Psychotherapy: Nancy Shaffer, Ph.D. -- Letter 2/2/2000

February 2, 2000
3801 Connecticut Avenue, NW
#136
Washington, DC 20008-4530

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

Dear Dr. Shaffer:

This letter will review two interpretations you made at a prior consultation that, I believe, reveal aspects of your moral reasoning or superego sanctions.

Both interpretations are interesting because they are manifestly problematic and also consistent. The interpretations concern two personal anecdotes that I offered relating to the issue of independence of thought and action.

ANECDOTE ONE:

I reported an incident that occurred in kindergarten. My classmates and I were assigned the task of preparing costumes for a school pageant. We were to make costumes out of craft items such as crepe and construction paper. The pageant was to be performed in the school auditorium before an assembly of students in grades four through six.

I told the teacher I did not want to participate in making a costume. I don't know what motivated my action.

The teacher said I was not required to make a costume, but that I would have to appear with the other students on stage, regardless. The teacher may have pointed out that I might feel a little silly if I were to appear on stage and be the only little boy not wearing a costume. I would have said, "I don't care. I don't want to make a costume." (This seems to suggest that I would comply with norms to the degree required, otherwise I would exercise my own discretion.)

The pageant took place. I was the only student in the kindergarten class who did not make a costume, and I appeared with the other students on stage in my street clothes. I was not distressed by the incident. As far as I can recall, I simply had the feeling: "They're doing what they wanted to do. I am doing what I want to do. That's fine with me." No students ridiculed me about my behavior. Probably at age 5, peer pressure and conformity are not powerful issues. The teacher didn't care. The only negative response was from a sixth-grader in the audience (Barbara Stein, Philadelphia High School for Girls, 1965), who happened to live next door to my family. She accosted me: "Why didn't you make a costume? Everybody else made a costume. You looked stupid up there on stage--the only person without a costume." I didn't care.

THERAPIST'S RESPONSE:

Couldn't you at least have made some effort to go along. Couldn't you at least have made a paper hat and put it on? Couldn't you at least have paid lip service to what the other students were doing?

ISSUES OF MORAL REASONING IMPLICIT IN THE THERAPIST'S RESPONSE:

1. First, the most glaring problem is that no one (other than a neighbor) disapproved of my behavior. I had the teacher's permission not to participate in the school program. Also, I reported that none of the other students cared that I did not participate.

Here, the therapist is simply projecting her value onto a group of persons (the kindergarten students) that it is wrong not to go along with the majority. We can say that in this instance the therapist shows the irrational premium she places on conformity with group behavior. In this instance, conformance had no practical meaning.

2. The therapist fails to see any signs of ego strength in the action of a 5-year-old child who "goes his own way" and is willing to face the consequences of his actions. Note that when it came time to appear on stage (that is, when it came time to face the consequences of my behavior), I did so without complaint or distress.

We saw echoes of this in my adult behavior when, on the evening of August 6, 1998, four federal law enforcement officers showed up at my apartment and two of them accused me of committing a serious offense. At that time I felt, "I did what I did, and I'll face the consequences." No begging, no pleading, such as: "You're not going to arrest me are you?"

It may also be significant that a five-year-old was able to distinguish between a mandatory requirement and an optional requirement. I did not make a costume, but that was not required. I appeared on stage without complaint, because it was made clear to me by the teacher that I had to do that.

3. In this instance, the therapist resolves a conflict between an individual's behavior and group behavior by asserting the need of the individual to conform to group behavior, regardless of the value of the group behavior or the value of conformity. This suggests the importance for the therapist of approval and fear of punishment or ostracism.

4. The therapist reveals a quality of mendacity or shallowness in her value system. Basically, in this instance, her value is "Do what others are doing, without regard for your own values. Do what others are doing to avoid the shame of being different, even if you are insincere. Basically, shame avoidance, conformity, and fear of punishment all trump sincerity and personal values."

5. The therapist avoids any analytic posture, and sees her role as one exclusively devoted to assessing the patient's report in terms of what the report discloses about his conformity to the values of the parental derivative. Here the parental derivative is, for the therapist, a group of five-year-old children (rather than the teacher); and, moreover, the value is a projected one. Remember, the children themselves did not care whether students conformed. If the patient conforms to the values of the parental derivative, then the patient is acting appropriately--a sign, for this therapist, of mental health and goodness. If the patient fails to conform to group norms, the patient is acting inappropriately, a sign of immaturity, illness, and badness. Therapeutic posture? Advise the patient to correct his behavior by conforming to group values, and he will avoid problems (punishment) in the future. That is, the therapist's exclusive emphasis is "fear of punishment" and conformity. If you are the person the parental derivative wants you to be, then all will be right with the world--as if there were only one power center, one parental derivative.

Note that the clinic at which this therapy takes place is a public clinic with an all-day group program, in which the patients' time and activities are closely monitored and controlled; and in which a basic therapeutic modality is the use of peer pressure to modify patients' behavior and assist in intrapsychic structuralization of individual patients. In some sense, the clinic's day program operates as a cult. It may be that this therapist in her work with individual patients applies the techniques of the day program; the therapist's primary emphasis on adjustment ("you need to do what others do"), utilitarianism ("how does this help you?"), and time management (her persistent intrusiveness and direction) being techniques derived from a therapeutic style that has been found effective in the group treatment of patients with serious deficits in ego structuralization.

I have identified an historical figure who, as a boy of fifteen, refused to wear a boy scout uniform like other members of his troop. A photograph taken of him together with the uniformed members of his troop, show him in flagrant nonconformity. That boy was the Nazi hunter Simon Wiesenthal. See Pick, H. Simon Wiesenthal: A Life in Search of Justice (Boston: Northeastern University Press). It may be significant in terms of personality assessment that aspects of Wiesenthal's personality (pages 3-4) parallel mine. Unfortunately, the therapist eschews assessment of the total personality and analysis of meaning, focusing instead on how the patient can secure approval by means of conforming his behaviors to those of a parental derivative. In effect, for this therapist, censorship supersedes inquiry: the question "how can this patient avoid punishment" supersedes "what does this mean?" For this therapist it is essential that the approval of the identified parental derivative be secured and retained--that is the only goal. Curiosity and intellectual mastery have no meaning for the therapist (except in instances where these values are goal-oriented in terms of peer acceptance and approval); correspondingly, she cannot identify with these needs in the patient.

6. It is interesting to observe how the therapist deals in one instance with conflicts between the requirements of her professional association (the APA), the Commission (her employer), and Medicare. She has apparently identified the Commission as the parental derivative. She will do whatever it takes to preserve the approval of the Commission. As far as Medicare is concerned, she has no problem billing that agency $10,000 per year to treat someone she cannot really help so long as "the hand that feeds her" (the Commission, her direct employer) is satisfied. Speaking metaphorically, she will "put on a hat" and pretend to provide valuable counseling services to comply perfunctorily with the requirements of her direct employer, the Commission. There is almost a delusional quality to her thinking. "But I really believe I can help the patient, and I view my services as valuable and my billing justified."

7. One suspects that this therapist will be hypervigilant in her scrutiny of any signs of insincerity in others: that is, that other persons may, speaking metaphorically, simply be "putting on a hat" to avoid shame or punishment. Perhaps, "Why did this patient suddenly decide to take medication? And then stop taking it after six weeks? Maybe he was just paying 'lip service' to medication."

ANECDOTE TWO:

I reported that when I was in the master's degree (LL.M.) program at The American University Law School (Fall semester 1984) (age 30) I took a course in international trade taught by Patrick F.J. Macrory, Esq., who at that time was a partner at the law firm of Arnold and Porter (and since 1990, has been a partner at Akin, Gump, Strauss, Hauer & Feld, my former employer). I reported that Macrory was considered an expert in the international trade field.

There was also a co-instructor named Jean Anderson, Esq., at that time an attorney with the U.S. Department of Commerce.

Macrory assigned a legal research project to the students, to be completed over a several-week period. The project concerned a realistic problem in international trade, on which the students were to prepare a written paper and deliver an oral report in class.

I did not consult with any students on their projects. I went about the project on my own, and completed my thinking and research independent of the thinking and research of other students.

The day of the oral presentations, several students preceded me. The students solved the legal problem in the same general way, each relying on the same international trade statute. I had the growing sense that I had done something wrong, because I had used an entirely different statute.

When I gave my presentation, Macrory became annoyed then angry. I was convinced, based on his reaction and the content of the preceding oral presentations, that I had made a serious mistake in relying on a statute that no one else had cited. At the end of my presentation, a fellow student, who happened to be a practicing attorney in the international trade field, said to me: "You did nothing wrong. It was him. He didn't know what you were talking about. He never anticipated that you would use that statute. He didn't know about that statute. You make him look like a fool."

As it turned out, I was the only student in the class to rely on that particular statute to solve the problem.

THERAPIST'S INTERPRETATION:

Isn't it possible that you intentionally tried to shame the professor by researching some arcane statute? You intentionally did that to shame the professor and stand out? Isn't it possible that you intentionally avoided a reliance on the most obvious solution, as all the other students had, simply to get attention?

ISSUES OF MORAL REASONING IMPLICIT IN THE THERAPIST'S RESPONSE:

Here, the therapist seems to have identified the professor as the parental derivative. The professor's reactions determine, in the therapist's mind, the rightness or wrongness of the patient's behavior. Since the professor was angry, the patient must have done something wrong. The parental object is never angry for no reason at all; the parent is always right and rational.

Since the patient's workproduct was not questioned by the professor, the workproduct itself cannot be questioned by the therapist. The therapist then engages in an act of confabulation. Perhaps, it was the patient's motives that can be linked up with the professor's anger. Perhaps, the patient had attempted to shame the professor and call improper attention to his "brilliance" as an original thinker. (Presumably, the patient, at his stage of legal knowledge actually knew what statutes were well-known and which were not; presumably, the patient would have logically assumed that one of the leading experts in the international trade field would not be aware of all the pertinent statutes.)

There are several problems here. The patient's workproduct was either meritorious or not, to some degree. Yet, in the therapist's value system the merits of the patient's work resided solely in the professor's reaction. And what about that professor's reaction? Is it beyond criticism? Is it not plausible that some professors might have praised the patient's original thinking? Keep in mind that at least one student in the class, a practicing attorney, believed the patient's presentation had merit.

The therapist needs to believe that something that can be identified as "bad" was the cause of the anger of the professor (the identified "good object," or parental derivative). The therapist's interpretation is consistent with a value system that holds that the parental object (the good object) is always rational, objective, and benign; and that when the parental object is angry, it is because the bad object (the child) has aroused that anger by his own bad behavior. The therapist's interpretation is consistent with the view that she needs to identify an object as the good object, and that one must avoid doing what displeases that object--that is, avoid doing what might lead to punishment. Thus, the good object, the parental derivative is retained as idealized. In effect, as in example 1, the "parent" is pardoned.

I pose a hypothetical. A group of researchers is at work in the field of cancer research. One researcher, working alone, develops a treatment that shows therapeutic promise and has few side effects. The researcher is rather egoistic, and it is shown that one motive for the researcher's work was to humiliate his peers. How many cancer patients would say: "This treatment offers the chance of cure with few side effects, but I can't accept this treatment. Why? The researcher who developed the treatment was an egoistic fellow who was just trying to humiliate his peers."

What does this hypothetical show? In a word, motives do not vitiate the value of independent thinking. And further, that the "goodness" or "badness" of an action or object can be relative. But where a person's value system is based solely on fear of punishment (punishment by the identified parental derivative) the "goodness" or "badness" will be made to appear absolute. The need to identify and rationalize what it was that angered the professor was the sole concern of the therapist; indeed, so intense was the therapist's need to identify the cause of the anger, and thereby exculpate the parental derivative and mitigate the fear of punishment, that she resorted to a quasi-delusional confabulation.

The therapist had to point to the patient's bad motives. Why? Because the therapist could not tolerate the idea that a parental object could be angry for no reason ("the parent is always right"); the therapist could not tolerate the idea that a person might be powerless to mitigate anger directed at him ("I cannot tolerate the idea that someone is angry at me"); and she needs to believe that there is something a person can do to mitigate object anxiety ("I cannot tolerate the idea that I am powerless to relieve my fear of abandonment and punishment"). The therapist assumes as a given that an individual would want to avoid another person's anger, regardless of the individual's own values and regardless of the rationality of the other person's anger.

The patient's purported motives served as a convenient explanation, or rationalization, for the professor's anger.

An additional issue is perhaps the therapist's belief that if something has genuine value, the parental derivative will necessarily recognize the value and reward its creator ("something good cannot be a source of pain, which is bad"). I am reminded of some anti-Semitic notes that someone scrawled in a library book: "If the Jews were good, Christians would necessarily accept them. What motive would a Christian have for not accepting a good person?" -- The sentiments reflect an inner world of sharply divided good and evil. In somewhat Kleinian terms: pleasant stimulus is a reward from the good object, unpleasant stimulus is a punishment for the badness of the self. Cf. Greenberg, J.R. and Mitchell, S.A. Object Relations in Psychoanalytic Theory at 133 (Cambridge: Harvard University Press, 1983).

It is clear what process underlies the therapist's moral reasoning. First, identify the parental derivative. (Note that in Anecdote One, above, the therapist identified the students as the significant parental derivative; the teacher, who did not disapprove of the patient's failure to conform, is ignored. In Anecdote Two, the teacher--the angry party--is identified as the parental derivative who must be placated; the approving fellow student--herself a knowledgeable practicing attorney--was ignored.) The therapist will assign the role of parental derivative based on her perception of which object arouses the most object anxiety, or which object is most likely to preserve self-esteem. Second, one must conform to the values of that object. And her own internal values? Those are her internal values: to locate, identify with, and preserve the allegiance of a nurturing external object (or the object that can cause the greatest harm in terms of punishment and loss of approval and self-esteem) and preserve (by means of conformity) relations in the interpersonal field that are nonthreatening.

The above hypothetical (concerning the mythical cancer researcher) has practical implications in a law firm setting. An attorney develops a legal strategy that might be useful to a client. The management partners disapprove of the proposed strategy for bureaucratic reasons relating to firm culture and practice. What do you do in that case? For an attorney with a highly-developed sense of moral reasoning, there is no simple solution.

One interesting and manifestly warped aspect of this therapist's views is that she seems always able to identify a single power center, or parental derivative. She does not seem to see conflicts that involve two or more external objects, each vying for allegiance. The world this therapist sees is too simplistic to be anything other than a projection of her own polarized value system, which basically comes down to Good Parent and Child. If the child does what the parent wants, it is a good child (strong, virtuous, mature, mentally healthy, developmentally adjusted, likable, worthy of approval, and with a right to feel good about itself); if the child does not do what the parent wants, it is a bad child (weak, mentally ill, developmentally arrested, unlikeable, not worthy of approval, and with no right to feel good about itself). (The child who feels good about itself without approval to do so by the parent is narcissistic.)

Further, one suspects that for this therapist autonomy is equated with the act of becoming the fear-inspiring parent--rather than developing an internal value system. By analogy, in the Soviet Union, one's maturity and virtue was expressed by becoming a loyal party member, not by standing up for one's own values (which the Soviet state would term childish and foolhardy rebellion).

For this therapist, the sole aim of therapy is to identify those specific areas in which the patient has failed to be good (i.e., failed to conform to the values of the parent--the object that is most feared) and persuade it to be good. The good child is a happy child. An unhappy child is one that is not conforming to the parent's wishes.

Sincerely,

Gary Freedman