In these posts I am often emphasizing a similarity between therapists and patients. The reason is partly to de-stigmatize the psychoanalytic encounter from the hierarchical perch it often rests upon and reframe it as a conversation between two equal human-beings. This hopefully does not diminish the usefulness and the complexity of psychoanalysis as a treatment modality and instead introduces an intimacy to the process of psychological healing that is both immensely personal and inclusive of every aspect of both the participant’s personalities. It is very much in line with contemporary thinking in psychoanalysis that the relationship between therapist and patient and its specific quality is of significant importance in the treatment of the patients problems in living. In fact relationships are at the center of psychoanalytic treatments because it is in the arena of relationships with others and relationships to ourselves that much of our problems and struggles arise. We are people in need of other people to satisfy our life’s goals which makes relationships the primary area of importance for psychological change. To speak as I do of similarity between analyst and patient is to actually speak of equality and it is equality that we seek in psychological health. Very often at the heart of our psychological problems lies a belief in our inferiority (Adler), our limitations, which we perceive as detrimental to achieving what we desire. We are too short, too dull, never rich enough, or attractive enough. We compare ourselves and get into problems of emotional turmoil that range from arrogant superiority to depressive inability. Psychoanalysis has always had its eye on the animality of humans and the attempt to rise above the body, sexuality, mortality, and illness. It’s purpose to reintroduce us to our bodies, our animal heritage and our primate needs has been central to bringing us closer to our purposes and motivations. Being human is the “predicament” that psychoanalysis tries to speak to and as such it applies to the therapist and patient, both as people, as human beings living in the world and attempting to achieve what they desire and deal with their limitations. Need, desire, and the ways in which we try to get them met, with, and in spite of other people, are at the heart of psychoanalytic treatments. Relationships are our area of focus because many of our needs are played out with others and require others to fulfill.
One of the needs I’ll focus on here is the need to overcome the anxiety and worry about being insignificant and inferior to others, and how in the face of permanent justifications for those feelings we must find ways to keep trying, keep living and aspiring to what we want.
When we are born into and live with our families, it is often our experience that we are less than others, weaker, less conscious and less knowledgeable. We are dependent on others for care, and our vulnerability is always a source of distress and even shame. Depending on what our experiences are like in these early years of our lives and then consequently, we develop a sense of who we are, what we can do to meet the challenges of life and of getting what we want. We get to have a sense of how others will relate to us and develop expectations and strategies of coping with the world. If the feeling we are left with, and many of us are, is that we are not good enough or significant enough to expect kindness, regard, dignity and love, we will resort to strategies of achieving some of these human needs that can get us in some trouble or distress. Some of those relate to how we are with others and some to how we treat ourselves. One of the consequences is that we lose touch with who we are. We dissociate our needs, our desires and can often remain diminished as people. A large part of the therapeutic experience is helping to learn about what we are as human-beings, what our desires are, what is normal to feel, and to accept our humanity in all its complexities and facets. This includes accepting vulnerabilities, limitations, and ways of coping with life that are not always “nice” or even ethical.
An equal and egalitarian environment, an environment of empathy and compassion towards these many facets of our being is essential to engage in the kind of conversation that would be considered therapeutic. As therapists we must never lose sight of all the ways people choose to meet their needs and seek to achieve their life goals. As Erich Fromm said “nothing human should be alien” to us. As patients we must have a sense that our lives will be given respect and a sense of dignity by the person we are speaking to, even when our lives might appear in chaos and upheaval. This egalitarian environment is essential for us all to speak freely, openly, honestly, and discover our full capacities as human beings.
Erich Fromm, who had a significant impact on contemporary thinking in psychoanalysis, also said that we hide behind hierarchies of superiority and inferiority. We allow others to be superior while we remain inferior so as to relinquish our own responsibility for our choices and our lives. When we choose superiority over others we hide our vulnerability, deny our flaws, and seek acceptance through domination and control. Hierarchies ultimately corrupt our freedom and our self knowledge and too often only provide us with ways to blame others. Unfortunately in blaming others we are diminished because by choosing this option we lose something of ours, our own actions, our own thoughts, and a connection to our own motivations. The psychoanalytic relationship like any other can be weighed down by similar false conceptions of superiority and inferiority and of power hierarchies as defensive options. It takes an effort on both sides of any conversation to listen with respect to the opinions of others, even when we might disagree or not understand one another. A therapeutic relationship is characterized as one in which one can speak freely, where those participating can ask and be asked questions and where hierarchical thinking is uncovered and willingly given-up. This requires cooperation, trust and openness which is always a work in progress and must be earned. It is only in an equal and egalitarian atmosphere that we can honestly and courageously look at our own ways of living and non-defensively examine them. This egalitarian relationship is what a psychotherapy aims to achieve.
Psychoanalysis as well as other therapeutic traditions have taught us to be mindful of our defenses, our competitive emotions, and our wish for control, so as to look beyond them and find ways towards better coping with our life’s problems. The demands of life are constant and for some unmanageable. We resort to domination or submission as ways of gaining some security and yet these coping strategies always require complex manipulations, self-diminishment, and a tiring effort to maintain. It is when we accept ourselves as we are and seek neither domination nor submission that we can live well with others, cooperate, become useful and find joy in our lives. On this road to equality we must keep our connection to the patient within, the needy one, to the child, and to the outcast. Rather than seeing these sides of ourself as bad or unworthy, psychotherapy asks us to incorporate them, accept them and care for them as we would our own children. Much of our suffering occurs where we have given up expecting care for sides of ourselves we deem unacceptable and where we have hardened rather than allow for our more vulnerable sides to speak out and up.
Can we say that to live better has some connection to being kind to ourselves and to be kind to others? How often is one sacrificed for the benefit of the other? Either I am more important than you, my needs superseding yours and I feel hardened, competitive, and envious. Or your needs are superior to mine and I feel depressed, scared, diminished and resentful. We cannot win and should in a sense stop trying to win. We can though try to increasingly feel at one with the world and with others. To be less competitive, less concerned with our status, our standing in the world and live with others in a more honest, respecting and caring way. Maybe it is our task in life to embrace our sufferer, our “misfit” and not cast them aside by favoring only the “ego’s” ideals like to be always a success or to win at all costs. Unfortunately for many of us, we can too often feel thwarted in our goals, encounter more barriers to our desires than some, and are discouraged by some of life’s demands. We overly identify with being incapable. Depending on our expectations of life, of other people and our assessments of our own capacities, obstacles can have the force to dishearten us. The more we encounter that which appears beyond our capacity to handle, the more solidified our disbelief in ourselves becomes and the more life and other people could seem unfriendly at best or like enemies of our well-being.
Therapy is an opportunity to speak about those obstacles, the times in life we’ve been overwhelmed by, and to courageously observe our ways of living and to receive encouragement to observe life differently, ourselves differently, and to make changes that might be novel, frightening and unfamiliar but that can reconnect us to life’s pleasures and challenges with new perspectives.
For many of us the fear of being deficient or insufficient draws us to becoming therapists and to being patients. Our hopes of learning how the mind works and of gaining some mastery over ourselves, our relationships and our feelings of inadequacy are so central to many of us interested in psychotherapy. Many of us are afraid and have a difficult time overcoming our fears of life. We are afraid of not fitting in, of not being good enough to be useful to others and afraid of feeling insignificant. Many of us doubt our capacity to handle successfully the life tasks that are thrown our way and need encouragement, support and a belief in our abilities. Mostly what we need, more than success, is the knowledge that we will still be okay when we fail. As therapists we need to offer that encouragement and support and to try and encourage people to risk failure, to speak their minds and risk someone out there not liking it.
There are so many ways to fail to live up to the many ideals of our culture and we often can feel ashamed of our humble humanity and limitations. As a coping mechanism and defense against feeling “imperfect” we often hide ourselves, create unstable self identities, avoid trying, blame others and pathologize ourselves unnecessarily. Rudolph Dreikurs says that one of the first steps is to recognize that we are “prejudiced against ourselves”. Rather than think too highly of ourselves, he claims, many of us do not trust our own abilities and believe too readily in our insufficiency and powerlessness. Our shame at the exposure of these insufficiencies and fumblings can generate rage, depressive sadness and discouragement from continued trying. Just as our patients resort to these defensive measures and coping mechanisms to hide vulnerabilities and feelings of inferiority, therapists too hide their thoughts, their beliefs and their life choices from patients for fear of rejection and shame. I believe that the more we do so the more we support the idea that superiority, infallibility, power and status are the only roads to security and well being. Rather than therapy being a search to achieve perfection and infallibility in order to avoid the many pitfalls of life, there is strong evidence to suggest that working towards the “courage to be imperfect” brings with it more security and equality with our fellow human beings.