To Begin at the End
The idea to end treatment started like an itch. It wasn’t that I felt cured, a wrongheaded notion to begin with. It wasn’t the money, though my inner economist could always enlist that rationale (health insurance had long since bowed out). In a culture that privileges speed and statistics, why would anyone choose a long-term process with no guarantees? Psychoanalysis is for navel-gazing, over-actualizing narcissists, right?
I had by no means run out of things to say. Just the opposite; I could imagine still talking thirty years on. That gave me pause. Had my hope in the process become hopeless overdependence? Was it time to leave the nest? Was it time to break up? Was this less about ending than simply stopping, abrupt and graceless, the way I was most familiar with saying good-bye?
All of the above. None of the above.
Dr. S. sometimes referred to my “treatment.” I never liked the word until the second phase of our work, after I traded the Northeast for Los Angeles, a new job and fresh start after losing a mentor to suicide. Then, two weeks supporting my hundred-year-old great aunt through what hospice termed “active dying,” a process both brutally practical and surreal as her body, mind, and ineffable parts proceeded at different rates to the exit. Without thinking about it, I took the stance of attentive focus I knew from analysis, open to her fast-evolving needs, tangible and intangible. I had some inkling about her fixation on doors. Afterward, I knew only one place where I could really talk about it.
Dr. S. suggested we try Skype, and we resumed the treatment. By then, I had taken a few courses in screenwriting (when in Rome) and liked the term’s resonance: a treatment is one step up from an outline but less than a full script. Partial but not incomplete. A stage of development. (Film critic Elvis Mitchell’s KCRW radio show The Treatment is aptly named. He’s known for astonishing his guests—directors, actors, cinematographers, writers — with insights about the psychological themes running through their bodies of work.)
After our last session, Wednesday felt like a hole in the calendar. One week, I locked myself out of the house. Another week, I lost my keys. I missed the anchor of our practice. And it is a practice, in the way yoga and prayer are practices. After so many years, Dr. S. knew my dream vocabulary as well as — and often better than — I did. He could hear threads running among images and memories, through moods and mundane details. Even more, he had a knack for hearing what I was not saying, feelings and thoughts conspicuous by their absence. He would invite back what I had exiled. In our work, those silences eventually had the most to say.
Beginning to Speak
Feeling free to speak is no small feat. First, I had to be willing to show up and be seen. My early journal entries remind me that I regularly called to cancel appointments. “Okay,” Dr. S. would say. “I’ll keep the hour open if you change your mind.” He heard my conflicting currents: opening a window while anxiously barring the door. Wanting to be seen — without being looked at. In the end, I always showed up, as did he.
Trust was skittish. I became fascinated by the double doors to his office, part of the soundproofing design that included baffled (!) walls. In myth, thresholds are dangerous places. Transitions require care. From public to private, rules change. Radically different possibilities come into play.
From the waiting area, I would hear the muffled whoof of air unsandwiched when the inner door opened. Then the outer door swung open. If it swung slowly, a patient would emerge. If it swung swiftly, it was the doctor, leaning out with a typically friendly smile, a host’s invitation to this thing we were about to attempt. A thing that for me was at first a performance, later a tightrope walk, and at the end something like swimming underwater with no need of oxygen.
Behind me, he would close the outer door — separating private from public. Then he would close the inner door — separating the everyday private from the formal intimacy that requires no small talk. The psychoanalytic space.
At session’s end, he would open the inner door and stand by, as if to see me off on a trip. His full presence door to door, entrance to exit, made me aware how often my mind leaves a room ahead of my feet. I’d make a last comment, linger a few seconds, then open the outer door and break the seal on the hour.
Working over Skype, I missed that ritual of entrance and exit. He suggested that, while he initiated each call, I should be the one to end it. I began sending a short email afterward — the lingering thought. Those details restored a familiar rhythm and texture of attention to our work.
Unlike the popular image of a patient in analysis, I was never on the couch. In our first meeting, he indicated a chair opposite his. I sat there but eyed the couch, waiting for the day I would go horizontal. I occasionally looked at the ceiling, just to get a sense of the view. I thought, that’s when we really begin.
But Dr. S. had quickly sensed that seeing and being seen were a core of my story. Maybe it was my usual sidelong glance, a retreat to inspect the sky while his words turned to static. Our mutual gaze, the way it held or broke, would be as crucial as our words. He also talked more with me than is usual in strict analytic practice (which is not to say he spoke much at all).(1)
Over the years, words and glances piled up, but freedom to speak has nothing to do with quantity. If there’s anything we know in our Information Age, it’s that more words do not equal more meaning. Fluency is not always intelligent. Intellect is not always wise or kind.
Friends joked that I was turning therapy into a career. Or was it a joke? Was my analysis a roundabout wish to be an analyst? Around this time, a highly intelligent, multi-degreed friend attempted suicide. She was hospitalized for several weeks and emerged with a new purpose: she would become a psychiatrist.
This clarity seemed to give her relief. I was happy for her — and envious. While I sank deeper into my mental mud, she was rising heroically above or at least moving through with unstoppable determination. (Today, she’s a practicing psychiatrist.)
I was also alarmed. Academic rigor had been my cover for chaos. A stellar report card and schedule bursting at the seams were my sleight of hand. No one looked too hard past such achievement. Allied with professors, I sidestepped feeling alien among my real peers. I mastered material while failing at life.
So, naturally, I first approached therapy like a research project. Why am I like this? How can I fix it? Problem-solution. But accumulations of knowledge and applications of theory are not the same as understanding. They are no substitute for direct experience of the unheard, unseen, unexpressed self (or selves). That’s what I needed most. Those delicate, sometimes terrifying moments that are easily obliterated by hovering notions of progress or — worse — productivity. Had I sought accomplishment over experience, I imagine I would today be an analyst with a great deal of craft but no possibility of art.
One day, I slid over one too many unknowns with glib answers and confident conclusions. Dr. S. saw through it: “Don’t confuse uncertainty with incompetence.” He was speaking of mine and his own, not to mention the process itself.
The Work Gets Real
Psychoanalysis is the one place you can say with no irony, “But enough about me. What do you think about me?” I’m usually the one who lets other people talk, so at first it was an uncomfortable spotlight.
I was less prepared for the shadow of that spotlight, a certain humiliation I felt in the very nature of the analyst-analysand relationship. Trust is usually built (and betrayed) in relationships through back-and-forth disclosures. But the fact is, I will never know Dr. S. the way he knows me. That’s a condition of the gig. He learned my secrets. I learned his taste in ties.
In one way, that simplified things. As he remained a relatively blank slate, my own dramas had more space to emerge, with him as stand-in for the dynamics I needed to explore. But on such intimate ground with no mutual disclosure, what was stopping this from being voyeurism on his part, exhibitionism on mine?
The queasiness of that question grew as my defenses loosened in some areas and doubled down in others. I had no desire to binge and purge anymore, but I had developed a troubling fascination with BDSM pornography. And though that interest was a secret, I apparently reflected it in my demeanor. A colleague spontaneously dubbed me “editorial dominatrix.”
Dr. S. reminded me, “Sometimes we guard a symptom because we need to tell a story about it.” So what was the message in that flip-flop of domination and submission, two sides of the same coin? Why could I not look away?
We talked about the function of perversions’ shock value, how a lurid surface distracts attention from an underlying wish that is more threatening — and more ordinary. While I was busy judging myself, Dr. S. stepped back from both spectacle and moralizing to open up a third perspective. From that stance beyond either/or, we could begin to tease out the real subject. (Locating that third perspective has become a life skill.)
Navigating my sideshows, Dr. S. returned us again and again to bedrock that became frustratingly familiar but each time incrementally more livable. Instead of straight-line progress, our work spiraled. (Freud saw links between the practice of psychoanalysis and poetry. In this experience of recursivity, I felt a shock of recognition at poet Richard Howard’s pithy observation that “prose proceeds; verse reverses.”) I did learn this: what I couldn’t allow myself to say, think, feel, entertain, expect, or hope for in that room didn’t stand a chance of happening anywhere else.
Misunderstandings were inevitable, a fact of language’s imprecision. Not bugs but features of the process. Not misunderstandings but meaning. What? That’s not what I said. But maybe that’s what I meant.
In one dream, to escape pursuers I had to merge a 2D compass drawing and its directions into a 3D map. I’d be saved if I could merge the perspectives, but I didn’t know how. Week after week, Dr. S. heard and saw much that I couldn’t or wouldn’t. “Did I hear you right?” he’d ask. Or say, “Let’s try that again . . . let me put it another way.” Expression is one thing, but clear communication requires astute listening and respectful persistence. And in the work (as in life), it had to go both ways. I usually spoke out of the top of my head. Only later did my voice start coming from someplace lower, gut rumbling and heart seeping.
Led by my dreams, life history emerged when it needed to. I was grateful not to recount memories like spadework, those stories I’d told to myself about myself until repetition made them unassailable. The ritual of analysis brought that history alive in a way I hadn’t allowed. I began to understand what biologist Gerald Edelman meant: “Every act of perception is to some degree an act of creation, and every act of memory is to some degree an act of imagination.”(2)
I cleared away Cosmo-quiz answers and self-help stereotypes. I got better at respecting clues that showed up like graffiti in my dreams, thick and colorful. I was working out some intangible, bunged-up constipation. It was dark, and it often stank. We teased out a clutch of knots and deadlocks that stretched back as far as I could remember: A body that was too much for me while my mind went about its business. Disconnections that heightened depression, took shape as compulsion, were mystified by fetish and masked by productivity. Either/or thinking that only dug the ruts deeper. I went to Dr. S. because I couldn’t write, but what was really at stake was nothing less than my life.
Session parameters — physical boundaries, time constraints, fees charged — created restriction and urgency that made meaningful work possible. The parts of me that felt like “too much” began to fit. The psychoanalytic space, it seemed, could contain me, as well as him. Then we were both on the line, as analysand and analyst. We were both in it, as human beings.
He showed up in my dreams: as long grass on a riverbank I grabbed to keep from being swept away; as a peacock (those neckties!); as a beloved celebrity; as a talking lizard; as a man who points me to a construction site where I’ll be suspended in a tangle of wire over a large hole. I can’t get out yet, but I’m not falling in.
I don’t know what Dr. S.’s experience of our work was in the moment (any more than I know what you’re thinking now). Closing the session, he would offer an interpretation, a thought I could take with me. Never a grand pronouncement. More like a curation of the hour’s particulars into farther-reaching terms. An angle I hadn’t considered before, like moving a familiar vase to a different spot, so it could be noticed anew.
I worked to hang on to what happened in those hours, but our topics and his interpretation could easily evaporate. If they did, I knew we were getting somewhere. Would they disappear while I waited for the elevator? At the first intersection? When I opened my front door?
What I forgot turned out to be as useful as what I remembered. Recalling those ideas, elegant fragments still too unwieldy for my mind, became an exercise in recalling myself. That involved not panicking at the blankness, instead trusting that what was necessary for me to know would find its way back. Those thoughts I wasn’t ready to hear did return again (and again) until I could hold them reliably in my mind. It took a lighter touch and more self-respect than I was used to.
Constructing his thoughts, Dr. S. would glance out the window or at the painting on the wall behind my chair. He was putting something together. Attentive but loose. Composed but in motion. He wasn’t short on psychoanalytic theory, but instead of a doctor cutting a prescription to size, he seemed to be doing what Miles Davis advised: “Don’t play what’s there, play what’s not there.” Analysis was, like Claude Debussy’s definition of music, “the space between the notes.”
It was a sort of focused drift or dérive through the landscape of overlapping minds. We listened for multiple meanings: wholly, holey, and holy. Disgusted and discuss dead. Defective stilettos in a dream signaled badly healed.
Context matters. Silences. Words and syntax. Slips of mind and tongue. Interruptions, the feel of the chair, the view. A glance away, into distance or sidelong. What matters is between and among, where the as-yet-unspeakable accumulates.
Those sessions were the first time I was able to look at my own loose ends without a knee-jerk desire to tidy them. Orderliness was essential to my day job, but in this work that skill got in the way. I finally understood the old joke about a man whose wife thinks she’s a chicken. He would be happy to have her cured, except that they need the eggs.
Myth of the Big Breakthrough
At some point, friends began asking when I would be done. Therapy in the movies always builds to a big breakthrough, the perfect tap of the chisel that reveals the masterpiece. But that model of progress was part of the problem, with “perfect” the enemy of “good” as well as “good enough.”
I had gotten over the urge for a diagnosis, quieting my inner bureaucrat who wanted an official name for my problem. On the way to Dr. S.’s office in Cambridge, I would pass a corner where a guy usually hung around talking to himself. Angry. Imploring. Frustrated. One day I asked Dr. S. what was wrong with him.
What? Years of practice in psychiatric hospitals and “crazy” is all you got?
“Is that a technical term?” I tried to joke.
He shrugged. We moved on.
It took me years to recognize the humanity in that reply. As a passerby in that guy’s world, I had no business diminishing him to a diagnosis. “Crazy” keeps him in the human family; “crazy” is something we all (if we’re honest) can relate to. And I suspect Dr. S. knew that in entertaining curiosity about that man with too much of himself on his hands, I was really entertaining a fear about myself.
From the outset, Dr. S. understood that the tangible problems I brought into the room were code for my real subject matter, infinitely more slippery and deeply rooted. Bulimia as code for (among other things) certain refusals. Bondage as code for (among other things) a desire to protect others by restraining myself. Thoughts of suicide as code for (among other things) my longing for change.
In suspending the fact of the matter, he took us sideways. Through associations, we began to engage the conversation I had been trying and failing to have with myself for decades. My tired refrains began to fade, revealing the elaborate strategies I devised to get in my own way. What began to emerge was what I really believed about myself, without political correctness and well-meant pantomimes of the person I wished I was. I was getting down to the messy personal ideologies that truly defined my desires and set my limits.
But that sounds too neat. When I think of what happened in analysis, I think not of progress but of process. The charged silence when words hung in the air, like the shimmering quality of Gamelan music, a result of instruments being slightly — deliberately — out of tune. I think of my neighbor’s hound dog howling at sirens because she hears what I can’t.
Some frequencies just aren’t available in the usual pitch of the day. The work of analysis was a way to hear them, talk about and talk with them. More of myself came into play.
Psychoanalyst Bonnie Litowitz uses the term “entanglement of minds” to describe what happens between an analyst and analysand.(3) She points out that psychoanalytic theory itself does not have adequate terminology for this interaction. The descriptions of psychoanalysis have not adequately captured what happens in the room.
Dr. S.’s and my entanglement of minds was powerfully disruptive and creatively freeing. This depended on him being both guide and participant, always inside and outside the conversation, consciously willing to be implicated in our analytic drama. Only then did verbal ping-pong change states. Solid words became liquid, then vaporized to create a different atmosphere, contained but free. Finally, I could breathe.
Listening between the lines and speaking eye to eye is a rare thing to carry off, and it makes the sublime in analysis possible. Something I thought I knew cracked open and became something else. It was not what I thought it was. I am not who I think I am.
But again, that sounds too simple. How many times in those years did I, in various ways, try to give up? Ruminating on yet another plunge into despair, I said, “This is unsustainable!” Dr. S. replied, “Sadly, it is sustainable. But it’s not acceptable.”
Yes, I needed to give up — but still misapprehended what exactly needed to be given up. Here’s a clue: Litowitz says that in asking patients to communicate freely, analysts are really asking patients to “relinquish their fantasy of perfect understanding — to have faith in the processes of communication . . . the processes that they and we [analysts] have been born into, but somewhere along the line have lost faith in. . . . All our interventions are aimed at restoring that faith.”(4)
To Be Continued
The treatment has ended. Now, paradoxically, there is so much more to be said. Dr. S.’s persistent optimism on my behalf has seeped into my veins. I’ve felt it writing, from what poet Donald Hall called the “vatic voice,” his term for the individual’s internal well of inspiration — a concept derived from his own experience of free association in psychoanalysis.(5) “I know that as you grow older you can learn better how to listen to this vatic voice. You can learn better not to dismiss it, you can learn not to be frightened of it. You can learn to let it keep talking.”(6)
So who am I now? I can say I am more myself, somehow closer to my own bones. I spend less time in the cycle of anxiety-repression-depression. I stay in touch with the associative, even surrealistic, mode of thinking that energized analysis and today energizes other creative acts. On the surface I still appear (as more than one friend has described me) “terminally serious.” In other words, I don’t appear to be happier, which can seem baffling.
But happiness has never been the point. Philosopher Slavoj Žižek puts it this way: “When you are in a creative endeavor, in that wonderful fever — my God, I’m on to something — happiness doesn’t enter it. You are ready to suffer.”(7) Which is not to say that I seek suffering but that I absolutely need the creative endeavor. I do laugh more than I used to.
A week after our last session, I dreamed that a community gathered in a brick schoolhouse to tell me that they had all bought lottery tickets in my name. My winning would be good for them all, and they were certain I would win.
Two months after our last session, I checked in with Dr. S. A friend had died, and I was again at a loss for words. It was good to see him and be seen by him. We talked. What happened in that hour? Nothing that an ordinary observer would find strange. But in that entanglement of minds I was recalled to myself, as Litowitz puts it, “in solitude and in solidarity.”
It is some sort of music. It is a form of humane love. It is belief that stumbling and sideward glances are necessary for living fully, which is itself a movement of incomplete parts. It is belief in talking about what’s more than apparent and yet still not seen.
- In preparing this essay, I asked Dr. S. how he would describe our work: “The most precise term for our work is intensive analytic psychotherapy, which uses the insights of psychoanalysis but is not limited to interpretation, rather allowing for and seeing the value of other interactions, discussions, exchanges, or support that may be useful. I think of our work as very analytic and that the elements of our work that were not primarily interpretation were there to support the analytic process. For me, that involves the gaining of freedom of thought and the understanding of the barriers to self-awareness and respect, in whatever way best serves the process.” (Personal correspondence, July 16, 2014.)
- Quoted by Oliver Sacks in Musicophilia: Tales of Music and the Brain (New York: Knopf, 2007), 157.
- Bonnie E. Litowitz, “Plenary Address: Coming to Terms with Intersubjectivity; Keeping Language in Mind,” American Group Psychoanalytic Association National Meeting, Waldorf Astoria, New York City, 2014.
- “Donald Hall, The Art of Poetry No. 43,” Paris Review 120 (Fall 1991),http://www.theparisreview.org/interviews/2163/the-art-of-poetry-no-43-donald-hall.
- Donald Hall, “The Vatic Voice,” Goatfoot Milktongue Twinbird: Interviews, Essays, and Notes on Poetry, 1970–1976 (Ann Arbor: University of Michigan Press, 1978).
- Slavoj Žižek, “Why Be Happy When You Could Be Interesting?” Big Think, June 25, 2012, http://youtu.be/U88jj6PSD7w.
Thank you to Anne Horowitz and Creative Nonfiction for their support in developing this piece.