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TitleMaking a Difference in Patients' Lives: Emotional Experience in the Therapeutic Setting (Psychoanalysis in a New Key Book Series)
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Total Pages338
Table of Contents
                            Front cover
Chapter 1. Basic Assumptions about Human Emotions*
Chapter 2. Empathic Recovery of Emotional Balance
Chapter 3. Empathic Responses to Shame
Chapter 4. Facing Painful Regret
Chapter 5. Joy as a Universal Antidote
Chapter 6. Grief
Chaptr 7. Empowering and Disorienting Anger
Chapter 8. Thinking Analytically
Chapter 9. Emotional Preparation for Practicing Psychoanalysis
Chapter 10. Developing the Personal Strengths of a Psycholanayst
Epilogue: Making a Difference
Back cover
Document Text Contents
Page 2

Psychoanalysis in a New Key Book Series

Volume 8

Making a
Difference in

Patients’ Lives

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150 Making a Difference in Patients’ Lives

I told him I was sure that, in one way or another, I’d be grieving for her
for the rest of my life, but that grieving for her did not mean I could never
feel happiness again. I told him that my mother’s death had affected me
deeply; it made me more aware of my own mortality and fueled my desire
to live the rest of my life as fully as I could. (pp. 492–493)

As has already been suggested, a profoundly complex question is
the issue of what we really lose when someone we love dies. First, just
what do we lose of the aspect of ourselves that was an interpersonal
product of the relationship with the deceased? Also, to what extent
can we really preserve the essence of the lost object, either through
an internalized object relationship with them, or through an iden-
tification with them, as Freud (1917) and others suggest? I think it
can be tempting to create a sanitized version of mourning that tames
its agonies and fails to do justice to our need for palpable, living,
embodied, unpredictable others, and not just notions of others. As
I have already suggested, I believe that a true grasp of our inter-
personal natures forces us to conclude that the loss of actual, spe-
cific, intimately known others is irreplaceable. We need to feel their
breath, to hold their hand, to watch them laugh, to experience them
in the living moment, through every sense, and not just in memory.
This need is given poignant voice by survivors like Didion and Bay-
ley who will settle for nothing less than the continuing presence of
their beloved. Anything else denies the importance of the body, of
surprise, of the unpredictable moment. No matter how mature and
well developed our inner life, there is no object relational substitute
for an alive partner when you want to go dancing.

These issues are extremely controversial in that they bring into
focus our understanding of the nature of the self. I would suggest
that it is here, more than on any other issue, that the analyst’s fun-
damental theoretical orientation determines his or her outlook. To
what extent do we each believe that the self is primarily a product of
ongoing, real interpersonal interchanges with living others?

From my own understanding of human grief I would suggest that
it is extremely important to differentiate the sorrow that is an inherent
aspect of the human condition from pathological states. For exam-
ple, a woman consulted with me, stating that she was “depressed”
because she found out she could never bear a child. While it is, of
course, possible that she was suffering from a depressive disorder, I
would not assume that this must be so. It is common, in our culture,
to use the words “sadness” and “depression” interchangeably. After

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Grief 151

considerable discussion I came to see this patient as extremely sad
about what, for her, was a significant loss, but not clinically depressed.
Developing this distinction together proved valuable to us both.

I see significant losses as affecting the whole balance of a person’s
emotions. This affords clinicians a wider range in their focus as they
listen to patients. If we don’t privilege sadness, but remain open to
hearing about, for example, the patients’ loneliness, we may find that
addressing that feeling first might have greater impact. Patients and
analysts frequently get stuck trying to soften a sadness that is simply
a human response to loss. Sometimes a focus away from that sadness
is more effective. Believing that the emotions exist in balance, with
every emotion affecting the intensity of all the others, means to me
that I can have an impact on patients’ sadness by facilitating their
curiosity or becoming a presence that modulates their loneliness.

I see loss as an ongoing aspect of human experience, not a dis-
crete event. It is a part of every hour of every day, including every
treatment session. Some moments are not formulated as losses until
much later in the work. Concrete losses crystallize the ongoing expe-
rience of loss and bring it from background to foreground. In every
session, for example, I fail to understand some of what patients are
trying to communicate, and, therefore, I confront them with the
inherent loneliness of being human beings. They feel the loss of the
hope they may have had that I would “get” their experience. Then, if
a more concrete loss occurs, it is likely to evoke the pain of all their
accumulated losses. For example, if I tell them I will be away for
a week, they may seem to “overreact” to this temporary loss, but I
believe that reaction is really a product of the many types of loss we
are living out at that time.

Treatment affords a unique opportunity for dealing with loss. For
me, this is an aspect of the significance of the treatment frame. It
crystallizes the omnipresent limitations of human relatedness. This
is part of the reason that the frame so often elicits strong reactions.
An interesting example of this occurred in Sussillo’s (2005) paper
on working with people who had lost a parent during adolescence.
Sussillo describes her treatment of Judy, a 24-year-old socially with-
drawn patient whose mother’s death from recurrent cancer occurred
when the girl was 16; her father succumbed to a longstanding heart
disease when she was 17. As this depressed woman poignantly
explained, “I feel all alone in the world; I am no one’s daughter any-
more; I don’t know who I belong to” (pp. 514–515).

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