Psychotherapy: Nancy Shaffer, Ph.D. -- Clinical Notes 11/15/2000

TO: Nancy Shaffer, Ph.D.
FROM: Gary Freedman
DATE: November 15, 2000
RE: Notes Regarding Previous Session
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November 1, 2000:

Therapist made the following statement: "If you had engaged in peer relations in adolescence, what do you think you would have derived from that?"

--possibly nothing. See Fernando at 22. There the patient had normal social relations in adolescence. Her manifest problems had their onset in late adolescence and early adulthood.

In that case, peer relations did not modify an underlying ego disturbance, and conversely, the underlying ego disturbance did not prevent normal peer relations.

parallel with supportive psychotherapy. The mere capacity to do supportive psychotherapy may be deceptive. The underlying ego problems do not prevent doing it, and doing it does not alleviate the underlying ego disturbance. (cf. Shuren).

Implications:

1. highlights the limitations in superego values that focus on actualizing a capacity. Merely actualizing a capacity (peer relations in adolescence, or doing supportive psychotherapy in a shallow sense, has no larger effects.)

2. highlights idea that the social system is for therapist a good object (a "good parent" derivative), which has something "good" to give the patient.

3. ignores symptoms or qualities that prevent doing social relations or psychotherapy (teenage age depression, guilt, anhedonia,)

4. Attributes my inability to engage in social relations to dependence on my family. Ignores extent to which I suffered from ego impairment as a result of development in a disturbed environment. (Shengold at 10-11)
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psychoanalysis:

Therapist: "How can you do psychoanalysis if you are obsessive? You tried that and what happened?"

1. highlights symptom that precluded doing act. Depicts symptom as a bar to doing act.

2. did not inquire as to what I might derive from psychoanalysis.

3. depicts psychoanalysis as if it were form of improper impulse gratification for patient: "You say you may be coming down with something, how can you go out and play? What happened the last time you went out to play when you didn't feel well?"

Same idea expressed by Suzanne Pitts, M.D.: "What you did with Dr. Palombo was play. What we do here is real work." Cf. Freud, "Creative Writers and Day-Dreaming." -- "The difference between play and work is not what is serious but what is real." The hard work of psychoanalysis is, in fact, the analysis of fantasy -- the ego immature therapist may have difficulty in appreciating the seriousness of fantasy, and she may equate that with childish play.
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work.

I prepare written statement that indicates existence of paranoid ideations, possible fixed delusonal system of long-term duration. ("Statement of Gary Freedman re: Mental Status Affirmation of the Corporation Counsel") therapist: "You are hypersensitive" (attributes symptom). But reduced symptom to something that is confined to a verbal, intellectual level. Says: "No employer would hire you if he saw this document." Implication: Here symptom is depicted as something that I can conceal and that it would be advisable to conceal for the higher good of actualizing my capacities (getting a job).

1. Reduces the communication to the level of a symptom (hypersensitivity) that I can conceal from employer. Ignores extent to which the communication discloses serious mental disturbance (psychotic mental state).
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THERAPIST'S ATTRIBUTIONS:

Family is a good object, which nurtures. Family cannot be a source of symptoms, because it is good. Over-dependence on good object can be bad, if it prevents transfer of emotions onto social system. Over-dependence on family is form of improper impulse gratification.

Social system is good object, which nurtures. Impairments in capacity to merge with social system are not excuse to fail to seek out social relations. (Denies the extent to which the peer group's approval of a member's impulse gratification vitiates guilt or shame pertaining to the gratification. See Kernberg. Denies extent to which peer group can set limits to impulse gratification, acting as a parental substitute. Paradoxically, the peer group can be as over-indulgent as the overindulgent parent in its permission to gratify impulses without guilt or shame; and can be more strict than the most authoritarian parent in its use of social mores. See Kernberg.)

Psychoanalysis is not a good object that can offer good. Impairments in capacity to do analysis (obessessiveness) is bar to doing analysis. Therapist stated: "Well, you looked into analysis on one occasion, what happened--you were not accepted for treatment." Note lack of symmetry: Therapist would not say: "You sent out one resume, what happened?" Or -- "You tried to make a friend, what happened?" In all probability therapist would maintain: "You need to keep trying, don't give up! -- you need to be 'obsessive' about looking for work and making friends."

Work. Work is good object that provides good things. Impairments in capacity to obtain employment are not an excuse not to work. If you have symptoms, then you conceal them if you can. (Note the emergence of mendacity here. Note also the way the therapist implicitly equates the over-indulgent, naive parent with the Social Security Administration--an agency that is easily duped by the mendacious claimant.)
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Where's the aggression? In the therapist's modeling of these various issues, one interesting feature is that she has totally dispensed with the issue of aggression: (1) aggression of the family directed at the patient; (2) aggression of the social system directed at the patient; (3) the patient's internal struggle relating to aggression, including the patient's act of directing aggression against himself in the form of self-victimization (resulting in guilt and anxiety in relation to drive expression). The total focus is on impulse gratification, the actualization of capacities, and whether a "symptom" serves as an adequate excuse.

Inconsistencies in the way the therapist deals with issues of impulse gratification and impulse control indicate warps in superego development.