Elizabeth Carr’s Story by Carol Levin: The Emergence of a Modern Self Psychologist

When the editors of PSC invited us associate editors to interview a modern contributor to self psychology, I immediately knew I would choose Elizabeth Carr. Elizabeth’s generous appreciation of my first paper soon after I graduated from my analytic training encouraged me to continue writing, and our interaction about that paper transformed what had been a brief acquaintance into a genuine friendship that has grown over the years as we work together as associate editors of Psychoanalytic Inquiry. In reading Elizabeth’s papers and hearing her present over the years, I view her, at work and in her thinking, as emergent from Kohut’s foundational belief in empathic immersion with patients as the royal road to healing and growth. She has earned my admiration and respect for her deep knowledge of, commitment to, and expansion of self psychology’s theory and practice, as well for as her talent, spirit, energy, generosity and administrative ability.

Elizabeth’s story illuminates how a child’s innate gifts can be affirmed by a complex surround that catalyzes her growth and development. Betty, as she was called, grew up in Charlotte, North Carolina in a Catholic family. When she was nine years old, she, her two older brothers and her mother were all in the car when a drunk driver slammed into them. The horrific accident claimed the life of her father and seriously injured her mother and one of her brothers. She remembers riding in an ambulance with her gravely injured father and being the one in the family who possessed the composure to tell the emergency workers what had happened. Yet this catastrophic trauma didn’t derail her development—surely her mother’s and late father’s love, and her temperament, had given her the resilience to move through this tragedy and go on living and flourishing.

Extended family members took care of her and her brothers until her mother’s injuries healed, and her maternal grandmother and aunt moved from Connecticut to Charlotte to help her widowed mother, a homemaker who had led a sheltered life, raise her grieving family. In this matriarchal world, Betty found powerful role models as she identified with these strong women who lived feminism before its second wave. She surely internalized her beloved mother’s strength as it emerged over those challenging years. Working at the petroleum company that had employed her father, her mother became the breadwinner of her family, taking on more and more responsibilities over the years. Elizabeth lived female empowerment, implicitly and explicitly.

Memories of how helpless she felt in the ambulance as she sensed her father’s life slipping away were engraved in Betty’s mind, and she wanted to become a nurse, she thinks, to help master the trauma of the accident. Elizabeth says she was just an ordinary high school student, busy with friends and activities, and she wasn’t encouraged to excel. Her oldest brother was the “brilliant one” in the family. Elizabeth credits her mother for encouraging her to attend the University of North Carolina, rather than a three-year nursing program, to earn a bachelor’s degree in nursing. It would offer her more opportunities, she said. Of course it would, and it did. Betty’s surround was propelling her move forward, and she followed her mother’s advice at this tipping point in her development. Elizabeth says that it was at UNC that she actually learned how to study—in high school she never needed to. No one realized she how gifted she was. But when faced with the challenges that found her, Betty mobilized her resources, as she had done before, actually, even if it was under the family’s radar. She was on her way.

UNC trained its nursing students to care for their patients as whole people, and looking back, Elizabeth sees her education there as her first encounter with self psychology, as yet unarticulated. She discovered she loved talking with her patients, and that they responded positively to the time she spent with them. Her innate gifts, and her determination, now affirmed by her surround, were moving her forward. After graduation, filled with her zest for life, Betty wanted to experience the world outside North Carolina.

Elizabeth’s first job was at a community mental health center in Washington, and she soon realized she would need a masters’ degree to advance as a psychiatric nurse. After enrolling in the MSN program at Duke, she found the program to be stultifying and again mobilized her resources to transfer back to UNC, where she was welcomed and felt affirmed. The clinical climate of that program fit her. Elizabeth even brought some of her classmates from Duke with her, another theme in her life, generously helping colleagues to move forward and develop. New opportunities found her at her first job in Burlington when her surround again recognized and affirmed her abilities. She was asked to manage the child and adolescent program at her community mental health center when the director went on maternity leave, and of course she said yes. Elizabeth discovered then honed her abilities as an administrator while pinch-hitting.

One thing led to another, and after a move to Los Angeles, Elizabeth was again working in community mental health, and seeing a need, she proposed and created a program for at-risk mothers in the San Fernando Valley. She knew how to administer a program, after all. And she started her first private practice. It was in LA in 1979 that she heard one of Kohut’s final lectures, and she was enthralled. Elizabeth had found her theoretical home, and she immersed herself in reading Kohut’s work.¹ A few years later, back in DC, she enrolled in a four-year psychotherapy training program at the Washington Psychoanalytic Institute, where she found the indoctrination in ego psychology, the zeitgeist of the 1980’s, deadening, to be sure, but there was no alternative. Elizabeth completed the program while actively searching for something more—her sense of agency² is a constant in her life.

After hearing Joe Lichtenberg speak at her institute, Elizabeth had found her first self psychology supervisor. Their work was revelatory, she says. No longer instructed to impose her (supervisor’s) ideas on her patient, she was moved when Joe encouraged her to respond empathically to her patients’ experiences in the present moment. Imagine being encouraged to “sense what my patient is telling me in a particular moment [and] to understand as fully as possible my patient’s experience … and to communicate my understanding to my patient and then closely track her responses … ” (Carr, 2006, p. 739). “It made so much more sense to me, and my patient responded,” feelings echoed by so many of us who were entrained by the ethos of ego psychology in earlier days.

Elizabeth’s relationship with Joe deepened over the years of their work together as they shared their interest in developmental research and its application to clinical work. Joe affirmed her gifts as he became Elizabeth’s mentor and supporter. In 1994, he and Rosemary Segalla were starting a new psychoanalytic group, and he invited her to their meetings and soon asked her to become the membership chair of what has become ICP+P, a new analytic organization “founded on the principles of friendly cooperation, openness to exploration, democratic governance, and mutual respect” (2006, p. 744). It was an invigorating and exciting time, Elizabeth remembers. She was embracing the opportunities that found her, and then later working to create the opportunities she wanted. In 1998, she and her colleague Marie Hellinger persuaded ICP+P to create a psychoanalytic training program.

In addition to the usual tripartite model of classes, personal analysis and supervised patient analyses, ICP+P’s program was unique in that their class held a weekly, leaderless, peer group meeting to present cases. Their goal was to “examin[e] the emotional interplay of the analytic process and develop an appreciation of the candidate’s subjective responses in unfolding analytic moments” (2006, p. 745). It is worth quoting Elizabeth’s description of her group, a unique and valuable experience of cooperative learning.

The peer group helped [us candidates] to enhance trust and cohesion … and … there was real satisfaction and pleasure in seeing our analytic development … . My classmates and I created an open, safe space to compare and contrast our ideas and experiences … and [it was] invigorating, even joyful, [to find ourselves] developing a sense of mastery from both engaging in analytic processes … and [from] our growing capacities to think and talk about psychoanalytic ideas, apply them in our practices, and help each other (2006, p. 745).

Analytic identity, emerging. The bonds Elizabeth created in her group enrich her professional and personal life to this day.

After her graduation, Elizabeth went on to become ICP+P’s director and later take on leadership roles both there and at IAPSP, where she was a long-time member of the governing International Council and has had the honor of delivering plenary papers in 2012 and 2019. She recently co-chaired (with Roger Segalla) the first post-COVID IAPSP conference in Washington, and again one thing led to another when Amy Joelson, IAPSP’s incoming president and a long time friend, asked her to be her special advisor. I feel moved when I learn of Elizabeth’s long history with so many of her friend-colleagues both at ICP+P and IAPSP,³ organizations she has been so deeply engaged with from their inception.

In the late 2000’s, Joe, as editor-in-chief of Inquiry, asked Elizabeth to become an associate editor.⁴ Of course she said yes. Over the years, she has been an issue editor or co-issue editor of several issues for the journal, all the while mentoring her invited contributors. Elizabeth is an astute reader and generous with her time. She readily seeks consultation and advice for herself, and she is thoughtful and determined as she works to find solutions to, or acceptance of, the difficulties that find her, as they do us all.

Elizabeth started writing after Joe asked her to present one of her analytic cases to Andrew Morrison at ICP+P’s first annual conference in 1995 and invited her to publish her paper (1999) in the PI issue that she guest edited, Is Shame the Central Affect of Disorders of the Self? In 2006, she was the guest editor of a PI issue she created: On Becoming a Psychoanalyst: Reflections on Contemporary Psychoanalytic Training Experience. I have already quoted passages from her paper in that issue (2006) which, in addition to describing her training experience, stands as a primer on modern relational self psychology. Elizabeth explores a vignette that brings to life the concept of intersubjectivity that was emerging in our literature as she unpacks her own contribution to an impasse with her patient through her associations to the word that came into her mind in a session, “pray.” She traces how a childhood exchange with her mother was inhibiting her empathic responsiveness to her patient’s anger, and how knowing more of her own story frees her to deepen her engagement with her patient. The field shifts as her patient responds to her honesty about her own contribution to the impasse they found themselves in, and their mutual inquiry moves their work along, again. Elizabeth’s self-analytic work brings to mind one of my teachers who told me that being an analyst was a privilege, for her work offered her continual opportunities to grow. Elizabeth writes:

My personal analysis has greatly expanded my self-understanding and fostered my commitment to a disciplined and sustained practice of facing myself anew, even as it involves facing and reconsidering primary coping strategies. I have also found that the very process of coming to know myself more deeply was greatly enhanced by my analytic work with my patients, and I am very grateful to them … (2006, p. 738).

In this early paper, Elizabeth’s theory has emerged. Insight (in the explicit, symbolic realm) and relationship (in the implicit, enacted realm) each play their part in analytic change processes. And as I have heard her present her clinical work over the years, she brings her awareness of her participation in her patient’s world as it emerges in a present moment to her deep empathic immersion in her patient’s experience, Kohut’s royal road.

Elizabeth’s most recent paper, written with her long-time friend-colleague Marie Hellinger, “Self Psychology and Aggression—Reflections on Aversive Experience, Culture, and Building Developmental Capabilities” (2021), is a seminal response to a time-worn criticism of self psychologists, that we avoid our patients’ aggression (that Elizabeth first addressed in her 2006 paper). Marie and Elizabeth acknowledge the foundational belief of the first generation of self psychologists that empathic immersion in a patient’s world was the royal road to development, to healing the narcissistic injuries and selfobject failures of our patients’ childhood surrounds. But while affirming that “one of self psychology’s most significant contributions to psychoanalysis [is that] analytic treatment [is] a process centrally involved in restoring and revitalizing a patient’s stalled developmental trajectory” (p. 211), they integrate Lichtenberg, Lachman, and Fosshage’s complex, aversive motivational system into our theory of change processes in treatment.

In rejecting classical theory’s undifferentiated aggressive drive, the more compley aversive motivational system—fight or flight—protects us from infancy onwards and has its own developmental line. It is composed of a complex array of feelings—anger, aggression, rage, frustration, annoyance, irritation, disappointment, shame, humiliation, disgust, guilt, fear and terror—that permit us to deal effectively, or not, with threats and impingements.

Marie and Elizabeth, who identify themselves as cis, heterosexual, married women, bring awareness of their social embeddedness to the work they describe with their patients, convincingly demonstrating that helping our patients to identify and regulate negative affects as they emerge in the transference as well as in their outside lives is crucial for the creation of a strong and cohesive sense of self. Their paper is a plea, really, for us therapists to have the fortitude to welcome and work with our patient’s aversive feelings. Marie and Elizabeth believe that if our attachment to out patient, and reciprocally, our patient’s attachment to us, is secure enough (p. 207), they will go on working through the disruptions and repairs inevitably find them. It takes a long time for a patient and her analyst to find their way to genuine transformation.

In conclusion, let me return to Elizabeth’s personal life. Now in her mid-70’s, Elizabeth’s prodigious energy is barely diminished, and, although she is no stranger to loss—the traumatic loss in her childhood and now the inevitable losses that find us all as we age, she cherishes her life with her innate optimism and an appreciation for all that she has and has earned. Her daughter and Dutch son-in-law moved back to Washington from Europe a decade ago, and now Elizabeth and her beloved and loving husband, Bill O’Brien, are enjoying their newly remodeled long-time home and helping to care for their toddler granddaughter who lives nearby. Elizabeth gave up her long-time downtown office and now works, in person and of course on-line, in a home office. A pandemic gift for many of us, really, the simplification our work lives!

Additional information

Notes on contributors

Carol B. Levin

Carol B. Levin, M.D. is on the faculty of the Michigan Psychoanalytic Institute, and a member of the Michigan Psychoanalytic Society. She is a member of the Early Career Professional Committee of IAPSP, an associate editor of Psychoanalysis, Self and Context and Psychoanalytic Inquiry, and co-chair of the Ralph Roughton Paper Prize awarded by APsaA. Her papers bring a complexity sensibility to her analytic training, to her training analysis, to a second analysis of a patient, to interpretation, and to writing. She is in private practice in Okemos, MI.

Notes

¹ We all have our own stories of discovering self psychology. At a tribute to Joe Lichtenberg at the recent IAPSP meeting in Washington, Estelle Shane recounted her seminal discovery of his Motivational Systems book. For me, it was listening to Anna and Paul Ornstein and Michael Basch at the Cape Cod seminars in the 1980’s.

² One ego psychological concept that I find meaningful.

³ Elizabeth was generous in introducing and including me in her IAPSP world when I started attending the meetings after training at an APsaA institute.

⁴ Mel Bornstein, the editor of Inquiry, also asked me to become an associate editor, and so from then on Elizabeth and I have been working together.