Psychotherapy: Nancy Shaffer, Ph.D. -- Letter 3/6/2000

March 6, 2000
3801 Connecticut Avenue, NW
#136
Washington, DC 20008-4530

Nancy Shaffer, Ph.D.
Community Mental Health Center
Washington, DC 20007

Dear Dr. Shaffer:

I have identified a paper that provides, what I believe to be, a useful model that identifies core issues in my personality and distinguishes them from comparable issues found in other personality types. In his autobiography of the psychoanalyst Otto Rank (Acts of Will at 402-03) E.J. Lieberman, M.D. offers a brief summary of the following paper: Donald W. MacKinnon, "Personality and the Realization of Creative Potential." American Psychologist 20: 273-81, 1965. Dr. Lieberman is a local psychiatrist and a clinical professor of psychiatry at the George Washington Medical Center Department of Psychiatry.

MacKinnon gathered personality data on architects. The data clustered into three personality types: (I) the artist (creative), (II) neurotic (conflicted; artiste manqu‚), and (III) the average (adapted). (Architects were chosen because they combine art with science, business, even psychology). His research found significant differences among the three groups.

Group I scored highest, in MacKinnon's analysis, on aggression, autonomy (independence), psychological complexity and richness, and ego strength (will); their goal was found to be "some inner artistic standard of excellence."

Group II scored intermediate on independence, close to (I) on richness, and highest on anxiety; their goal was "efficient execution."

Group III scored highest on abasement, affiliation, and deference (socialization); their goal was to meet the standard of the group.

I believe these categories provide a useful axis for personality assessment and comparison, particularly with respect to differing social needs; possible sources of interpersonal conflict; the nature of impulse control (whether largely internal or external, i.e., whether in the form of internalized values or in the individual's relations with the social group [which exerts peer pressure and offers conventionalized norms]); and also, possibly, different types of moral reasoning.

You will also appreciate that these categories provide insight into conflicts between you and me in the clinical setting that center on the differing nature of our respective values and needs. One interesting aspect of MacKinnon's study is that it concerned a population of occupationally-adjusted professional persons; the results, therefore, are relevant to an understanding of the relationship between, on the one hand, the psychological functioning of the individual professional and, on the other, his or her corresponding professional values and needs.

Perhaps, one might elaborate MacKinnon's categories to include the following issues:

TYPE I

(a.) derivatives of the early mother attachment will reside to a significant degree within the individual;

the need to gratify these internal structures will be an important motivating factor in the individual's behavior;

(b.) the individual will not be easily swayed by peer pressure; will not need to accept conventionalized social norms for the purpose of affiliation; or experience fear of ostracism or social rejection;

(c.) conventional social affiliation alone will not gratify the universe of this person's psychological needs; a form of psychotherapy that focuses predominantly on the need for social adjustment or affiliation will arouse frustration and hostility in the individual. A form of psychotherapy that depends on the patient's acceptance of the values and norms of the therapist will be ineffective;

(d.) the individual may experience difficulties, possibly severe, in groups that place a premium on abasement, affiliation, and deference (socialization), and whose members' goal is to meet the standards of the group. In such a group, the needs and values of Type I may be depicted as expressions of a lack of social adjustment, grandiosity, inability to conform, warped thinking, or paranoia, etc. Put another way, the needs and values of Type I that are products of his ego strength may be depicted as expressions of psychopathology;

(e.) the individual's ego strength will permit the individual to house intellectualized representations of aggression. The individual will be able to comprehend the idea that he may be a victim of aggression (which will be depicted by Type III individuals as an expression of paranoia), that the social group can engage in acts of aggression (again, "paranoia"), that the mother or mother derivative can be inappropriately aggressive or deficient, or that the self may be justified in aggressing on others (as, for example, in isolating the self, refusing to conform, or criticizing the social group or protected family members, etc.) .

TYPE III

(a.) derivatives of the early mother attachment will reside to a significant degree in the individual's relationship with the social group; the need to conform with external values and norms will be a decisive motivating factor in the individual's behavior;

(b.) conventional social affiliation alone will gratify a significant portion of this person's psychological needs; a form of psychotherapy that focuses on social needs, adjustment, or affiliation will be effective. The effectiveness of the therapy will itself be based on the need of the patient to conform to the thinking of the external object and its values, as represented by the person of the therapist;

(b.) the individual will be dominated by the need to (1) conform to peer pressure and social norms; (2) modify aspects of his own thinking that conflict with external values; and (3) avoid ostracism or social rejection; similarly, in the clinical setting, the patient will need to conform to the therapist's values, will readily modify his thinking, and will seek to avoid the therapist's disapproval;

(d.) the individual will place a premium on abasement, affiliation, deference (socialization), and his goal will be to meet the standard of the group;

(e.) the individual's relatively lower ego strength will not permit the individual to house intellectualized representations of aggression. The individual will not be able to comprehend the idea that he may be a victim of aggression (the notion of "external aggression against the self" will be denied defensively as an expression of paranoia or hypersensitivity); that the social group can engage in acts of aggression (again, "paranoia"); that the mother or mother derivative can be inappropriately aggressive or deficient; or that the self may be justified in aggressing on others.

A therapist who happens to be Type III will apply psychoanalytic concepts or models in a trite and simplistic manner that conceal her own need to deny aggression. ("You complain about abuse; but your report is a product of your own ego vulnerability and your need to project your own aggressive trend." -- Such an interpretation, which satisfies the therapist's need to deny aggression, renders the patient a repository of fear and aggression in his social matrix. Other persons in the patient's social matrix are thereby rendered benign or, alternatively, victims of the patient's (the "bad object's") own aggression.)

Moral reasoning may be dominated by the view that the social group (the mother derivative) is always rational, objective, and benign; and that it is the duty of the individual to conform to the values of the social group. And that the failure to conform justifies aggression against the nonconforming party (the bad object). Moral reasoning will be dominated by externalizations that preserve the integrity of the image of the Good Object (in the form of the social system, which is always benign when unprovoked) and that retain the image of the Bad Object (in the form of the nonconforming or "unadjusted" party, which object must remain a repository of all fear and all aggression). ("Why does he sit at his desk all the time, working?" "Don't you know, he's extremely shy." "No, I think he's full of rage about being left out of things.")

A therapist who happens to be a Type III will emphasize her own Type III values as universal moral values, the adoption of which by the patient will constitute mental health. The therapist will emphasize the need for self-abasement, social affiliation, deference (socialization), and the need to conform to group norms and standards. The therapist will depict the patient's individualized thinking as expressions of narcissistic disorder or other psychopathology. The therapist will be unable to house intellectualized representations of aggression, and will deal defensively with a patient's report of past abuse by means of simplistic attributions of narcissistic vulnerability or paranoia.

MacKinnon's findings, which implicitly link up the individual's psychological functioning with his professional values, suggest that there may be a relationship between the psychological status of the therapist and the fact that she works at a public clinic where self-abasement and conformity to group norms are important values. Put another way, there may be a relationship between the fact that a therapist works at a public clinic and the fact that she has difficulty dealing with the patient's experiences of (and reports of) past victimization that centered on his status as an outsider. ("You are doing everything that I avoid doing here at the clinic in order to get along with my colleagues. Your social difficulties are really a punishment for your bad act of failing to conform.")
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I have identified a published article that, I believe, exemplifies what might be termed "Type I" (creative) functioning in a mental health professional. The article is titled "Trauma and War: A Fragment of an Analysis with a Vietnam Veteran" and was written by Sidney H. Phillips, M.D. The Psychoanalytic Study of the Child. Volume 46: 147-180 (1991).

The author's creativity, applying MacKinnon's criteria, is disclosed, interestingly, in different levels of the text: in the author's choice of, and approach to, the subject matter; the author's self-appraisal; the author's act of exceeding the requirements of his profession; and in his unusual level of curiosity (and probably also in other areas).

You will recall that according to MacKinnon the creative professional tends to score high on measures of aggression, adherence to an inner standard of performance that exceeds the basic standards of the profession, the lack of self-abasement, among other criteria. Consistent with studies in the creative process, one might add another criterion: unusual curiosity.

AGGRESSION:

First, the very thesis of the paper concerns trauma: the experience of trauma by the patient and the ability of the therapist to deal in a non-defensive manner with analytic material relating to the patient's experience of trauma. The author observes that his handling of clinical material relating to trauma is not typical. Analysts may tend to interpret a patient's response to a traumatic event as a product of pre-existing ego vulnerability or childhood fixations or conflicts. Phillips at 165.

It is likely that psychoanalysts' difficulty in listening to the graphic details of massive trauma contributes to an inability to resolve some theoretical problems in the area. Moses (1978), for example, acknowledged his own lack of exposure to catastrophic trauma and his denial and delay in personally confronting the impact of the Holocaust. Phillips at 165.

Perhaps, an analyst's ability to work with victims of trauma or abuse may reflect his level of ego strength and a corresponding ability to intellectually house issues relating to aggression. MacKinnon's work suggests that the more creative the analyst, the greater his tendency or capacity to interpret clinical material relating to trauma or abuse as an event sui generis, not solely a product of pre-existing ego vulnerability or neurotic conflict. Dr. Palombo take note!

A possible additional indication that the author is able to work non-defensively with clinical material relating to aggression is his ready acceptance of, even delight in, the details of the patient's traumatic experiences. The precise significance of this observation is suggested by the Letter from Gary Freedman to Dr. Shaffer dated February 9, 2000 (which explains the therapist's turning away from the details of the patient's report as a form of "identification with the aggressor"). The published paper (Phillips) is dotted with expressions such as: "He related new details" (154); "after talking in such detail" (155); "he had spoken about both incidents in great detail" (160).

INNER STANDARD OF PERFORMANCE (CURIOSITY):

The author's adherence to an unusual standard of performance that exceeds the standards of his profession is revealed in a passage of the paper that also illustrates an unusual level of curiosity. Phillips at 172.

In reviewing the process notes written during the course of this analysis, I came upon the session where Mr. B. spoke of the "About Men" column in the New York Times Magazine entitled "Nicknames." The patient's elusive way of referring to the article made me curious. I tracked down the article and discovered, to my surprise, that Mr. B. had failed to mention a fascinating aspect of this article. The author, a Vietnam veteran himself, reported a flashback experience startlingly similar to Mr. B.'s later flashback. Phillips at 172 (emphasis added).

Certainly, the analyst's action in researching a back issue of the New York Times reflects both an unusual level of curiosity in a psychoanalyst, and an action that exceeds the expectations of the profession.

Compare Letter from Gary Freedman to Lisa Osborne dated August 5, 1998 (p. 6) concerning the professional work of William D. Brown, Ph.D.; the psychologist's persistent mechanical questioning of the patient is described as an "as if" pseudo-curiosity.

LACK OF SELF-ABASEMENT:

The author's appraisal of his work and his contribution to psychoanalysis is noteworthy. The concluding paragraph of the paper is couched in language that is personalized and eloquent, indeed poetic.

Clinical work in the controversial seas of war trauma demands new directional beacons of theory that illuminate [Erikson noted that the word "theory" is derived from the Greek word that means "to gaze at" or "to gaze in wonder at"] and accurately map the existing terrain. To my knowledge, this is the first paper to present detailed material from clinical psychoanalysis with a Vietnam veteran. Admittedly, my approach is empirical, but my aim remains in the context of discovery: to generate hypotheses that need further validating descriptive studies and veridical testing. Indeed, another aim of this paper is to invite psychoanalysts to publish their accounts of clinical work with Vietnam veterans. If I launch a guiding buoy or two along the way, I will be pleased.

The author's expression of unusual curiosity, adherence to an inner standard of performance that exceeds the standards of his profession, the lack of self-abasement, and his non-defensive handling of clinical material relating to trauma (and, by extension, child abuse) may constitute a complex of personality factors that, according to MacKinnon's work, may be signals of creative ego functioning in a mental health professional. The co-expression of these disparate personality factors in one text may be no mere coincidence. To quote Otto Rank: "It must be so!"

One additional matter of note is the author's use of words and phrases relating to locomotion, discovery, and mapping, suggestive of "the journey": thus, "I tracked down" (p. 172); "veered away" (154); "again veered away" (159); "veer away" (p. 164); "map the existing terrain" (178); "directional beacons" (178); "guiding buoy" (178); "context of discovery" (178). See Shengold, L. Soul Murder at 286 (New Haven: Yale University Press, 1989) ("The metaphors that interconnect with that of the journey include views and prospects, locomotion, ascents and descents to heights and depths, explorations, demonstrations, light and fire, darkness. They are all involved with the map of the world within and the world outside the mind--with how the world outside is registered within. The metaphors are aspects of the journey that lead to insight and outlook[.]") See also Letter from Gary Freedman to Lisa Osborne dated August 11, 1999 (discussing the use of the word "map" by another psychoanalyst, Warren M. Brodey, M.D., in reference to his contribution to psychoanalysis; coincidentally, both Brodey and the present author preface their respective papers with separate quotes by Freud that feature concrete references to orientation and locomotion).

(Incidentally, as a footnote, I believe the above material raises additional questions about why a supremely creative individual like Sigmund Freud (who, as a Type I personality, could readily house intellectual representations relating to aggression, abuse, or trauma) would choose to abandon his research in the area of child abuse (i.e., the so-called "seduction theory") to focus instead on the inner world and fantasy. The solution to that riddle may well lie in further inquiry into the very nature of Freud's creative ego functioning.

In light of this material, the following observation of Jeffrey Masson's carries added meaning: "[W]hatever Freud's ultimate decision, it is my belief that he was haunted by the seduction theory all his life.")

Sincerely,

Gary Freedman