Dale C. Godby, Ph.D.

Dr. Dale Godby will offer the final presentation in DSPP’s Wednesday night series on Finding and Being Found: Self and Other Through the Life Span. Dr. Godby’s presentation, The Emergence of the Therapist, will explore the development of the therapist across the life span. There are no selected readings for this evening so you are encouraged to reflect on your emergence and development as a therapist. For those of you who would like to read something, Dr. Godby suggests Dr. Carl Goldberg’s, The Seasoned Psychotherapist: Triumph over Adversity and Dr. Martin Grotjahn’s, My Favorite Patient: The Memoirs of a Psychoanalyst.

Consideration of the following questions will help prepare you for the evening’s lecture:

• How have your youthful values and perspectives on neurosis and human conflict been changed by your years of practice?

• How have Freud’s remarks concerning the pure gold of analysis and the copper of suggestion affected your development as a psychoanalytic psychotherapist?

• What have you found useful in terms of self-renewal? In what larger context of values do you see the psychoanalytic task? How have you managed disillusionment? When do you consider a return to the couch, supervision or peer consultation?

Dr. Godby was DSPP’s fourth president and has been actively involved with the organization over the years. This past August he presented a workshop at the International Group Psychotherapy Association’s meeting in London with Drs. Verhagen and Hegger of the Netherlands on Spirituality in Psychodynamic Group Psychotherapy. In February, he presented a workshop at the American Group Psychotherapy Association meeting in Houston with Mrs. Meg Sharpe from London and Dr. Robert Bennett from Dallas on Establishing Twice-Weekly Groups in an Outpatient Practice. Recently, he and a small group of colleagues have formed the Dallas Group Analytic Practice in order to develop the study and practice of group analysis in Dallas.

Kenneth L. Farr, Ph.D.

Though Dr. Brix offered apologies for having no dramatic tale of entry into the field to rival the one told at the February meeting by Dr. Schenk, he nevertheless provided an eloquent and lucid presentation that clearly stirred the interest of his audience. Dr. Brix used Settlage’s article Transcending Old Age as a vehicle to consider two broad issues. First, by questioning whether the treatment described by Settlage was truly psychoanalysis and then integrating ideas from Tarachow’s article Interpretation and Reality in Psychotherapy, Dr. Brix encouraged the audience to consider what really constitutes analysis. Second, Dr. Brix wondered what Settlage’s article and more generally, psychoanalysis, can offer us in understanding and treating "superannuated" patients.

In his article, Settlage described the unusual relationship between him and his patient, a woman who was ninety-four when Settlage met her. The relationship began as a friendship based on common interests. It transformed into an eight-session treatment one year later, followed by a second treatment of twice-weekly sessions which began when the patient was ninety-nine years old. Dr. Brix summarized the article, noting several important elements. The friendship, which characterized the early stages of Settlage’s relationship with his patient, was apparently a relationship marked by complete mutuality – each person relating to the other as a real object. The first treatment involved primarily an exploration and normalization of the patient’s repressed anger spawned by her agonizing caretaking of her husband who had recently died after three difficult years of mental and physical deterioration. This treatment paved the way for the patient to mourn her husband’s death. The second treatment, conducted in the patient’s home due to her own physical deterioration, was clearly conceived of by Settlage as analytic. Dr. Brix pointed out the remarkable psychological mindedness of Settlage’s patient, who at ninety-nine years of age recognized that her somatic complaints (severe palpitations) could have a psychological basis. Settlage proceeded to describe a wonderful treatment lasting several years and terminated by the patient’s death, in which repressed anger with pre-oedipal roots and an unfulfilled yearning for closeness emerged as predominant themes as the patient came to terms with her own mortality.

Dr. Brix detoured to a discussion of Tarachow’s article in which the author lays out his conception of the treatment process where relationships between patient and therapist are viewed as a spectrum ranging from one extreme where both parties take each other entirely as real objects, to the other extreme where everything enacted by the patient is viewed as bearing the stamp of his or her past. In other words, at one extreme nothing is transference, at the other extreme everything is transference. Tarachow emphasized the central problem in the treatment process – "the task of setting aside the other as a real object." To the extent that the relationship is taken as real, symptoms and life events are also taken as real, precluding their exploration in the pursuit of insight and destroying the "as if" potential of the transference. The therapist must refrain from responding as a real object and tolerate loneliness. Dr. Brix remarked that in his own analysis, his analyst’s "unrealness" added immeasurably to the therapeutic process. Admittedly, this is a rigorous conception and not perfectly achieved in practice, yet these conceptions can enrich our understanding of the treatment process.

Next, Dr. Brix returned to the Settlage article asking the question: "Was it really analysis?" Settlage defines analysis in terms of therapeutic action which results in structural change, and argues that his patient indeed experienced such a change. Dr. Brix proposed that Settlage was perhaps overly optimistic in his interpretation of the evidence for structural change in his patient, and wondered if Settlage may have been gratifying his own wish to have his patient fit nicely into his particular frame. By weaving Tarachow’s ideas into the discussion, Dr. Brix showed that the treatment conducted by Settlage was considerably closer to Tarachow’s notion of psychotherapy than to his notion of analysis. Conducting treatment in the patient’s home and having a friendship with the patient (knowing each other as real objects) prior to treatment favor the classification of this treatment as psychotherapy, at least in Tarachow’s terms.

Next, Dr. Brix offered the following generalizations about his office work with elderly patients:

• most have had previous contact with a mental health professional;

• none have been ready to set aside the expectation that Dr. Brix would relate to them as real objects;

• each came with great internal and external turmoil;

• they were able to participate in treatment with no out-of-pocket costs more frequently than younger patients, leaving it difficult to examine resistance related to money issues;

• negative transferences rarely surfaced, keeping the nature of the treatment largely supportive.

Dr. Brix noted that this last point most accurately distinguishes his experiences from that reported in the Settlage case in which the patient revealed negative transference elements. Most elderly patients insist on having a real relationship with their therapist as a prerequisite to forming an alliance (without which the treatment is immaterial at best), and this requires that more of the therapy be conducted in the displaced field – there and then.

Finally, Dr. Brix suggested several items that psychoanalytic theory offers when working with elderly patients. It champions insight and ego mastery within a context of safety, perhaps support. It implies that interventions be interpretive to the extent permitted by the treatment alliance. It suggests our comments speak to the patient’s conflicts, and to the extent we can do so we will be experienced as empathic. It tells us to attend to resistance before moving on to other things. And it tells us of the importance of neutrality, placing no greater value on one type of material over another. With patients of any age, being listened to intently, with little interruption, and an absence of narcissistic competition, is powerful.

In her thoughtful response to Dr. Brix’s presentation, Denise Humphrey, M.M., focused her discussion around the question: "If this is accepted as a successful analysis, was it because Settlage was able to set his patient aside as a real object, or precisely because he did not?" Ms. Humphrey noted several ways in which Settlage’s task of setting aside his patient as a real object was made particularly difficult, and she mentioned three internal themes that this case likely evoked in Settlage: the loss of the patient in reality as a real object; stirrings of the idea of losing his own mother; and the pondering of his own mortality.

Ms. Humphrey laid groundwork by reviewing ideas about working with the elderly from developmental literature and she emphasized the element of art involved in Settlage’s case. Ms. Humphrey brought this year’s theme: Finding the Other and Being Found: Self and the Other Through the Lifespan to bear on her main question. She noted that Settlage’s work in this case could not be characterized as an extreme stance according to Tarachow’s model of therapeutic process, and questioned the utility of rigidly defining his relationship with his patient. Does it really matter how we characterize the relationship between Settlage and his patient?

In support of flexibility, Ms. Humphrey brought Modell’s ideas into her discussion. Modell has opposed dichotomies such as that implied by the recent relational or intersubjective school which some hold as an alternative to more traditional Freudian theory. Modell has argued that it is unnecessary to dichotomize relational and Freudian theories, and doing so is an injustice to the subtlety and complexity of Freud’s work. A lively discussion by the audience followed.

LETTER TO THE EDITOR

Dear Editor:

In the spirit of DSPP's current motif of dialogue, I appreciate this opportunity to respond to Dr. Ron Schenk's critique of my review of the case, which he presented at the Fall Workshop (DSPP Bulletin, February, 1999). My sentence to which Ron objected as misrepresenting his experience reads thus: "Not only did the patient seem lost, but we, the supervising audience, could make little sense of the process because the therapist was lost in the patient's unconscious reenactments."

It certainly would have been more precise -- and more diplomatic -- if I had written "... the therapist seemed lost in the patient's unconscious reenactments." My description of Ron's seeming lostness was actually meant as a recognition of his remarkable analytic presence, as well as a compliment to his presentation. I thought this because he seemed to demonstrate himself as (1) the recipient of his analysand's unconscious communication, via the enactments, (2) able to analyze those enactments, and (3) the mediator of the parallel process through which the audience in turn became immersed in the patient/therapist experience. We got it because he got it, and Shapiro could not have been more complimentary of this in vivo demonstration of his topic -- projective identification, enactment, and working through.

Nevertheless, I appreciate that Ron believed himself to be misunderstood -- not a great experience, particularly following the exposure of such intimate work. I believe a person who is not present can never really comprehend how it was for the dyad struggling in the trenches.

Myrna Little, Ph.D.

1991 French Film won 7 César Awards

Stars Jean Pierre Marielle

Gérard Depardieu

Film examines the relationship between Sainte Columbe, the 17^th century baroque composer and cellist, and his protégée, Marin Marais. Exquisite soundtrack.  Characters worthy of analysis.

Saturday, May 22, 1999, 6:00 P.M.*

Hosted by

Alice VanHuss

3813 Azure Lane

Dallas, TX 75001

972 484 4338

A discussion focused on psychoanalytic issues arising from the film will follow.

PSYCHE MATTERS WEB SITE

Hosted by Cheryl Martin, RN, LPC

Psyche Matters has two new articles online:

• Winnicott's Potential Spaces: Using Psychoanalytic Theory to Redress the Crises of Postmodern Culture by Michael Szollosy (University of Sheffield, UK), and

• Attacks on Links in the Work of Samuel Beckett

and Wilfred Bion by Dr. Kay Torney Souter (La Trobe University, Australia).

These papers were presented for "The Psychoanalysis of Winnicott and Klein in Literature and Theory," a Special Session at the 1998 MLA Convention in San Francisco, CA. Abstracts and articles available.

Psyche Matters also hosts extensive links to online articles as well as information and institutional contacts related to psychoanalysis, analytical psychology, counseling, psychology, group therapy, family therapy and more. DSPP members are welcome to submit articles of interest.

For more information contact Cheryl Martin by email: CherylMartin@psychematters.com or web address: http://www.psychematters.com

CE credits for psychologists offered.