I treated a couple in which the wife was a beautiful, sensitive and creative middle-aged woman. She had achieved considerable success as a sculptor and was actively involved in the daily lives of her three adolescent boys. I was puzzled and frustrated by her lack of interest in my observation that her temper outbursts were adding to her husband's depression and passivity. I was delighted when she accepted a referral to a colleague with whom I have worked extensively.
I was looking forward to a change in her lack of insight. When nothing happened, I talked to her therapist, hoping for some understanding. Instead, I found he was having a similar experience. This was reassuring, since I had wondered whether countertransference issues were interfering with my ability to communicate on specific topics with this otherwise insightful woman.
If I had not trusted my colleague, I could easily have blamed him for poor work. Into this mix of personalities, roles and relationships, we must also introduce the husband's individual therapist. The wife was contemptuous of this therapist who had not "made a man of him." She saw me as active and powerful and wished I would take on the job of making something of her husband. Being idealized in this way is highly seductive. This is a setup for a "split transference," me being the good therapist and the husband's therapist being the bad one. If the wife's therapist and I had accepted and reinforced this split, the result would have been a destructive deval-uation of both the husband and his therapy.
Many forces, conscious and unconscious, were at play in this situation. For me, some of these were: my attraction to the wife, my sympathy and, to some extent, identification with the husband, my affection for and rivalry with my known colleague, and my suspicion of the colleague whom I did not know. These forces are all potentially damaging to the therapy. The most powerful counterforce to this destructiveness is the willingness to be open with oneself and, to the degree it is appropriate, to be open with colleagues and patients. It may be shameful to act on these feelings; it is not shameful to have them.
Psychoanalysis had its early development within the traditional Western ideal of man as hero. English author William Ernest Henley declaims, "I am the master of my fate/I am the captain of my soul." Poet John Milton has the fallen Satan speak, "A mind not to be chang'd by time or place/The mind is its own place." The individual was considered a complete and boundaried phenomenon.
Contrast this with John Berryman, a more contemporary poet. In one of his "Dream Songs," a female student who has come to him in distress apologizes for crying. He says to her: "No,/go right ahead/Cry. She did, I did/I am her." How unheroic! How lacking in boundaries! We have softened.
Interdependence, affiliation, shifting boundaries and regression have all been added to the former assertion that the highest psychic achievement is autonomy. We, along with the general culture, have changed, but we have also exchanged insights with our neighboring disciplines. Psychoanalysis has learned humility not only from those who work with groups, couples and families, but also from the need to use chemicals to alter psychological states.
Psychoanalysis is adapting to a different ideal of humanity. I am myself, but I am different under different circumstances. My boundaries are not impermeable. With family, with friends, at work or in public, I am me, but I am not the same. As therapists, whether an individual, a couple, a family or a group is in our offices, we are dealing with only part of a larger system. We choose which part of this complex interweaving of people and society, past and present, we can work with, based on who is available, and also on our own talents and inclinations.
Our work is enriched when we remain aware that we are all parts of different wholes that are themselves only parts of wholes. Each perspective, while valuable in itself, is only one of many possible ways of seeing.
Dr. Ehrlich is on the faculty of the Psychoanalytic Couple and Family Institute of New England and the Center for Psychoanalytic Studies in Boston and is a member of the Boston Psychoanalytic Society and Institute.