had few friends, close or casual, no romantic life, and no hobbies or other interests aside from video games.  On his job, he barely earned enough to get by and was not on a career path for advancement; although his company did offer some opportunity for that.

It didn’t take a Sufi to see that he was unbalanced both in his approach to spirituality and to life; living an over-isolated lifestyle in the name of his quest for truth, and concentrating his ambition on achieving a solitary spiritual breakthrough, rather than reaching out for life, love and learning while continuing his spiritual quest.  I pointed out that, as far as I knew, spiritual development requires being able to live a normal life in society, to have relationships with people of different backgrounds, and to have a balanced life of which the spiritual search was a part.   Accordingly, I advised him to seek more social life, and more engagement in life in general, outside the solitude of his apartment.  That was several months ago, and he’s trying.  Although he lives in a city that has at least some resources for social, recreational, educational, vocational, and other life enrichments, he doesn’t find it easy to reach out.

This young man’s situation is an example of how the spiritual search can become co-opted in the service of one’s existing personality and behavior patterns.  The truth is that psychological growth, whether in our ordinary lives or in spirituality, often involves disconfirmation of how we think of ourselves, others and life, and requires stretching ourselves into new experiences which may be unfamiliar, unexpected and uncomfortable.  In my model of how the brain learns in psychotherapy and spirituality, this involves the development of new neural networks, and new interconnections among existing neural networks.  In fact, multiple examples of how people short-circuit their spiritual search are included in Shah’s literature, which this young man had read.  Fortunately, because he was familiar with this literature, he was immediately able to recognize his situation when I pointed it out it to him.

Sometimes psychological growth involves confirmation of subtle experiences that we’ve tended to ignore.  I advised him to pay attention to small experiences of perception, “little ‘e’” enlightenments, rather than looking for a “BIG E” breakthrough; which reflects an approach to learning also mentioned in Shah’s literature, and in fact supported by it.  But he still craves that “big breakthrough;” even though he has read that such cravings are more often characterized by unfulfilled emotional needs than genuine spiritual ones, and that too much emotion decreases rather than increases perception, spiritual or otherwise.

Of course, there are congregations and paths that privilege emotion and call it spiritual, and perhaps he’ll find his way to one of them.  Eventually that might even be a way for him to realize what emotion can, and can’t, contribute to the spiritual search.  One of my clients is a chaplain who was, for a time, a member of a charismatic sect, which cultivated highly emotional experiences within a cult-like atmosphere.  It served his needs for a time, and when it didn’t any more, he moved on.

“Which You Are You?” by Pat Williams

I’m not a “one size fits all” psychologist—quite the opposite—but one of my favorite one-stop teachings about human nature and therapy is “Which You Are You?” by Pat Williams.  Originally released as a spoken CD by Human Givens Publishing, in the United Kingdom, “Which You Are You” is now available as an mp3 from the Human Givens website, https://www.humangivens.com/category/cds-mp3s/mp3s.

Journalist, playwright, author, storyteller, and therapist, Williams speaks, in “Which You Are You?,”  both as a therapist to other therapists, and as a deeply thoughtful person sharing an important understanding of human nature (see her interview at http://www.brightontherapypartnership.org.uk/pat-williams-interview/, and her memoir http://portobellobooks.com/king-kong-our-knot-of-time-and-music).

Williams begins “Which You Are You?” with a kind of “human given:”  “Every one of us, and we see it the minute we think about it, has many ‘minds’ rather than just one…These divisions in our psyches are a matter of daily personal experience.  We are unmistakably made up of many self-contained personalities, some of which are helpful allies, some delinquent or even at war with each other, and some of which we are utterly unaware.”  Although “we think of ourselves as whole,” our real condition is a continuous transition of “what psychologists call sub-personalities.”

The basic idea is not new.  “Unsurprisingly, the knowledge of sub-personalities is in fact centuries old, found in many traditional religious and esoteric practices, and presented in various forms,” including the differing characters of the Hindu gods, and the beliefs of ancient Greeks, “who saw humans as intrinsic to the dramas of the many gods above.”  In medieval times, “people believed that they could become possessed by a whole bestiary of demons, devils and imps…capable of causing disabling mental states…We find it too in the Gospel according to Mark, when Jesus meets a man possessed by demons.  When asked for his name, he replies, ‘My name is Legion, for we are many.’”

Coming up to the present, “When we come to relatively modern times, and look at Western psychology, we find Freud describing personality as a continuing struggle of elements within a divided mind, and Jung talking, even before Freud, about divisions in the psyche.  We see the ideas surface in Maslow’s work, and in (Roberto) Assagioli’s, where the work is to unify the sub-personalities.  It’s there in the work of Gurdjieff, and in quite a bit of the psychological literature in recent decades.”

Multiplicity of personality reflects the structure and function of the brain.  Williams introduces “Multimind,” the 1986 book by psychologist Robert Ornstein, saying  “I think he may be the first in modern times to make the connection that our multiple selves, some of which are valuable allies, and others of which can give us a great deal of trouble, are actually a reflection of how we are made.  Given the machinery of the brain, it could hardly be otherwise.”  https://www.amazon.com/gp/product/1883536294/ref=ox_sc_sfl_image_1?ie=UTF8&psc=1&smid=ATVPDKIKX0DER

This dovetails with my own view of personality; not surprisingly, since “Multimind” is foundational to it.  My “elevator speech” about therapy is:  “Personality exists in parts, as neural networks in the brain, adapted to the conditions in which we grew up.  When circumstances change, and the parts and configuration are no longer adaptive, we have to revise and reconfigure them.  That’s what therapy is for.”

Williams notes the look of surprised recognition in her therapy clients when she describes this view of personality.  “The fact that we are a congregation of minds, many (of which) have no idea of, or even interest in, what another of their number is doing, is so familiar that we take it for granted.”  She invokes Walt Whitman:  “Do I contradict myself?  Very well then, I contradict myself.  I am large, I contain multitudes.”

The “small minds” are “states of locked, internal focus; in other words, trance states.”  This recognition helped generate a metaphor in Williams’ work with a client, which she has since used often with other clients.  This woman loved opera, and Williams drew the distinction between opera, in which there can be several characters on stage at one time, following directions, and the “opera of our lives,” in which “we normally can have only one character on stage at a time, and sometimes it’s the wrong character” for the situation, “hogging the spotlight and refusing to stop singing or get offstage.”  Similar metaphors—a ship and its crew, for example—have provided ways of helping clients to achieve a distance from their problem, and take “greater, sometimes almost exquisite, control over their own states of mind.”

The sub-personalities don’t become the whole focus of therapy in William’s approach; bringing up the metaphor when needed makes it more powerful.  The “observing self,” described by psychiatrist Arthur Deikman, “equates with the director of the show,” while “positive and negative trance states and emotional arousals are the characters.  Clients are thus separated from their problem,” and their resources for self-awareness and self-regulation can be “recognized, named, and brought into play.”  Williams encourages her clients to name the various parts of themselves—playfully, not too seriously— that claim the stage.  One of my clients, using this method, identified “The General,” who comes onstage whenever he feels slighted, while another client identified the “C.O.O.” (chief operating officer), who takes over in the absence of a C.E.O. (chief executive officer).  Another metaphor I’ve found useful in therapy is that of an orchestra and conductor, used by neuropsychologist Elkhonon Goldberg to describe the role of executive functions (the conductor) in his The New Executive Brain. https://www.amazon.com/New-Executive-Brain-Frontal-Complex/dp/0195329406/ref=sr_1_1?s=books&ie=UTF8&qid=1514583481&sr=1-1&keywords=the+new+executive+brain+frontal+lobes+in+a+complex+world

“Naming anything…brings a measure of control,” Williams says, “and this is certainly true in the case of the characters.  Naming the character requires the client to move into his or her observing self to take a look.”  Williams highlights the “power of naming,” to shift the locus of control.  “Once you’ve named them, then whenever you feel disturbed in some way, you can quickly identify which small mind is creating this impact, and become aware that you need to move it out of the way.”  Williams then gives several examples, from her work with clients, of how identifying sub-personalities, such as “Valerie Victim”—essentially states of mind established long ago in response to circumstances that no longer apply—were usurping control and undermining them.  By helping her clients identify their sub-personalities and then learn to direct them, Williams helps her clients reclaim control over their inner lives; for example, by replacing “Valerie Victim” with “Confident Connie.”  Each character brings its own style, varying in attunement to our current situation and needs, replacing the one on stage before.  “Whenever a new character arrives, the one before is forgotten,” Williams says; recalling, for me, Elkhonon Goldberg’s description of consciousness as, “a neural network operating at a sufficient intensity for a sufficient period of time.”  When one neural network replaces another, consciousness changes.

Williams describes self-undermining states as emerging from “An over-alert amygdala, pattern-matching traumatic memories to vaguely analogous situations…The whole point of drawing attention to these switches is to help people break out of imprisoning trances, and also develop an ease and flexibility which allows them, deliberately and consciously, to shift between states, or to pull back into the observing self.”

Because we have this kind of personality structure, we are always vulnerable to one self-state coming forward to dominate the others.  “We all know people in whom one character, self-pity maybe, or a dominator, is more or less permanently on stage.”  Williams gives several examples from her work with clients of the importance of our becoming capable of identifying such controlling selves, moving them off stage, and replacing them with selves who are more attuned to, and competent for, the situation we are in.

The metaphor of an opera can be effective in couples work too. “Even if two people love each other, some of their characters may still be slugging it out.”

These inner characters—states of self—have their own attitudes and histories, plusses and minuses.  Sometimes the state we need isn’t available in our internal array, so we have to import it, as it were, from outside; from people we know who can be, for example, good at interviews.  “Identifying with the psychological skills of others…connects us with the same potentials in our own minds.”

“Which You Are You” envisions the goal of our being in the right state for whatever situation we are in.   “What you’re learning is that you can bring whatever character you need on stage, allowing you to handle a situation skillfully.  And you’re also learning how readily a mismatch between a part and a situation can generate problems…What an extraordinary sense of control and personal power, when you know and appreciate all the different parts of yourself.”

It’s important not to be too perfectionistic or serious about this.  “In all of this…a light touch is crucial, an essential safeguard against self-absorption or pretentiousness.”  Keeping it light helps us regain our balance.  “When we have identified sufficient characters in the dramatis personae, we can look at any of them evenly, without judgment…Lighthearted naming lessons tension and helps pull us back into the observing self…Any of the characters can be allies, just as long as we have them rather than them having us.” And, “Any character will hold up the show…if something else is needed…I have never seen anyone, after encountering their ‘opera,’ exclusively identifying with any character, although they may have done so…before that.”  Williams quotes Nietzsche, :  “Woe to the thinker who is not the gardener, but only the soil of the plants that grow in him.”

Williams, like Deikman, has a spiritual perception at the core of her understanding of personality.  The approach that she’s describing “leaves the essence of what we are, the heart of us…always intact.  Who we are can perhaps be thought of as partly material, partly transcending that, but it is always safe, because it is the bit that nobody can ever get at…Awareness of our many minds opens up a trail leading well beyond the bounds of therapy.”

In addition to being “an invaluable, commonsense way of helping us begin to know our many selves,” this approach helps us to know others too, Williams says.  “Societies and nations have their multiminds too, and operas of their own.  I sometimes think that if we were able to identify and manage their characters, with the same purpose, clarity and success that we can learn to manage our own, how different perhaps the life of human communities might be.”

I LOVE this presentation, because it contains so much useful information about our minds and how we get stuck and can get unstuck in our lives.  “Which You Are You?” illuminates human nature and experience as they are, rather than trying to fit them into some dogmatic theoretical, philosophical or other package, as so many presenters on therapy and human nature do.  Much as I love it, however, I have two hairs to split, and a bone to pick, with “Which You Are You?”

First, Williams uses the word “psychodynamic” as a synonym for “psychoanalytic,” as many psychoanalysts and others do, in order to differentiate her approach.  But if we understand “psycho-dynamic” as I prefer to, to include any model of mind in which parts are engaged in dynamic (energized) relationships, “Which You Are You?” fully qualifies.

Second, there sometimes seems to be a nuance of difference between how Williams uses the term “observing self” and how I understand Deikman to have used it.  Deikman was an investigator of the mystic tradition as well as a psychiatrist; the subtitle of his “The Observing Self” is “Mysticism and Psychotherapy.”  https://www.amazon.com/Observing-Self-Mysticism-Psychotherapy/dp/0807029513/ref=sr_1_1?s=books&ie=UTF8&qid=1514583673&sr=1-1&keywords=the+observing+self+deikman  He distinguished between the “object self,” which can be viewed like any object, and the “observing self,” pure awareness, which cannot be seen as an object.  When Williams advises her client that “They (the sub-personalities) come and go, you are always there…You are the same person you always were, and that’s all we can say about it,” she is drawing from this well.  Yet she also sees the observing self as a director, switching selves on and off the stage, which seems to me to be an object function.   This is something that I’ll need to meditate on.

Third—this is the bone to pick—Williams’ case examples seem to suggest that therapy can be done on a short-term basis with complex clients through the application of metaphors of self that include multiple parts under some sort of direction, in the context of a supportive and guiding therapeutic relationship.  In therapist peer study groups I facilitate, when we’ve discussed “Which You Are You,” my colleagues welcomed its description of mental life and use of metaphors in therapy, but didn’t see how that would lead to successful brief treatment with most of the clients with whom we are working.

In “Which You Are You?,” Williams is speaking from the Human Givens approach to therapy.  Human Givens is a short-term treatment approach which encourages the therapist to get right in there and deal with what’s happening with the client.  That’s great, but I haven’t seen, in the Human Givens approach, a recognition that clients can present with multiple complex issues that may have to be discovered and dealt with in therapy over time; reflecting clients’ need to develop psychological capacities they didn’t possess, to the necessary extent, when entering therapy.

“Which You Are You?” presupposes a fairly highly developed ability, on the part of our clients, to detach from their sub-personalities and observe them in action, given therapeutic guidance.  Many of our clients, however, don’t come to therapy with much of that ability, so the dynamics of the sub-personalities, as they affect the issues that the client has come to therapy for, may take time to become evident to client and therapist; sometimes a long time.  For example, a client with whom I’ve been working for over five years, with an early traumatic history that itself had taken some years to emerge in therapy, has only recently begun to identify a kind of vigilant guardian self that has been firmly in control throughout much of his life, protecting him and others at the cost of greatly restricting his experience of self and others, and his capacity for relationship.  Another client, with whom I’ve worked for over ten years, listened to “Which You Are You?” perhaps three years into his therapy.  He immediately grasped the principle of the of the selves, and it has contributed often and meaningfully to the value and depth of our therapeutic conversation, but it hasn’t shortened it.  It’s great when therapy can be brief and successful, but it’s by no means, well, a human given, that it will be.  The parts of our personality are neural networks in the brain, and so are the abilities to observe and redirect them.  It can take time to grow the neural networks to observe, adapt and redirect the neural networks that are the sub-personalities.

In fact, “Which You Are You?” has a lot to contribute to psychodynamic therapists who do long-term work, like me.  One contribution is to deliberately focus the therapy on the cultivation of, and access to, the observing self.  In my view, this is often more of an unintentional side-effect of therapy than a main focus, but it is responsible for much of the actual value of most therapy.  Another contribution is to help therapists avoid approaching our clients with theoretical presuppositions about what the parts are—ego, id, superego, Oedipal complex, archetypes, for example—and instead to keep an open mind to discovering them as the client experiences them, in the collaborative therapeutic relationship.

“Which You Are You?” is a favorite single source of information about how our minds work and what our experience is really like.  I regard it as a better source of information about what really happens in the psychological dynamics of our lives, and how we might reorganize them adaptively in therapy, than most of the books I’ve ever read about therapy, put together.

Consultation to Inform and Refine Therapists’ Awareness, Perceptions and Skills

I’ve just completed presentations on consultation for therapists at the annual conferences of three professional associations:  The National Association of Social Workers- Illinois Chapter, the Illinois Psychological Association, and the Illinois Counseling Association.  Each presentation was organized around a lecture/slide show about consultation, and included a live demonstration in which I provided consultation to a volunteer therapist consultee.  Each presentation also had its own emphasis:  more information about consultation, and psychodynamic and cognitive-behavioral concepts, for the NASW-IL; less focus on consultation in general, in order to allow for an additional focus on trauma-informed consultation, for IPA; and less focus on consultation in general, in order to allow time for participants to practice peer consultation with one another, at ICA.  Each of the programs went well, based on participant engagement, comments, and the feedback I’ve received.  In this post, I’ll cover some of the consultation presentation, with the caveat that the live demonstration is what makes it really, well, come alive.

There is an infinite amount of learning about how to do therapy that mental health professionals can explore and accomplish after achieving licensure.  Consultation is a key way for working therapists to inform and refine our therapeutic awareness, perceptions and skills.

Consultation is not supervision, which has specific legal meaning in licensure law for each profession.  In supervision, the supervisor, or program for which the supervisor works, is clinically and legally responsible for the supervisee’s work.  The supervisor is a professional gatekeeper who is responsible for evaluating the supervisee’s qualification to enter the field.  Supervisees cannot select their supervisors at will, and may have to work with supervisors whose therapeutic styles, methodological preferences, and theoretical commitments are not a good match for their own talents, skills or interests.  Nor can supervisors select supervisees; they may have to work with supervisees in whom they have little confidence, or about whose talents and abilities they may have doubts, due to program commitments.  And supervisees have to work under supervision for a legally designated number of hours in order to be eligible for licensure.

Consultation, on the other hand, is a relationship between independently licensed professionals, which aims at informing and refining the consultee’s therapeutic awareness, perceptions and skills.  It confers no formal certification and is entirely at will.  Consultees can select any consultant they’d like to work with who will work with them (and with online consultation, their consultant can be anywhere in the world).  Frequency of meeting is up to the consultant-consultee pair; weekly, every other week, every third or four week, etc.  There is no required amount of time for consultation; it continues until either or both parties decide to stop.  Basically, we select people to consult with from whom we can learn.

There are different types of consultation.  Mentoring consultation is a teacher-and-learner relationship, in which the consultee works with a consultant from whom the consultee has something to learn.  In peer consultation, colleagues consult on an equal basis for mutual benefit.  Either mentoring consultation or peer consultation can take place on a 1:1 or group basis, and either form of consultation can be time-limited or ongoing.

In addition to types of consultation, there are styles of consultation.  The length of time the consultee prepares to present a case can vary from none (a completely spontaneous presentation) to some (some forethought, review of therapy notes, making some notes to present from), to extensive (preparation involving hours of writing and pages of text).  The length of time after the consultee begins presenting the case, before the consultant (or, in a group, consultants) begin to engage by asking questions or making comments, can vary from a few minutes to half an hour or more.  Some consultation is strictly within a particular theoretical model, while other consultation uses any model of mind, and of how therapy works, that helps to make sense of the cases and experiences which consultee and consultant are discussing.  The amount of coherence expected in the consultee’s presentation of the case can also vary.  My preference is not to expect too much coherence, because that risks the consultee and consultant trying to make the therapy fit a particular theoretical model.  I prefer to allow coherence to emerge in the discussion of the experience of the therapist, the experience of the client, and the experience of the therapist-client pair.

What do consultants and consultees talk about?  We talk about the client’s situation, history and experience, past and present, outside the therapy office.  We also talk about the client’s experience, feelings and behavior in the therapy office, and the therapist’s experience of being with, and working with, the client.  We talk about how the therapist understands the client, and her therapeutic relationship with the client, and about areas where the therapist feels confused or stuck; and ways the consultant might see the therapy that the consultee is describing.

We also talk about the “frame” of the therapeutic relationship, which means the therapeutic, economic and professional roles and responsibilities of the client and therapist to themselves and each other in their work together.  This includes such areas as late arrival, extending sessions, missed payments, missed sessions, control of the focus of the conversation, etc.   We talk about the therapeutic agreement or contract, meaning the goal(s) or purpose(s) of therapy, and whether they are clear, achievable, and agreed by client and therapist.  A lot of therapy takes place in a kind of preliminary phase, where the goals and purposes of therapy are, at best, implicit and emerging.  Clarifying goals itself can be a therapeutic process.

From psychoanalytic culture comes the idea that there are two levels of therapy.  The first is where the client receives the attention, respect, caring, concern, presence and empathic support of the therapist.  These are all necessary ingredients of the therapeutic relationship, and that can often be as far as the therapy goes.  The second is where the therapy is providing that support and also making it possible for the client to work on her- or himself.  This means that the client is looking at his own issues outside the room, in life outside of therapy, as well as inside the room, in the therapeutic relationship.  Some analysts call these two levels the supportive relationship and the analytic relationship.  I’ve referred to them as the supportive relationship and the working relationship, in order to make headroom for work, with and on the self, that may include, and also extend beyond, the traditional mental models of psychoanalysis.  Consultation can help therapists establish the first level, and then co-create bridges, with their clients, to the second.

Since consultation is so valuable, why isn’t it more widely known, recommended and practiced?  Part of the explanation lies in the fragmentation of the world of psychotherapy, in which people in different therapeutic cultures keep pretty much in their own silos. Psychoanalytic culture does feature what it still calls supervision, even after licensure and certification.  But that culture tends to be wrapped up within itself, and affords few points of entry for mainstream therapists who don’t wish to steep themselves in its theories, terminology, or fealty to Freud or other iconic figures.  Jonathan Shedler, a leading psychodynamic researcher and practitioner, commented that he had learned, from teaching therapy to beginners, that if he couldn’t explain what he meant to them in ways they could understand in the context of the therapy they were doing, that meant he didn’t understand it well enough.  “If you’re only talking to other people steeped in the same history and traditions, you operate on the assumption that you both understand what you are talking about.  I thought I understood (basic psychodynamic concepts) until I had to explain them to someone who wasn’t steeped in that tradition, and I floundered with it” (personal communication).  He emphasized that it’s up to consultants to “bridge the gap” between what they know and what their consultees need to learn.

Cognitive-behavioral therapy, on the other hand, has tended to be narrowly focused on specific conditions and treatments, allowing little space for the complexity of human experience involved in the exploration of relationships, identity and meaning.  Nor has it tended to recognize the potential wellspring of learning that can be harvested from the complexity of the client-therapist relationship itself.  That is beginning to change with the development of hybrid treatments like Dialectical Behavioral Therapy and Acceptance and Commitment Therapy, but a narrow focus on problems and goals tends to be characteristic, as does the role of the therapist as director rather than collaborative guide in the work.  What’s needed is a general practice of consultation beyond therapeutic silos, by consultants who can add value to consultees without requiring them to spend years acquiring a new culture–most of which will be irrelevant to them–or to trim and package their work with clients to fit within a silo’s theoretical framework.

Therapy cultivates reflection:  the client’s reflection on himself, the therapist’s reflection on the client, and both client’s and therapist’s reflection on their therapeutic relationship.  Consultation adds another dimension of reflection, in which the consultant helps the therapist reflect on herself. her client, and their work together.  The therapist “polishes the mirror” for the client, and the consultant “polishes the mirror” for the therapist.


Having Difficult Conversations More Effectively

This is an edited summary of my blog post of May 31, 2013, in response to inquiries about how to have difficult conversations more effectively.

Communication fads come and go, but difficult conversations are here to stay, so information that helps us to have them more productively is welcome. The books, “Difficult Conversations,” and “Crucial Conversations” describe a number of ideas, attitudes and skills to help. Most of the concepts I’ll mention come from “Difficult Conversations.” “Crucial Conversations” looks at the same territory in a somewhat different way, with one very important difference.

We All Have Difficult Conversations

Communication fads come and go–there’s a new one every few years in the worlds of human education, therapy, human relations and organizational training—but difficult conversations are here to stay.  In my work, four impressions have become clear:

1. Many difficult conversations that go badly don’t need to be had at all. They occur because of a misunderstanding that could have been cleared up through simple inquiry, or because people acted on feelings and assumptions they should have taken time and effort to understand and manage rather than “letting them out the door” prematurely.

2. Many difficult conversations that should be had are avoided, because the people who need to initiate and manage them don’t know how to. The result is that bad consequences happen because no one is dealing with a problem that needs to be dealt with.

3. When difficult conversations are necessary, there are attitudes and skills that can help them to go better.  Such conversations can be useful and even healing.

4. When difficult conversations happen without the necessary attitudes and skills, they can be counterproductive, with people feeling worse, and attitudes, perhaps based on incomplete information, hardened.

The book “Difficult Conversations,” by Douglas Stone, Bruce Patton, and Sheila Heen, of the Harvard Negotiation Project, takes an in-depth look at how difficult conversations can go wrong, and describes a set of concepts, attitudes and skills to support having difficult conversations more effectively and productively.  I’ve found it useful in my work in individual and couples therapy and organizational consultation and training.  It’s on Amazon at:  https://www.amazon.com/Difficult-Conversations-Discuss-What-Matters/dp/0143118447/ref=sr_1_1?ie=UTF8&qid=1508357024&sr=8-1&keywords=difficult+conversations+how+to+discuss+what+matters+most

Some Key Ideas From “Difficult Conversations:”

1. Shift from a Conflict Conversation to a “Learning Conversation.”

The purpose of applying the “Difficult Conversations” methods is to move difficult conversations from being antagonistic or adversarial conversations, in which people are attacking and defending, or trying to achieve goals through power or manipulation, to being learning conversations in which both parties are listening to one another as well as saying what they need to say.

2. The “Three Conversations.”  A key idea in “Difficult Conversations: is that every difficult conversation is really three conversations:  1. The “What Happened” conversation, consisting of “3 stories” (see below),  2. The “Feelings” conversation, and 3. The “Identity” conversation.

3. What Happened: The Three Stories.  There are three stories about “what happened” in every difficult conversation: each party’s story or version of events, and the “third story.” The “third story” is the story which might be told by an impartial third party, such as a mediator, which includes elements of each party’s story without casting any blame.

For example, in a school situation, a parent and teacher might need to have a difficult conversation about a child’s failure to complete his homework.  Let’s say that Johnny, a fifth grader, has stopped handing in his homework and is falling behind in class. The teacher’s story is that she is sending homework home with Johnny but his parents are not following through to make sure that he does it. Johnny’s parents both have demanding jobs and the teacher thinks that they are just too drained when they get home to have the energy to do the difficult work of making Johnny do homework, especially if he doesn’t want to do it. She also thinks Johnny’s parents might feel guilty about spending so much time away from home at work, so they might be overly permissive and allow him to avoid homework.

Johnny’s parents’ story, on the other hand, is that Johnny is being bullied by a bunch of kids at school, and he’s hurt, sad and angry about it, and doesn’t want to even think about school once he’s out of there. So that’s why they think Johnny isn’t doing his homework. And they think his teacher is either accepting other students bullying him as normal behavior and letting it happen, or she’s too weak to stop it, or she is just too inattentive to even notice that it’s happening.

The “third story” is that Johnny is not doing his homework and falling behind in school, so now his teacher and parents need to look at this together to try to understand why he’s falling behind and see how they can work together to help him get back on track.

The “Difficult Conversations” authors suggest starting a difficult conversation with the “third story.” Johnny’s teacher might do that at the beginning of her meeting with his parents, to start the conversation on a good foundation that she can “reframe” back to if the conversation is in danger of becoming undermined or blown up as it progresses.

4. The “Feelings Conversation.”  According to “Difficult Conversations,” every difficult conversation is powered by feelings, which are often not acknowledged. It can be very important to acknowledge these feelings without letting them undermine the conversation. For example, Johnny’s parents may feel angry about Johnny’s being bullied at school, helpless to do anything about it, and let down by his teacher. His teacher may feel let down by Johnny’s parents, and angry at them for unfairly blaming her, like a scapegoat. It’s important for both parties to acknowledge and respect one another’s feelings, while not letting them derail the conversation. If someone becomes too upset, taking a time out and returning to the conversation in a few minutes, or even rescheduling it to another day, can help to keep it on track.

5. “Reframing.”  Reframing is one of the most important “Difficult Conversations” skills. If Johnny’s parents accuse his teacher of not caring about him, she could allow the conversation to get blown off course, by reacting defensively or counterattacking, or she could reframe the conversation by interpreting their comments as an expression of their concern, emphasizing that she is concerned too–that’s why she called the meeting–and getting the conversation back on track.

6. The “Identity Conversation.”  The “identity conversation” could be described as the stake that each person’s ego or self has in their personal or professional role in the conversation. For example, if Johnny’s parents accuse his teacher of not caring about Johnny, they are attacking her identity as a teacher. If she then gets stuck in defending herself–”of course I care about him, I’ve been a teaching for a dozen years and I care about every one of my students!”–or gets too upset to remember her agenda for the meeting and keep managing her role as facilitator, the conversation is likely to become useless or counterproductive. And of course the same thing could happen if she counterattacks Johnny’s parents with: “If you took your parenting responsibilities more seriously, you’d make sure he got his homework done!”

7. Reframe From Blame to Contribution.  The “Difficult Conversations” authors regard the establishment of blame as not a useful strategy. Instead, they assert, it’s more useful to think in terms of the relative contribution of each party. In our example, it doesn’t really help anyone for Johnny’s parents blame his teacher or his teacher to blame his parents. But if, as a result of the difficult conversation, Johnny’s parents and teacher can have a learning conversation, the teacher might realize that she’s contributed to the problem by not being aware that Johnny was being picked on (or at least feeling picked on), and his parents might realize that they’ve contributed by letting Johnny avoid his homework.

8. Avoid “Intention Invention.”  By “intention invention,” the authors mean that we make up reasons about why we think someone we’re in a conflict with is doing whatever they’re doing, when in fact we don’t really know why they’re doing it.  “Intention Invention” reminds me of two rather complicated ideas, which I’ll mention without going into in depth: “attribution” in cognitive psychology, and “projective identification” in psychoanalytic psychology.

The “Difficult Conversation” authors emphasize that most of what we do has multiple motivational sources. In our school example, Johnny may be falling behind in his homework partly because he’s being picked on, partly because he feels the teacher doesn’t like him, partly because he finds the work difficult and would rather avoid it, partly because there are more enjoyable activities for him to do after school, and partly because he can get his parents to let him, which makes him feel special as well as getting away with not doing it.  His teacher and parents will have similar multiple motivations contributing to their own perceptions, feelings, and attributions. So it’s generally a mistake to think that someone we’re in a conflict with is doing whatever they’re doing for only one reason,; or that we ourselves are. We are almost always operating on the basis of a mixture of motivations.  “Intention invention” is a modern version of the old saying, “Give a dog a bad name and hang it.”

9. Authentic Listening.  Authentic listening is a key skill in any difficult conversation. Everyone knows that you’re supposed to listen, but people often just go through the motions of listening, and sooner or later the other person usually gets this.  You don’t have to accept what the other person says, or thinks, but you have to really be there, and really listen.

“Crucial Conversations” and the importance of truth

Another book that provides insight, attitudes and skills for having difficult conversations effectively is “Crucial Conversations: Tools for Talking When the Stakes Are High,” by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler. “Crucial Conversations” provides ideas such as “Speaking Persuasively, Not Abrasively” and “Making It Safe” in a conversation, and many others, covering much of the same territory as “Difficult Conversations,” in another way. But one key difference between “Crucial Conversations” and “Difficult Conversations” is in the attitude toward truth.  It’s on Amazon at:  (https://www.amazon.com/Crucial-Conversations-Talking-Stakes-Second/dp/0071771328/ref=sr_1_1?s=books&ie=UTF8&qid=1508357115&sr=1-1&keywords=crucial+conversations+tools+for+talking+when+stakes+are+high).

“Difficult Conversations,” holds that each person has their own truth; there isn’t necessarily an objective truth per se, so what’s important is that the parties can listen to one another and have a learning conversation about how each other is seeing things. “Crucial Conversations,” on the other hand, sees objective truth as existing in situations, so much so that the goal of conversational skill is to be able to speak the truth about a situation in a way that everyone in the conversation can hear it. So, in “Difficult Conversations,” there’s my truth, and your truth, and we have to work it out. In “Crucial Conversations,” there’s the truth, and we have to be able to acknowledge it together.

In my work, I’ve coined the phrase, “the minimum necessary truth.” In a difficult situation, we may not have have access to the complete truth—when do we ever?—or even to a larger view of what’s true, but there is a minimum necessary amount of truth which must be acknowledged if things are to get better.

“Them and Us:” Arthur Deikman

Psychiatrist Arthur Deikman (www.Deikman.com) makes an important contribution in his book, “Them and Us: Cult Thinking and the Terrorist Threat.”  Deikman discusses the effect of propaganda and how cult-like thinking can foster the illusion of debate of issues rather than genuine consideration. “In most conflict situations, disagreements are based on differences in interpretation and in the priorities given to different values, but these differences are seldom stated, and, lacking that clarification, we absorb highly selective information, are swayed to one side or the other, but end up no wiser…opposing propagandas do not assist the democratic process but produce partisans, each with the mind-set of a cult member…” It’s easy to see how the same attitudes undermine the necessary difficult conversations of life, when the participants try to win (however they define that) rather than have an actual conversation.

Deikman indicates four areas that can usefully be clarified in the discussion of a controversial problem:

“1. The key data. (Are they disputed?)

2. Interpretations of the data.

3. Value conflicts. (Reason for giving one value priority over the other?)

4. Error indicators. (What events or facts would indicate to each side that their belief or strategy should be changed?)”

Clearly these ideas, and the attitudes underlying them, can usefully be included in many difficult conversations.  “Them and Us” is on Amazon at:  (https://www.amazon.com/Them-Us-Thinking-Terrorist-Threat/dp/097200212X/ref=sr_1_1?s=books&ie=UTF8&qid=1508357180&sr=1-1&keywords=the+and+us+deikman).

Application: From Passive to Active Understanding

The attitudes and skills for having difficult conversations more successfully are not easy for most of us to acquire and use. We generally don’t learn them through our professional education, or even our moral, religious, or spiritual education. Doing difficult conversations well requires a lot of executive functioning; staying on task, not taking criticisms and attacks too personally, continually monitoring the conversation and reframing as necessary.

Psychologists distinguish between different forms of learning, such as semantic and procedural. It’s one thing to know the key ideas about how to have difficult conversations more effectively so that one can define them or answer multiple choice questions about them. It’s entirely another thing to know them deeply enough to apply them in actual situations. When I’ve taught these concepts to groups with lecture and slide show, I’ve often found that people seem to understand them intellectually pretty well, but when we start discussing cases or role playing, they revert instantly to a “them and us” attitude.

One of my favorite teaching stories is about Ibrahim Ben Adhem, a prince who, like the Buddha, left his royal home to seek knowledge. As he was walking down the road he came across a stone on which was written: “Turn me over and read.” Turning the stone over, Ben Adhem read: “Why do you seek more knowledge when you pay no heed to what you already know?” (Retold by Idries Shah in his Caravan of Dreams, within the narrative, “Encounter At A Hermitage.”  On Amazon at:  https://www.amazon.com/Caravan-Dreams-Idries-Shah/dp/178479015X/ref=sr_1_1?ie=UTF8&qid=1508355989&sr=8-1&keywords=caravan+of+dreams+idries+shah)

This is why experiential learning is so important when it comes to learning difficult conversation skills (and many other relationship skills!). Discussion of actual case situations, and role playing of actual and simulated situations helps to bring home the meaning of attitudes and skills for difficult conversations. Even participants who just watch can potentially benefit from watching others.

Learning a concept doesn’t necessarily mean knowing it deeply enough to apply it, and we all tend to revert to old habits and “them and us” attitudes in actual situations. So, in addition to presenting the information, I recommend depth learning through experiential methods, including discussion of cases in detail, role playing, and pre-conversation preparation and and post-conversation reflection and debriefing.


(I don’t know why one Amazon book link came out live and the others didn’t!)  

“Projection” Before Freud

Freud and his followers thought that they had discovered the human tendency to project one’s own assumptions and preoccupations onto others.  When this happens in therapy, it’s called “transference” (patient projects onto therapist) or “countertransference” (therapist projects onto patient).  However, this tendency has been well known, in at least some circles, since ancient times.

Idries Shah gives a tale illustrating this in his “Special Illumination: The Sufi Use of Humour.”

One day a scholar ran into a gang of bandits who threatened to kill him.  “I think you are a spy or a police agent,” the chief said.

“No I am not.  I am only a poor scholar,” said the unfortunate captive.

“‘How can you prove it?”

“I can read from a book.”

“That’s no good to us:  we’re all illiterates.  How do we know you will really be reading, and not just making it all up?”

So they killed him.  “I didn’t become head of this band of outlaws by believing everything people told me, you know,” said the chief.  And his wisdom was, of course, unanimously applauded by his men.  (Octagon Press, 1977, p 40-41)

Shah comments:  “The attributing of one’s own characteristics to others, so common amongst—for instance—generous and stingy people alike, needs both illustrating and fixing in vivid tale.  The brevity of this tale enables one to shock someone out of this habit pattern.  The need to point out the syndrome is there because Sufi understanding cannot come to people who are too extensively self-deceived.  To imagine, therefore, the other person’s motivation is what is actually one’s own is self-deception.”

Because this knowledge was not generally available in Western culture before Freud—along with others with whom he was in collaboration and conflict, often characterized by their own projections onto one another—created psychoanalysis, it has been incorrectly believed that the psychological projection of one’s own preoccupations onto others is a new discovery, and that only psychoanalysis can bring it into conscious awareness.  In fact, it has been perennially known to genuine spiritual traditions, which include methods—for example, this story—for helping learners become aware of this process in themselves and others, and escape being controlled by it.

Brene Brown in Evanston

I went to Brene Brown’s appearance in Evanston last week, wrote down some of her comments, and had a thought about them.  The remarks I wrote included:

•”Speak truth to bullshit.  Be civil.  Refute bullshit with generosity, curiosity, civility.”

•We need to move from “dehumanizing” others to “rehumanizing” others.

•We should move from “conflict resolution” to “conflict transformation” (quoting a teacher at the Kellogg School at Northwestern University).

•She spoke about someone having “a ministry of presence.”

•She advises having a “strong back, a soft front, and a wild heart.”

•”Stop walking through the world looking for evidence that you do not belong, that you are not good enough, because you will always find it.”

Many of her remarks seemed to me to apply to that motivational space that Maslow described as the transition from the lower to the higher levels of identity, self-respect, self-esteem.  At the lower level we are emerging from the belongingness needs and we seek status and identity within the context of approval of others with whom we are affiliated, which could include family, friends, professional organizations, etc.  At the higher level we are seeking to be in touch with and true to our authentic sense of who we are, and how we should be true to ourselves while responding to others.  This all takes place within Maslow’s fourth level in his hierarchy of motivation, “Identity,” above “Belonging” and below “Being.”  However, Brown’s comment about having a “ministry of presence” seems to have more to do with what Maslow called “Being.”  Her remark about a “strong back, soft front, wild heart” seems to be trying to put it all together; to be true to one’s identity, to find attachment and belonging with others, even those with whom we disagree, and to remain open to inspirations that may not fit easily into our belonging relationships and may even challenge or transform our sense of our own identity.

At the International Psychohistory Association 2017 Conference

The International Psychohistorical Association held its 40th annual conference May 31-June 2 in at New York University, and I attended and presented.  The main theme was “Exploring the Intersection Between History and Psychology,” and the sub-theme was “Psychohistory in the Age of Trump.”  There were more presentations than I could attend, and I wasn’t taking notes all the time, so this isn’t a comprehensive report, just some of my notes.

Wednesday, May 31

Howard Stein:  “Organizational Poetry As a Portal to Understanding 

Organizations, Society and History”

Who would have thought that poetry has anything to do with understanding organizations?  Howard Stein, of the University of Oklahoma, opened with a talk on “Organizational Poetry as a Portal to Understanding Organizations, Society and History.”  Stein, who was honored at this conference for his contributions throughout the years, is both an organizational consultant and a poet; an unusual combination.

Poetry makes it possible to say “the undiscussable, out in the open,” Stein said.  He read a poem of his called “Slash and Burn,” about “downsizing, reengineering, outsourcing” etc., including:  “Falsehood is truth, disagreement is betrayal, fear is victorious, death triumphant, furies rule the night.”  From another poem, also about downsizing, Stein read, “What is happening has not happened, and if it has, we do not want to know.”  From another poem about a hospital system in which 1,000 people had been laid off, he read, “Where is the blood?”

Stein referred to “an enormous literature on what’s called ‘transformational leadership,’ people brought in by shareholders, boards of directors, to rescue an organization that they fear is going downhill.  The ‘transformational leader’ gets rid of the dead wood, gets rid of fat, trims muscle to the bone, gets rid of the old, which is (seen as) the source of what is wrong with the organization.  This happens even when organizations show profit, but not enough.”  Then he read a poem, beginning, “The new CEO arrived like a god on a chariot…”

Stein then invited us to write our own poems about organizations, and several people read theirs.  It certainly provided another avenue to access and express the experience of being in an organization.

Peter Kuznick:  “Trump and Foreign Policy”

Peter Kuznick, of American University, then spoke on “Trump and Foreign Policy,” which, he said, was like trying to hit “a moving target.”  Kuznick was in Russia several times during the 2016 campaign, and “nearly everyone supported Donald Trump there, perceiving Clinton as hostile to Russia.”  Kuznic agreed that Clinton was hostile to Russia, and also a hawk, but saw her as a better choice than Trump, because of his “inconsistency and unpredictability.”  About nuclear weapons, Kuznick quotedTrump as saying, “What’s the use of having these weapons if we can’t use them?”

Despite Trump’s signature narcissism, Kuznick described him as in the tradition of other American presidents, particularly George W. Bush, who started the war in Iraq, and Harry Truman, who dropped the atomic bomb on Japan.  He read a list of American foreign policy transgressions over time to emphasize the point that, while Trump’s style is in some ways unique, his policy positions are consistent with America’s foreign policy history.  As to making up stories, Kuznick said that Trump is comparable to Ronald Reagan, who told Israeli prime minister Yitzak Shamir that he had been in a signal corps during W.W. II that liberated a concentration camp, and had kept the film to prove that the camp existed against Holocaust deniers.  In fact, Reagan had never left the United States.

Robin Stern and Judith Logue:  “Gaslighting:  From the Personal 

to the Political”

Next, Robin Stern, of the Yale Center for Emotional Intelligence, and Judith Logue, in private practice, presented on “Gaslighting—From the Personal to the Political.”

Stern wrote “The Gaslighting Effect” ten years ago, and her part of the presentation was about “the personal function of Gaslighting,” which is when one person makes another person think she’s crazy by lying to her and making her doubt her perceptions of reality.  “Gaslighting is always a co-creation of two people,” Stern said, “the gaslighter, who is more powerful, disqualifying the perceptions, memory and sanity of the gaslightee.”  However, “the gaslightee holds the keys to her personal prison, if she finds the courage to refuse the gaslighter’s influence over her.”  In her therapy practice with couples, Stern often saw one partner gaslighting the other.

Judy Logue then talked about gaslighting going political.  The steep reduction in the middle class creates a situation in politicians can gaslight the electorate about the causes for their economic decline.  “Isolation is the most important tool in the Gaslighter’s kit,” she said.

Elizabeth Lomback, Natasha Zuretsky, and Dagmar Herzog: “The Legacy of Christopher Lasch’s The Culture of Narcissism.”

Continuing the theme of psychohistory in the age of Trump, the next panel included three speakers discussing Christopher Leach’s 1979 book, “The Culture of Narcissism.”

Elizabeth Lomback, of Harvard, author of “The Americanization of Narcissism,” observed that “the upsides of narcissism have to do with Trump’s success, and the discussions of the downsides of narcissism don’t help us to understand his appeal.  There are paradoxes here; (the narcissist seems) to be caring at some times and ruthless at others…What is at issue is not the narcissist’s personality but the ways he mobilizes that personality to make connections with others…Visionary, charismatic, ambitious, (with) high self-esteem, ruthlessness—“ these are characteristics of skillful narcissistic leaders.

Natasha Zuretsky, of Southern Illinois University, author of “No Direction Home:  The American Family and the Fear of National Decline, 1968-1980,” spoke next.  “The displacement of politics by spectacle” is one of the characteristics Lasch saw in a culture of narcissism.  In the late 1970’s, Lasch “recognized the decline of the American middle class,” which has since progressed to unemployment and underemployment, the opioid epidemic, high rates of diabetes and heart disease, death rates that are increasing after having diminished in the population, “expressing the hopelessness of the middle class.”  “The decline of the middle class was masked to some extent and for some time by the conscription of women into the workforce.”  This “made a culture that was more equal and inclusive, even as economic inequality increased with lower status and wages in available jobs.”

Dagmar Herzog, of the City University of New York Graduate Center, author of “Cold War Freud,” “Sex in Crisis,” among others, spoke next.  She commented on “the transportation of Lasch’s ideas into the cultures of West Germany and Switzerland  in the 1980s, and also the ideas of psychoanalysts Heinz Kohut and Otto Kernberg, on whose work Lasch relied.  “It was not easy to return psychoanalysis to post W.W. II Germany, which was anti-semitic and anti-psychoanalytic.  Eventually, psychoanalysis received more prestige and welcome in West Germany, in its view of aggression as a basic drive…”  Over time, analysts’ perceptions of their patients changed from one preoccupied with Oedipal issues, as conceived by Freud and his followers, and came to focus on narcissistic issues, as discussed by Kohut and Kernberg.  “Dozens of analysts decided that they had misdiagnosed their patients as neurotic when they were all narcissistically disturbed.” “Kohut was a permission giver to analysts to be warm with patients,” instead of neutral and unresponsive.

Arnold Richards, Arthur Lynch, Bert Seitler:  

”The Politics of Exclusion–Discussion of Dr. Richards’ Selected Papers”

“The Politics of Exclusion and Institute Stagnation,” is about the exclusion of some psychoanalysts by others in psychoanalytic institutes.  Arnold Richards, of the New York Psychoanalytic Society and Institute, Arthur Lynch, of Columbia University, and Burt Seitler, of the Journal JASPER (Journal for the Advancement of Scientific Psychoanalytic Empirical Research), discussed the topic (note:  I didn’t have any notes from Lynch).  Richards said, “Psychoanalysis as an institution needs to come to terms with its history, which includes a legacy of exclusionary politics.”  The way forward, he thought, was not “theoretical restoration”—the search for an inclusive theory—but rather “a politics of inclusion,” an “integrated pluralism.”

Seitler read a paper, “Dissension Within the Sanctum Sanctorum, the Psychoanalytic Institute.”  He began his talk with a sardonic, amusing question:  “Why is it that supposedly well analyzed individuals stimulate the most primitive (emotional reactions) in one another within the Institute, (including) jealousy, narcissistic rage, and sibling rivalry?”  He continued, “To begin with, the notion of being ‘completely analyzed’ is a delightful fiction…The early history of psychoanalysis is marked by bitter excommunication of once-cherished disciples, (including) Jung and Adler…Psychoanalytic institutes were originally founded to support and protect creative thinking, but the dynamics of institutes may mitigate against that.”

Richards then commented that psychoanalysts Sandor Rado and Karen Horney wrote the report for setting of standards for training (under the imprimatur of a better known person), under which the Americans had a franchise for psychoanalytic training.  Later, both Rado and Horney were excluded from being accepted as qualified to offer training in the USA because (if I heard Richards’ comments correctly) one wasn’t a psychiatrist and one wanted to do analysis and training only three times a week, instead of 4!   Richards commented, “The division between the haves and the have-notes, the training analysts and the non-training analysts, persists to this day.”

Thursday, June 1

Paul Elovitz, David Cifelli, and Peter Petschauer:  

“The Psychology of Trump and the 2016 Election”

Paul Elovitz, of Ramapo College, saw Trump as needing “to pick fights and win,” and said,  “One of the great dangers of Trump as president is that he will pick fights with other countries” because of that need.  Elovitz saw Trump as having a “personality characteristic of being left behind and vulnerable,” which “helped him to connect with many people who feel that way.”

David Cifelli, a student formerly at Ramapo College, had spoken with a number of Trump supporters, and found them responsive to Trump’s “shift(ing) the blame to others, provid(ing) ready-made scapegoats.”  One older person said “I would be ashamed if he were my son, but we don’t have to elect a nice guy, we have to elect a president.”

Peter Petschauer, emeritus professor at Appalachian University, observed that “There is a similarity to authoritarian regimes across the world, not only in how they (behave) in power but also in how they got into power.  Getting into power usually involves slogans, and you have to make an impressive figure.”  They need to have “flags everywhere, massive assemblies of troops, even before the person gets into power.  Trump had more flags on the podium” than Petschauer had ever seen.  Petschauer found that authoritarian regimes often come to power supported by “promises to correct a lost war, even centuries earlier,” as had been the case with Milosevic in Yugoslavia.

“Trump talks about America as a loser,” Petschauer said.  Authoritarian leaders make promises to correct past wrongs, attracting the support of those who feel left behind.  They gain the support of conservative religious groups; Hitler had such support, and Putin has the support of the Orthodox Church.  There is also an attack on certain individuals, generally disliked ethnic groups, and women, in some form or other.  “Hatred is such a satisfying quality.”   Authoritarian leaders “export lies,” and lie often—Hitler said the more you repeat a lie the more it will be believed—and “use the latest forms of media effectively; Hitler used the radio.”  They “surround themselves with sycophants.  Have big construction projects.  Start wars.  Pack the judiciary.  Arrest journalists.  Sideline and arrest opposition.  The first people in Germany put into concentration camps were not Jews, they were socialists and communists.”  They “excuse misbehavior of supporters and friends, who have permission to lie, bully, steal,” and engage in “massive personal, financial, political corruption.
The good news is that, “in the long run, these authoritarian leaders fail.  Hitler, Mussolini, Berlusconi.  Putin’s regime is beginning to crumble, (though) Erdogan is on the upswing.  Dictators hear what their sycophants tell them, which is what they want to hear, not what is really happening.” But “Trump is everywhere, everywhere you go, (which) will ultimately turn against him.”

In the Q and A period, I asked Petschauer about the viability of the institutions we have in the era of Trump.  He responded that “There is a lot of professionalism in our institutions, but people value their jobs.”  He referred to Germany, where professional and independent legal and educational systems were undermined from the top, by people that Hitler appointed.  In Turkey, people are being arrested en masse, to undermine institutions.

“One thing about power is that it is so wonderful,” Petschauer continued.  “Power is better than any other human form of expression.  When people get into power, they will do almost anything to stay there.  Congressmen will do almost anything to stay in power,” and this weakens the integrity of institutions.

Ken Fuchsman and Irene Javors:  

“New Directions in Psychohistory and Psychobiography.”

Ken Fuchsman, of the University of Connecticut, began by observing that “Although psychohistory as such is in disrepute” (among the disciplines of history), historians use psychology and psychotherapeutic concepts.  Psychology and a psychological perspective on leadership personality is an inevitable component in historical writing, and some of the most important issues in history cannot be approached without psychology. “The inevitable intersection of psychology and history sneaks in the back door.”  Fuchsman quoted Peter Gay:  “The historian is an amateur psychologist.”  And, “Self-actualization cannot occur without cultural actualization.”

Irene Javors, of Yeshiva University, presented on: “Do Ask, Do Tell, Contemporary Questions for Psychohistorians and Psychobiographers.”  She said that “The concerns of psychohistory and psychobiography have been too focused on psychopathology, without enough focus on cultural issues” of prejudice and oppression.  She gave the illustration of a client, gay and the survivor of gay-bashing as well as organizing for civil rights in the south, who, putting his hand out to prevent an African American woman, preoccupied with her cell phone, from walking into him on the sidewalk, was shouted at, “Keep your hands off me, you white bastard!”  Javors sees this from a social point of view, institutions and cultural norms impacting individuals.

During the Q and A, a questioner objected to Javors use of the term “intersectionality” to include her white gay client.  The questioner felt that “intersectionality” properly referred only to nonwhite groups.

Molly Castelloe, Appreciation of Howard Stein

The next program was a celebration of Howard Stein, and one of the speakers was Molly Castelloe, of the Metropolitan College of New York.  Appreciating the recognition of complexity which Stein’s poetic approach to understanding organizations affords, Castelloe observed that “Trauma spreads in cultures through many vectors,” including “horizontally (between peers), and vertically (in power relationships).” She continued, “Trauma (meaning, I think, traumatic events in the world we live in) finds (the) unacknowledged grief in groups.”

Janice Gump:  

”We Can’t Know the Present Absent History of the Past:  

The Transmissions of Slavery’s Traumas”

Janice Gump, PhD, of the Institute of Contemporary Psychotherapy and Psychoanalysis, gave the afternoon’s keynote address:

Slavery “was the most determining aspect of African-American being” or subjective personal experience in this country, “and also what may have been one of the most determining aspects of the United States, economically and culturally, (including) to slavers and their supporters.  I think it is as important if not more important to understand those who do the victimizing as to understand those who are victimized…The most fundamental aspect of slavery was the belief that blacks were fundamentally inferior to whites, defective, not quite as human.  This made it possible for them to be treated as property,” and left a legacy of trauma transmitted through the generations. “Children who experience unbearable affect in the absence of attunement by attachment figures are likely to feel responsible for their distress and also for the absence of the parent,” whether that absence is physical or emotional.

My presentation:  “The Election Pie Chart:  How Did This Happen?”  

In the summer of 2016 I bet a couple of guys a bottle of wine each that Trump would win–hoping to be mistaken!  After the election, I spoke with them, and several others, about why the election had gone the way it had, and began an informal pie chart of the contributing factors.  That grew into my submission of “Election 2016 WTF:  The Pie Chart,” and the title was gentled while entering the conference brochure.

Of course, Hillary Clinton and the Democrats deserve credit for winning the popular vote by nearly 3 million votes, but still lost the election.  So I wanted to look at what happened with what I called a “ruthlessly realistic” perspective.  Here re the slices, which of course overlap:

•The economic disenfranchisement of the middle class, with corresponding loss of social status and economic control over one’s life, is the largest single slice.  Psychologist Hadley Cantril, in 1941, published “The Psychology of Social Movements” in which he studied, among others, the rise of lynchings of African-Americans in the American South after the Civil War, and the rise of Naziism in Germany after W.W. I.  In both situations there were the dynamics of a disenfranchised former middle class which, in a less extreme way and to a lesser extent, were present in the USA during the 2016 election.  I reviewed some of Cantril’s findings from the post Civil War South and post W.W. I Germany, and compared them with the situation here.  The causes of this economic disenfranchisement–mainly mergers and acquisitions, globalization and the ending of the U.S. unique manufacturing hegemony after W.W. II, and automation of manufacturing–are too complex and long-term to be captured in a simple slogan or amenable to a simple solution, but Trump’s slogan and strategy galvanized support from this large segment of the population.

•Health Care:  Democrats didn’t get how much the public misunderstood about health care, and how much resentment there was about it, allowing Republicans to claim the issue.  Republican intransigence in refusing to collaborate in fine-tuning the inevitable shortcomings of the Affordable Care Act meant that its problems proliferated, and Republicans PR successfully pinned that on Democrats.

•Democratic mismeasurement of the electorate, which I called “Delusion by Mismeasurement.”  The official measure of unemployment, which showed only about 8% unemployment at the time of the election, failed to include the structurally unemployed.  A 2012 CNN report noted that the labor force, as measured, only includes those who are working or who have looked for work in the last four weeks, which includes only about 64% of the population, leaving a whopping 36% structural unemployment category unmeasured.  The GDP, which has been continually rising on average, and which the Democrats presented to voters, similarly doesn’t reflect the disparity of income.

•Democratic misunderstanding of women as mostly sharing certain feminist values.  Journalist and editor Tina Brown commented, in the Guardian, about the Democratic strategists’ misunderstanding of women in “the heartland,” working 2 and 3 jobs, the wives, daughters and mothers of unemployed and underemployed men who cringed at Trump’s coarseness but bought his spiel about being the best job-creator, and who wondered why he was any worse than Bill.

•Democratic failure to have a competitive primary.  A democratic strategist told me, “We didn’t have a primary, we had a coronation.”

•Republican strategy reflecting a long term and short term determination to win, which itself had several ingredients.  They include:  a long term (over a generation) strategic effort to mobilize Republican political presence at every level, from the school board to the town council to state government, as well as federal government, with gerrymandering to support repeated elections (Democrats gerrymander as well, but Republicans seem to have been more successful nationally); congressional intransigence to prevent the government from operating effectively, and then winning the PR fight to blame the ineffectiveness on the Obama administration and the Democrats; having a real primary, in which the winner, though not really “one of them,” was embraced.  I proposed that there is a difference in party culture, such that Republicans want to win, and Democrats want to be confirmed in their values and worldview.

•Republican strategy in keeping investigations of the Benghazi tragedy and Clinton’s emails going and succeeding in sticking her with negative public perceptions about that (Clinton has her own negatives too, of course, but Republicans appeared to strategically tar her in public perception with these investigations, which appeared to have been mainly politically motivated).

•The October Surprise, when FBI Director Comey announced that the FBI investigation of Clinton’s emails, which had been declared over, was re-opened.  That happened because Clinton trusted Huma Abedin who was married to Anthony Wiener, who was under separate investigation for improper sexual communications online, in the course of which potentially restricted emails appeared on his laptop.  (My slide of this is my favorite one!)

•Republican superiority in political messaging, as observed by linguist George Lakoff:  Republicans speak of values, Democrats talk about percentages (which, as I’d mentioned, were often based on mismeasurement).

•Mysogyny, pure and simple, played some role.

•The misperception that feminism can’t include femininity, which produced a backlash against Clinton, separate from mysogyny as such.

•Electorate misinformation amounting to self-selective brainwashing, over years, on the part of listeners and viewers who get their news from media outlets that galvanize, monetize and politically weaponize grievance.

•Russian intervention, which continues a tradition going back at least into the Russian Empire and the Ottoman Empire.  We still don’t know the extent of the Russian intervention, and we may never.

The Q and A was lively, and one person made the point that some Trump voters were disappointed former Obama voters.

Friday, June 2

Ken Fuchsman and Inna Rozentsvit: 

“Love Before First Sight, Attachment, and What it Means to be Human.”

Ken Fuchsman said that “Our understanding of attachment is being expanded to include infant temperament, selectivity of a primary attachment figure, culture, and the tendency of the human infant to select both a primary attachment figure as an infant and, later, a primary mate figure.”

Inna Rozentsvit, of the Object Relations Institute for Psychotherapy and Psychoanalysis, referred to the English analyst Winnicott, who said, approximately,  “The baby only knows about herself by looking in the mother’s eyes and, like a mirror, finding his reflection there.”  And the English analyst Bowlby’s attachment theory was “a new type of instinct theory, (of) relational bonds as a primary human instinct.”

Susan Kevaler-Adler:  

“The Psychohistorical Impact of D.W. Winnicott’s Mother.”

Susan Keveler-Adler is the Founder/Executive Director of the Object Relations Institute for Psychotherapy and Psychoanalysis, a co-sponsor (with the NYU Silver School of Social Work) of this conference.  She spoke of the relationship and conflict between analysts Melanie Klein and D.W. Winnicott, both of whom have had a significant impact on how psychoanalysis is understood and practiced, and discussed their relationships with their respective mothers and how that contributed to their views of human nature and of method in psychotherapy; “Contrasting mothers, contrasting theories.”

Keveler-Adler advocated combining Winnicottian and Kleinian theory, combined with ideas of her own, into “an organic theory, like Argentine Tango.  When we face our split-off parts and contain those of our own patients,” we can “intuit the truth,” which involves “the movement to health through heartache.”

Lunch was on our own, and I smelled my way to a wonderfully seasoned Havana pork sandwich, which I ate in Washington Park, across from the NYU building we met in.

Krystina Sanderson:  

“The Concepts of True Self and False Self as Exemplified by Jews Who Survived on “Aryan Papers” in Nazi-Occupied Poland:  

A Historical and Psychoanalytic Perspective.”

Krystina Sanderson, of the Psychoanalytic Training Program at the Blanton-Peale Graduate Institute, told the story of two girlfriends, Sima and Apolonia (“Pola”), one Jewish and one Polish, in which Pola and her family saved Sima’s life during W.W. II by having her live with them under a false Aryan identity, something which could have gotten them all killed.  The handout included pictures of both women during W.W. II, and also in 1989.  The Jewish woman’s daughter was present at our meeting, and said that she wouldn’t be alive were it not for the generosity of the Polish woman and her family.  After the war, the Jewish girl, now a young woman, emigrated to Israel, where the Polish woman sent her food packages—conditions being even harder in Israel then in Poland after the war.  Then the Jewish woman moved to Florida, and from there she sent care packages to the Polish woman, and brought her over to the U.S.A. for a visit.  Sanderson wrote the story and sent it to Yad Vashem, the World Holocaust Remembrance Center in Israel, where the Pola was named “Righteous Among the Nations.” This story was hugely touching, and is written at the United States Holocaust Museum:  https://www.ushmm.org/remember/the-holocaust-survivors-and-victims-resource-center/benjamin-and-vladka-meed-registry-of-holocaust-survivors/behind-every-name-a-story/sima-gleichgevicht-wasser

Jack Schwartz:  

“The Dance Between the Latent and the Manifest While Interpreting Dreams:  A Practitioners Guide”

Jack Schwartz, of the Object Relations Institute for Psychotherapy and Psychoanalysis, discussed dreams as “multifunctional events,” and the telling of a dream as part of the relationship in therapy.  “Trauma kind of fixates, programs, your consciousness,” he said, and dreams have an adaptive function.  “So what need is served to a repetitive dream?  It must be to learn something that is not yet being learned.”

end of notes