“What Do These Analysts Want?” A Response to Levine and Wilson on Desire and Influence

Abstract

The target paper had the purpose of drawing attention to something “beyond countertransference”—the impact of the therapist’s psychology on the treatment, not in reaction to the patient, but as desires and defenses that operate throughout. The illustrative issue was a speculation that my development and analytic engagement carried elements that led me to interact with women patients in a way that increased the likelihood of their conceiving. The respondents reacted differently to the provocative aspect of this idea, but have in common a recognition of the analyst’s desire as an important part of the relationship. A further case vignette is introduced in this reply to examine some of the points raised by the respondents, in particular how the analyst’s desire may be expressed in a form that is modulated by the analytic role and at the same time has an impact on the patient’s life decisions. In sum, we are players in the drama of analytic work, and the more we think about what and how we are ourselves in treatments, the more informed our inevitable impact will be.

Notes

¹ Levine raises questions of how these issues would play out with a more complex understanding of gender identities and choices. I don’t have the expertise to do this, but I would posit that the psychological issues in reproduction would continue to include many of the issues that come up in the heterosexual situation.

² My earliest psychoanalytic paper, “Psychological Change in Jane Austen’s Pride and Prejudice” (Almond, 1989), posits “mutual influence” as a central process in therapeutic process. An earlier draft of my paper here had “Co-constructed Pregnancy” in the title.

³ Since completing the target paper, an ex-patient of mine who, like Louisa, terminated after delivering her first child wrote me with a cogent explanation for leaving. She observed that she carried a fear—stemming from her experience of her mother—that she could not love two people at once, so she had to leave me when the baby was born.

⁴ “Old-fashioned” is a tricky phrase as applied to psychoanalytic theorizing. While new perspectives in culture and in psychoanalytic thinking always bring out valuable new aspects of human experience and treatment, they too often are touted as the whole story, replacing defunct “old” ideas. The result is a loss in the breadth of our conceptual vocabulary.

⁵ For example, a patient who had talked extensively about her mother’s “drab and dowdy looks” was inviting me, I felt, to be aware of, and ultimately to comment on, the vicissitudes of her own apparel. I also comment in a similar way about male patients’ shifts in appearance. I see these sensibilities as a part of a wider interest in, and use of, patients’ nonverbal expressiveness, as well as referencing their body awareness.

⁶ It would be interesting to explore the Dirty Old Man as a trope in popular culture. Like “motherf—er,” the words condense an entire psychological realm, boiling it down to a demeaning slur. Each term contains a whole oedipal narrative, with desire and defense embodied in the appeal/revulsion of the term. Levine’s reference to the possibility that there is an ulterior motive—my finding an antidote to aging—frames my desire in pejorative, Dirty Old Man, terms, while I would argue that the vitality that my work provides me is an inevitable and useful part of psychoanalysis.

Additional information

Notes on contributors

Richard Almond

Richard Almond, M.D., is a Training and Supervising Analyst, and faculty member of the San Francisco Center for Psychoanalysis; Adjunct Professor of Psychiatry and Behavioral Sciences, Stanford Medical School; and founding Chair of the Palo Alto Psychoanalytic Psychotherapy Training Program. He is the author, with Barbara Almond, M.D., of The Healing Narrative: Fictional Relationships and the Process of Psychological Change (Praeger, 1996).