COR Course Review: Eight Gates to Listening: Exploring A Psychotherapist’s Attention, Instructor Jeffrey J. Eaton, MA, FIPA
In this seminar, Jeff Eaton explored a variety of listening tasks within the psychotherapy process. He built on the work of Melanie Klein, Donald Meltzer and Wilfred Bion, among others, to develop different listening perspectives, which he calls “gates”, to help the clinician explore the patient’s “picture of the world,” and how this internal world picture affects the way a person experiences and navigates their emotional life and external reality. The goal of Eaton’s listening model is to help clinicians organize, focus, and make use of their attention as part of the listening process.
In the first few sessions, Eaton laid out what he feels needs to be attended to by the therapist in the psychotherapeutic encounter, what he calls “an improbable conversation.” This is the process of gathering the data of a session and getting to know the individual. He offers thoughts on “the fate of pain” and the emotional suffering of the person as key to understanding their experience and to help them make meaning of their experience by connecting with their own internal world and opening a space that can foster the possibility of emotional growth and development. He suggests the therapist listen at the level of the interpersonal, intra-psychic, and within in the transference to create the conditions for a “container-contained” experience to develop. It is within this experience of container-contained that an individual can move from emotional distress to emotional comfort as they no longer feel alone with their suffering.
As the seminar progressed, the sessions moved to exploring the shifting states of mind patients present with and detailed important factors to listen for and observe that may help the clinician determine a patient’s “country of the mind,” or in Kleinian terms, what position (i.e. Paranoid-Schizoid, Depressive, etc.) the patient is speaking from. Eaton discussed specific ways to listen as the patient expresses themselves through words, tone, rhythm etc., that point to the country of the mind the patient is experiencing in the session. This way of listening can help the clinician think about how, and at what level, they want to make an intervention. He also addressed countertransference issues that these different countries of the mind can bring forth for the therapist. He does this, in part, by “listening to himself listen to the patient” and paying attention to what emotions this stirs up within him.
A seminar that I found particularly complex, important, and clinically thought-provoking was Eaton’s discussion of the patient’s “floor of emotional experience.” This level of the psyche is pre-object relating and develops at, or even before, birth. Eaton articulates the many different domains (e.g. biological, cultural, interpersonal) that go into establishing the stability of the child’s internal world at this level, and what may occur when there are impingements or deprivations on psychic development. Psychic disruption at the level of the patient’s floor of emotional experience is similar to what Bion writes about as a patient’s “background of catastrophe,” Balint’s “basic fault,” or Winnicott’s “primitive agony.” It is this foundational floor that establishes what occurs later with preobject relating and beyond.
Throughout the seminar, Eaton brought in clinical examples drawn from his work with seriously disturbed children and adults which help to illustrate the application of his ideas to the therapeutic encounter and bring theory to life. The format of the seminar gave ample time for questions after sections of each lecture for participants to get clarification which allowed the content of the presentation to be digested in manageable increments.
“Eight Gates to Listening” is a clinically relevant and practically useful seminar for clinicians interested in deepening their capacity to listen for the complicated and nuanced factors occurring in the therapy process. Eaton’s rich synthesis of complex ideas drawn from Object Relations theory, combined with years of work with psychotic children and adults, yields a model of listening that helps to cultivate one’s ability to pay attention to the emotional pain and suffering of another. This seminar is useful for therapists with different levels of experience, but especially for early career psychotherapists and psychoanalysts.
Carol H. Hekman, Ph.D., FABP, Faculty and Training and Supervising Analyst, New Center for Psychoanalysis, Los Angeles. Private practice, psychotherapy and psychoanalysis, Pasadena, California.
Pandemic-Era Use of Zoom, Insistence and Peril
At the start of the pandemic, many of us made a quick pivot to work remotely, and much of that work is done over Zoom. Obviously, Zoom is the corollary to nearly every in-person interaction we had pre-pandemic. We are forcing school, happy hours, conferences, and funerals into the Zoom format. While video conferencing is a very good tool, it still feels rudimentary in many ways. If we want to get fancy, we learn how to set up a break out room. Familiarity with using modern technology doesn’t equate to possessing a nuanced theory of the medium. Likewise, I feared my thinking about how and why I am using Zoom for therapy was undeveloped and obtuse, until an encounter with horror as a patient set my mind to remedy.
With the primary action of therapy embedded in speaking and listening, the telephone would seem to be the analog for mediated psychotherapy. However, few patients may be familiar with using the couch in such a way that looking directly at one’s therapist when speaking, while being together, isn’t part of the experience. If a patient sat across from us face-to-face in the office, hesitation on the therapist’s part not to use video would seem completely puzzling. The most literal description of doing therapy: I see a therapist, I see patients. Therefore, if I can’t see you in person, I can still see you virtually.
Privileging the visual image of one another at the time of the session, especially moving from lying on the couch to Zoom, suggests that there is something we want from the visual that we believe we can’t get any other way. In debating the question of what is art, the early Greek philosophers put forth the mimetic theory that the representation of an object is an imitation, a copy, of the transcendent idea or an ideal form that makes up reality (Sontag 2001, 4). I believe we may have applied this same mimetic theory of art to our understanding of video conferencing technology. It makes sense that in the midst of a crisis, we would turn to our most familiar, imbedded heuristics to make our decision about how to carry on with this work. Make a copy, sings the Greek chorus. Zoom promises a representation of reality as we wish it to be, not how it is. Susan Sontag (2001) criticized our insistence on keeping the mimetic theory alive, “The world, our world, is depleted, impoverished enough. Away with all duplicates of it, until we again experience more immediately what we have” (7). Zoom cannot compensate for the loss of the corporeal presence of the other. I say, away with the duplicate until we experience more immediately what we have lost.
I recall more fear and panic than pragmatism in those early pandemic days of late February and the first weeks of March. In some ways, expressing fears about dying, wrestling with mortality, is familiar material in the analytic setting, showing up in dreams and underpinning anxious, ruminating thoughts. In our offices, we coax that which catches in the back of the throat into language. Then, the pandemic introduced the specific threat of losing real people we love. When I think about why I might have been quick to adopt video conferencing for therapy, I think about turning to Zoom to manage the dread of losing Her, of losing what can develop between two people in a session, of losing the maybe-just- emerging internalized good object. Melanie Klein (2002) writes, “Every experience which suggests the loss of the real loved object stimulates the dread of losing the internalized one too” (267). If I wanted anything in the early days of the pandemic, I wanted visual reassurance, moving from lying on the couch on March 12th to face-to-face video sessions with my therapist by March 17th. I want to see that you are okay.
The relief of seeing one another despite the pandemic, but not in spite of the risks, felt like a triumph of sorts. Reflecting now, though, on Zoom as a precocious tech work-around to the pandemic brings to mind Carol A. Seigel’s 1999 study titled “Effects of baby walkers on motor and mental development in human infants.” Babies who are placed in baby walkers with opaque trays cannot see their own legs, “a deprivation,” concludes Seigel. I’m upset now as the deprivation comes into view. Hour after hour, going on ten months now, the duplicate representation is in fact a perversion of that original experience of corporeality. We are only seeing a part body, our own and the other’s.
Quite recently, I observed Her, whom I can now only see from the shoulders up, apparently write something by hand. A surprising mental exclamation came to me on a flood of relief: She has arms! Klein (2002) writes, “The object world of the child in the first two or three months of its life could be described as consisting of gratifying or of hostile and persecuting parts or portions of the real world” (291). With the silly-absurd children’s game Mr. Potato Head, a kid can snap on some spindly legs and add some arms with a purse, but the blobby shape is essentially unaltered. The whole world is a breast. Or, filling in missing parts can be the stuff of nightmares. In China Miéville’s 2002 steampunk fiction novel The Scar, for example, some human bodies are surgically altered into machine parts as punishment; one is magically remade amphibian by choice. The whole world is disturbed.
Realizing I lost touch with the intact body of my therapist over video reveals how Zoom can re-invigorate an early object relation world. On the couch we implicitly consent to the absence of the visual cues. When we consent to use Zoom, we are operating on the phantasy that Zoom will do the job of mirroring our embodied ways, and we feel secure in our ability to accurately imagine what is out of the range of the camera. Zoom requires a great faith in Freud’s concept of “hallucinatory wish-fulfillment” having a positive outcome (Kristeva 2001, 67). The fact that we can’t often avoid seeing our own truncated image in the corner of the screen demands we absorb a reflection of a minimized self, limbs and trunk missing. It’s a short step from absorbing a video feed of a part body to worrying about a disintegration of parts of self. I find myself upping my defenses to protect myself from one of the more insidious psychological costs of using Zoom, the insinuation that I must traverse the scary landscape of pathological projective identification whenever I open my computer. Even as I immerse myself in the literature containing the words and terms that explain the phenomena that I think are active under the surface of our Zoom sessions, I hear myself protest: Don’t remind me how bizarre objects come to be!
Yet, who has the stomach to suggest untethering from the visual anchor we’ve come to depend on at this point? Zoom is going to be our way of life for a while longer. We can, however, untether ourselves from any insistence that Zoom is a neutral and adequate copy, because we think we need it to be this way for a time. It’s impossible to go back to March 2020 in order to mount a reimagined technical response to the pain the pandemic wrought. Instead, we have the present task of linking our felt suffering to our thinking. In challenging the idea that with Zoom we possess a duplicate, the visual mimetic of being in the same room together, we may experience more immediately what we have lost. We may come closer to what we really want, the experience of holding the image of you in my mind, a whole person.
Klein, Melanie. Love, Guilt and Reparation: and Other Works 1921-1945. Simon and Schuster, 2002.
Kristeva, Julia. Melanie Klein. New York: Columbia University Press, 2001.
Sontag, Susan. Against Interpretation and Other Essays. Farrar, Straus & Giroux, 2001.
Eliza Baughn, LMHC, is a psychoanalytic psychotherapist with an interest in critical theory. She has been working in private practice in Seattle since graduating from Bastyr University with a Masters in Counseling Psychology in 2014.
Winnicott, Closeness, and Distance
If he were alive today, what would Donald Winnicott say to us as clinicians, as some of us try to carry on our careers at home while our children, in the next room, need help with their schoolwork? Or when we are preoccupied with at- risk family members, or are at risk ourselves? If the past provides a key, he would reassure us that we are “good enough” and should trust our clinical instincts. He would understand our conflicted feelings and the helplessness of not knowing.
Donald Winnicott, born in 1896, grew up in a privileged family, with a wealthy father who believed strongly in public service. Although his father had wanted him to go into business, Donald decided to be a doctor, and became both a pediatrician and a psychoanalyst. Early in his career he took a position at Paddington Green Children’s Hospital, where he remained for 40 years. As he was establishing himself at the hospital, Winnicott also began psychoanalysis. He started his psychoanalytic training in 1927, shortly after Melanie Klein moved to London from Germany. Along with Klein and Anna Freud, Winnicott was deeply involved in the psychoanalytic treatment of children. As a pediatrician, Winnicott was aware of the significance of the actual relationship between mothers and their children, and this became the focus of his life and work.
In 1939, as the Second World War began, British parents were encouraged to send their children from the cities to live in the countryside with families who would accept them. Many parents brought their children home after a few months, but the following year the Blitz began and hundreds of thousands of children were sent away, this time remaining until the end of the war in 1945. Winnicott was deeply concerned about the separation of families and served as a consultant to the children’s evacuation program. He began meeting weekly with social workers in Oxfordshire, advising them about how to treat boys whose behavior was so disturbed that they were placed in hostels rather than private homes. In 1943 he also began a series of BBC talks for mothers, which would continue until 1966. These talks convey the depth of his empathy for the daily lives of mothers and the challenges that parenting presents.
Famously, Winnicott is the prominent spokesperson for relational space, whether it is transitional space where two people communicate freely and openly, or the space of being alone in the presence of another, or the deeper solitude of subjectivity that cannot be penetrated. I wonder if the bombs that dropped on London, undermining privacy and self-protection, left him with a capacity for fluidity and an awareness of the profound challenges of establishing and maintaining boundaries. For Winnicott, we are most ourselves when we examine the spaces that both separate us and bring us together. This insight has made his work a highly significant, creative, and original contribution to psychoanalysis.
What would Winnicott think of the new world we currently inhabit, where danger lurks with too much closeness and where “social distancing” impacts relationships, even with our families? What would he want us to say to children today, who are separated from their friends and social circles? I like to think that he would reassure us, reminding us that human bonds transcend the particular challenges we face and that historical circumstance can be met and overcome. The only danger is denial, not facing the realities of the moment. He would encourage us to address our needs for connection and for privacy, to be as direct and honest as possible, and to acknowledge the limitations as well as the possibilities of love and security in our closest relationships.
Katherine Weissbourd was awarded her doctorate in clinical psychology from Northwestern University in 1978. In 2009 she received her certificate in psychoanalysis from the Northwest Center for Psychoanalysis in Seattle, and she is a training and supervising analyst at the Institute for Contemporary Psychoanalysis in Los Angeles. Kathy teaches at SPSI and COR on clinical technique. She is in private practice with adults in Seattle.
Carol H. Hekman, Ph.D., FABP, Faculty and Training and Supervising Analyst, New Center for Psychoanalysis, Los Angeles. Private practice, psychotherapy and psychoanalysis, Pasadena, California.
What Are Theories Good For?
ENIKA COCOLI BOWEN
This question—What Are Theories Good For?—has been on my mind and others’ minds as the result of conversations we’ve had during these past months. It’s particularly important to find out how theories help when everything hangs in the balance.
Theories have organizing value for us to live in our worlds, realities, and meet those of others. I was both surprised and not surprised to find out that the root of the word “theory”—after undergoing transformations in its nearly 3,000 years of history—derives from the Greek θεωρός. Its basic meaning is “to be a spectator,” an activity that implies seeing. It is intriguing to think that theorizing and theories are essentially the business of spectators. This is linked to early Greek life, when poetry was young and tragedy and philosophy hadn’t yet fully emerged—and to oral storytelling, spectators watching the telling of The Iliad and The Odyssey. The spectator created an organized internal story of what was on stage; this is theory. The methodical and systematic efforts of philosophy created the platform where some organizations of ideas prevailed and shaped thought and minds. How we know ourselves, the question of consciousness, involves a very enduring conglomerate of theories.
Nearly 100 years ago, the theory of quantum mechanics emerged. While its implications are still being digested, it changed a fundamental rule in “spectating”: The observer/spectator is never outside the observation; rather, the very presence of the observer/spectator changes the field and findings. But then again, was the Greek spectator ever outside the observation?
Wilfred Bion put himself in the place of both spectator and participant, as being a sort of “quantum psychoanalyst,” quite distinct from the classical psychoanalyst (pun intended!). He, too, approached the question of the development of the mind, through his theory of thinking and beyond, from a psychoanalytic vertex. In the Homeric metaphor, the alpha function usually takes and keeps center stage. It is a constant character. Even in the presence of deeply psychotic states, a bit of it is still there and, where it is not, its absence is a character unto itself.
The pandemic opened up for me a deeper layer of the elements. While I cannot visualize the alpha elements and how the alpha function “moves” and “speaks,” other than using the stage metaphor, giving birth to elements of thinking, I have felt compelled to feel beta elements, as best as I can, although I am aware these are by nature unconscious. In today’s life, being surrounded by uncertainty, having question marks about the future of everything, concrete and symbolic, has allowed the emergence, with full force, of having very little certainty. Not knowing anything else, that certainty is strangely calming and made of bits that are loosely held together. I can fall apart at any moment. We all can. Achilles, that most famous of heroes, died in battle through the very weak spot that confirmed his strength. Cassandra, that most famous knower, died desperate and exiled. Odysseus, that most intelligent of men, wandered for ten years trying to return home, never knowing what the next day would bring, never knowing if he’d ever see his wife and son again. Strength, knowledge, and intelligence are desirable attributes, but they do not hold a candle to the basic nature of unintegrated bits constantly striving to hold together and maybe even giving rise to something beautiful, like a meeting of minds, shared experiences, or breathtaking points of contact. The pandemic, living in it and practicing in it, has laid bare the limits of strength, knowledge, and intelligence.
So: What are theories good for? Theories are good when they arise out of the belly of experience through continuous digestion of uncertainties; out of the heart’s rhythmic oscillation of coming together and falling apart; out of the breathing in and out of each other’s presence and reminding ourselves we are never outside of the realities we observe.
What is between the bits, what exists in the empty spaces, the gaps, the caesurae—in the unpredictability of living and working during these months— has forced into consciousness the existence of the links. What is between the bits? “Catastrophe,” Bion would answer. “Beta elements are […] aspects of personality linked by a sense of catastrophe,” he wrote in 1963. “Investigate the links!” he told us late in his life. In other words, “Investigate catastrophe!” In “peacetime,” I did think about what he may have meant, but in this current “virulent wartime,” those catastrophic links are made clearer, more visible, to the internal eye. So, back to theory and spectators, we who look and take in what we see.
Spectators and participants! All in!
Enika Cocoli Bowen, PhD, is a clinical psychologist in private practice in Everett. She began studies of clinical psychology and psychoanalysis in Milan, Italy, in 1996. Her interests have included empirical investigations of attachment theory in both theoretical and clinical settings. She provides psychoanalytically informed individual therapy to adults as well as assisting individuals, couples, and attorneys with psychological assessments in the context of custody cases. She supervises doctoral practicum students and interns at Fairfax Hospital.
Reflections on Living in a Time of Global Pandemic
Living and practicing psychotherapy during this time of COVID-19 has generated a wide variety of thoughts and feelings in me. This has, of course, included times of having difficulty thinking at all, especially in moments of sheer exhaustion. However, as the days have turned to weeks and the weeks turned to months, there has been a particular set of associations to working with the challenges of the times that I have found immensely helpful. Namely, a grounding frame of reference for me in trying to adjust to a world that feels unrecognizable—has been my past experiences with international mobility and navigating cross-cultural transitions.
Growing up internationally, I have had several seasons of life characterized by the challenges of moving from one part of the world to another. Many of these transitions occurred during my childhood and early adulthood, and the dynamics that come with having my entire world turned upside down and inside out are in some ways deeply familiar. The spoken and unspoken rules for how to do life can look incredibly different in various parts of the world. Culture dictates all kinds of things as it relates to living in a particular society. To name a few of these things, cultural norms impact how one walks and talks, how one dresses, how one approaches greetings and farewells, which hands are used for what kinds of activities, what is considered appropriate as it relates to personal space and touch, which parts of life require certain levels of vigilance to maintain safety, what expectations there may be as related to personal hygiene practices, what conceptualizations there may be as to how members of society conduct
business, how lines are formed, how money is exchanged, what expectations there may be around levels of productivity, what can be anticipated as it relates to access or lack of access to various material goods and resources, etc., etc., etc…..
Often, during this time of COVID- 19, I have found myself thinking that something about all of this feels familiar. I live in a different country now, the country of COVID-19. Once again, my world has been turned upside down and inside out. Thinking of it this way helps me to make room for my emotional experience and, hopefully, the experiences of my patients. It helps me to notice and grieve the losses that come with this kind of wholesale transition. It reminds me to try and return again and again to a posture of curiosity. It reminds me to try to extend as much extra grace and patience toward myself and others as I can muster. In this new country of COVID-19, the way I interact with the world is different. There are new customs to learn, new norms and expectations to observe and incorporate. I cannot take for granted that I know how it works. I need to be open to learning. I need to be willing to make adjustments. I can expect to feel disoriented, confused, and exhausted. I can expect that I will make mistakes. I will have unsure and embarrassing moments. I will experience feelings of tension, fear, and insecurity. I will feel uncertain about who to trust. I will need extra care. These things can be expected. Of course, thinking of it this way does not solve all of the challenges, but it sure has helped me stay at least somewhat grounded. While certain nuances of this particular transition feel remarkably new, I have also navigated some of these kinds of challenges before. It is hard. But expecting it to be so helps. I have experienced the grief and excitement of being transported to new worlds in the past, and I can try to learn about how to live in a new world once again, as the old saying goes, one day at a time.
Josh Sandoz, MA LMHC, received his MACP in 2008 from The Seattle School of Theology and Psychology and currently works in private practice in Lower Queen Anne providing individual psychotherapy for children, adolescents, and adults. Specializing in working with those impacted by international mobility, he also curates the International Therapist Directory online. Josh is the outgoing past president of the Board of Directors of COR.
COR Course Review: Narcissism: A Clinical Approach
The COR course Narcissism: A Clinical Approach came at just the right time for me. When I signed up for this course, how could I know that the practice of examining my own narcissism would benefit me greatly in the process of also dismantling my whiteness? I did not anticipate that this course would ultimately help me on my journey to become a more useful participant in Black liberation.
While we also read Symington, Kohut, and Rosenfeld, I want to share what has been so pivotal for me in this class, which is a personal discovery I made as we discussed Melvin R. Lansky’s essay “Unbearable Shame, Splitting, and Forgiveness in the Resolution of Vengefulness.” The discussion that Ann Glasser and Pam VanDalfsen led on this particular reading broke open my understanding of the narcissistic structures we all hold, our need to avoid a shame experience that we perceive to be unbearable, and the lengths we will go to, in order to keep our psyches organized around it.
I began to think about my own defenses against that shame and the “hidden grandiosity” that has often driven me. The insidious need to be liked and to be seen as “good” has been the chorus of my life, and it often deludes me into thinking that I am safe. But, in the words of Lansky, “splitting, instigated by shame conflict (i.e., the anticipation of unbearable shame due to awareness of a massive discrepancy between one’s view of oneself and one’s ego ideal, one’s sense of the conditions for self-respect and self-approval before oneself and others) results, often rapidly, in rage.” I began to see how my own unacknowledged shame had stalled me on my own anti-racism journey. I discovered that, as a white woman, the harm I had caused and continue to cause was/is egodystonic and therefore bringing up a mountain of shame. Avoiding it was only sinking me further into complicity with a violent system.
What I am instead coming to believe is that I am not as fragile as I fear. That I can feel the shame that is there for me and that I will develop resilience the way one develops lung capacity while training for a marathon. And while Lansky helped me dig into my own destructive narcissism, I’ll be listening to Black womxn as I move forward. Let’s work together to center their voices as we interrogate our own participation in the myth of white supremacy.