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  • 03/18/2016 2:14 PM | Anonymous

    “The most awful thing happened to me last week,” Francis begins. “I was walking out of Macy’s and a security guard stopped me. He asked me to open my purse. I looked at him like he was crazy and asked why. I even wondered if he was a security guard or if he was just wearing the uniform and wanted to steal my wallet or something. He kept insisting. I asked him if he thought I stole something which mortified me and he just kept asking me to open my purse. I finally did and he looked through everything. I felt like a thief. And then he said, ‘Thank you, ma’am, I guess there was a mistake.’ I was shaking. I ran out of the mall. When I got into my car I burst into tears. It was awful. And now I can’t stop thinking about it. I replay it over and over in my head.”

    Francis is a conventional woman nearing fifty who came into therapy when the last of her children left for college, wondering what was next for her in life. “It sounds awful. Can you say a bit more about what you felt?” I ask.

    “Humiliated. I couldn’t believe this was happening to me. How could anyone think I’m a thief? And I felt scared. Like I said I wondered if the security guard was an imposter and if he’d rob me. I know how crazy that sounds, but it didn’t seem any crazier than me stealing something.”

    Francis was the “good girl” who evolved into the “good wife and mother.” It is hard to imagine her doing anything rebellious, let alone illegal. “Did you feel angry as being unjustly accused?”

    “I guess I did. You know I don’t do anger very well.”

    “And since the incident, what is it that you feel when you replay it in your head?”

    “The same thing, humiliated and scared. I don’t feel the anger all that much.”

    “Does the incident remind you of anything in your past?”

    “No! I never stole anything in my life, if that’s what you mean.”

    “No. That wasn’t what I meant. What made you think I was suggesting that?”

    “I don’t know,” she says, starting to cry. “I just feel so awful. I feel like a criminal. I feel dirty. I know it’s crazy. It was a mistake. I need to let it go.”

    “So you understand that what you’re feeling is an overreaction, but we need to figure out what’s causing that overreaction. I’d say it was something from your past, something that made you feel guilty or ashamed or both. That doesn’t mean you did anything wrong. You could feel you did something wrong even if you didn’t.”

    “When you just said I didn’t do anything wrong, I felt this tremendous relief, like a burden was taken from me. But I have no idea why. What do I feel so guilty about? What did I do that was so bad? I was always the good kid.”

    Various of my childhood and adolescent transgressions flit through my mind: blaming a friend’s sister for my mischief, wearing make-up when I wasn’t allowed to, lying about having a boyfriend. I don’t carry guilt for any of these infractions, but I’m sure far more serious “sins” exist in the cauldron of both my and my patient’s unconscious. “It doesn’t have to be anything you did, Francis. It could be something you wished for or dreamt about. It could be a fleeting thought, like ‘I wish you were dead.’”

    “I killed my younger sister’s turtle,” Francis blurts out. “It was an accident. The turtle got out of its little house and I accidentally crushed it with my rocking chair. My sister was really mad. She said I was a murderer. My mother was mad too. I kept saying it was an accident, but they didn’t believe me.”

    “Another example of being blamed when you didn’t do anything wrong.”

    Francis hesitates then quietly says, “I didn’t like that turtle. It smelled bad. And I don’t like things that crawl around like that. But it was an accident. I didn’t deliberately kill it.”

    I wonder if the turtle is a stand-in for Francis’ childhood feelings about her sister – something that smells bad and crawls around – but I decide to leave that interpretation for another day. “But it sounds like you still felt guilty, both because you might have wished the turtle dead and because your sister and mother were so angry.”

    “But I didn’t do anything wrong,” she has almost plaintively.

    “No, you didn’t do anything wrong,” I say. I suspect this “good girl” has many forbidden thoughts and feelings, but that too is for another day.

  • 02/25/2016 10:18 PM | Anonymous

    Tall and thin, with long, straight brown hair, Alicia fidgets in the chair. “I have a new obsession,” she says hesitantly. “I keep worrying about your dying. I feel funny talking about it, but who else can I talk to about something like that?”

    I’ve been seeing Alicia for almost five years now. She began when she was 20, when she was so paralyzed by anxiety and by magical, obsessional thoughts that she had to drop out of college. She’s much better now. She’s gone back to school and should graduate in a little over a year.

    She continues. “I know we’ve talked about my being afraid of my parents dying in some horrible accident when they left to go out when I was little. And you said that was because part of me wished they were dead because I was mad that they were leaving me. But I don’t feel mad at you. At least I don’t think I do. Do you think I’m mad at you?”

    “I think only you know how you feel, Alicia.”

    She pouts. “You could help me.”

    There is a childlike quality to Alicia. She looks to me to protect her, to save her, to give her the magical answer. I feel the pull to oblige, but think it best that Alicia find her own strength, her own voice, her own answers. Her mother was overly protective and although both parents pushed Alicia to succeed, there was the contrary message that she stay close to the protection of home.

    “I will help you, but I can’t tell you how you feel.”

    “All right. All right. Be that way.” She crosses her arms over her chest and glares at me.

    I remain silent, but present in the room with her.

    “Well now I feel angry. A little. No, not really. I know you can’t tell me what I feel. 

    The problem is that I don’t know what I feel myself.” She pauses. “Scared. I feel scared. I feel scared if I think about your dying. And it’s not like I imagine your dying in some gruesome accident. I just think what if you got sick and died? I mean I know you’re not old. But you’re not young either. Would I even know if you were sick? And how would I know if you died? I wouldn’t want to read it online somewhere.”

    “Do you have any thoughts about what triggered your fears of my dying?” When I look in the mirror I certainly know I’m not getting younger, but I suspect Alicia’s fears have more to do with what’s going on for her internally than with my actual age.

    “I just thought of something. My father’s been talking to me about graduate school. I keep telling him I’m not ready, that I still haven’t finished undergrad, that I have to take one step at a time. I can’t think about graduate school. It scares me. It was after that I started worrying about your dying.”

    “So talking about graduate school means growing up, leaving home and that brings up fears about loss, including the loss of me.”

    “You didn’t have to put it that bluntly. Now I’m terrified.”

    “I’m sorry. I didn’t mean to increase your anxiety, but we do need to know what the issue is before we can work on it.”

    “I could never leave you! I’m not even sure I could leave my parents. Oh my God, what happens when they die?”

    “Alicia, let’s put the question of death to the side for a moment. What feels so scary about leaving home?”

    “I can’t. I don’t think I could make it.”

    “It feels as though you’d die?”

    “It kind of does. But when you put it that way, I don’t know, that doesn’t really make sense.”

    “So the idea of leaving home feels terrifying, feels like you couldn’t survive. But when you think about it rationally it’s not so clear what you’re afraid of.”

    “Yeah. That’s right. That actually makes me feel a little better.”

    “You know, Alicia, although leaving home does involve loss, it also involves gains: growth, independence, freedom. It’s about adding to your life, not just taking from it.”

    “Yeah. I can see that.”

    “On the other hand, I don’t want us to ignore your underlying feelings, including your fear of my dying. I do hear that you feel terrified and we need to talk about those feelings again and again until you’re more sure of your adult competence and your ability to cope.”

  • 02/17/2016 6:44 PM | Anonymous

    Bob Samuels looks as though he would once have been a handsome man. Now his disheveled white hair, creased brown pants and too small plaid shirt, along with his sad eyes and almost shuffling gait, gives him the appearance of a man who has grown old before his time.

    “I read your book,” he begins. “I thought maybe you could help me. You know about loss. But I worry that you don’t know about regret. You don’t mention it much.”

    I immediately flash on some of the regrets I have regarding my husband’s treatment of prostate cancer and heart disease: Should we have chosen surgery rather than radiation? Why did no doctor ever tell us about the possible false negatives from chemical stress tests? Yes, I have regrets, but they don’t plague me. I accept that no one is infallible; no one can anticipate or control everything. I say nothing and wait for Mr. Samuels to continue.

    “My wife died of ovarian cancer five years ago. She was diagnosed five years before that. In the beginning she put up a valiant fight, although I always wanted her to pursue more alternative treatments in addition to the chemo. I don’t mean anything way out there. Stuff like nutrition. I thought she should become a vegan, try juicing, stuff like that. But she couldn’t deal with it. And then in the end, when the cancer came back again and then again, she called it quits. Said she had enough. She stopped all treatment and just died. I wanted us to go to Europe and try some of the experimental treatments that aren’t available in the States. But she said she couldn’t, said she was done.”

    I think about my husband’s words when he too decided to stop treatment: “It’s enough already.” He had fought for years to stay alive. But he reached his limit. Although I was grief stricken, I understood his decision.

    “Sounds like you’re angry at your wife for giving up,” I say to Bob.

    He startles. “No, no,” he says. “I could never be angry at her. I’m angry at myself for not being able to convince her, for not being able to make a good enough argument. I’m inadequate. I couldn’t make her see.”

    “You couldn’t make her see what?” 

    “That there was a chance. That there were still things we could do.”

    I believe that Bob is angry at his wife for letting go. I also believe that he can’t let himself feel that anger, that he blames himself rather than her. And he can’t tolerate the helplessness we must all deal with in the face of death. But these interpretations are all too premature.

    “It sounds as though you miss your wife tremendously,” I say instead.

    He sobs. Reaching for the tissues he tries to control of himself. “I’m sorry,” he says, his voice breaking.

    “There’s nothing to apologize for,” I reply.

    “It’s five years. I shouldn’t be like this anymore. But I keep tormenting myself. What if I’d done X? What if I’d say Y? What if I was enough of a husband for her that she wanted to stay?”  

    “You think if she loved you enough she would have fought harder?” I ask, wondering if his wife’s decision to stop treatment felt like a narcissistic injury to him.

    He cocks his head and puts a finger to his lips, pondering my question. “I think I always loved my wife more than she loved me. I mean, she did love me, but I adored her. She was the only woman who really ever mattered to me. So do I think if she loved me more she would have continued to fight? Maybe I do. I don’t like to hear myself say that. It sounds so selfish, so much about me.”

    “You know Bob, in the end, none of us can defeat death, no matter how much we might love or how much we might want to stay.”

    “I know.”

    “I wonder if you do. I mean I’m sure you know intellectually that we all die, but I wonder if on a gut level you feel that if only we do enough, if only we try harder, somehow we’ll be able to continue on.”

    “I don’t know.”

    “Bob, my sense is that we jumped right into this very painful, difficult topic because you’ve obviously been struggling with these feelings for quite some time. But I wonder if we could go back a bit so I can get some sense of you, of your life, of who you are.”

    He takes a deep breath. “Where would you like me to start?”

    “Wherever you’d like.”    

  • 01/27/2016 5:17 PM | Anonymous

    I am aware of feeling annoyed as I go to the waiting room to greet Philip. It’s been five weeks since I’ve seen him. Each of the last four weeks he cancelled three or more days prior to our session – well within the time required by my 48 hour cancellation policy to avoid being charged – with various excuses, mostly related to business. Philip is a successful import/exporter. It’s not unusual for him to travel, but we’ve usually been able to reschedule during the week or arrange to talk by phone, even when he’s out of the country.

    “It’s been a while,” he says greeting me with a broad smile that enhances his already handsome face. “I’ve been incredibly busy. Business has really picked up. Not that I’m complaining. I know lots of people are hurting, so I’m more than grateful. Other than that, not much is happening. Things are going okay with Serena, although she hasn’t been too pleased with all my traveling. I have been able to keep up with my kids, although I can find myself squeezed between time with Serena and time with the kids.” 

    “And us?” I ask.


    “We haven’t seen much of each other the past several weeks either and now you seem to be saying that there’s not much to talk about.”

    “Truthfully, I haven’t had much time to think about myself. I just keep on truckin’.”

    “Does that strike you as strange? You’re someone who usually spends a lot of time reflecting about yourself, trying to understand why you do what you do and now you’re being kind of flip and indifferent.”

    “Maybe I’m just tired of spending all this time ruminating on myself. Maybe it’s time to just start living.”

    “Philip, what’s going on?”

    “What do you mean?”

    “First you disappear for over a month …”

    “I didn’t disappear,” he interrupts. “I called every time to say why I couldn’t come. Gave you enough advance notice too.”

    I find myself confused, annoyed and stymied. When Philip kept cancelling, I thought about our last several sessions trying to understand what might have triggered his desire to keep away and hadn’t come up with anything. Now he’s being disinterested, dismissive and even hostile and I have no idea why. Was he feeling too close and needing to get away? And what was that comment about giving me advance notice? Philip is a wealthy man. Money never seemed to be an issue between us.

    “Was it important that you gave me advance warning?” I ask.

    “Yeah. Wouldn’t want you to be charging me for a session when I’m not here, especially since you just raised your fee.”

    I try to keep my surprise from registering on my face. I raised Philip’s fee by $25, an amount I thought would be insignificant to him.

    “Philip, what did it mean to you that I raised my fee?”

    “Nothing. You’re entitled. This is your job. You deserve to make a living. And $25, it’s no big deal.”

    “Seems like it is a big deal, Philip.”

    “Don’t be silly. I can give $25 to the valet when I leave my car at the airport.”

    “Except I’m not the valet,” I say quietly.

    “I didn’t mean to insult you,” he says quickly.

    “Philip, let’s stop a moment. I feel like we’ve been sparring all hour and I think I do understand what’s going on. I understand that the actual $25 an hour increase is inconsequential to you. But I think what it did is remind you that we have a professional relationship, that in addition to our human relationship, in addition to the caring interaction that goes on between us, you do pay me for my time. It reminded you, as you said, that this is my job. And I think that made you feel uncared about.”

    “I never thought of that. At least not consciously. But now that you put it into words, I think you’re right.” He pauses. “Know what I just thought about? I thought about the time when I was a kid and my father and I had baseball tickets. I’d been looking forward to it for weeks. And then sometime before the game a delivery guy arrived with an electric guitar I’d been wanting and a note that said, ‘Sorry, kid, can’t make it. Enjoy. Love, Dad.’ I never did play that guitar. I realize it’s not the same thing …”

    “But it felt that money, material things were taking the place of time and caring and that’s how it felt with me too.”

    “I guess. I’m sorry. I know that’s not fair.”

    “Nothing to apologize for. I’m glad our relationship matters to you. It matters to me too. And I’m glad we were able to figure out what was going on.”

  • 08/06/2015 10:57 AM | Anonymous

    “Evidence-based therapy” has become quite the catchphrase.

    The term “evidence-based” comes from medicine. It gained

    attention in the 1990s and was, at the time, a call for critical

    thinking. It reflected the recognition that “we’ve always done it

    this way” is not a good enough reason to keep doing something.

    Medical decisions should reflect clinical judgment, patients’

    values and preferences, and relevant scientific research.

    But “evidence-based” has come to mean something very different

    in the psychotherapy world. The term has been appropriated

    to promote a particular ideology and agenda. It has become

    a code word for manualised treatment—most often, brief, highlystructured

    cognitive behavioural therapy (CBT). “Manualised”

    means the therapy is literally conducted by following an instruction

    manual. The treatment may be pre-scripted in a way that

    leaves little room for understanding patients as individuals. ...

    Click below to read the the full version of the recently updated paper from Division 39 member Jonathan Shedler, PhD.

  • 04/05/2015 9:53 AM | Anonymous

    Secrets--by Linda B. Sherby, Ph.D., ABPP

    Tall, thin, with neatly coifed grey hair, Estelle Harrison, fidgets in the chair, looking decidedly uncomfortable. “I’ve never done this before. I’m almost 80 years old. I can’t believe I’m coming to a psychologist. But I have to talk to someone. My husband has lung cancer and he won’t let me tell anyone. Another secret. I’ve been the keeper of secrets my entire life.”

    “Why is your husband’s cancer a secret?” I ask, thinking how unimaginable it would have been for me to keep my late husband’s cancer secret, how more impossible it all would have been without the support of friends and family.

    “He feels ashamed of being sick, like it’s a weakness.”

    “So you’ve told no one?”

    “Our daughters know. They call. But they have their own lives. And truthfully,” she says sighing, “I’m not sure how much they’d care anyway. Dave wasn’t a very good father. In fact, he was a terrible father. He used to beat them. That was another secret I kept. He’d take down their pants and beat them with a belt.”

    For a reason I cannot completely explain, I think, “Did he get off on it?” What I ask is, “How old were they?”

    “I can’t remember how old they were when he started. Young. Too young.”

    “Until …?” I ask.

    “They both left the house pretty early, so I’d say until they were seventeen. Actually after Maureen left – she’s the oldest – Liz got it worse.”

    Finding this difficult to listen to, I say nothing. My mother didn’t protect me from my father’s rages, but he wasn’t beating me and his rage wasn’t fueled by a perverse sexual desire as seems to be true for Dave Harrison.

    As if reading my thoughts, Mrs. Harrison says, “You think I’m terrible don’t you?”

    “I don’t think you’re terrible, but I’m not sure why you didn’t try to intervene, to protect your daughters.”

    “I was afraid he’d get physical with me too.”

    “And did he?”

    “He slapped me across the face a couple of time.”

    I am again silent.

    “You younger generation, you all think I should have left him. But it wasn’t so easy back then. I was a housewife. I had no way to support myself. I wouldn’t have known what to do,” she says starting to cry.

    Feeling more compassion, I say, “It sounds like your daughters are angry with you for staying, for not protecting them. That must make it harder for them to be available to you; that must make you feel all the more alone.”

    She nods her head, still crying.

    “This might seem like a foolish question, but why haven’t you told whomever you want about your husband’s illness, regardless of what he wants?”

    She looks at me, startled. “I can’t do that. It’s his illness. If he doesn’t want me to tell, I just can’t.”

    I feel myself getting angry at Mrs. Harrison’s passivity. Is that reasonable? Or is my anger at my mother seeping into this therapy session? Or, yet another possibility, am I feeling Mrs. Harrison’s own anger?

    “Are you angry with your husband, Mrs. Harrison?” I ask.

    “I can’t be angry at him. He’s sick.”

    “You can still feel angry with him. You can feel angry for his mistreating you and your daughters. You can be angry that he won’t allow you to speak, to tell people who could be supportive of you.” Suddenly I wonder, “Does your husband know you came here today?”

    “Oh no, I could never tell him that. He’d be furious at me for telling our secrets.”

    I again feel annoyed. Now I wonder if I am feeling angry like her husband, angry that she is so passive, angry that she presents as a martyr just waiting to be beaten. Does she carry within her both the beaten child and the angry parent, with the angry parent projected outward so she doesn’t have to feel the rage herself? Way too complicated for a first session but I do ask, “What about your own childhood, Mrs. Harrison? Were you beaten?”

    “Oh no. I was the good one. My brother and sister got my mother’s rage, but I always did what she wanted and I never talked about what went on at home.”

    “Just as you did with your husband. But were you angry with your mother?”

    “I couldn’t be. I was too afraid I’d give her some sassy answer one day and then I’d get it too.”

    “Sounds like you might have lots of angry stored up inside.”

    She shrugs. “I guess.”

    Unsurprisingly, another passive response.”

  • 03/30/2015 2:08 PM | Anonymous

    The Mask by Linda B. Sherby, Ph.D., ABPP

    Elaine, burying her head in her hands, begins sobbing as soon as she sits down. Struggling to speak she says, “Baxter has cancer. That’s why he hasn’t been eating. I may have to put him down. I can’t believe I’m carrying on like this! I didn’t even shed a tear when my grandparents died.”

    Sadness floods me as I feel for both Elaine and myself, thinking immediately of Pippin, the regal black and white cat my late husband and I adopted shortly after we moved to Florida. Putting her down two years after my husband’s death was beyond painful. “I’m so sorry, Elaine, I know how attached you are to Baxter, how much he’s meant to you.”

    “And this is supposed to be good? Feeling like a wreck, feeling like my heart will break?” she says sarcastically.

    I know what Elaine is referring to. I remember when she first walked into my office four years ago. Although attractive with tasteful make-up, Elaine looked like a doll, her face mask-like. Her mother died when she was three, her father when she was seven. She lived with her step-mother until their conflicts became unbearable, then moved to her paternal grandparents, who saw her as an unavoidable inconvenience. Listening to Elaine’s story I felt overwhelmed by sadness, while Elaine seemed devoid of feeling.

    Elaine came into therapy because she couldn’t maintain a relationship. She had no difficulty finding men but the relationships never lasted. The men said she was unconnected, unavailable, that there was no passion. Sex wasn’t the problem, it was something else, but she didn’t know what. I suspected I knew. It’s impossible to connect to a doll. Our job would be getting behind the mask. It wouldn’t be easy. She had spent years fending off the pain of all her losses. The mask would have to be peeled off slowly.

    “I have no memory of my mother or my father,” she told me. “Just pictures I’ve seen and what my step-mother was willing to tell me, which wasn’t much since she preferred not to talk to me. Of course my grandparents didn’t like to talk to me much either. Besides, they were old, they didn’t want to be reminded of their son’s death. I can imagine that would be painful for them.”

    “And you don’t think it would be painful for a three year old, for a six year old?”

    “I can’t feel what I can’t remember.”

    Finding Elaine’s memories would be crucial to her growth.

    While we focused mostly on Elaine’s difficulties with relationships in both her personal and professional life, over the years I asked questions about the past: “Do you remember your first day of school? Who took you? Do you have an image of the house you lived in with your father? Do you remember moving from your step-mother’s to your grandparent’s? Did you have to change schools? Leave friends?”

    One session when Elaine came in she looked different. There was a crack in the mask. “I had a dream,” she began. “There was a child standing in an empty field. She was holding someone’s hand, a man’s. They were looking down. When I woke up I felt incredibly sad. I didn’t think the child was me. But then I wondered if it was me with my father standing at my mother’s grave. Could I possibly remember that? I was only three.”

    “Let’s stay with your feeling, Elaine,” I say softly. “What is it like to feel that sadness? What does it bring up for you?”

    “I don’t know,” she says starting to cry. “I guess I’m sad for that little girl. Standing by her mother’s grave, not knowing that in three more years her father will be dead too. It’s really awful. I guess I never thought of it like that. I guess I never thought about it at all.”

    “You didn’t want to think of it, Elaine. You didn’t want to deal with your pent up sadness. But today you’ve taken a big step forward.”

    Two years separates the session of Elaine’s dream and her telling me she might need to put down Baxter.

    Returning to the present session I say, “I know you’re feeling tremendous pain, Elaine, not only for your beloved Baxter, but for all the losses you’ve endured in your life.”

    She sobs. “Please tell me this pain is worth it.”

    “It’s worth it, Elaine. If you can’t allow yourself to feel your sadness, you can’t feel joy either and, most importantly, you can’t be truly alive.”

  • 03/18/2015 11:04 AM | Anonymous


    Twenty-seven year old Carla sits crying in my office, her eyes red, shredded tissues in her lap. “I can’t believe it happened again,” she says. “I thought Martin was different – kind, sensitive. I couldn’t imagine him being unfaithful. I don’t understand why this keeps happening to me!”

    And that, I think to myself, is exactly the question. Carla is tall, attractive, shapely, smart, articulate, funny and yet Martin is the third man who’s been unfaithful to her. For the moment, however, Carla needs to deal with the immediacy of her pain.

    “I thought I’d surprise him,” she continues. “Bring us Thai food for lunch. I knew he’d be writing. Or I thought he’d be writing. I didn’t even register the strange car in his driveway. Until he didn’t answer the door. I rang and rang. My stomach started to get all queasy. He finally answered in a bathrobe, tried to make some feeble excuse, but I’m not stupid. I threw the food at him and ran. I wanted to key the girl’s car as I went, but I knew that would be dumb. So here I am, betrayed again. What’s wrong with me?” she asks, beseechingly.

    Odd, I muse, I had a similar experience with a man I dated 40 years ago, showing up at his door only to find him with another woman. I was both devastated and enraged. But that was a long time ago, those feelings long gone, not distracting me from my role as therapist.

    “I don’t think there’s anything wrong with you, Carla. But I do think it’s important to understand why this scenario does keep repeating. What are your thoughts?”

    “I don’t know!” she responds, crying. “My parents have been together for over 40 years. I’d be shocked if my father ever cheated on my mother.”

    “And your mother?” I ask.

    “What!?” she says, furrowing her brow. “You’re asking if my mother ever cheated on my father?” she asks, incredulously.

    I nod.

    “That’s impossible. My mother was the least sexual person around.”

    “Is that because she’s your mother or …?”

    “My mother pulled away when my father tried to be affectionate. And sometimes I could hear them arguing. He was frustrated.”

    “So why are you so sure he was never unfaithful?”

    “Because he wasn’t that type.”

    “Obviously, Carla, I’m not saying that your father was unfaithful. I have no idea. But I do think it’s interesting that you’re so convinced he wasn’t.”

    Shaking her head, she says, “My father stressed the importance of good moral values, insisted we go to church, lectured us on being good people. He’s a wonderful man.”

    I’m surprised by Carla’s naiveté. I think of the people I’ve known – both men and women - who were unfaithful to their partners. Many of them were good people.

    “Two questions. Do you think only “bad” men are unfaithful? And are there similarities between the men you’ve dated and your father?”

    “Actually, Martin reminded me of my father. He even looks a bit like him.” She smiles uncomfortably. “You think I have an Oedipal thing going with my father?”

    “What do you think?”

    Carla looks out the window. After a pause she says, “My father put up with a lot from my mother. She’s difficult, demanding, cold, particularly to him. He dotes on me. I love him a lot so, yes, maybe I’m kind of in love with my father.”

    Well, I think to myself, that opens up lots of possibilities. Does Carla choose unavailable men so that she can remain faithful to her father? Is her father more of a womanizer than she thinks and is she choosing men who are like her father? And if they’re like her father does the relationship feel incestuous so that she unconsciously does something to subvert it? If her mother is cold, is she choosing men like her mother to try to win in the present that which she lost in the past? Does she try to be not her mother and end up being too smothering and intense? Lots of questions, none of which will be answered today.

    “How do you feel, Carla, about being kind of in love with your father and how does it affect your relationships?”

    “I don’t know. Right now, all I know is that I’m sad. I’ve lost again.”

    “As in you’ve lost Martin and lost your father again?”

    “I haven’t lost my father,” Carla declares emphatically.

    “Except that he’s with your mother, not you,” I respond gently.

    “Oh, I get it. I don’t know. This has gotten too Freudian.”

    “It’s time for us to stop for today, but you opened up lots of things today and I’m sure we’ll get back to them.”

  • 02/06/2015 7:58 AM | Anonymous

    Enemies on the Couch. Why is War Endless?

    Interview with Vamik Volkan, M.D.

    By: Donna Bentolila

    Dr. Volkan, psychoanalyst, four time nominee for the Noble Peace Prize, spoke with me in October of 2013 regarding the development of large group identity that results in brutal confrontations amongst groups due to ethnic, religious or political differences.

    History shows us that human beings have fought and killed each other since time immemorial. The advance in civilization has not been sufficient to arrest this aggression. The urgent problems faced by our world today lead us to think that this problem will continue to exist, perhaps in an even broader scale, due to the technological advances allowed by science.

    Vamik Volkan is particularly schooled in these matters. In his professional career he has dedicated his life as observer, mediator and participant, to the study of ethnic conflicts, civil wars, terrorist attacks, identification with political leaders, and possible ways to intervene with adversarial groups who have long been in conflict with one another.

    Dr. Vamik Volkan was born in Cyprus, is Emeritus Professor of Psychiatry of the Virginia School of Medicine, Emeritus training Analyst of the Washington Psychoanalytic Institute, Past President of the International Society of Political Psychology, Member of the Psychoanalytic Society of Virginia, The Turkish North-American Society of Neuropsychiatry and the American College of Psychoanalysts.  Dr. Volkan is also the Senior Erik Erikson Scholar at the Erikson Institute of Education and Research of the Austen Riggs Center, Stockbridge, Mass.  He has been awarded honorary Doctorates from the University of Kuopio, Finland, and from the University of Ankara in Turkey.

    For almost three decades, Dr. Volkan coordinated interdisciplinary teams in multiple problematic areas around the globe. He was able to engage important representatives of “enemy groups” in order to sustain non-official dialogues for long periods of time. His work in this field has allowed him to develop new theories regarding the behaviors of large groups in times of peace and in times of war.

    Dr. Volkan was nominated for the Nobel Peace Prize four times, with the support of 27 countries. His wide and fruitful range of publications surpasses well over 40 volumes.  His teaching has addressed clinical questions about mourning, psychotherapeutic technique, psychology of large groups – their ”traumas“ and       “chosen glories”, the intergenerational transmission of trauma, the psychology of terrorist leaders and an autobiographical narration of his international work, including the founding of the Initiative for an International Dialogue.

    “Enemies on the Couch: A Psychopolitical Journey Through War and Peace”, is his new book in which he illustrates how psychological factors affect international relations, and how an interdisciplinary group knowledgeable about those factors can advance and help to establish a peaceful coexistence.

    My interest in his work is long standing. In 2005 I had the privilege of meeting him personally and beginning an exchange that has continued to the present. The generosity with which he shares his knowledge is admirable and his amazing international trajectory never takes away from the kindness and simplicity that characterize him.

    Interview with Dr. Volkan

    1) You are a Training and Supervising Analyst for the American Psychoanalytic Association who has worked in private practice. What led you to become interested in questions beyond the individual and to the dynamics of large groups?

    In 1979 the then Egyptian president Anwar Sadat went to Israel. When he addressed the Israeli Knesset he spoke about the existence of a psychological wall between Arabs and Israelis and stated that psychological barriers constitute 70 per cent of all problems between these two people. This statement was a turning point in my professional life. The American Psychiatric Association’s Committee on International Affairs of which I was a member was given the task of examining Sadat’s statement. With the blessings of the Egyptian, Israeli and American governments, my colleagues and I brought influential Egyptians, Israelis, and then later Palestinians together for a series of unofficial negotiations that took place between 1979 and 1986. This is how my psychopolitical journey started.

    2) Can you tell us how the Virginia Institute for the Study of International Affairs was founded? What are its aims and framework? How has it developed since its establishment in 1987?

    When the Egyptian-Israeli unofficial dialogue series ended in 1987, I opened the Center for the Study of Mind and Human Interaction (CSMHI) at the University of Virginia’s School of Medicine. The CSMHI’s interdisciplinary team (made up of psychoanalysts, former diplomats, political scientists and historians) became involved in bringing together influential Americans and Soviets for a series of dialogues at the time when the Cold War was ending. Later we conducted years-long unofficial diplomatic dialogues between Russians and Estonians, Croats and Bosnian Muslims, Georgians and South Ossetians and Turks and Greeks. Apart from bringing opposing political representatives together for psychoanalytically informed psycho-political dialogues at different locations, we also evaluated the psycho-political environments in societies that had experienced massive traumas. For example, we studied Albania after the death of dictator Enver Hoxha and Kuwait after Saddam Hussein’s forces were removed from that country. I also participated in the former US President Jimmy Carter’s International Negotiation Network (INN) activities in the 1980s and 1990s. This helped me to meet many political leaders in various countries and investigate political leader-followers psychology.

    I retired from the University of Virginia in 2002 and the Center for the Study of Mind and Human Interaction was closed three years later. During the last ten years I spent several months each year at the Erikson Institute of Education and Research of Austen Riggs Center in Massachusetts as the Senior Erik Erikson Scholar. In 2008 the Erikson Institute became the administrative home of the International Dialogue Initiative (IDI). Lord John Alderdice,Convenor of the Liberal Democrats in the House of Lords in London and a psychoanalyst, Robi Friedman, a group analyst from Israel and I are co-chairs of the IDI. With the help of two more psychoanalysts from the Austen Riggs Center, Edward Shapiro and Gerard Fromm, we have been bringing influential people from Iran, Israel, Lebanon, West bank, Turkey, Germany, Russia, United Kingdom and United States together twice a year and examining world affairs from different cultural and political views. Meanwhile, for over two years, I was involved in bringing together influential people in Turkey, both Turkish and Kurdish origin, in order to open a dialogue between them and come up with suggestions for the solution for the so-called “Kurdish problem” in Turkey.

    I have been involved in international relations for over 30 years. These experiences directed me to begin to develop a large-group psychology in its own right.

    3)  In your new book “Enemies on the Couch, A Psychopolitical Journey through War and Peace”, you review some of the work that you have done during the last thirty years in war and conflict zones.  How has your perspective and thinking evolved in regard to what you refer to as “large group identity”?

    I use the term “large group” to refer to tens of thousands or millions of people, most of whom will never know or see each other, and who share a feeling of sameness, a large-group identity. A large-group identity is the end-result of myths and realities of common beginnings, historical continuities, geographical realities, and other shared linguistic, societal, religious, cultural and political factors. In our daily lives we articulate such identities in terms of commonality such as “we are Apaches; we are Lithuanian Jews, we are Kurdish; we are Slav; we are Sunni Muslims; we are communist.” Yet, a simple definition of this abstract concept is not sufficient to explain the power it has to influence political, economic, legal, military and historical initiatives or to induce seemingly irrational resistances to change such initiatives. When our large group is attacked, our large group narcissism is hurt, or we are humiliated as Arabs, as Jews, as Americans—we begin clinging to our large group identity.  In certain situations, large group identity becomes much more important than our individual identity. Wars, war-like situations, terrorism, diplomatic efforts, shared losses and gains associated with shared mourning or elation are all carried out in the name of large-group identity. This is true even though this psychological source is usually hidden behind rational real-world considerations—political, economic, legal, and moral.

    4) Can you describe what large group psychology is in its own right?

    Considering large-group psychology in its own right means making “formulations” as to the unconscious and dynamic aspects of shared psychological experiences and motivations that exist within a large group and that initiate specific social, cultural, political, ideological processes that influence this large group’s internal and external affairs, just as we make formulations about the internal world of our individual patients in order to summarize our understanding of their internal worlds and interpersonal relationships. Let me give an example:

    We are very familiar with a person’s externalizing his or her unacceptable self and object images or projecting unacceptable thoughts or affects on another person. This creates a personal bad prejudice. “I am not the one who stinks; my neighbor is the one who stinks!” If we want to understand at least one key aspect of societal prejudice, we will try to describe what happens when a large-group uses externalization and projection. When a large group finds itself asking questions such as “Who are we now?” or “How do we define our large-group identity now?”—usually following a revolution, a war, a humiliating economic trauma, or freedom after a long oppression by “others”—it purifies itself from unwanted elements. Such purifications stand for large-group externalizations and projections. After the Greek struggle for independence Greeks purified their language from all Turkish words. After Latvia gained its independence from the Soviet Union its people wanted to get rid of some 20 dead “Russian” bodies in their national cemetery. After Serbia became independent following the collapse of communism Serbs attempted to purify themselves of Muslim Bosnians and that led to tragedies such as the one in Srebrenica. There are non-dangerous as well as genocidal purifications. Understanding the meaning and psychological necessity of purifications can help to develop strategies to keep shared prejudices within “normal” limits and from becoming destructive.

    5)   What would you say is the most important factor as to why humans are often led to raise walls that end up separating communities in conflict with one another?

    Even in the present globalized world where persons from different large groups live in locations with mixed populations, most of the time the “other” shared by thousands or millions of individuals is still on the opposite side of some kind of physical border: a legal political border of a nation, a geographical border created by nature between tribes or ethnic groups, or a border created by force when an enemy surrounds another large group.  When there is no extensive conflict between neighboring large groups, a physical border remains simply a physical border; when there is a conflict, the physical border assumes great psychological meaning as the border separating large-group identities.

    As a way of handling the opposing large groups’ anxiety, two basic principles begin to govern the interactions between enemies in acute conflict:

    1. Two opposing large groups need to maintain their identities as distinct from each other (principle of non-sameness).

    2. Two opposing large groups need to maintain an unambiguous “psychological” border between them.

    If a political border exists between the enemies, it becomes highly psychological. The aim of creating a psychological border is due to our wish to keep what one large group externalized and projected onto the “other” from returning to the first large group. 

    6)  What can you tell us about the manner in which the marks of trauma and historical conflicts are transmitted from generation to generation?

    Massive societal catastrophes can occur for any number of reasons, including natural or man-made disasters, political oppression, economic collapse, or death of a leader, but tragedies, brutalities and deaths that result from the deliberate actions of other ethnic, national, religious or ideological large groups called “enemies,” must be differentiated from other types of massive shared trauma. This is because they involve severe large-group identity issues. When the “other” who possesses a different large-group identity than the victims humiliates and oppresses a large group, the victimized large-group’s identity is threatened.

    When a large group traumatized at the hand of the “other” cannot reverse it’s feelings of helplessness and humiliation, cannot assert itself, cannot effectively go through the work of mourning and cannot complete other psychological journeys, it transfers these unfinished psychological tasks to future generations. All tasks that are handed down contain references to the same historical event, and as decades pass, the shared mental representation of this event links all the  individuals  in the large group and evolves as a most significant large-group marker (Chosen Trauma). The chosen trauma makes thousands and millions of people designated – "chosen" – to be linked together.

    When individuals regress they “go back” and repeat their

    childhood ways of dealing with conflicts contaminated with

    unconscious fantasies and mental defenses. When a large-group regresses the large-group also goes back and inflames chosen traumas. For example, under Slobodan Milosevic Serbians inflamed the 600-year-old image of the Battle of Kosovo.

    When enemy representatives get together for dialogues they become spokespersons for their large groups. When one side feels humiliated they reactivate the images of historical events. For example, while discussing current international affairs, Russians might begin to focus on the Tatar-Mongol invasion or Greeks may refer to the loss of Constantinople; both events occurred centuries ago. When such images of past historical events are reactivated within a large group, a time collapse occurs. Shared perceptions, feelings, and thoughts about a past historical image become intertwined with perceptions, feelings and thoughts about current events. This magnifies the present danger. Unless a way is found to deal with the time collapse routine diplomatic efforts will most likely fail. Today’s extreme Muslim religious fundamentalists have reactivated numerous chosen traumas and glories. We need to study and understand them in order to develop new and hopefully more effective strategies for a peaceful world.

    7)  If I understand your correctly, you view the ideas that Freud presents in “Mass Psychology and Analysis of the Ego” as lacking and insufficient in that they only address the intra-psychic.  What can you say about your contribution to this question?  How do your concepts of “large group identity,”  “shared glory” and “shared trauma” complement Freud’s ideas in his work on Psychology of the Masses?

    Freud was the great discoverer of the hidden aspects of an individual’s mind. He also described some aspects of crowds and large groups. Generally speaking he told us what a large group means for an individual. Large-group psychology in its own right as I defined above is something new.

    8)  In your book you underline how “the other,” being both enemy and friend, can quickly shift from one position to the other. You also remark how enemies are often alike, physically and psychologically. Can you please tell us more about this phenomenon and dynamic?

    If someone shoots at you the danger is real. Enemies are both real and fantasized. Since one large-group externalizes and projects many unwanted things into the enemy the latter’s image includes elements that originally belonged to the first large group. In this sense the two opposing large groups become connected.

    9)   In your latest book “Enemies on the Couch” you underline the importance of the “Initiative of Interdisciplinary Dialogue” in order to offer models of thinking that can help us to better understand social conflicts.  Please tell us more about this idea.

    At the Center for the Study of Mind and Human Interaction (CSMHI) we developed the “Tree Model” to tame conflicts between opposing large groups. The application of this methodology takes years----like it takes years to analyze an individual. It has three basic phases:

    1-Psychopolitical assessment of the situation (representing the roots of a tree).

    2-Psychopolitical dialogues between influential members of opposing groups (representing the trunk of a tree)

    3-Collaborative actions and institutions that grow out of the dialogue process (representing the branches of a tree).


    In Enemies on the Couch as well as in my several other books I describe this methodology in depth and give illustrations of its application.

    10)  As a continuation of the last question, can you tell us how the knowledge that you have gained has helped you to create models to assist large communities after they have undergone massive traumas?

    After a trauma at the hand of the “other” there are specific societal responses (due to specific circumstances and historical issues) mostly in the service of protecting and maintaining the large-group identity. There are also typical societal responses. For example, the large-group rallies behind the leader. If the leader cannot maintain “basic trust” severe splits and fragmentations occur within the large group; the large group focuses on minor differences between itself and enemy group; large group members experience increased large-group narcissism (it can be masochistic or malignant narcissism), magical thinking (or religious fundamentalism) and reality blurring; the physical border becomes the boundary of the large-group’s identity; the large group engages in behaviors symbolizing “purification;” the personality organization of the political leader becomes a significant factor in societal/political realities and so on.

    After a massive trauma at the hands of enemies, or after a period of political oppression by a government the people in the victimized group experience a shared sense of shame, humiliation, and even dehumanization. They cannot be assertive, because expressing direct rage toward the oppressors would threaten their livelihoods and even their lives. Their helpless anger interferes with their mourning over losses that touch every aspect of their lives, ranging from their dignity to their property, relatives or friends. Shared unfinished psychological tasks are then passed on from generation to generation. So guilt experienced by people belonging to the victimizing group may also be involved in transgenerational transmissions.

    How to deal with traumatized societies is a vast topic. The facilitating team needs to spend time in the field in order to assess destructive responses and find “entry points” to tame them. In many of my books, including in Enemies on the Couch, I give detailed examples.

    11)  How did you come to consider yourself professionally as a “political psychologist”? Does this self-designation interweave global and personal perspectives?

    I am a psychoanalyst working off the couch in order to understand large group psychology and find ways to tame, when possible, some large-group conflicts. I never called myself a “political psychologist”. But, many persons refer to me using this term.

    We should also remember that there is no single theoretical or practical point of view or application of political psychology. Since I am also a psychoanalyst, I tried to examine both, conscious and unconscious motivations of how people with different large-group identities behave in peaceful or in stressful times. Other types of political psychologies depend more on the “logical” evaluations of conflicts and on “logical” solutions.

    12) History shows us that humans have been slaughtering each other from time immemorial and that man will continue killing and murdering each other, perhaps in even larger numbers given the technological advances man has achieved. How do you understand the place of aggression in human beings? You seem to think, not without a dose of pessimism, that men will continue to slaughter each other.

    There are various psychoanalytic theories on “aggression.” From a practical point of view, the human aggression as expressed in large-groups is here to stay. Psychoanalysts need to evolve a large-group psychology in its own right further if we wish to be effective in having a role in societal and international arenas.

    Dr. Volkan, thank you for sharing your thoughts and ideas on this all important subject for both us as psychoanalysts and for all of humanity.

    Nota Bene: A Spanish language translation of this interview first appeared in volume 25 of the cultural online Journal Letra Urbana.

    Donna E. Bentolila, L.C.S.W. is a Past President (2014) and a board member of the Southeast Florida Association for Psychoanalytic Psychology (SEFAPP). She is a Teaching Analyst at the Florida Psychoanalytic Institute and a member of the American and International Psychoanalytic Associations. She maintains a private in Boca Raton and in Miami.

  • 02/02/2015 9:59 PM | Anonymous

    An Eye for an Eye

    “I’ll never be able to have sex again,” sobs 22 year old Ashley, her face, buried in her hands with her long brown hair falling forwards, her voice barely audible. “I don’t know how I could have been so stupid. I know better. I’m not some dumb freshman, for God’s sake. I know you don’t get drunk at a frat party and go have unprotected sex with some guy you’ve never met before. My life is over!” she wails.

    It has been a month since Ashley confirmed that she has herpes. We have been dealing with nothing else since her diagnosis. She is understandably distraught, unable to move beyond the feeling that she has forever ruined her life.

    I think about some of the patients who have, over the years, told me about having herpes: The 60 year old woman who felt forever dirtied and punished by God. The session with a man who began by saying he needed to tell me his “secret,” and was then for so evasive, that I became afraid he was going to tell me he had committed murder. The young woman who said she contracted herpes after she had been drugged and raped, only to tell me months later that she had fabricated that story to hide her shame. All tragic stories that forever cast a shadow over the person’s life. And now there is Ashley.

    “I can’t believe I’ll never be able to have sex again. I’m only 22. I’ll never get married. Never have children.”

    “Ashley, I’m by no means minimizing the pain and difficulty of having herpes, but it doesn’t mean you can’t have sex or get married or have children,” I say, trying to temper Ashley’s overwhelming feelings of despair.

    “And risk doing to someone else what that asshole did to me! Never!!”

    I think about the anger that almost invariably accompanies contracting herpes: the 60 year old who talked of being punished by God, my fantasy that my male patient might have committed murder, the young woman who fabricated a story of rape. Rage makes its way into the experience one way or another.

    “I certainly understand your angry at that guy.”

    “Yeah, I’m angry at him. Lot of good that will do me.”

    “Well, it’s important that you’re aware of your anger, rather than being scared of it.”

    “What are you talking about?”

    “You’re angry. You’d love to get back as this guy, but there’s really no way to do that. So you feel powerless and that makes you even more angry.”

    “So, yeah, and what does all that mean?”

    “You notice, Ashley, that you’re also getting angry with me, which is perfectly all right, but I think it’s an indication of how angry you feel and how easy it is to direct your anger at me or someone else.”


    “You have nothing to apologize for. It’s just important that we look at what’s happening and try to understand it because I think it’s related to why you think you can never have sex again or get married or have children. I think you’re afraid – not consciously, of course – that your anger would spill over to a new partner, that perhaps you’d want to give him herpes, just as it was given to you.”

    “No way” Ashley says, shaking her head emphatically, her hair flying from side to side. “I’d never, ever want to do that to someone else.”

    “I know you’d consciously never WANT to harm someone else, but your unconscious desire for revenge is another matter. If you’re afraid of wanting to hurt, you might try to protect others from what you’re afraid is your dangerousness by depriving yourself of the pleasure of sex and marriage and children.”

    “But how could I possibly have sex with someone and know I could harm him - especially if you’re saying I want to harm him?”

    Although Ashley’s question might sound as though she’s still stuck, I hear some hope for she’s at least considering the possibility of having sex again. I reply, “It’s not that you’d want to harm a new partner, it’s that you might be afraid your anger could be expressed in that way. And the more we can deal with your anger here, the more you know about your anger, the less afraid you would be of expressing it unconsciously.”

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