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,     

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?”  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


“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.

A Psychological Metaphor for the 2016 Presidential Election

This is adapted from a post that was shared with psychoanalytic colleagues who were distressed about, and trying to come to psychological grips with, the alarming presidential campaign:

Here is a psychological metaphor on the election:  What if we viewed the USA as undergoing a national dissociative crisis, characterized by self-undermining, if not self-destructive, behavior?  And if, among the dynamics energizing that crisis, we privilege psychoeconomics, the psychological relationships with money among individuals and groups, in the context of an emerging planetary culture?

If we viewed the USA as undergoing a national dissociative crisis, instantiated in our politics, particularly during this presidential election, we would view conflicting parts of the polity as dissociated but dynamically interrelated parts of a whole.  We would see the dissociated parts as struggling for control, each experiencing the brunt of disavowed aspects of the other, and each having its own trauma history, supported by narratives incorporating fantasy and reality.

If we were working with a trauma patient, even if the patient had become unrealistic, delusional, or self-harming, we would still validate the experience of trauma as we tried to support an extension of awareness leading to healthier integration.  We would see self-undermining and self-destructive behavior as attempts at adaptation.  And we would try to understand, together with the patient, where the trauma actually came from; although we may not be able to get to all of it.

If we viewed the nation from that perspective, how would that help us contribute to the national discourse?  To begin with, we might help to start one.  In treating dissociation we invite the patient to join with us in co-creating a therapeutic conversation and relationship in which we allow credibility for all aspects of the self; and especially for the underlying feelings, and the experiences that gave rise to those feelings.

Of course, if we were treating a dissociated patient, the person would have come to us in the first place, needing help, and we don’t have that here.  Yet the fact that there is so much anger, fear, sense of disenfranchisement, and lack of a sense of direction and hope for actually facing and getting on the better side of the complex problems that face the nation, indicates that something real is going on, even if we may find the attributions and imagined remedies for those problems, to a lessor or greater extent, unrealistic and even delusional.

What if we viewed the dissociative conflict as primarily driven by psychoeconomics, the psychological relationships with money, and with others through money?  Money, having no intrinsic value, is itself a metaphor; a form of stored social energy whose value is whatever society agrees it is.  In the psychoeconomic dimensions of life, there are winners and losers, and among the losers are those who have lost, or are threatened with the loss, of their identities, including their visions and expectations of their futures.  Even the meaning of the past is at risk when, for example, the pension and healthcare benefits earned over a career can vanish in a company or civic bankruptcy, or a professional can no longer find viable work.

We can observe trends that contribute to widespread economic and psychosocial disenfranchisement, dislocation and disorientation, even as they also contribute to widespread opportunities and potential for liberation, going back to the founding of psychoanalysis.  It was in pre-WW I Vienna, capital of the Austro-Hungarian Empire, at a time when the great empires of Europe, the middle east, and to a lesser extent central Asia, were increasingly impinging on one another, and science and technology were overturning systems of belief, social hierarchy, and how people made their livings and related economically with one another, that psychotherapy took the form of two people meeting together to talk about the problems of one of them, for an hour at a time, over a series of meetings.  The intensively reflective space of psychoanalysis, with its privileging of unconscious and non-rational processes affecting thought, perception, and behavior, was criticized as irrational by authorities of the same cultures that, believing themselves rational, stumbled blindly into the worst war ever up to that point, resulting in the ending of the Austro-Hungarian, Russian and Ottoman empires, redrawing the political map of the planet, and leading to repercussions which are still playing out today; including in the current election.

If we viewed the nation, metaphorically, as a dissociating patient within the context of a planetary culture emerging in fits and starts and with much conflict, would that help to shed light on the current situation, and indicate ways of thinking and talking about it that might be useful?


At the 2016 Spring Psychoanalytic Psychology Conference, Part 1

I attended the annual spring conference of Division 39 (Psychoanalytic Psychology) of the American Psychological Association.  The conference, entitled “Hot and Bothered,” included presentations on sexual and erotic issues, although there were a wide range of other presentations.  There were a lot of programs and I could only attend some, so here are notes from “my” conference.

Relational Dream Work:  The Bridge Between I and Thou

Kendle Hassinger, LPC

This preconference workshop was one of the most enjoyable and personally useful programs in “my” confefence.  Hassinger’s approach to dreamwork was as a relational process in therapy.  That is, it’s not a matter of the therapist being some sort of dream expert and pronouncing interpretations, but a process of therapist and client moving together into a deeper understanding of the client’s dream.  Hassinger sees the relational process itself as mutative, regardless of theoretical orientation.  (“Mutative,” in psychoanalytic context, means it facilitates a beneficial change the state or self-organization of the client or analysand.)  She sees the therapeutic relationship as involving two I-Thou relationships: one between the analyst and analysand, and the other between, as it were, the client and herself; between the client’s conscious self and her inner process, objects, and private experience.  By definition, the process of striving toward health in these I-Thou relationships is never complete, and the therapist’s job is to facilitate them.

Hassinger asked what we thought dreams were for, and I commented about the relationship between dreams and learning in mammals.  This sparked a discussion among the participants, during which a Mexican graduate student said that mammals dream “because they have mothers.”  I’m still reflecting on that!

Hassinger encouraged us to participate in discussion, and we talked about research into dreams (REM sleep increases during periods of intense learning) and different analytic perspectives.  Freud saw dreams as concealing meanings whereas Jung saw dreams as revealing the unconscious rather than disguising it.  Her perspective integrated a number of analytic and non-analytic elements, but was more Jungian than Freudian overall.  This was one of several presentations that had an inclusive attitude toward methods and concepts in different approaches to psychoanalysis, contrary to the history of divisive conflict between schools that characterizes so much of psychoanalytic culture, both then and now.

For example, Hassinger mentioned Jung’s comment that “The ego is a complex among other complexes,” and described therapeutic exploration as finding and exploring “feeling-toned complexes” (another Jungian term), which is a different way of looking at the inner life than the more dichotomous “I-it” (ego-id) of Freud; yet her discussion integrated both and flowed easily from one to the other as it suited the context.

Jung saw exploring the “feeling-tone” as the way into exploring the dream, and focused on the details of the dream image.  For example, if a barn, in a dream, is full of healthy animals and fodder, or neglected and dirty, it will have a different set of meanings associated with it.

We paired off to do brief explorations of one another’s dreams, and I was paired with a graduate student from Mexico.  Interestingly, both of our dreams involved animals—hers were birds, and mine a dog—and both yielded deeper meanings upon exploration.

An Evening With Nancy McWilliams

Nancy McWilliams is a distinguished and prominent teacher, leader and writer in psychoanalysis.  This pre-conference gathering was mainly an appreciation of her, and a Q. and A. session.  Some selections from my notes:

Q:  “You don’t belong to any camp, though you speak to every camp.”  NM:  “I used to walk the halls to find someone to have lunch with.  I’m an integrator temperamentally.  I approach anyone from (the perspective of, “What can I learn from this guy,” not “I’m better than this guy.”  Different patients make different therapists look good, and and different theories evolve to (explain different kinds of patients).”

Responding to a question about the difference between psychoanalytic diagnosis (which she’d written a book on) and the usual DSM-type psychiatric diagnosis:  “Psychoanalytic diagnosis is basically about individual differences,” which, she added, helps explain why it is so popular in Eastern Europe and other more collectivist cultures.  She recalled a question she’d received when teaching in China:  “What do we do about our depressed grannies?”

I had submitted a question (questions were submitted in writing) on the similarities and differences between the terms “psychoanalytic” and “psychodynamic.”  She replied:  “That difference has never been salient to me.  I think it’s a very artificial difference made up by psychologists who are not familiar with psychoanalytic ideas, who tend to define psychoanalysis as a technique, passé, on the couch, three days a week, etc.  If you define it as a treatment, then you have to have another word for all the rest of psychoanalytic knowledge that applies to everything else we do that’s not on the couch.  I’m an integrator, what Darwin would call a lumper rather than a splitter.  I prefer Freud’s definition, he had a lot of definitions, but I prefer the definition as any activity in which you are attending to transference and resistance.  It’s psychoanalytic to work with psychotic people, borderline people, and so forth.  I see what the distinction is but I think it’s created more heat than light to try to make that distinction.”  (I appreciate Dr. McWilliams’ inclusive perspective, which was characteristic of the attitude toward psychoanalysis in this conference, but I respectfully disagree.  The conflicts about what is really psychoanalytic and what isn’t goes all the way back to Freud and Jung, is a distinguishing feature of the history of psychoanalytic culture, and has been particularly virulent in the USA.  As Dr. McWilliams said, Freud had a lot of definitions, but she didn’t mention his requirement that his associates agree with whatever his definition of the moment was.  I prefer the term “psychodynamic,” because it includes all the perspectives from within the various schools of psychoanalysis, bypassing their conflicts and turf wars, and also has room for perspectives of neuroscientifically and spiritually informed views of mind from outside of psychoanalysis per se.  Still, I appreciated her personal warmth and professional inclusiveness within the culture of psychoanalysis.)

In response to a question about eating disorders, Dr. McWilliams said that she thinks extreme eating disorders should be considered psychotic, “when someone weighs 80 pounds and believes she’s fat and is starving herself to death.  We’ve been criminal in our treatment of psychotic and other persons, we just medicate them, as if they don’t have souls, as if they don’t have lives.”

Asked about the difference between psychoanalysis and cognitive-behavioral therapy, Dr. McWilliams said, “The important differentiation isn’t between psychoanalysis and CBT, they run into the same issues we do, they develop their own language to describe it.  The biggest abyss we have is between clinicians and researchers who have increasingly become alienated from what clinical work is really like.  It’s not their fault, it’s conditions in academia (where) it’s so hard to get grants (that) it would be professional suicide to have a small practice on the side.  (So) researchers have no idea what it’s like to be a clinician, they think it’s like what they do in the lab.  I think we should be allying with cognitive-behavioral, humanistic, family therapists, anyone who is in the trenches.”  (This is the direction that we have been moving in with CAPP, the Chicago Association for Psychoanalytic Psychology.)

Q:  “How do you understand resilience, beyond ego strength?  Do you have a dynamic formulation around resilience?”  NM:  “No, but I’ll hazard a guess.  It all has to do with whether you have somebody who can bear your pain.  If you have somebody who can be there with you, you can go through pretty bad pain, you go through a mourning process, mourning is the process by which we adapt to the painful aspects of life.  If you have the same traumatic experience and you have nobody who can go with you through it and bear your pain and bear witness to what you’re going through, I think you’re much more likely to be dissociated, because it is unbearable to go through crisis without someone who can bear witness.  That’s a time-honored goal of psychoanalytic therapy.”  (Note:  I see dissociation as a normal aspect of brain function and self-formation, and find support for this view in the “neural networks” model of neuroscience and the “multiple selves” model of spiritual psychology.  Psychoanalysis has described traumatic dissociation, and specialized in treating it.)

Q:  “You’ve talked about a number of different camps.  There’s an ideological process of all this, perhaps a tribal component, who’s on the inside, who’s on the outside.  In the history of psychoanalysis, and in many respects of CBT, the ideological component has been so important, to define themselves against (other schools), how do we begin to look at these tribes that we form and bridge those divides?”  NM:  “In this field, where ideas matter so much, I don’t think it’s been so bad, as long as we can come together in the fight against torture, against accreditation that’s depersonalizing” (here she’s referring to issues within the American Psychological Association).  “The danger in psychoanalysis is that we get so distracted by these internal differences between us that we’re fighting over deck chairs on the Titanic.”

Society, Self, and Psychotherapy: The March CAPP Conversation

CAPP Conversations are a series of conversations for psychotherapists by the Chicago Association for Psychoanalytic Psychology.  Here is the March Conversation:

Society, Self, and Psychotherapy

A CAPP Conversation

Shunda McGriff, M.S. Counseling, LPC, NCC, Jay Einhorn, Ph.D., LCPC
March 17th, 10:00-11:30 AM

Evanston Location

To what extent is the self shaped by the social world in which it develops?  And to what extent is that social shaping of the self recognized by theory and training in psychotherapy?

From the beginning, the vision of personality in psychoanalysis, and the various schools that evolved out of and around it, focused mainly on dynamics within a limited field of relationships:  the attachment dyad, the Oedipal triad, the family system.  This view of human nature, valuable as it can be, fails to give proper proportion to the person in society—and society in the person.  The neural networks of the brain form in neuroplastic response to impacts from many people, and many subcultures of society, from the block to the school, the church or temple, the workplace, the ethnic culture, the nation and beyond.  The relationship of the individual to society becomes particularly salient for psychotherapy when the client’s self has developed in a disempowering social context.  Relational-Cultural Theory (RCT) grew out of the recognition that the central role of relationships, particularly in the lives of women and minorities, and the experience of inequality in relationships, needed to be appreciated for counseling/psychotherapy to be adequate to the needs of clients with these experiences.

In today’s Conversation we will consider the traditional view of self in psychotherapy, then look again in the light of RCT, and see whether that brings us toward a more comprehensive view of human nature from which to ground ourselves as therapists.
Shunda McGriff, M.S. Counseling, LPC, NCC is currently a doctoral candidate at Governors State University in the Counselor Education and Supervision program. She is a 2014-2015 National Board for Certified Counselors (NBCC) Minority Fellowship Program (MFP) Fellow.  Professionally, Shunda has worked as a college counselor for 15 years with low-income, first-generation, and minority student populations.  Jay Einhorn, Ph.D., LCPC, is President of the Chicago Association for Psychoanalytic Psychology, a therapist in private practice in Evanston and Glencoe, consulting psychologist at Roycemore School, and a supervisor in the counseling program at the Family Institute.


Advocating Psychotherapy–Sort Of–In the New York Times

(This column is Dr. Einhorn’s article in the current Cappstone, the newsletter of the Chicago Association for Psychoanalytic Psychology. Dr. Einhorn is Chair of the Advocating Psychotherapy project at CAPP. To arrange for a presentation about psychotherapy, contact Dr. Einhorn through the website contact link.)

In this time of the prevalence of a one-dimensional medical model of mental suffering and treatment, and the increasing marginalization of psychotherapy as health care reorganizes under intense economic pressures, a colleague has advanced, and perhaps also hindered, the cause of advocating psychotherapy, in a recent column in the New York Times (9-29-13). Op-Ed contributor Brandan A. Gaudano, clinical psychologist at Brown University, writing on “Psychotherapy’s Image Problem,” begins by pointing out that “In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent,” despite the fact that “a recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.” “As well they should,” he continues, “…Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.” (entire article at:

Dr. Gaudano attributes “the gap between what people might prefer and benefit from, and what they get,” to the fact that “psychotherapy has an image problem.” And what is that problem? “Primary care physicians, insurers, policy makers, the public and even many therapists are unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries–industries that, not incidentally, also have the money to aggressively market and lobby for those practices.”

So far so good. We heartily agree with Dr. Gaudano’s comments, which are entirely in harmony with the perspective of CAPP’s Advocating Psychotherapy project. But when it comes to identifying what constitutes effectiveness in psychotherapy, Dr. Gaudano is beating the drum of randomized controlled trials. “For patients with the most common conditions, like depression and anxiety, empirically supported psycho- therapies–that is, those shown to be safe and effective in randomized controlled trials–are indeed the best treatments of first choice.” Referring to a recent survey that he completed with his colleague Ivan W. Miller, for the November edition of Clinical Psychology Review, Dr. Gaudano states that “It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).”

“Psychotherapy’s problems come as much from within as from without,” Dr. Gaudano states. “Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which–like some old-fashioned Freudian therapies–should be abandoned.”

Here, I am afraid that some of Dr. Gaudano’s comments tend to muddy the waters about what psychotherapy is and how it can be of value, at the same time that he’s trying to clear them up. For example:

•The use of randomized controlled trials (RCT) as the “gold standard” of outcome study is misleading. RCT requires the standardization of patients into relatively pure diagnostic groups (depression, anxiety, etc., with careful pre-screening to have as close as possible to “pure” diagnostic groups) and therapies into methods defined by techniques (cognitive-behavioral, interpersonal, etc.), overlooking the individuality of patients, therapists, and patient-therapist pairs. Such clarity, simplicity and replicability are not found in the real world, in which patients are usually quite complex, therapists have to adapt whatever methods they are using accordingly, and the interaction between patient complexity and therapist adaptability often has more to do with outcome than diagnosis or treatment method per se.

•The largest contributor to outcome in therapy is quality of relationship between client and therapist (as Jonathan Shedler described in his overview of studies, “The Efficacy of Psychodynamic Psychotherapy,” in American Psychologist (Feb-Mar. 2010). This is not to dismiss the importance of methods and techniques, or the value of a well-stocked toolbag for therapists with more than a narrow specialization. But the methods and techniques are applied within a relational context, which has as much to do with their efficacy as technical skill per se.

•The practice of treating psychodynamic, cognitive, interpersonal, etc., interventions as if they are separate is misleading. I’ve never seen any successful therapy in which unconscious factors in the patient weren’t elicited and transformed, in which the patient didn’t learn to think and perceive differently, and in which the interpersonal life of the patient wasn’t in some ways altered for the better through interaction with the therapist.

•A key mistake, often repeated in the history of modern psychology, has been to reduce our understanding of human behavior and experience to the currently available scientifically accepted methods. “Science” does not mean “whatever we can study with RCT.”

•While it’s good to see psychodynamic therapy included in the winner’s circle of empirically proven methods, the emphasis on short-term therapy overlooks the need of many patients for longer-term work. Symptoms may be resistant to treatment, and can change into a focus on underlying existential issues as therapy proceeds; all of which can take a lot longer than 20 weeks.

•Dr. Gaudano’s assertion that empirically supported therapies are superior to medication still takes place within the medical model, in which mental and emotional disorders are disconnected from the facts and experiences of people’s lives. “Safe and effective” are statistical abstractions within this model. In practice, what is safe and effective for one person may not be for another; thus the lengthy caveats about problems with safety and/or effectiveness in medication advertisements.

As to “psychotherapy’s image problems,” psychoanalytic authorities and institutions have certainly contributed to them, but so have proponents of “empirically validated” treatments. In fact, just about every form of treatment in the field of psychotherapy has been heavily influenced by gifted authoritarian empire-builders and their followers, resulting in a mine field of claims and counterclaims, in which conviction based on reductionist thinking at the expense of wider truth, together with contemptuous dismissal of alternative paradigms, is the currency of the realm. There is no “one size fits all” therapy, or therapist, or method of determining efficacy.

This mine field is the main “image problem” of psychotherapy. The basic method of therapy, in which two people meet to discuss, and try to understand and resolve or improve on, the mental, emotional, and relational problems of one of them, during which they form a particular kind of working relationship which evolves if the work goes well enough–and each of those relationships is unique–continues to be more powerful than the ability of any theoretical model to explain.

Neuroscientific advances will contribute to our understanding of what’s happening in psychotherapy. Neuropsychologist Elkhonon Goldberg, in his The New Executive Brain, states that “even relatively brief but sustained cognitive activity is capable of affecting brain morphology and is detectable in neuroanatomically specific ways” (p. 239). Goldberg is talking about kinds of learning such as new languages or music, but the application to therapy is clear. All this work between patient and therapist, when effective, cultivates salutary brain changes in the patient; and perhaps also, to a lesser extent, in the therapist. Research in this area is already proceeding, although the methods and conceptual frameworks remain relatively crude. Such research, when it reaches maturity, has the potential to reformulate how we understand schools and methods of therapy.

In wider perspective, we can see that therapy and medication, mental and emotional disorders, have all evolved within our society, where rhetoric and practice in politics, education, economics, medicine, the military, religion, government, and business, are characterized by misleading oversimplifications, dogma and ritual mistaken for knowledge and truth, turf wars, cult-like processes, and successive fads; each claiming superiority until it, too, is debunked. And the people, including professionals as well as consumers in each field, tend to be blind to the process itself, caught up in the cycle of fads, one after another. Why should psychotherapy be any different?

What’s needed, across the board, is better information and better informed consumers and practitioners. Now that’s a long-term process; it will probably take more than 20 weeks. But contributing toward it, in whatever ways we can, is the goal of our little Advocating Psychotherapy project here at CAPP.

“The Essential Other:” Robert Galatzer-Levy’s Keynote Address at the Conference Honoring Bertram Cohler

On Saturday, September 21, Dr. Robert Galatzer-Levy gave the keynote address at a conference entitled “The Essential Other: Generativity, Resilience, and Narrative, A Conference Honoring the Life and Work of Bertram Cohler, Ph.D.” The name is a mouthful, but the conference delivered plenty of nutrition–cheers to conference organizer (and panel presenter) Dr. Christine Kieffer and host (and panel presenter), at Francis Parker School, Dr. Daniel Frank.

Dr. Galatzer-Levy, a psychoanalyst and teacher, had been a long-time colleague and friend of Bert Cohler’s, who died in May of 2012. They had written a book together, entitled “The Essential Other,” published in 1994, thus the title of the conference. Dr. Galatzer-Levy gave the keynote address.

“Why,” he asked, “are people important to each other?” Aristotle’s answer, because man is a political and social animal, is circular. Freud’s “beautiful theory” is that people have drives which can only be satisfied by others; for example, the infant’s need for food and the more mature person’s need for sex. Renee Spitz found that the infant’s needs go beyond merely being taken care of physically. Heinz Kohut noticed that people have an experience of living that is disorganized, so people need “selfobjects” (difficult word) who provide functions like the mother who soothes and calms the child. This experience with the mother, and/or with other selfobjects, including the therapist, is the precursor to the child’s later experience to organize itself. Self = the experience of being in the world. Objects = other people, the focus of drives.

In the late 1980s, Galatzer-Levy and Cohler were very recent grads of the Psychoanalytic Institute and students of Kohut. The then current psychoanalytic concepts didn’t capture the aliveness of being in the world, in relationships with other people and institutions. For Freud, development ends with adolescence, more or less, with the ego and superego in place. Galatzer-Levy and Cohler weren’t satisfied with that and wanted to develop a theory that development continued across the life course. “We were driven by the wish not to be dead at 50.” Their collaboration on “The Essential Other” was easy and productive.

Other people are best conceptualized not as abstractions but as concrete expressions of bodily alive relatedness with someone doing something. The experience of other people combines these things. Cohler and Galatzer-Levy “didn’t have an abstract relationship, we wrote together, did things together.” The idea of the essential other combines the vigorous activeness of actual people with the need for others to meet our needs.

Galatzer-Levy criticized the idea that development means that one moves from dependence to independence. There is, instead, “a shift from a very narrow focus of dependence to an ever wider spectrum of essential life and functioning.” Llinear developmental sequences fit neatly on charts–oral, anal, etc.–but life is not a sequential unfolding, and pathology is not a deviation from that sequence. “Life is continuing transformation across the life course. The only thing abnormal is stasis.”

Theresa Benedict noticed that development is a mutual experience in which there is a change in the caretaker by virtue of the process of caretaking, a mutuality. Cohler would say, to freshman at the University of Chicago, when he was teaching Freud’s “Interpretation of Dreams,” “We are all equal before the text.” The benefits of teaching, of caretaking, go in both directions. Memories can serve “essential other” functions, entities can be present in a way despite the fact that they are not physically present, even no longer here, as is the case for Galatzer-Levy with his friend and collaborated, Bert Cohler.

Galatzer-Levy emphasized the importance of friendship, “about which psychoanalytic theory has little to say.” Kids who are happy have friends who matter a great deal to them. Most people, asked who the most important people in their lives are, will include their friends. Galatzer-Levy recommended Huckleberry Finn as a study in friendship, in which Huck Finn and Tom Sawyer were essential others to each other, as their dialog moves both boys forward.

In addition to “essential other” relationships between people, there is the relationship of the individual with institutions. Cohler’s relationships with the University of Chicago “played a central role in his psychological life,” beginning as a patient/student at the Orthogenic School. “The University of Chicago’s values were his own,” including “close reading of text,” and within the University framework Cohler taught classes of freshman “year after year.”

Noting that “The Essential Other” is 20 (or so) years old now, Galatzer-Levy considered what changes he and Cohler might make were they to do a revised edition today. “The work of developing coherent narratives is a lot of the process of psychoanalytic work (and) the editing of narratives is a large part of psychoanalytic work.” Another difference: “We described a 1:1 relationship between individuals, and between individuals and institutions.” But today’s models for analyzing networks provide a richer way to see the individual’s role within a network.

Galatzer-Levy noted that fractals provide another way of looking at people. “Fractal structure separates the inside from the outside in a complicated way, you can’t specify what’s inside and what’s outside. The fractal vision of boundaries doesn’t fit with the issues of one person interacting with another as analysts usually think of it. The boundaries (between inside and outside) are much richer.”

I very much appreciated and enjoyed the clarity of Dr. Galatzer-Levy’s overview of a stream of psychoanalytic thought beginning with Freud and going through Kohut, with significant contributions from others. His jump from Aristotle to Freud did overlook a few significant developments in understanding human nature between the one and the other, but, as Doris Lessing pointed out, this is typical of the Western academic tradition. I was delighted to hear Galatzer-Levy consider the implications of fractals for understanding, or at least modeling, metaphors of human behavior, since I’m interested in the question of whether fractal math can complement the math of probabilities and the normal curve upon which all of psychometrics (the math underlying psychological testing), and most if not all of science, is currently based. I was especially impressed with the concept of “the essential other” in our understanding of human nature and development through relationship. Certainly therapists become “essential others” for clients or patients, when the therapy is working. The concept of “the essential other” is also powerful in relationships between individuals and persons no longer physically present, and with institutions.

On Loneliness: Notes from the March, 2012 Chicago Assn. for Psychoanalytic Psychology Conference

The Chicago Association for Psychoanalytic Psychology’s 2012 annual conference was on the theme of “Loneliness:  An Interdisciplinary Exploration,” and I have written up my notes here, which may be of interest.  They are only my personal notes, and are neither intended to reflect a comprehensive review of the presentations nor fact-checked. The speakers were:

• John Cacioppo, Ph.D., at the University of Chicago, where he is Tiffany and Margaret Blake Distinguished Service Professor; Director of the Center for Cognitive Neuroscience, and Director of the Social Neuroscience Laboratory; presenting on: “Loneliness:  Human Nature and the Need for Social Connection.”

•Molly Witten, Ph.D., faculty member at the Erikson Institute, Chicago, and the Chicago Institute for Psychoanalysis, gave a case study presentation on: “Relational Mis-Attunement in Infancy and One Path Into and Out of Loneliness.”

•Ann-Louise Silver, M.D., faculty member at the Washington Center for Psychoanalysis, who’s presentation was entitled: “The Interrelationship of Our Patients’ and Our Own Loneliness.”

Dr. Cacioppo got the conference off to a great start with a well informed and (at least for cognitive neuroscience nerds and therapists, of which I am both) very catchy presentation on the cognitive and social neuroscience of loneliness.

“It’s your ability to have grandchildren that determines whether your genes make it into the gene pool,” he said.  What differentiates us from other animals is how much we learn socially.  Research has focused too much on the individual and not enough on the group and the individual’s relationship to the group.  “What it means to be an adult in a social species is to be the one on whom others can depend.”  To which I would add, to be able to depend on others.  “The pain and dysphoria of social isolation evolved as an aversive biological signal to support social connection, as well as vigilance for predator threat.”

Over five different studies, more socially integrated people have longer lifespans.  The hypothesis has been that other people encourage us to live a healthier lifestyle, so people with others around them will tend to live longer.  But Dr. Cacioppo disputed that hypothesis, noting that “All social animals either die early or show pathology when isolated.  The fruit fly that dies in the absence of company doesn’t die because other fruit flies don’t encourage it to exercise…Loneliness is a predictor of mortality regardless of exercise, so that nails the coffin of the ‘social connection encourages exercise’ hypothesis.”

Emotional loneliness is characterized by:

•lack of companionship

•feeling left out

•feeling isolated from others

•being unhappy about being so withdrawn

Dr. Cacioppo consults with the military, and noted that people, especially men, underestimate their own loneliness.  A military leader told him, “Loneliness is not a word we use.”

People who are socially connected are giving when with others and take individual time for solitude as needed.  Marriage is health protective if it is a positive connection, negative if the individual feels trapped.

Dr. Cacioppo used chronic pain as an analogy with loneliness.  “Loneliness is the social pain that connects the person socially.  Acute social pain motivates us to reconnect with others.”  Loneliness can be factored into two kinds.  “Social loneliness” involves feelings of relational connection, and a predictor for social loneliness is the number of personal contacts the person has had over the past two weeks.  The second kind of loneliness involves a kind of social or collective connection, for which the number of group associations a person has is a predictor.  The relational area is a little more important for women, and the collective area is a little more important for men, Dr. Cacioppo said.

Loneliness is not necessarily about how many people one knows.  “People can be around others and still feel lonely, or have one significant relationship and feel close.”  Loneliness seems to be about 50% genetic and 50% environmental.

Children are sent to time out because they are acting selfishly.  A more effective time-out is in the presence of others, rather than sending children to their room with toys.

Neurocognitivelly, the lonelier you feel the less activation of the tempero-parietal region bilaterally, which is involved in “theory of mind.”  Lonely young adults rate hassles as more severe than socially connected adults rate the same hassles.  The anteroventral striatum lights up at scenes of beauty (like a butterfly) and social connection (like a baby smiling), and lights up more in socially connected people than in lonely ones.  Social and physical pain overlap in the brain; acetaminophen and opiates both lessen the pain of loneliness.

There are significant differences between lonely and non-lonely people in factors of social support, shyness, social skills, anger, anxiety, self-esteem, fear of negative evaluation by others, optimism, positive mood, and negative mood.  Interestingly, the effect size of the differences is just as large between the same people when hypnotized to feel lonely or not lonely, in research at Stanford.

Lonely people have a different pattern of genes turned on and off compared to non-lonely people.  Feeling lonely changes the oldesst cells in the immune system.  Isolation increases immune arousal.  Loneliness also affects sleep:  the lonelier they were, the more microawakenings each night and the less beneficial the sleep that subjects experienced.  Lonely adults take more sleep medications.

An AARP study found that 35% of people are lonely.  The prevalence of loneliness seems to be increasing, as is the proportion of people living alone.

Oxytocin, the neurochemical associated with emotional bonding, decreased the perceived threat in picures, and loneliness decreased with both the amount of and sensitivity to oxytocin.  Lonely people may perceive threats and react to others as if they are threatening, which drives the perceptions and responses of others toward them.

Denmark has declared loneliness to be a national problem.

Later on, in panel comments, Dr. Cacioppo observed that “The brain has 5% of the body’s weight but uses 20% of the oxygen” that we breathe.  He also observed that “consciousness is a small part” of mind, most of which functions implicitly, even if in ways that were once learned consciously.

More information on Dr. Cacioppo’s work is at:

Dr. Witten then presented a case study of a child whom I’ll call:  “David”

Dr. Witten’s presentation changed the focus from the general and researched to the individual and clinical, but was no less fascinating and informative.  The subject was the relationship between “David,” who was nearly 10 months old when he and his parents came to see Dr. Witten, and his parents.  David’s one-minute and five-minute Apgar scores were 7 and 7, and he had low motor tone and couldn’t suck, so he’d fall asleep when nursing.  His mother had a history of depression and of having been the daughter of a mother who was so depressed that she ended up mothering her own mother, in some ways.  When David was six months old, his parents found a dula who gave him a preemie nipple and then he could suck, but by then he’d become “prickly.”  At nearly ten months, David would become upset and then “shut down his sensory-motor functioning by limiting what he would allow himself to take in and inhibiting how he would allow himself to relate,” a response which Dr. Witten saw as a kind of dissociation.

Luckily, David’s parents had consented to videotaping sessions and to their use in professional education, and Dr. Witten played tapes from an early family therapy session, and from one much later; I didn’t note the dates, but recall it being about a year and a half later.  I didn’t take detailed notes on the clinical presentation–partly because I was so busy watching and listening and partly because it’s easier to take notes on a research-based presentation like Dr. Cacioppo’s than a clinical one, especially when there’s a videotape.  My notes indicate that David’s mother (and father) were challenged in establishing a healthy reciprocal relationship with their new infant because of their own histories.  “The baby becomes the (projective screen) on which those images (of parent history) are played out,” Dr. Witten said. She quoted Andre Green:  “We carry within us the totality of our past, not as memories but as organizers (italics added).”

In her family therapy work with David’s parents and David, Dr. Witten helped his parents learn to engage with David rather than disengaging from him when he disengaged from them.  A videotape clip of a session later session, when David was walking and talking, showed a much more engaged family unit.

Dr. Witten’s psychoanalytic background made it possible for her to focus on two important processes which are acknowledged in psychoanalytic culture, but only emerging in neurocognitive culture:  dissociation and a kind of implicit organizing memory that analyst Christopher Bollas called the “unthought known;” which workers in the neurocognitive domain might think of as an implicit affective-perceptual-attributional memory.  This raises the question, “What kind of memory, neurobiologically, is not ‘remembered’ consciously but organizes perceptions and responses?”

In the final Question-and-Answer session, Dr. Witten commented, “Being a therapist means having a higher than average capacity to ‘be with’ someone else.  It’s not ‘mirroring,’” in the sense of just reflecting back to clients what they have said.  “To ‘be with’ is to be a witness to someone else’s experience.”

Ann-Louise Silver, M.D.:  Frieda Fromm-Reichmann & Therapy with Psychotic Patients

Dr. Silver’s presentation focused on the life and work of Frieda Fromm-Reichmann, one of the pioneers of psychotherapy, and the importance of doing therapy with psychotic patients, as Fromm-Reichmann did, rather than consigning the treatment of psychosis entirely to medication, as is so often done today.  Her presentation was highly informative–I didn’t know that the William Alanson White Institute, a rebellious psychoanalytic training program in New York where several of my teachers were trained, was started by therapists working in Washington, D.C., among whom was Fromm-Reichmann–but didn’t really address the topic of the interrelationship of patients’ and therapists’ loneliness.  Yet Dr. Silver’s humanity was clearly shown throughout her presentation.  “We need to wean ourselves from a professional dependency on the DSM,” she said, “thinking of loneliness as a depression.  One person (the client) comes with suffering, and you’re forming a team until the person doesn’t need you anymore.”

In all, it was a really valuable conference.  Thanks to CAPP, and President Bernadette Berardi-Coletta, Ph.D., for conceiving and organizing it.  (I’m a member of CAPP and Chair of Peer Study Groups.)

Commentary on the Film, “A Dangerous Method”

This Commentary is reprinted from the Winter-Spring, 2012, CAPPSTONE, the newsletter of the Chicago Association for Psychoanalytic Psychology. It appeared alongside a review of the film by my colleague Michael Losoff.

The story of Freud and Jung needs to be told, because of its importance for our time; especially, though not only, for those of us who practice psychotherapy. So I am grateful to “A Dangerous Method” for telling that story. I’m also grateful that the film takes a big step toward restoring Sabina Spielrein to her rightful place in that story. Yet I found the film more useful for prompting me to look into source material, than for conveying the characters of Freud, Jung, and Spielrein. One doesn’t blame the film for this, but rather acknowledges that there are certain qualities of extraordinary character that are difficult, if not impossible, to portray artistically.[more…]

Something similar happened with “Nixon,” the film about Richard Nixon and Watergate; another “must be told” story for our time. Several years ago, I happened to be at a great local bookstore, the Bookstall at Chestnut Court in Winnetka, when Elliot Richardson, Nixon’s attorney general who resigned rather than follow his chief’s order to fire independent prosecutor Archibald Cox, was making an author’s appearance in support of his book, and so I was present when Richardson was asked what he thought about the film. Richardson said that Nixon had personal qualities that inspired loyalty and respect and made people want to follow him, that couldn’t be conveyed by an actor, no matter how technically proficient. He went on to say that Nixon’s fatal flaws–by which he meant the paranoia, grandiosity and manipulativeness that ultimately undermined him–needed to be seen in the context of his exceptional leadership personality. Freud, Jung, and Spielrein were all exceptional personalities too, yet in “A Dangerous Method” they seem so ordinary, even when they are discussing extraordinary matters, such as the creation of psychoanalysis, or doing extraordinary things, such as Jung dutifully paddling a semi-nude Spielrein.

It’s unfortunate, though perhaps inevitable, that the “danger” in “A Dangerous Method” is the risk of consummated erotic attraction between doctor and patient. The greater danger in the psychoanalytic enterprise, one which is much more difficult to portray dramatically, is the inevitable insufficiency of knowledge on the part of the doctor who enters into a treatment relationship with a patient centered around how the patient’s unconscious processes are undermining him or her, within a cultural milieu which constitutionally keeps certain experiences unconscious. The analytic therapist must thread his or her way through the lack of sufficient information about people in general and this person in particular, the false security of theoretical dogma, the narcissistic appeal of making up some apparently adequate explanation of the patient’s problems out of whole cloth, and the tempting attractions of transference and countertransference; to arrive, eventually, at enough of a cocreated understanding of this particular person to effect a series of healing, corrective experiences. Mindfucking, rather than sex, is the greater danger of the “dangerous method.”

After watching “A Dangerous Method,” I’ve been reading “The Freud-Jung Letters,” abridged edition, edited by William McGuire, and “Sabina Spielrein, Forgotten Pioneer of Psychoanalysis,” edited by Coleen Covington and Barbara Wharton (available on Google Books). It’s clear that both Freud and Jung were acutely aware that they were overturning the prevailing logical-rational view of human nature, and erecting in its place a view of human nature as largely at the mercy of unconscious forces that could only be brought into the light of awareness and made civilized through the “dangerous method” of psychoanalysis. Their early union, productive collaboration, eventual conflict and final break is the stuff of legend, and well enough told in the film. But what about the role of Spielrein in the development of psychoanalysis?

Freud, Jung and Spielrein were all forces of nature, and are inevitably diminished in the film; but Spielrein’s character, played by Keira Knightly, is the most attenuated. The role focuses on her emotional neurosis, physical beauty, and emotional-sexual attraction to Jung, while underplaying the contribution of her conceptual brilliance to her personal and erotic magnetism. It seems to have been her brilliance, no less than her eroticism, that made her love for Jung impossible for them to resist, and led to a kind of fusing of identities with Jung, at least for awhile; which he seems to have found both inevitable and profoundly upsetting. In the film, when Jung finally relents and becomes Spielrein’s lover, he is giving into his needs, and hers, but not merging with a brilliant partner whose self and love resonate with him as they merge into an eroto-analytic third; as seems to have been the case in their actual relationship. In the film, Jung is dutiful, and Knightly beautiful, but we don’t get that merging of identities, or the reversal of roles in which she becomes the more powerful and nurturing figure, and he the more dependent and suppliant. Yet something like that seems, from her diary, to have happened. We get a hint of that, for example, in this diary entry about a last meeting with Jung; whom, at one point, she refers to as “my beloved little son!:”

“My friend and I had the tenderest ‘poetry’ last Wednesday. What will come of that? Make something good of it, Fate, and let me love him nobly. A long, ecstatic kiss in parting, my beloved little son! Now—may luck be with me! What a difference between his diary entry and mine…in spite of the colossal similarity between us. How remarkable the difference in the way he, the man, and I, the woman, contemplated the tasks ahead of us. With him the sacredness of his profession occupied the foreground, with me the sacredness of love…”

Coline Covington describes Spielrein’s profound role in influencing Freud’s and Jung’s evolving ideas, a role which was acknowledged but minimized by both. “It was in Oct., 1911, that Spielrein first met Freud, in Vienna. The following month Spielrein read her first theoretical paper, “Destruction as the Cause of Coming Into Being,” at one of Freud’s meetings, in the presence of Freud, Federn, Rank, Sachs, Stekel, and Tausk, among others. Here she introduced the concept of the death instinct, later to be incorporated and developed by Freud in Beyond the Pleasure Principle (1920) in which he refers in a footnote to Spielrein’s idea of the ‘destructive’ component of the sexual instinct. Commenting on her paper some months later, Freud wrote to Jung, “She is very bright; there is meaning in everything she says; her destructive drive is not much to my liking because I believe it is personally conditioned; she seems abnormally ambivalent (McGuire, 1974: 494).” Jung acknowledged Spielrein as the originator of the idea of the death instinct, but not until the revised edition of his Symbols of Transformation, in 1952, by which time she was long dead–murdered by Nazis in Russia, where she had gone to live.

Perhaps Spielrein’s neurotic problems were partly due to her incredible ability to tolerate conflicting feelings and ideas together, without having to artificially resolve the conflict by rejecting one side or the other; and perhaps this is the “ambivalence” that Freud refers to. Covington quotes Spielrein, in her diary entry of 26 November, 1910, as she “expressed her fear that Jung would ‘simply borrow the whole development of the idea (of the death instinct).” Spielrein wrote, “’Is this another case of unfounded distrust on my part? I wish so fervently that it might be so, for my second study will be dedicated to my most esteemed teacher, etc. How could I esteem a person who lied, who stole my ideas, who was not my friend but a petty, scheming rival? And love him? I do love him, after all. My work ought to be permeated with love! I love him and hate him, because he is not mine. It would be unbearable for me to appear a silly goose in his eyes. No, noble, proud, respected by all! I must be worthy of him, and the idea I gave birth to must also appear under my name.’ (Carotenuto, 1982: 35).”

Defending his advocating the same or similar ideas as Spielrein, Jung had said that they were thinking along the same lines, had stimulated one another’s thoughts, etc. I expect that there is truth on both sides here. The situation of Freud, Jung and Spielrein has undeniable parallels with that of Rosalind Franklin and Watson and Crick. Franklin was a biophysicist and x-ray crystallographer whose x-ray diffraction images of DNA were studied by Watson and Crick and lead to their discovery of the double helix shape of the DNA molecule. Watson and Crick’s paper didn’t acknowledge anything like the full contribution of Franklin’s work to their discovery, and she was not included in their Nobel award, as many feel she should have been. Like Spielrein, Franklin died young, of ovarian cancer, at 37. The film, “The Double Helix,” helped restore Rosalind Franklin’s place in the historical record, as “A Dangerous Method” might eventually do for Spielrein.

Spielrein went on to a distinguished career as a psychoanalyst, among whose analysands was Jean Piaget, practicing in Switzerland and in her native Russia, where she married and started a school, before being slaughtered. Thus was another veil cast over her life and accomplishments, much like those of her compatriot, the pioneering psychologist Lev Vygotsky, whose influence on psychology and education is profound but mostly unacknowledged.

As I often say, psychoanalytic psychotherapy is a powerful and sometimes necessary method for understanding ourselves and finding our way in this world, yet the teaching and learning of it has been so deeply infected with pathologies of personality and politics by its originators and transmitters that we must engage in much work of disentangling what’s useful in it from what isn’t. To some extent, analytic therapists need to cultivate an anthropological attitude toward the culture of psychoanalysis, in order to sort out “the baby from the bathwater.” I am grateful to “A Dangerous Method” for highlighting the intertwined truths and pathologies present at the birth of psychoanalysis, and also for providing a delayed acknowledgement of the indispensable contribution of an overlooked woman pioneer. Her role can now be studied, acknowledged, and incorporated into our understanding of where we have been, where we are, and where we might be going.