I walked into the common room at the Hampstead Clinic, where I was training to become a child analyst, to see my revered supervisor sitting silently, pale and tense at the table. “What’s wrong? Are you all right?” I asked. She smiled and answered, “Yes, it’s just that I am about to meet a new patient. It’s the first time and I’m nervous.”
Our first experiences at the beginning of training matter. They set a tone, lay the foundation for what may become a lifelong stance and challenge us to define ourselves in a developing analytic identity.
My honest supervisor taught me in that moment that my worries at meeting a new person, a stranger whose world I would try to encompass, were legitimate. They were not just a function of my inexperience and I should not try to make them go away. Rather, I could stay open to what would unfold. She helped me see that both people in the clinical encounter have feelings, uncertainties and hopes, that we meet each other on common ground, where we try to build a structure of security from which we can venture out together to explore the wilds.
Fast forward another year – I was seeing my 4-year-old patient in a room at the top of the old Clinic house. At the end of the session, we had to go down three flights of steep stairs to rejoin her mother in the waiting room. Automatically, I held out my hand and she took it. A faculty member saw us and reproached me later in the common room: “You shouldn’t offer your hand – that’s not analytic.”
Her statement challenged me for the first time to assess that idea consciously. Up to that point, I had been learning how much psychoanalysis encompasses, how completely a metapsychological description includes phenomena from multiple levels and domains, how rich our technical repertoire can be. Now I was hearing about what someone thought should be excluded, and it made me profoundly uncomfortable.
At first I was annoyed, since the faculty member’s remark seemed somehow disproportionate to the context. Then I felt anxiety, possibly self-doubt – after all, I was just a 24-year-old student and what did I know about what was and wasn’t “analytic?” Here I was training in a mecca of the field, where they surely knew everything there was to know.
But that internal discomfort was an important signal that made me really look at my own developing identity as an analyst. What was my psychoanalysis going to be? I had begun the never-ending journey of self-discovery and self-definition that is integral to our field, where we honor the individuality of each analyst and patient, and where we ourselves are the instruments of the work. My presence as myself in the analysis is a physical, objective, practical, emotional and conceptual reality. I had to think about the complexities of reality in my work.
First reality -- my patient was a little girl on steep stairs and I was a trusted adult. I believed then and believe now that any adult’s job is to keep any child safe. This is both concrete and metaphorical. Jack Novick and I have written about a hierarchy of clinical values, where safety is primary (Novick, K. and Novick, J. 2005, Novick, J. and Novick, K. 2009). In that discussion, we engaged with our sense that no treatment is possible unless both people can create a place of emotional safety. One of the analyst’s early tasks is to understand the conditions the patient needs to set up in order to feel safe. How these help and impede trust in the relationship and the capacity for joint work at various moments will occupy much of the analysis. This was my second reality.
Looking more deeply, I became aware of the powerful reality of her transference longings and my role-responsiveness to her wishes for a dependable, caring mother. I was learning about the overdetermination of the analyst’s responses – a third reality. From that insight, I could listen differently to our interactions and find the complexity of her many feelings about me, as well as mine about her.
Fast forward another fifteen years. During that time I had practiced as a child and adolescent psychoanalyst, working also with parents, but refrained from treating adults in analysis because I had not gone through formal adult training. I entered my adult training with some unexamined preconscious assumptions, among them the idea garnered from some adult-only colleagues that child and adult analysis were very different from each other, on many dimensions. My theoretical work and writing, however, had usually addressed ideas, dynamics and techniques that were not limited to any age group.
I was intrigued, therefore, when one of my first adult patients told me that she particularly wanted treatment with me because I was a child analyst. She was concerned about her level of anger with her children and thought I would be able to understand those interactions because I would see both sides. Thus began a revelatory journey together which offered me a much more comprehensive view of psychoanalysis.
For the first time, I could engage directly with inter-generational material, and discover that my technique was not restricted by the age of the patient. I began to think in terms of one psychoanalysis, a life-cycle psychology of development and functioning.
I hope there will be more first times yet to come.
References
Novick, J. and Novick, K. (2009). Expanding the domain. Annual of Psychoanalysis, Ed: Jerome Winer. Catskill, NY, Mental Health Resources. pp. 145-160.
Novick, K.K. and Novick, J. (2005). Working With Parents Makes Therapy Work. Jason
Aronson: New York.