Second Hand Rose: Attempting a Difficult Second Analysis as Second-Best Analyst

Abstract

Certain kinds of second analyses are destined to be difficult. The situation where a patient is compelled to leave a highly idealized analyst to seek another analyst's help is replete with opportunities for the patient to find the new analyst to be irretrievably disappointing. A powerful idealizing transference to the previous analyst can function to obscure and redirect feelings of abandonment and hostility. In addition, allowing a new, positive therapeutic alliance constitutes a threat to one's fidelity to the previous analytic experience, which may need to be protected at all costs. Three brief case examples illustrate how this dynamic can lead to a disrupted second analytic endeavor. Taking on a second analysis may require the new analyst to use a different approach, particularly when an idealizing transference in the first analytic relationship is interrupted in such a way that the development of another therapeutic alliance becomes an impossibility.

Alcune esperienze di seconda analisi sono destinate a essere difficili. Quando un paziente è costretto a lasciare un analista intensamente idealizzato per cercare l'aiuto di un altro analista, può facilmente trovarsi esposto nel percepire quest'ultimo irrimediabilmente deludente. Un potente transfert idealizzante nei confronti del precedente analista può avere la funzione di oscurare e di reindirizzare sentimenti abbandonici e ostili. Inoltre, la disponibilità a sostenere una nuova positiva alleanza terapeutica costituisce una minaccia al legame di lealtà della precedente esperienza analitica, che può necessitare di essere protetta a tutti i costi. Tre brevi esemplificazioni cliniche illustrano come questa dinamica possa ostacolare il secondo impegno analitico. Intraprendere una seconda analisi può richiedere al nuovo analista l'uso di un approccio diverso, in particolare quando un transfert idealizzante nella prima relazione analitica si è interrotto in un modo tale da rendere impossibile lo sviluppo di un'ulteriore alleanza terapeutica.

Certaines analyses sont destinées à être difficiles. La situation où le patient est forcé à quitter un analyste hautement idéalisé et doit rechercher l'aide d'un autre analyste, offre forcément maintes occasions à ce patient de trouver ce second analyste irrémédiablement décevant. Un transfert idéalisant intense à l'analyste précédent peut obscurcir et rediriger des sentiments d'abandon et d'hostilité. De plus, permettre la création d'une nouvelle alliance thérapeutique positive constitue une menace à sa fidélité à l'expérience analytique préalable, et celle-ci peut nécessiter d'être protégée à tout prix. Trois brefs exemples de cas illustrent comment cette dynamique peut perturber une deuxième entreprise analytique. Entreprendre une deuxième analyse peut exiger du nouvel analyste qu'il utilise une approche différente, particulièrement lorsqu'un transfert idéalisant dans la relation analytique préalable est interrompu de telle manière que le développement d'une autre alliance thérapeutique devienne une impossibilité.

Eine gewisse Art von zweiten Analysen ist von vornherein schwierig. Die Situation, in der der Patient gezwungen ist, einen hoch idealisierten Analytiker zu verlassen und die Hilfe eines anderen zu suchen, ist voll von Gelegenheiten, den neuen Analytiker als nicht wieder gut zu machende Enttäuschung zu erleben. Eine starke idealisierende Übertragung auf den früheren Analytiker kann dazu führen, Gefühle von Zurückweisung und Feindschaft zu verdunkeln und umzulenken. Hinzu kommt, dass das Eingehen auf eine neue positive therapeutische Verbindung die Treue zur früheren therapeutischen Erfahrung bedroht, die vielleicht um jeden Preis geschützt werden muss. Drei kurze Fallbeispiele illustrieren, wie diese Dynamik zu einer Unterbrechung des zweiten analytischen Unternehmens führen kann. Eine zweite Analyse anzufangen, kann vom neuen Analytiker ein anderes Herangehen verlangen, besonders dann, wenn eine idealisierende Übertragung in der ersten analytischen Beziehung in einer Weise unterbrochen wurde, dass die Entwicklung einer neuen analytischen Allianz unmöglich wird.

Ciertos tipos de segundos análisis están destinados a ser difíciles. La situación en la que el paciente se siente forzado a dejar un analista altamente idealizado para buscar la ayuda de otro analista está repleta de oportunidades en las que el paciente puede vivir al nuevo analista irremisiblemente decepcionante. Una intensa transferencia idealizada hacia el anterior analista puede servir para oscurecer o redireccionar los sentimientos de abandono y hostilidad. Además, permitir una nueva alianza terapéutica positiva constituye una amenaza a la fidelidad a la experiencia analítica anterior, que puede ser que deba ser protegida a toda costa. Tres ejemplos breves ilustran como esta dinámica puede llegar a interferir el segundo tratamiento analítico. Tomar en tratamiento un segundo análisis puede requerir que el analista utilice un abordaje distinto, particularmente si la trasferencia idealizada con el primer analista queda interrumpida de manera que el desarrollo de otra alianza terapéutica deviene imposible.

Keywords:

• difficult
• disruption
• failure
• idealization
• idealizing
• loss
• second analysis
• therapeutic alliance

Notes

¹Words and music by Grant Clarke and James F. Hanley. Recorded by Barbra Streisand, 1965.

This article was presented on October 23, 2010, at the 33rd Annual Conference on the Psychology of the Self in Antalya, Turkey.

²I know there were psychodynamic elements of repetition in her continued criticisms of me, but showing her how her critique of me had developmental origins, or had occurred in all previous analyses, may have been experienced as an attack on her—a type of psychotherapeutic “one-upmanship.” My effort to remain empathically attuned to her experience of me kept me in a benign, but more powerless, position. This kind of disciplined empathy can be very difficult to sustain when you feel so criticized.

³A colleague saw the patient's behavior of criticizing and rendering me inadequate as an enactment that served to “embalm” the lost analyst, functioning to protect and preserve him (Jenny Twiggs, personal communication, October 24, 2010).

⁴I use the phrase “relational template” to describe an internalized relational pattern that has been learned through repetitive exposure, often beginning in early development, and applied to interpersonal circumstances throughout life. An individual has a stockpile of templates waiting to be mobilized when needed. A relational template is comprised of two (or more) linked roles, each manifesting specific, contextually driven, reflexive relational behaviors with associated memories and affects. In this case, I felt there was going to be a significant clash between our relational repertoires, which originated in our two very different relational histories.

⁵I continue to keep an open mind about theories that I do not subscribe to, and find it refreshing and instructive to come across effective clinical work that uses either a language or framework significantly different from mine. In regard to this particular theorist, however, I had yet to see such work.

⁶Thanks to my daughter, Andrea, who suggested that idea.

⁷Thanks to Drs. Judith Rustin, Randee Johnson, and Linda Huehn, who all suggested that I needed to focus on this possibility.