The Analyst’s Need and Desire
Andrea Celenza, Ph.D.
Andrea Celenza, Ph.D. is Faculty, Boston Psychoanalytic Society and Institute; Faculty and Supervising Analyst, Massachusetts Institute of Psychoanalysis; Assistant Clinical Professor, The Cambridge Hospital, Harvard Medical School; Private Practice, Lexington, MA.
Earlier versions of this paper were presented at the Boston Psychoanalytic Society and Institute Symposium, “What Do Analysts Want? The Use and Misuse of Patients,” April, 2008; the Division 39 Spring Meeing, New York, 2008; and the American Psychoanalytic Association, Winter Meeting, New York, 2009.
ABSTRACT
The analyst’s capacity to do analytic work is both a talent and a need. This paper discusses the analyst’s empathic capacity as arising from early childhood wounds and deficits that draw us to the profession in the first place and sustain our commitment to it over time. The selection of analytic work as a career is, for many and perhaps most of us more an imperative than a choice. Over time, the pressures on the analyst’s narcissistic equilibrium can change, exposing vulnerabilities that may be insufficiently attended to, as we valorize the needs of others over our own.
Psychoanalytic work demands a regressive and progressive fluctuation of emotional resonance within a context of structured power imbalances. There are also dynamic, resistive pressures to level the imbalances from within ourselves and from the analysand as the analytic context both stimulates and frustrates needs and wishes for both analyst and analysand. We must come to this work centered and fortified, past injuries largely healed and mourned, our present desires largely sated. The importance of social supports, including a primary intimate relationship, is discussed as part of the necessary framework around which we conduct our work.
The Analyst’s Need and Desire
One day my son Derek, then 8 years old, made a perceptive remark about a friend. Something about this friend’s hidden motivation to act in the way he did. The details of that part of the story escape me now. At the time, I was impressed with my son’s natural ability to ‘see inside’ and it was not the first time I had seen it. So I said to him, “You know, Derek, I don’t need this from you, but if you wanted to do what I do when you grow up, you could. You have the talent.” To which he responded, “Oh mom, I don’t want to listen to people talk about their problems all day!”
Why do I tell you this story? Though I was half disappointed to hear Derek would probably not be accompanying me to conferences in the future, I was also gratified by his response. He had answered in the language of desire, not need. He said, “I don’t want to.” I then remembered myself at his age, different from my son. I had already decided to do this work, to be a therapist, a decision that was not at that time based on desire. It was based on need. Desire reflects some measure of choice; need is an imperative. I was glad to see that my son did not have that need. And you have to have a need, otherwise, why would we want to listen to people talk about their problems all day?
What is this need? On the surface, it is a need to help others heal their wounds but this is a thin disguise for our own need to heal ourselves. And this profession does not want for wounded healers. Though it may be argued that psychic wounding is not a prerequisite for all of us, it is my experience that this is true for many and perhaps a large majority of us. From what and from where does this need arise? Couple this with the most basic of all skills in doing this work . . . that is, the talent for and skill of empathic capacity, and I think we may have a problem. The skill of using ourselves to help others find themselves coincides with our own pressing need to heal ourselves and to do so by finding ourselves in the other.
Of course, I’m talking about the capacity for empathy, a capacity that has multiple levels: observational, reasoning, imaginative, affective. But probably the most important level involves the capacity to find in ourselves an emotional resonance with the emotional state of our patients. To find in ourselves some area or experience of similarity where we can, in a temporary or trial identificatory way, (Bachrach, 1968; Buie, 1981; Schafer, 1959; Davis, 1983) evoke a similar affective state in ourselves. Researchers and theoreticians have referred to this mechanism as a temporary loss of self-other differentiation from where we can authentically convey to our patients that very healing experience of “You are not alone,” “I understand,” and the Clintonesque, “I feel your pain.” That going back, finding in ourselves an affective and meaning state that concurs with what our patients are expressing.[1] It is essentially a regression in the service of understanding (Celenza, 1985).
But the capacity of emotional resonance, if used in a therapeutic context, requires more than the evocation of an affective state. There is a recovery from that regressive state that is required as well, a re-assertion of self-other differentiation because, after all, we are not our patients, we have different histories, different meanings attached even to similar experiences, and, fundamentally, we are separate. This separateness may be defensively resisted (by either one of us), but it is a psychic fact. It is necessary to reassert our individuality because we are not hired in order to indulge a fantasy of merger, nor are we hired simply to connect (healing is not that simple). We are hired to offer our expertise, our knowledge, based on our psychological understanding (from the inside, as in emotional resonance, as well as from the outside, as in careful observation, reasoning and formulation). Failing re-assertion of our individuality (and difference), we could say empathy privileges sameness.
The empathic skill we largely employ in doing this work is a fluctuating process of regressive/progressive activity in the terrain of self-other identifications and differentiations. It is emotionally moving – we travel, as it were, to many different affectively-charged places throughout the day. How many times have you experienced this: A patient tells a riveting story, you feel intensely moved, you say to yourself, “Oh, I have to tell ______(a colleague or member of a peer group), the hour is over and what happens? You see another patient. Unprocessed experience (Harris and Sinsheimer, 2007) – maybe even trauma. Where does it go?
This experience gets processed unconsciously, or not. And it may lead to another kind of effect as we go about the day finding in ourselves some piece of the other. This fluctuating activity can lead to narcissistic imbalance or difficulties maintaining narcissistic equilibrium. An “Is this you or is this me?” kind of confusion.
In the moment, the answer to that question is unknowable. Even from a distance, we may never know. In the best of therapies, it is both/and. Where is the pain? Whose terror? There is a level at which analytic psychotherapy and psychoanalysis require an intensely absorbing emotional disregulation (Stechler, 2003), a tandem disembodiment or merger (Grand, 2007), as our patients delve and have us revisit moments of despair, suicidality and the like (Bernstein, 2003; Frankel, 2003; Grand, 2003). These are, in fact, the issues that dominate in cases of sexual boundary violations, not simple erotic longing.
In addition, the skill of empathic engagement (on emotional, intellectual and imaginal levels) has often been hatched and honed through childhood trauma: the capacity to find in our (wounded) selves an emotional resonance with the emotional state of our (wounded) patients.
Our basic activity in the analytic process involves revisiting areas of emotional vulnerability, perhaps at times our sorest points, along with the challenge to return to a state of narcissistic equilibrium in order to put that state aside. It’s another way of saying that our greatest gift is our Achilles heel – (Harris and Sinsheimer, 2007). We are not all equally capable of the necessary flex – some have trouble going there, others have trouble coming back - and we are not always at our best at every moment of our lives. The so-called situational stress or life crisis of analysts and therapists who have engaged in sexual boundary violations has been well-documented. There is not a case of sexual boundary transgression that has occurred outside of a highly stressful context in the life of the practitioner.
Flexibility is about tapping into pain and being able to step back enough to think about it. The Achilles heel – is it e-e-l or e-a-l? is that our need to do this work is part and parcel of our capacity to do this work, or, it might be said, that there is a convergence just at this point. The therapist’s job of finding in yourself some aspect of the other, driven by the patient’s need has become supplanted by finding some aspect of yourself in the patient, driven by your need. This is one step in how we can get stuck in the temporary identification with the other, a self-other confusion as another pitfall in the now familiar slippery slope (cf. Davies, 2000; Gabbard and Lester, 2000).
To fully appreciate the significance of the bind I am trying to describe, it is necessary to think about the complexity of the treatment context itself (see Celenza, 2007 for a more elaborated discussion of the structure of the psychoanalytic setting). By virtue of the two defining dimensions of the treatment setting, mutuality and asymmetry (Aron, 1996; Hoffer, 1996), an important dialectic is established that greatly intensifies the experience and longing for intimate, sexual union in the psychoanalytic context. First, there is the background experience of mutual, authentic engagement. This dimension is bi-directional in the sense that there are two persons committed to working together and withstanding whatever emerges. As already mentioned, this commitment holds out the hope for and promise of continued acceptance and understanding for the patient of even the most loathsome aspects of the self. Since the analysand is invited and encouraged to reveal areas of self-contempt and self-hatred, the promise of continued engagement in the face of these aspects of the self is simultaneously dangerous and seductive. The danger is inherent in the risk of rejection or withdrawal, despite the (sometimes overt) promise of sustained commitment. The seductive aspect coincides with the universal wish to be loved totally, without judgement or merit. Though rarely actualized, the wish to be loved totally without having to give anything in return remains a lifelong wish (see, for example, S. Smith’s [1977] discussion of ‘The Golden Fantasy’). These longings are never given up but can be set aside as life fails to fulfill them. One aim of analysis is to fail the patient in tolerable ways so that the analysand may mourn these wishes and get on with her life.
The seductiveness of unconditional acceptance and commitment is fueled and intensified by other fundamental and universal wishes as well. These include: a) the desire for unity (to be loved totally and without separateness), b) the desire for purity (to be loved without hate and unreservedly), c) the desire for reciprocity (to love and be loved in return), and finally, d) the desire for omnipotence (to be so powerful that one is loved by everyone everywhere at all times). All of these universals figure prominently in fantasies of romantic perfection and are stimulated in the treatment setting since the treatment contract partly institutes their gratification. It can be said that the treatment frame both stimulates and frustrates these universal wishes which will be freighted with the analysand’s historical meanings and unresolved developmental trauma.
A male patient with a history of subjugation to his single mother says, “I want to flow with my emotions for you, but it’s a trap. I can flow, but I don’t want to because I’m always reminded that this is not life. I want to believe it is real between us and be able to say, “She really cares about me.” I ask myself, do I feel something personal between you and me? I would like to believe there’s something flowing from you to me, but I don’t trust it. Is it our purpose? Why is it relevant? Is it unprofessional? It’s not our work, it’s not your job. If I want to believe you care for me personally, then I’m in the analysis trap.”
But the analytic context is stimulating, seductive and frustrating for the analyst as well. The frustration for the analyst is inherent in the second dimension of the treatment context, defined by the asymmetric distribution of attention. This comprises the analyst’s professional and disciplined commitment to the analysand. In the psychotherapeutic and psychoanalytic setting, the treatment context is defined by the asymmetric distribution of attention paid to the patient.
We are used to referring to the power imbalance in treatment to mean that the therapist has it and the patient doesn’t, but it is more complicated than that. This axis of asymmetry is hierarchical in that it is constituted by several power relations, yet it is not straightforward or simple. It is an asymmetry that frames several power imbalances at once, each of which is ambivalently held by both patient and analyst. On the one hand, the analysand is positioned as special (and thereby of elevated status) and at the same time, in a desiring or needful state (thereby vulnerable and disempowered). The analyst, by contrast, is relatively contained in his/her need of the analysand (thereby empowered) yet also discounted in terms of the distribution of attention paid (and thereby dismissed, in terms of his/her personal needs). This asymmetry deepens and is concretized as the treatment progresses in the sense that the analyst continues to learn more about the patient while the reverse (relatively speaking) is not true.