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Abstract
Progress in psychoanalytic work can seem slow and arduous. Patients noticing this may harbor inner questions and doubts as to how and when—and even whether—they will finally “get better.” After examining the status of the related concept of “repetition compulsion,” this article explores such concerns by enumerating certain heretofore underappreciated barriers to psychic change; it also discusses various potential—but currently undersung—facilitators of such change. To help illustrate these factors, a case example is presented of someone struggling with a micro-traumatic pattern that might be called “subservient caretaking.” In this maladaptive dynamic, the individual (often the male in the context of heterosexual couples) behaves in an overly nurturing, self-abnegating way toward his partner (often, female), who he perceives as weak and therefore needing this kind of “patronage.” The relevant obstacles and potential aids to overcoming this sort of deeply ingrained pattern are explored in relation to the case example offered.
Notes
1 My presentation of Andrew’s case uses disguised identity, fictionalized elements, and paraphrased dialogue to ensure the actual patient’s privacy and anonymity. Of course, the psychic patterning of his life and relating have been kept as true to life as possible.
2 It is interesting that it’s been the male who was most likely to be in the caretaker role in these relationships (which, in the subsample I have in mind, were heterosexual pairings). This gender skew might have been merely coincidental or the product of the male patients’ subjective bias. (After all, it was usually the males who were the ones reporting the dynamic. And, I should clarify that my observations have arisen from my individual rather than my couples work.) Of course, it’s possible that the gender differential I’ve observed in this caretaker/care-receiver dynamic is actually true—that it really is reflective of couples in the general population. To the degree this is so, I don’t have a ready explanation for it, though it certainly merits further thought.
3 For simplicity of exposition, because Andrew is the prototype for this role, and (as just noted) males appear to predominate in the nurturing position in this dynamic, I’ll use the masculine pronoun going forward for the caretaking one in the couple.
4 Woe to the therapy in which an actual professional clinician self-subjugates excessively, over-reassuring, over-providing, or coddling the patient under the mistaken impression that this is the only pathway toward the person’s being able to gain psychic fortitude and well-being. This often creates a kind of problematic enclave (see O’Shaughnessy, Citation1992) or bastion (see Baranger & Baranger, Citation2008) that actually blocks the patient’s progress.
5 Among the major psychodynamic obstacles that frequently play a role and warrant our continued attention are the discrediting, insufficiency, or outright absence of a self-monitoring and/or a self-soothing inner self-representation. Luyten, Lowyck, and Blatt (Citation2017) adduce empirical evidence that the presence of “self-critical perfectionism” is a major “individual variable” (or intra- and interpsychic dynamic) that significantly disrupts a patient’s ability to benefit from psychotherapy of any kind.
6 The continued pursuit of insufficiently effective psychic strategies is attributed to different motives depending on one’s school of thought—within Freudian theory, it can be viewed as being underwritten by the conservative operation of the death instinct (i.e., toward tension release), or the wish to triumph over the Oedipal father, or the like; within self-psychology, it could be the grandiose self’s unresolved strivings; from a relational/interpersonal perspective, it seeks a reduction in interpersonal anxiety via getting the (m)other’s ultimate approval, promoting a sense of security; and so forth.
7 I’m indebted to Dodi Goldman (personal communication, January 2018) for this observation, and for suggesting how obstacles to change could be contextualized within the attachment paradigm.
8 Dodi Goldman alerted me to this apropos explanation (personal communication, January 2018).
9 Another external and societal obstacle is the partisan psychoanalytic prejudice that discourages our openness to “providing,” or being prescriptive or directive, even when adopting these approaches temporarily may be profoundly useful. (The concern is of course that these might muddy and thereby disrupt our ability to make interpretive use of the transference/countertransference field.) In my view, the judicious offer of guidance or direct help by the analyst can counteract the demoralization that otherwise dampens the vital spark. See, for example, Wachtel (Citation2017) and Frank (Citation1993), who speak to the value of using pragmatic strategies that might include such elements. And McWilliams (Citation2003) argues that the analyst inherently and beneficially educates the patient along certain lines, especially vis-à-vis psychic functioning and the psychoanalytic process itself. This provision of knowledge must often serve to strengthen the patient’s spirit and hope.
10 Certain people in the role of subservient caretaker are remarkably gifted at massaging and working around their loved ones’ defensive structure (if only to a point!). Their capacity to do so rivals that of many a seasoned analyst trying to overcome a patient’s resistance. The fact that these caretaking individuals can be so successful in relaxing their partner’s defenses is part of what undercuts their willingness to renounce the pseudo-therapeutic role in favor of revising the larger dynamic. (This, by the way, is just as Mullainathan would predict.)
11 Stephanie Coontz (Citation2018), a historian and research director at the Council on Contemporary Families, cites relevant studies that highlight the importance for an individual of being “socially integrated.” That is, being meaningfully engaged with a larger social network beyond one’s nuclear family promotes optimal physical and emotional health. This finding counters the older view of marriage (as opposed to single status) being protective. Instead, it’s a person’s involvement with various subcommunities, and not couplehood itself, that provides these benefits—and this is especially true in older adulthood.
12 I’m thinking here of certain individuals who by temperament or other predilection (e.g., some on the autistic spectrum) may truly not flourish with such engagement.
13 Though at the same time, the clinician should be on the lookout to help certain types of patients avoid the pitfall of living as a “distributed self.” In this situation, facets of self are too widely projected into others, and facets of others are too frequently introjected into oneself whole cloth. One’s self-conduct depends heavily on consultation with the coterie of friends who approve and disapprove, advise, and consent. This leads to a weak center-of-self, which can readily have micro-traumatic consequences.
14 This is a term for low-income urban areas where the only food offerings are either unaffordable or of poor nutritional quality (see https://en.wikipedia.org/wiki/Food_desert.)
15 As Buechler illustrates: In I. B. Singer’s short story, “Gimpel the Fool” (Citation1957) the profoundly self-abasing protagonist Gimpel comes to the decision to remain with his wife despite her unfaithfulness. What matters here is that his doing so seems to reflect a strength of character and a high degree of self-awareness, rather than the unthinking compliance of a cuckolded husband whose foolishness was thereby compounded.
16 At the same time, like most psychoanalysts, Leffert deplores the thinking of positive psychology (as opposed to his own “positive psychoanalysis”) that, ignoring unconscious life, seems to deny the need to uncover and work through maladaptive and destructive psychic issues. Leffert distances himself from the over-cheery optimism of proponents of positive psychology in their promoting the installation of happiness and other “feel-good” affects as the prime vehicle for psychological change.
17 DeSteno (Citation2017) adds, “Feeling pride or compassion has been shown to increase perseverance on difficult tasks by over 30 percent. Likewise, gratitude and compassion have been tied to better academic performance, a greater willingness to exercise and eat healthily, and lower levels of consumerism, impulsivity and tobacco and alcohol use” (p. 4).
18 DeSteno’s argument obviously bears directly on the child-rearing dispute between Andrew and his wife—it lends support to Andrew’s attuned approach over his wife’s harshly judgmental, exacting one to handling their son’s maladaptive functioning.
19 This, of course, also speaks to the potential value of integrating various other useful modalities (e.g., cognitive behavioral therapy, group therapy of certain stripes, biochemical means) into a customary psychoanalytic one (see Frank, Citation1993; Wachtel, Citation2017).
Additional information
Notes on contributors
Margaret Crastnopol
Margaret Crastnopol (Peggy), Ph.D., is on the faculty of the Seattle Psychoanalytic Society and Institute, and is a supervisor of psychotherapy and faculty at the William Alanson White Institute of Psychiatry, Psychoanalysis and Psychology in New York City. She is also an associate editor of Psychoanalytic Dialogues, and on the editorial board of Contemporary Psychoanalysis. Dr. Crastnopol is on the executive committee and the board of directors of the International Association for Relational Psychoanalysis and Psychotherapy (IARPP). She is the author of Micro-Trauma: A Psychoanalytic Understanding of Cumulative Psychic Injury (Routledge, 2015). Dr. Crastnopol is in private practice for the treatment of individuals and couples in Seattle, WA.