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.
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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.
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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
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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).
1
Recent neuroscientific research on mirror neurons (Olds, 2006) has explored the neurophysiological
substrates of this identificatory capacity, especially the biological mechanism of imitation and its
relationship to identification. These mechanisms include the capacity to evoke memories from the past
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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
(attunement) as well as those involved in imagining new or different experiences outside one’s subjective
repertoire. Both are part of empathic resonance, however I focus here on aspects of attunement that evoke
personal references from the analyst’s past.
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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
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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
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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
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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
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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.
These two axes, mutuality and asymmetry, function in dialectical relation.
For example, the asymmetry deepens the analysand’s need for mutual, affective
engagement as a way to ameliorate the humiliating, disempowering aspects of
being the continuous focus of attention. In this way, it is the facilitation and
encouragement of the analysand’s openness and vulnerability that makes the
analyst’s love and acceptance all the more important (Hoffman, 1998). Likewise,
it is the extent to which the analysand reveals him/herself, especially areas of
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self-hatred and self-loathing, that intensifies the analyst’s power in relation to the
analysand. In other words, it is the analysand’s self-revelations that empowers
the analyst and intensifies the desire for a mutual, authentic engagement
(deriving from the analysand’s disempowerment).
In these ways, the treatment setting is a complex structure that uniquely
instantiates several contradictions. Especially interesting is the way in which the
treatment setting combines these two contradictory axes: the axis of equality and
mutuality (a ‘we’re in this together’ type of experience) along with the
contradictory and imbalanced focus on the analysand (a ‘you are in this alone’
type of experience). The treatment setting is the point at which these two axes
converge, creating the paradox of a simultaneous feeling of mutuality and
asymmetry, of intimacy and aloneness, and of equality and hierarchy. These are
tensions that the analysand is persistently moved to resolve, to disequilibrate or
level the hierarchy, so to speak, and to make contact with the authentic person
behind the professional role.
It can be said that psychoanalysis is a process by which the analysand
attempts to both empower and disempower the analyst (and vice versa) in an
ongoing, and increasingly more urgent way. By virtue of the special
combination of mutuality and asymmetry, a tension is established that the
analysand both desires and hates. This necessarily will reconstruct and
recapitulate the analysand’s relationship to authority and power in general. The
psychoanalytic context and the analysand’s experience with the analyst given the
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power structures within it, is a particularly intense instantiation of this relation.
Not surprisingly, in those for whom parental experiences are freighted with
trauma and hypocritical or exploitative uses of power, the analytic process will
be experienced with great mistrust and skepticism. (For a more elaborated
discussion of the power dimensions of the analytic process, see Celenza, 2007.)
Likewise, for the analyst, there is a powerful contradiction inherent in the
intersection of these two axes. The constant dismissal of personal need is
frustrating and depleting yet the analyst is also partially gratified and titillated
by the moments of attunement that the analysand offers. It might be said that the
frustration of asymmetry is counterbalanced by the seduction of mutuality and
momentary attunements; ‘we’re in this together differently’ mistakenly becoming ‘we’re
in this together the same.’ These vicarious identifications evoke and temporarily
unsettle the analyst as he or she decenters and resonates with the analysand’s
experience. Recentering and thereby re-asserting separateness and difference are
crucial aspects of this fluctuating dialectic that can become more muted, less
sharp and only half-heartedly asserted over time.
For the analyst, the experience (and skill) is one in which his or her needs
are put aside. In this way, we are disempowered and, it might be added, there is
the attendant need to re-empower oneself that the analyst/therapist must
continually resist. Idealization and seduction (by the patient) can be special
temptations.
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The patient, on the other hand, is the central focus. The patient is thereby
empowered but by a humiliation; there is the attendant need to become
empowered in a different way, to be loved and to see perhaps, the analyst give
up all other ties for her, including those to his or her profession. To say that there
is a vicious power play engendered by the structure of the analytic setting puts it
mildly.
How complex and demanding the work of psychotherapy and
psychoanalysis is! There is the fluctuation of regressive and progressive
emotional resonance, the inherent structured imbalances, and the dynamic,
resistive pressures to level the hierarchy from both within and without, i.e. from
within ourselves and from the patient. We must come to this work centered and
fortified, past injuries largely healed and mourned, our present desires largely
sated. Yet we are not rocks – we will be influenced and changed through our
relationships with our patients (Mitchell, 1997). Mostly this will be in a mutually
growth promoting way. At the same time, the work can be wearing and
draining. Parenthetically, it may not surprise you to know that most therapists
who engage in sexual boundary violations work long hours and are relatively
isolated in their practices.
It can be useful to compare the occupational hazards of those whose work
is fundamentally different. My husband Bruce is an attorney. He talks all day.
He makes decisions and the thing I envy the most, he tells people what to do,
gives advice (and they listen), all day. I, on the other hand, mostly listen, resist
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giving advice, measure my comments based on the patient’s readiness, and so
on. When I get home at night, I’m virtually chomping at the bit to talk about my
day but especially to tell someone what to do. My husband, on the other hand,
doesn’t want to speak another word. Most of all, he does not want to make
decisions. I decide what’s for dinner, for example, and he’s happy to let me. At
the end of the day, we make a good pair.
A colleague who works too many hours, sometimes 11 hours a day –
confided in me that he cannot stop at red lights. It’s not that he will go straight
through them, mercifully, but he will drive around the block in order to avoid
them. He explained, “I spend all day at the behest of my patients, waiting, in
effect, for them to be ready. When I am out of the office, I cannot wait another
second.” Similarly, I notice in myself a contemptuous impatience in stores, with
tellers and salespeople, and refer to myself as “waiting impaired.”
These are everyday minor symptoms that are only further reinforced by
our fast-paced impatient culture (see Slochower, 2003 for a discussion of minor
delinquiencies enacted within the treatment frame). But there are more pressing
imbalances as well, for example, when a patient talks of suicide or we are told of
a serious illness (perhaps our own). As I mentioned, there are no cases of sexual
boundary transgressions without severe stress on the narcissistic equilibrium of
the analyst. But this disequilibration is not solely from the patient’s needs and
demands. There is also the draining effect of the work itself (Harris, 2007, 2008).
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I find myself needing fortification throughout the day, but I am unclear
what the appropriate balm is. After 8 or 9 patient hours, I notice a wanting, a
need for something. Am I hungry? Is it thirst? Do I need caffeine? None of
these addresses the longing I feel. I am decentered. It is a kind of dissociation.
This constant fluctuation and finding the other in myself (or myself in the other)
takes its toll. At the end of the day, my boundaries are blurred. And if I had
seen and connected with (in this blurring of boundaries way) a patient whose
despair mirrors some aspect of my own from the past . . . the temptation to
rescue, to stay in it with them or to somehow take on their burden, perhaps do
for them what was not done for me, can be very great indeed.
The playwright Sam Shepard once stated that the problem with love is
that people confuse it with salvation (cited in Levine, 2007). There are other
confusions as well – the focused attention in the treatment situation feels like
love, also a certain kind of intense dependency that can get stirred up feels like
love. The sense of rescue when the other is in a fragile state is particularly
seductive.
Like Paul Weston, from the HBO series In Treatment, we can’t help but
notice how distant, I would say, decentered, disconnected from himself, he is.
Paul is stuck in this dangerous decenteredness – stuck in the other’s shoes, so to
speak, a flight from himself rather than the temporary decentering of empathy.
And it appears from the condition of his marriage that this decentered altered
state has actually become the steady state. Temporary decentering is part of
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empathy. In Paul, it has become a permanent state. Herein lays the occupational
hazard. A cautionary tale to all of us.
Another scene from In Treatment features Paul in a heated discussion with
his son when he tells his son that his mother has gone to Rome with another
man. His son reacts in an utterly reasonable way, “How could she do this to
you?” To which Paul responds by defending his wife! He talks about how much
she has sacrificed, how long she has denied herself pleasure, how his son
shouldn’t talk about his mother this way . . . Finally his son interrupts his father
and says, “But Dad, what about you? What do you want?” Paul looks genuinely
puzzled. He doesn’t know what to say. What was he doing? He was using
empathy as a defense – herein lays our occupational hazard.
A potentially useful measure for psychoanalysts and psychotherapists has
been construced to assess these vulnerabilities in all of us. This measure has been
derived from my work with sexual boundary transgressors and is designed to be
a self-monitoring instrument that can help us introspect, help us know if we have
the precursors, the childhood facilitating circumstances, the character structure
and the unconscious or felt needs that may put us at risk during special times of
stress (see the chapter on the BVVI, Celenza, 2007 for the instrument, scoring
method and empirical derivations).
It may not surprise you to know that the childhood history of sexual
boundary transgressors follows a certain pattern. These therapists and analysts
were identified early as the child who uniquely understood a depressed parent.
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Usually this is the mother; usually the therapist is an only son or in some way a
parentified “chosen” child. So there is a lifetime of training in connecting and
getting some semblance of need met through an empathic resonance. The same
can be said for female transgressors, although here the common finding is where
the therapist or analyst overidentifies with her patient (and usually the patient is
also a woman). The therapist will say, “She is the child I was.” Again, a
perversion of the therapeutic process by using an empathic resonance to meet the
therapist’s need. Then we must add to the mix the common finding that the
patient/victims of sexual boundary transgressions are often empathically gifted,
only too willing to rescue the therapist through a reversal of role.
This is to underline how important a role our significant others play in
recentering us at the end of the day. This recentering is an internal adjustment –
physical exercise can be helpful too and I am convinced this is because it works
on our body, the container of affects that needs a massage. But most
importantly, we need someone to get inside, to exteriorize our insides and find a
receptacle in which to deposit our angst, the unprocessed trauma to which we
have been exposed. In moments of severe stress and trauma in our own personal
lives, I think we can be desperate to refind ourselves in this constant
decentering.2 Add to this the fact that so many of us treat colleagues who are
2
In my experience, colleagues, supervisors and consultants do not sufficiently meet the need I am
describing. Though peer supervision groups and consultations play an essential role in our clinical life
(Gabbard, 2000; B. Pizer, 2000; S. Pizer, 2000; Celenza, 2006, 2007) too many transgressors were in such
groups or had received appropriate consultation yet transgressed anyway. There is a special quality of
intimacy that I aim to examine and pose here as a personal and occupational need. Various gratifications in
17
themselves therapists or analysts and we can easily (perhaps too easily) find a
way to recenter by decentering again and finding ourselves in the other. Is this a
mutual meeting of need or a reversal of the asymmetry? Confusing mutuality
with symmetry is the mistake Ferenczi (1932) made (Aron, 1996) and there is a
rationalization based on this confusion that boundary violators often make.
Erotic excitement – a normal and expectable response - can function to
recenter us by locating our experience in our bodies. As I have written elsewhere
(Celenza, 2007), all treatments must revolve, at some level, around the question,
“Why can’t we be lovers?” This question must be reckoned with and will
involve the use of erotic arousal in the dyad. This experience may dovetail with
the analyst’s need to recenter him or herself, situate or ground himself in his
body.
The treatment setting has many inherent seductive aspects for patient and
analyst alike. A male patient recently said, “The way you pay attention feels like
love. The attention helps, the love doesn’t.” This statement followed a previous
session where he had proposed that we spend an afternoon “having ecstatic sex,
fall hopelessly in love with each other, and run away together” (for a more
extended discussion of this case, see Celenza, 2006). He knows I’m married but
needed me to say no anyway. It didn’t help that he knows some therapists
actually have spent such afternoons with their patients.
the analyst’s outside life play similar functions and are certainly necessary but like consultations, they are
not sufficient to address the needs I am describing.
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Today, it is a surprise to hear a patient say that the love in the therapeutic
setting is not much help. We are growing more accustomed to the corrective and
healing aspects of the therapeutic situation, especially as they revolve around
loving. Love in the therapy setting is complicated, however, by the ways in
which it is entangled with power imbalances and other asymmetries.
Still, it might be asked, why does the urge to level the hierarchy
(prompted either by the patient or the therapist), the desire to disempower one
member of the dyad, so often become played out in the sexual realm? Given the
draining effect of our decentering work, the way in which our work necessarily
dissociates us, sexualization can become a tempting way to reconnect with our
bodies. As in sadomasochistic relations where the power play in the dyad is
polarized in an equally complex way (Celenza, 2000a), this power play between
therapist and patient has its own sexual tension.
Power, in and of itself, is sexy. This is universal, ubiquitous, and part of
what the therapist embodies in the psychotherapeutic relational matrix (Celenza,
2005). It is also not gendered (see Dimen, 2003 and Harris, 2005 for outstanding
discussions of intimacy and power in relation to gender). By this, I refer to both
the female therapist’s phallic power and the seductiveness of male receptivity
(Celenza, 2000b). The specific ways in which the therapist derives his/her power
transcends typically Western gender stereotypes and are sexy in and of
themselves.
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In addition, power is sexy because it always was, i.e. because this is the
way love was experienced in its first instantiation. We are born into a power
relation, directing our first loving feelings toward those who have a temporal
advantage, to those (parents or a parent) who have come before, so to speak. To
be in a relationship with a person more powerful than oneself activates
memories and expectations of love relationships structured around a power
imbalance, of which the parent-child experience is the prototype. Of course, this
is the transference phenomenon upon which all psychotherapeutic treatment is
based and which the treatment aims to explore.
Transference love derived from unresolved oedipal wishes or other
developmental moments will be fostered by virtue of the structured asymmetry.
And whenever love is in the air, sexual desire is not far behind. Love is, after all,
a four letter word.
In all, the treatment situation (perhaps any intimate relationship) lends
itself to sexual metaphor. The dialectic between holding and penetration fosters
a mutual deepening and this dialectic is itself a sexual metaphor. For both
therapist and patient, the psychotherapeutic work is penetrating and enveloping,
incisive and holding, a firm receptivity that retains, envelops and holds the other
in one’s mind.
Given the structure of the treatment setting, the ways in which power
imbalances work against each other and especially for us, as therapists and
analysts, the draining effects of the therapeutic process, these pressures combine
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to make our patients seductive objects for us too. The most common form of
sexual boundary violation occurs where the patient and therapist feel they have
found their soul-mate in each other – a kind of over-identification that is rigidly
fixed – it is beyond a love affair because there is no fascination with the other as
different, no space for a creative discovery. It is essentially a narcissistic oneness
fantasy where the other is experienced as the mirror image of the self. Here, we
might say that the empathic process has become derailed and perverted –
empathy in the service of not knowing. In stressful circumstances, perhaps a
failing marriage, a mid-life reassessment, the shadow of a progressive illness, we
may come to the therapy hour too decentered and needy.
In these ways, I aim to highlight the special brand of burnout entailed in
the work of psychoanalysis and analytic therapy. It is beyond the exhaustion of
too many hours and long days (a quantifiable effect). It is also beyond the
quality of burnout typically associated with the helping professions in general.
Most ‘other-centered’ occupations share in the effects of chronic depletion –
caring for others in the place of self-care. Psychoanalytic therapies, however,
also entail a specific mix of frustration and titillation that I aim to highlight here.
I believe the combination of this particular mix can be a perilous combustion at
certain times. It is the frustrating and titillating kind of decentering that is our
own. Psychoanalytic therapies take place within the highly seductive (and
potentially intimate) context of the therapeutic asymmetry – this potentially
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depleting and titillating structure making external supports and outside
gratifications crucial sources of re-calibration and equilibrium.
Not all analysts are equally vulnerable and it is also true that the majority
of us do not get into serious trouble. Plenty of analysts have satisfying and
balanced lives both inside the treatment setting and in our outside lives as well.
In this paper, however, I aim to show how this particular experience – the
simultaneous depletion and stimulation – is an occupational given and potential
hazard for us all. No one is immune from these basic needs, temptations and
experience within the analytic setting. The peril is both specific to the work we
do and ubiquitous within the profession as a whole.
Steve Behnke (2007, personal communication) recently talked about the
need for a developmental perspective on ethics – to take into account different
needs at different times in our lives. If we think of analysis as analogous to
dancing – we analysts may be good followers, we also can lead, some of us have
rhythm, or at least know a variety of steps. But we may not always be capable of
a tango – that passionate, intoxicating and provocative dance of fire and ice,
passion and precision.
We need to know when we should say, “I’ll sit this one out.” I used to be
able to treat child abusers but that was before I had children. Now I sit those out.
Perhaps there are times in our professional lives when sitting out certain dances
or going back to lessons should be at the forefront of our minds. More
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importantly, to tend to the day to day strain of this work, find ways to recapture
our balance, perhaps tango lessons with our spouse, would do the trick.
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Andrea Celenza, Ph.D.
11 Field Road
Lexington, Massachusetts 02421
781.652.8944
ACelenza@AndreaCelenza.com
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