Abstract
In our view helplessness is a primal, often intolerable feeling. It underlies and intensifies other feelings that are also hard to bear. Both analyst and patients face helplessness, and both resort to defenses, often intensely, in order to avoid it. The intensity of this battle can merit calling it a war. The analyst’s war is conducted using distancing, anger, blaming and disparaging as well as by intellectualizing the patient’s struggles. Patients then find themselves abandoned and helplessly alone. We analysts, of course, want not to fall into the trap of war, and we try to free ourselves from waging it. A major way we accomplish this is through continuously working, often with the help of analysis and self-analysis, to increase our capacity to maintain our emotional stability in the face of these intensities. We learn to find new forms of awareness, beyond words and ideas. It requires a new understanding of what is threatening to us, which fosters a deeper capacity to empathize with the patient. This helps us to find the psychic, physical and emotional space within ourselves in which to hold our helplessness and other profound affective experiences. In this way we become an increasingly steady resource for our patients as well as for ourselves.
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Notes
We believe animals, while they have self-preservative instincts, don’t have an awareness that they will die.
Note that our use of the metaphor “war” is different from that of the early analysts’ usage, including Freud’s (1938). They spoke of war as the analyst’s battle against the patient’s resistance to gaining insight into unconscious issues, such as the Oedipal conflict.
As early as 1894, Freud introduced the concept of defense mechanisms in “The Neuropsychoses of Defense” in which he refers to feelings that elicit defense as “unbearable” (in German: “unertraeglich”) as well as “incompatible.” (In German: “unvertraeglich”) By incompatible, we believe he primarily means feelings that are incompatible with a person’s view of himself or herself. Semrad taught that the feelings Freud described are inevitably linked to feelings of loss—past, present or anticipated (Good, 2009).
We include this account of supervision because it demonstrates that the supervisee was not deterred by her own confused helplessness but was able to use it within her own mind as a potential empathic clue to the patient’s experience. Consideration of the complex questions about the usefulness and timing of self-revelation by the analyst is beyond the scope of this paper.
We have been focusing on the wish to avoid feeling helpless. However, we want to call the reader’s attention to two exceptions in which the opposite is true. First is the not-uncommon characterological phenomenon of people who avow feeling helpless and use that state as a defense or rationalization against activity and for procrastination. For example, the graduate student who says: “I am helpless; I can’t bring myself to finish my thesis.” A second paradox is seen in the BDSM (Bondage, Domination, Sadism, Masochism) Community where helplessness and submission (e.g. being tied up or handcuffed) is the desired state. Deeper exploration of these two exceptions is beyond the scope of this paper.
For example, in Moses of Michelangelo, Freud (1914, p. 211) writes: “Works of art do exercise a powerful effect on me, especially those of literature and sculpture, less often of painting. This has occasioned me, when I have been contemplating such things, to spend a long time trying to apprehend them in my own way, i.e. to explain to myself what their effect is due to. Whenever I cannot do this, as for instance with music, I am almost incapable of obtaining any pleasure. Some rationalistic, or perhaps analytic, turn of mind in me rebels against being moved by a thing without knowing why. I am thus affected and what it is that affects me.” (quoted in Clynes, 1989 [italics are ours]). Here Freud is describing his need to create a detour from direct non-verbal resonance, by which we mean a form of empathy, into thinking and explaining through words. It is this aspect of Freudian tradition that analysts often retreat to when they need to “think in order to understand.” i.e. the “need to know” we referred to above. The “analyst’s need to understand” can actually be defensive.
Elvin Semrad, M.D. (1909-1976) was an influential teacher of psychiatry in the Boston area. He was training and Supervising Analyst and president of the Boston Psychoanalytic Institute, as well as clinical director of Massachusetts Mental Health Center (the teaching hospital of Harvard Medical School), where he taught psychiatric residents for decades (Rako and Mazer, 2003)
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Acknowledgements
We would like to thank Dr. Alan Pollack and Dr. Nina Savelle-Rocklin for their contributions to the paper and Drs. Anton O. Kris, Fred Busch, Jane V. Kite, Anita P. Hoffer, and Neal S. Kass for their careful readings and helpful suggestions.
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1Axel Hoffer, M.D. is Training and Supervising Analyst, Boston Psychoanalytic Institute (BPSI), Associate Clinical Professor of Psychiatry (Part-Time), Harvard Medical School.
2Dan H. Buie, M.D., is a Training and Supervising Analyst, Emeritus, Boston Psychoanalytic Institute (BPSI).
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Hoffer, A., Buie, D. HELPLESSNESS AND THE ANALYST’S WAR AGAINST FEELING IT. Am J Psychoanal 76, 1–17 (2016). https://doi.org/10.1057/ajp.2015.56
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DOI: https://doi.org/10.1057/ajp.2015.56