Sunday, June 13, 2021

More like Joyce, less like Proust: The Pandemic’s Signal to Noise Paradox. Part 1




Part 1 

 

It’s June. In the Northeast where I live, the pandemic is over. Here, Covid is a medical management problem and not a public health emergency. I hope it stays this way. I hope this is a cautionary remembrance of things past. 

 

Since a year ago March, when I moved my teaching and practice entirely online, I’ve logged more weekly hours than any time in my career. That’s come with benefits and costs. This is about some of the costs. 


In my consulting and clinical practice, I’d been hearing that production is high, but initiative, improvisation, and creativity are low and nearly everyone complains about Zoom fatigue.  That matched my state of mind.  That, and how many of us felt a bit like Billy Pilgrim, unstuck in time, not clear what day followed the one before.

 

Mid-May, grumpy, spent, I escaped to Provincetown. Immediately I felt much better. I think I’ve learned some lessons. First, maybe foremost, is when to play hooky. 


Provincetown in May 2021 was my second escape from Covid culture. The first, back in October, was the woods and beaches of Chappaquiddick Island.  Then, during one of our Friday conversations, I told Michael Kubovy how different I was feeling from the previous seven months and how this fit with what I’d observed about my clients and students.  I was relaxed and open, my mounting doldrums vanished. Helping me understand my changed state, Michael suggested that except for far less talent, we are generally more like James Joyce than Marcel Proust. We do better when spending our day strolling the streets of Dublin than in bed with shades drawn in a cork lined room.


By now, mid June, the pandemic has lasted long enough to change society, fostering a Covid culture that, while intent on protection, took a toll on those never infected and who did not share the pain or suffer the loss of someone who was. 

 

Some costs are moral and psychological. The pandemic left many in states of languish, and some, victims of acediaits depressive variant. Other costs were political: hostile splits over adherence and resistance to political “biopower” [1]. The public discourse, the rancor on mandated shutdowns and masks that quickly devolved into ‘which side are you on?’.  The incompetent, odious, absurd utterances of Trump that met an under-examined counter to “follow the science”; too often an incoherent collection of methodologies and data promoted by different communities of interest: medical, economic, and academic. Policy and implementation did not fare well. Nor did we. 

 

Social distance and masking took a toll, and there's Zoom. Online, work from home did not happen on a level playing field. Many parents try to restrict their children’s screen time and want them to spend more time playing outside. I’ve come to see the value of that for all of us. 


This is about the condition of folk like me. I don’t have the numbers, but it’s a safe bet I’m not in a minority. So before you roll your eyes, I didn’t have it that bad, not at all; my life and livelihood was never threatened. Knock on wood, I was never sick, not broke, and in a stable relationship. I’m one of the privileged: a senior academic clinical psychologist, mostly home with wife and dogs, with fast reliable ethernet, and no children needing to be home schooled. My concerns are trivial compared to the endangered front line workers, the truly isolated and impoverished, and those overwhelmed by grief, work, or worry.


Here’s some of the circumstances many of my ilk lived with: 


1) Stuck at home, more or less isolated with restricted encounters apart from our affinity groups. 

2) Engaged without handshakes. No collegial pats on the back.  Working, schooling, and shopping online. Living with less surprise and fewer random encounters.  

3) While productive  –– scheduling was easy, the commute gone, people knew where to finds us –– we experienced Zoom fatigue: a consequence, I think, of a diminished and restricted ‘sensory ecology’ of a less varied, less novel sensory stimulation that undermined multimodal perception, ‘inter-affectivity’, and empathy.  Facing each other on screen, our engagement was less informed, less moved, by the rhythms of gesture and speech, the ‘dance’ that naturally and ordinarily is part of being in the physical proximity of others [3]. Dancing in harmony invigorates; being held in place, missing the beat, is tiresome.

4) Masks and social distancing are problematic. When we ventured out and tried to connect, but avoided physical closeness with faces masked, our full expression was muffled; was less intimate and empathetic. From trivial inconvenience to severe handicap, verbal behavior is enhanced not only by clear speech but by simultaneous lip reading [4]. Talking together, relaxed and spontaneous, was below par at best.

5) And while out, leaving home, affinity group, and pod behind, we feared contagion and suffered an uncertainty of whether it would ever end [5].


With all this in mind, I think I can throw light on why many of us have been both productive and stuck in a funk.  Why we started cozy but ended irritated in our cocoons. 

 

In a nutshell, here is my premise: To thrive, to experience comfort, satisfaction, and vigor; to improvise, create, and initiate, we need all our senses frequently engaged. We need random, unexpected encounters with the natural, architectural, and social worlds. And here’s the kicker: We need distraction. We need shiny objects pulling our attention away from the task at hand. Keep in mind that what distracts us, what catches our attention, interests us. What actually interests us, what doesn’t go against our grain becomes available for consideration. And that availability might come in handy.

 

Distraction is important, not because we acquire the discipline to ignore it, but in the sense of a metaphorical signal to noise paradox, where the noise enhances the signal by offering additional content and context. (Unless, of course, it is merely distraction. Naps help sort it out.)

 

In particular, akin to a seed crystal, unexpected encounters and distractions are idea nodes: Cognitive and emotional behavior potential that can provide associational connection to the task at hand; something novel we might recognize as significant and decide to pursue. (Of course, we might not. It helps to have the breathing space to think about what we've been thinking about.) I am taking issue with ‘necessity is the mother of invention’ when necessity comes from adversity. Adversity rarely makes us stronger or creative. Mostly it makes us mean, defensive, and closed off.  


Seeking safety in social distance and masks, living our lives on Zoom, the pandemic diminished our encounter with the complexity and nuance of strangers, companions, and our worlds [2].  Our bodies less involved, our empathy strained, we ended up more worn than usual. We could produce but did not thrive. 

 

My remedy is unexpected encounters and distraction coupled with a strong dose of whatever fully engages the senses. And naps. 


  


Part 2 will be about what my students taught me.






My friend and esteemed colleague Mark Greenberg alerted me to the Japanese therapeutic practice of Shinrin-yoku (taking in the forest atmosphere or forest bathing) "for the restorative impact of multi-sensory, natural stimuli."  "The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan" Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y.,  Environ Health Prev Med. 2010;15(1):18-26. doi:10.1007/s12199-009-0086-9

 

[1] Michel Foucault’s term for "an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations” (The History of Sexuality 1976, Vol. 1 p. 140).

[2] The Black Lives Matter protests following the constantly televised police murder of George Floyd was a galvanizing distraction for white Americans not accustomed to being victim of police violence.  For many, a wake up significantly informing awareness.  

[3] Concerning difficulties maintaining empathy while employing Zoom, see “Embodied Affectivity: on moving and being moved” Fuchs & Koch (2014) Frontiers in Psychology. And “Degradation, Accreditation, and Rites of Passage” Schwartz (1979) Psychiatry.

[4] See for example, Altieri, N. A., Pisoni, D. B., & Townsend, J. T. (2011). Some normative data on lip-reading skills (L). The Journal of the Acoustical Society of America130(1), 1–4. https://doi.org/10.1121/1.3593376.

 [5] I’d like to believe I’ve overstated the problem in a blog posting The Affinity Group, the Mask, and the Counter-Progressive Politics of Suffering Alone (Some Reminders from Harry Stack Sullivan).









 



 

 

 


Friday, February 19, 2021

The Affinity Group, the Mask, and the Counter-Progressive Politics of Suffering Alone (Some Reminders from Harry Stack Sullivan)

The confined affinity group and the mask should be left behind if we desire a vibrant cosmopolitan society. With the advent of successful vaccines, coronavirus should become a problem requiring medical management and not a public health emergency.  We'll eventually leave the confinement of our bubble and pod affinity groups, but if masking remains an ordinary part of life, I fear 'same-as-us' identity politics will intensify, inadvertently inviting a dystopian future. Perhaps I'm overstating, but I suspect Fauci and his adherents would like us to remain masked into the foreseeable future. The personal and social costs of the pandemic should not be borne when the crisis is past.

By now we should be familiar with the tragic condition of the quarantined elderly and the hidden agony of the isolated and lonely. We are less familiar with the counter-progressive consequence of segregating the otherwise healthy, maskless only under a shared roof of kin and friends. What happens when they venture out masked and encounter others behind theirs? 

Trump encouraged a virulent populism. But after the crisis passes, will virtue-driven normalization of masking facilitate another version of tribal hostility? From the start of the pandemic to the present, the masked versus the unmasked has triggered rancor.

I don’t want to be misunderstood. Masks, pods and bubbles are vital components for managing a pandemic. But donning the mask and disdain for those who refuse has become, apart from actual health concerns, a badge of the progressive and anti-Trump. I am both.  There are problems lurking here. To the extent masks become a cultural norm, liberal cosmopolitan democracy can be undermined by life less informed by inclusiveness and diversity. When I wonder aloud about this, my well-traveled peers mention the extensive masking in Japan and the alien status of the gaijin

The liberal and progressive ideal of tolerant cosmopolitan community requires understanding and getting along with those different from one’s friends and kin. The liberal ideal requires loosening the natural tribalism of ‘us and them’ and resisting the tendency of ‘us versus them’. Facilitating engagement with people different from ourselves allows this to happen. But when huddled together, without mask only within home and pod –– avoiding the other as contagion –– tribal pathologies of blood and soil, of purity and danger, too easily come out of hiding; are too easily projected onto the mask of the stranger. It doesn’t take a sociologist to point out that our households and pods are generally inhabited by people very similar to ourselves. Folks with our complexion. 

Here’s a darker worry. For many of the financially secure and socially well connected, the lockdowns offered a cozy respite, marred by the annoyance of titrating a comfortable distance from those too much around. In contrast, the lockdowns have been awful for the isolated and lonely. We don’t hear much from them. Today, 35.7 million Americans live alone.   How do you think they are doing? Although we might like to believe adversity brings out the best in us, mostly it makes us mean.

For many people who live alone, the loneliness manageable during ordinary times is now intolerable. When they leave their homes, masked faces make it worse. Harry Stack Sullivan’s observations from 1940’s and 50’s are relevant. In the seminal volume, The Interpersonal Theory of Psychiatry, he wrote, “There are good many situations in which lonely people literally lack any experience with things they encounter…. loneliness in itself is more terrible than anxiety.” 

We rely on the acknowledgment of others, from the beloved to the stranger, to cure an otherwise empty heart. Without empathic responsiveness, we become aliens in a world without compassion.  Some need a responsive face more frequently than others. But we all need it. When significantly absent, when hope is replaced by demoralization, our demons and pathologies erupt. The prolonged demoralization of knowing there is no one nearby who truly cares, no one who has your back or understands how you feel can foment depression, rage, and suicide.  In such a world, the most terrible thoughts are not intimately expressed, soothed, or corrected.

Severe loneliness, Sullivan observed, deprived people of the companions needed to “integrate experience” creating defects in the ability to adequately appraise situations apart from wanting relief. It is unsurprising this breeds resentment toward whomever or whatever is held as cause. The masked face is a blank screen where resentment, fear, and anger are easily projected. 

Public masking has gone on for a very long time. When the pandemic began my socially conscious neighbors and most everyone else in my neighborhood wore masks and zigzagged as we crossed paths. We feared contact and avoided lingering and gesturing. I was lonely walking the dogs. But then something happened. A few weeks in, late March early April, I noticed I was deliberately smiling with my eyes, nodding when my sunglasses covered them, and saw my neighbors do the same.  We expressed solidarity as best we could.  But by late October, with the fall and no end in sight, these gestures mostly faded except among those already committed to each other. The sidewalk, crowded or not, became empty. 

I want to be clear.  I have little sympathy for those who feel the mask is a violation of their self-entitlement, an insult provoking “don’t tread on me”, an expression of indifference to the concern of others.  But ask, how do people eventually behave when they’ve been secluded, uncertain, anxious, and nursing whatever prejudice is consistent with what they blame for being locked out of life? And when the time comes, how do they vote?

Wednesday, September 16, 2020

Systemic Racism Is Akin to Negligent Homicide

Regarding systemic racism: "Systemic" does not have to be the explicit and stated aim of a law or policy but rather the systemic effect of its implementation. Think of it this way: systemic racism is akin to negligent homicide: death that is the result of reckless indifference to an ought-to-be-known consequence. Systemic racism is the neglect of the inequities amplified when broadly enforcing the status quo. Policing is a prime example. Even if the police honestly believe their job is not to promote racism, policing's implementation is all too often racist. Housing policy tends to be another. This use of "systemic" applies to any legislated or applied policy that when implemented has an ought-to-be-known consequence on people given their race, ethnicity, religion, class, gender, age, etc. Since police have a legal monopoly on violent force, they are often the witting or unwitting agent of systemic racism.

Friday, June 26, 2020

The Neglected Student and the Academic's Cozy Pandemic



I would think some of us –– those secure in a bubble of privilege ––  would remember what was essential in our own academic journey.  Are some senior faculty in American universities blind to the impact the closed campus has on students threatened by the absence of direct connection to mentors and peers? Is our unexamined comfort a source of collusion? What is our mission? Have we not failed if we do not produce passion for our subject matters, lifelong connections, or future academics? 

The virtual is not good enough. Students need in-the-flesh community to enact the rite of passage the traditional university is designed to provide.  This is especially crucial for graduate students as they enter and when they leave the university. Their life plans hinge on finding friends and mentors when they begin a new stage of life and to cement those relationships when they exit. It is unrealistic to believe this can be achieved online. The person to person connection and commitment is not the same. I write from experience. During the first months of the pandemic I taught entirely online “Case Studies in the Lives of Persons” at Harvard Extension School.  The face to face Zoom interaction often felt intimate and satisfying. But here’s the rub. I am fairly certain that if I was walking on campus and passed any of these students, I would not recognize them beyond some uncanny feeling they seem familiar. 

Most of my academic load is teaching and supervising doctoral level clinical psychologists. I am also a practicing psychoanalyst. In the past, before I would consider initiating or terminating a therapeutic relationship, I wanted to be physically present. Nonetheless, since the pandemic began, I have begun working online with a few individuals and couples who simply could not wait until we felt safe to meet in person. Online therapy has a different cadence and perspective. The face to face immediacy is both challenge and asset. And, as with my online only students, I fear I would not recognize any of my new patients if we sat at nearby tables in the outdoor cafes now open in Boston.

Here is what I am observing: Some of my peers, people at least for now reassured about their means, the ones not struggling with child care, those not worried about student evaluations for promotion and tenure, are sleeping better, feel less hurried, and find comfort in their extended, sheltered-in-place lives. We are enjoying our enforced staycation. 

Suddenly freed from showing up, freed from the demands of students, we are quietly invested in remaining at home, on Zoom, reading what we want, getting caught up on TV, tending our gardens, having our food delivered. We are thriving. Thriving, that is, at the expense of an obligation to our students and those less sheltered. This staycation is a relief for people secure in their social lives, family, and career. For people who are not secure or established, the profound isolation of shutdowns and the extreme uncertainty of what they face, if and when the pandemic passes, provokes responses from ordinary anxiety to scarring trauma. I witness both patterns daily.

For those the pandemic has not created desperation, has it offered a hard to admit but welcome break? Is whatever guilt we notice dampened by our virtuous acceptance of a social distance we don’t really resent?  

We are complicit in intergenerational injustice if we relish the cozy place we have in our retreats. I would not have thought this weeks ago, but I am discovering conflict with the comfort I have achieved. I say I want this over, but I am reluctant to have it end. When the lockdowns started in March, I would have thought I would want them ended as soon as it was clear our hospital systems were no longer in danger of collapse. Months later, I cannot claim my comfort with the closed campus is an ethical concern for the greater good of students; instead, it’s mainly about my comfort.

We all face a pandemic. A terrible disease for some elders and for those whose social conditions of race, ethnicity, and economic class place them in harm’s way; and for the medical responder inadequately protected and overwhelmed by a viral load. Nonetheless, ordinarily, the virus is a manageable sickness for most students and the young. There are horrible exceptions, many exceptions that require many cautions. 

We need proper planning to protect those who need protection and we need to be prepared for expected and unexpected tragedy. But this pandemic could last for years. The hope of a vaccine by the winter that actually works may be good for the markets but does not reflect medical or logistical reality. Anticipate this. Sequester vulnerable seniors in well lighted, well ventilated rooms with bright monitors and good headsets. Give us sufficient bandwidth; but let students and willing faculty gather with realistic caution of contagion. At this point some of our contentment is obvious, but what should be obvious is that this contentment is complicit with the degradation of a generation of future academics.

The pandemic is a prequel of global stress to come. We need a thousand solutions. Those enjoying their comfort should be aware they are part of the problem.  

6/30/20 edited 8/17/20

The current Rate of Transmission (RT) in my community is now hovering around .83. Very soon, Northeastern and Boston University will bring large numbers of students into my neighborhood. I expect the RT to rise. But is keeping them home a better public health practice than sending them back to school? On campus, masked and unmasked, will they maintain social distance? Of course not. They'll hop from classroom to bar; they'll party and generally mess around with each other. They will spread infection. No doubt. But what do we expect they'll do at home? Stay in the house? At home, who are the targets of infection? Friends, parents, siblings, grandparents, and others under the same roof, in the same rooms. A household vulnerable to sickness and death, some more than those on campus. We need a reasonable risk/benefit analysis that compares home risk to the problems of on-campus learning. Perhaps it's been done. If so, it would be useful to see.


A version of this posting appeared as an Op Ed in the August 17, 2020 Harvard Crimson:


1/24/21






Saturday, May 2, 2020

What to expect? The Pandemics effect on personality, culture, and politics.


Expect soliton waves: self-reinforcing waves of infection that propagate at a constant velocity.

I hope I've missed the likely better outcomes.

We are all in this together. None of us has ever experienced health and financial uncertainty in a global context where everyone else does, too. Historically, society wide unemployment has led to populist movements, from the totalitarian Nazi, to the New Deal versus America First. The New Deal brought people together. Pandemics and plagues elicit fear of the neighbor and the stranger. That sort of populism wants to build walls and rid itself of contamination and impurity.
Like it or not, adversity seldom brings out the best in us. Mostly, it makes us mean, suspicious, and selfish. It threatens narcissistic stability, and we act accordingly.
Social disruptions foster crisis cults and new religion. Collective trauma and deprivation are seedbeds for populist fear of the despised “other” and malevolent identity politics. 
The dilemmas of global stress creates temporary or sustained uncertainty. Cross-cultural stress, collective trauma, and a heightened awareness of difference in security, power, and privilege are already writ large. Look at some examples from cultural demography: The Great Depression, Post WW1 German trauma and deprivation, and the various holocausts and forced migrations. These collective circumstances affected communities and cultures many ways. What happened? Did people find common ground with the stranger or attempt their elimination? And, in contrast, consider the white middle-class post war Baby Boomer’s opportunities that moved people from the lower middle to the middle or better. But then consider the globalization that returned many to the lower middle. Consider their political shifts. With an expected recession, let’s be real: the lower middle is completely screwed.
Things to wonder about: Circumstances experienced globally are a vector for culture change. Global events of varying duration, now a context of our judgments and action, can change our character if acted on long enough to become in-character. If this changes enough of us, accompanying changes in our culture’s characteristic choice principles and social practices follow.
Here’s a key question: Given sufficient practice and experience, how long does it take to develop new ways of living? How long are these characteristics stable at different periods of life? Daniel Levinson’s ideas, taken with a grain of salt, offer a guide. Adult personality transitions require five +/- two years. Periods of ‘settling down’ are seven +/- two years. But how long does it take to fundamentally alter a child's rapid development and emerging view of self, community, and world? A year is a much larger portion of life for a kid than for an established "grown up".
How long will the pandemic last? What difference will it make to people at different phases of their life? Are you looking to start college or begin a career? Hoping to get out of debt? Are you a kid told to avoid the playground and the neighbor’s kid?
The pandemic’s major variables: How long will it last; how well will authorities understand rapid upward and gradual downward infection slopes; and how competently will they promote and apply varieties of corrective feedback. And, will there be ongoing and extended recurrences with or without adequate corrective action?
Will the the pandemic be a year or less of disruption; a painfully extended but temporary abnormal? Or will it last long enough to alter the shared course of people’s lives? And, in so doing, shift culture and personality? We are going to find out.


About Soliton Waves: Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period (Science, 22 May 2020:Vol. 368, Issue 6493, pp. 860-868)

Monday, December 30, 2019

Harvard Extension School: Case Studies in the Lives of Persons



Spring Semester 2020, I'll be teaching online and on campus "Case Studies in the Lives of Persons". 4 Graduate or Undergraduate Hours. Auditors are welcome. Here's a link for registration. 


I will be updating as I add reading. 

PSYC E- 2000:  Case Studies in the Lives of Persons

Course Overview
Semester and Year: Spring, 2020
Day/Times/Place: Wednesdays 5:40pm-7:40pm; 1 Story Street 304
Format: On campus classroom with online option-Zoom/HELIX
                      
Instructor Contact Information      
Name: Wynn Schwartz, Ph.D.                                                     
Office hours: by appointment
Email: wynn_schwartz@hms.harvard.edu                                                                                                                            
                                                                                                                         
Course Description and Learning Objectives
How do we go about understanding and describing the lives of persons? How can we empathetically depict a life that respects how people actually behave, how people come to be the way they are, and how people change? While acting more or less cognizantly and intentionally, engaged in varied roles in multiple and complex communities, people encounter and construct their worlds. Working from a theory-neutral descriptive perspective designed for comparative theoretical approaches, we will learn about and employ conceptual tools that facilitate an examination of the nuanced commonalities, differences, and significant through-lines in selected adults, and then apply these concepts in constructing a psychological biography or autobiography.

Course Materials
Schwartz, W. Descriptive Psychology and the Person Concept: Essential Attributes of Persons and Behavior.Cambridge, MA: Academic Press, 2019 (Electronic version available in Harvard libraries) In Syllabus as DPPC.
Instructor will post reading in January and throughout the semester. They can be found in Canvas under "Modules".
                                                                                                             
Grading
0%       Skills check – Provide a one page reflection to the blog post: Satisfaction, Narcissism, and the Construction of Worlds. (Links to an external site.) Due first week of class.
20%    Class Participation –participation in class and online discussion, evidenced by comments posted online.
40%     Through-lines descriptions (undergraduates, 4 descriptions, 1 page each; graduate students, 7 descriptions, 1 page each).  Due at the 9thclass meeting.
40%    Interview and biography and/or autobiography, 5 to 7 pages. (Undergraduates required to choose one; graduate students either both or 2 interviews and biographies). Due by the final class.
Course Outline and Schedule
 Most reading will be posted in January and integrated into the syllabus then; others will be selected in response to class discussion. (GS) indicates an optional reading for undergraduates but required for graduate students. Reading can be found under "Modules".

Read Preface and pp. 1-53 of Descriptive Psychology and The Person Concept (DPPC) for Lectures 1-4: 1/29-2/19
1/29    Introduction to our subject matter and our goals. What counts as an adequate description of a person?  Separating the signal from the noise. Ambiguity and significance. Clinical and moral narratives. Required skills check:  Due by 2/5: a one page reflection to the blog post: Satisfaction, Narcissism, and the Construction of Worlds.  (Links to an external site.)
Reading:
DPPC Significance, implementation, and some thoughts about psychotherapy. pp. 75-77.
Cushman, Philip. Psychotherapy as Moral Discourse
Objectivity, Subjectivity and the Gospel Truth (Links to an external site.) (blog posting)
2/5     The perspectives of the observer-describer. The romantic, comic, tragic, and ironic perspective.(Northrup Frye and Roy Schafer). Transferences and the unconscious and underexamined  constructions of  a person's relationships and circumstances.
Reading:
Andersen, S. M. & Berk., M. The social-cognitive model of transference: Experiencing past relationships in the present.
Gill, M.M. The analysis of the transference (GS)
Schafer, Roy. The psychoanalytic vision of reality (GS)
2/12     Through-lines and Significance. The dramaturgical perspective. (Irving Goffman, Rom Harré, Peter Ossorio) Through-lines as organizers of a person’s life story; leitmotifs describing Significance patterns implemented in various ways. In-character and out-of-character attributions. A person’s aspirations: fulfilled, compromised, substituted, and failed.
Reading:
Anscombe, GEM. Intention. pp-33-45 (GS)
Schafer, Roy. Narratives of the Self (Cp 2 from Retelling a Life)
Harre, Rom. “It’s All Discursive!” Crossing Boundaries and Crossing Words with Rom Harré"
2/19     The Person Concept and the interdependent component concepts of Individual Persons; Behavior as Intentional Action; Language and Verbal Behavior; Community and Culture; Worlds and Reality.  
2/26     Intentional Action. Parametric Analysis. The parameters of Intentional Action and its derivates: Cognizant and Deliberate Action. Actor-Observer-Critic social and self-regulation.
Reading:
DPPC Behavior as Intentional Action pp. 55-93
3/4    Methodologies for constructing a psychological biography. Empathy and the empathetic interview. Verification and the negotiation of a humane and useful understanding.
3/11     Community and Culture.  The normal and the abnormal in psychiatric anthropology. Satisfaction and thriving. Authenticity and how well one is cast for their "parts".
Reading:
DPPC Community and Culture  pp. 161-172
3/18     Spring Break, no class.
3/25     Degradation, accreditation and rites of passage. Acquiring, affirming, or losing one’s place in a valued community and the associated psychological effects. (Herbert Garfinkel). A person’s aspirations: fulfilled, compromised, substituted, and failed.
Reading:
From DPPC, pp 172-187
Garfinkle, Harold. Conditions of successful degradation ceremonies.                                                                                                                                                                       
 4/1       The Judgment Diagram and the domains of motivation. The problem of “the two sets of books”:  one available to introspection; the other only reluctantly examined.  Self-deception and unconscious motivations. Compromise formations and bungled intention.
Reading:
From DPPC The Judgment Diagram, Some Categories of Cognizance, and the Unconscious pp.95-130.
 4/8     Relationships, the Relationship Formula, and Emotional Action. (Peter Ossorio, Raymond Bergner)
Reading:
From DPPC Relationships, the Relationship Formula, and Emotional Competence pp.131-147.      
4/15     Emotional competence and family history. Attachment styles.
4/22     Dreams as a second perspective.  Problem representation during sleep as a guide to a person’s concerns and psychological state. The dream as adventure into possibility. Nightmares and bad dreams.
4/29     From Freud on: the unfolding historical views of the infant in psychological theory. From these starts, what sort of stories are told? How views of the infant are reflected in parenting guidance and psychotherapeutic practice.
5/6       The seasons of a person’s life. Are there natural units of maturation?  The works and critics of Daniel Levinson.
Reading:
Aktu, Y., & İlhan, T. . Individuals’ life structures in the early adulthood period based on Levinson’s theory.
Levinson, Daniel.  A conception of adult development.
5/13     Endings, memory, and looking back: Nachträglichkeit (retroaction, delayed reaction or response, retrospective attribution, afterwardsness). Reformulating one’s world and recasting the past: Ugly ducklings and memories with new significance. Mourning.
Reading:
Bistoen, et. al. "Nachträglichkeit'"
Marion, Paola. "Some reflections on the unique time of Nachträglichkeit' in theory and clinical practice" (GS)




Saturday, November 2, 2019

The Harvard Treating Couples Conference: Dramaturgical Problems in Self-Presentation and Reluctance




A paper given November 2, 2019 at the Harvard Treating Couples Conference:

Mistakes in Couples Therapy: 
Dramaturgical Problems in Self-Presentation and Reluctance

I’ll start with two categories of mistakes: One involves personal and professional insistence; the other, supervision.


To do the work I’m interested in, I want to know what really matters to people: I want to understand what they intrinsically value.  I want them to consider where their integrity really counts. And given the particulars of what they are troubling each other about, I want them to be able to acknowledge what they know is not all that important. Are they arguing the proper way to fill the dishwasher; does it really make a difference if the toilet paper unrolls from the top or from the bottom?  (Yes, I know it matters, it should unroll from the bottom.) Since they are going to keep score anyway, it should be more about the vital signal than the noise. 

I want everyone in the room to ask if their concerns are essential to their well-being; where, if they don’t take a stand, they’ll feel abused or violated. This need be clear enough to figure out where they have common ground, where they can appropriately compromise and have some wiggle room.  The devil is always in the details. Does the position they take allow their engagement to proceed? Is it a deal breaker or a game changer?

Working with couples, I need them to attempt to be honest with each other. An empathic honesty that respects their vulnerabilities.  (And that’s not easy). How open are they willing to be with each other and with me? What openness can they tolerate? What would be sadistic to reveal? In contrast, what serves intimacy if held back?

I want to know if they honestly feel their actions reflect their claimed values and self-assigned status. And when their actions don’t, how they account for that. 

Central to the working with couples is understanding what they expect and demand from each other. How well do they understand the roles they cast for themselves and their intimate companion? Do they adequately fit the part? Have they thought this through?  Consider the dramatic difficulty when actors are poorly cast for the parts played: frustrations, disappointments, and conflicts poorly staged. It is rarely a satisfying performance.

My life as a psychoanalyst has taught me the flexible policy of valuing the significance of what a person communicates over their manner of communication. I’m not primarily interested in helping couples communicate better. I might try to be helpful there but it’s a secondary concern. For the moment, I’ll not say more about improving communication but mention why I use the term “policy”.  Policies are principles we follow until or unless we have reason enough not to. Policies are not laws to insistently follow, come hell or high water. The “unless clauses” are important. We improvise with the exceptions.  It is a mistake to approach most things with rigid insistence. It’s akin to rolling with the punches, especially when punching above your weight. Rigidity fractures. That’s the first mistake to avoid. Don’t treat your favorite theories and therapeutic rituals as the gospel truth, written in stone. Don’t assume you have it sufficiently figured out. That’s above your weight. This goes for personal aspirations and claimed values, too. After I’ve made a carefully composed interpretation, clients often tell me “yes, but it’s more than that….” They sense my perspective is too narrow to capture their circumstance, and what it means to them. In a manner of speaking, “it is always more than that”. Even when working with the facts at hand, we never have them all. And even working off the same page, we find our perspectives differ on meanings and significance. 

The fundamental mistake, akin to failures in empathy, involves the competence to accurately recognize the varied perspectives that fit any circumstance and the ones that practically speaking, aren’t serviceable; ones that don’t fit or might, but not very well.

Perspective on perspective is key. This brings up another reminder:

The second mistake is to go it alone. We need a peer to talk through our work. A trusted and competent companion who knows us well; knows where the bodies are buried. This is mutual. We accurately recognize each other. We’ve revealed and demonstrated our vulnerabilities, strengths, and shticks. You need someone like this your entire career. Someone who can challenge your perspective. This is not the evaluating supervisor of your training years. This is the person you can talk over your work, have a drink with, and write it off on Schedule C.   

Keep these themes in mind as I proceed.  In some ways it can be summed in the wisdom of those great moral thinkers, Donald Rumsfeld and Sarah Palin. His, “You go to war with the armies you have” and her refrain, “how’s that working for you?”  We should appreciate what happens to treatment plans in the fog of a couple’s war. 

“The fog of war” is a segue to some practical realities:  The dilemmas of the therapist’s actual status in their client’s world –– and the therapist’s and client’s actual values. The values that actually influence what transpires. Since I’ve already given reference to the IRS, I’ll employ the image of keeping “Two Sets of Books”.  One open to inspection; one hidden from view. Your clients have them and you do, too.

I liken couple’s therapy – for that matter – all psychotherapy, consultations, and supervisions, as improvisations that hinge on negotiation in the form of a moral dialogue. What I mean by moral dialogue involves good faith attempts to be open and clear about our actual values in play, how we actually appraise each other, and given those appraisals, what we are prepared to take seriously. Unless the partners and work are taken seriously, nothing much is likely to change.  And, unless they have an accurate understanding of what the other is really up to, whatever they take seriously is likely run aground. 

So, I have mentioned two connected themes: The revealed values we take seriously and how seriously we take each other. The therapist-couple triangle involves both. Both require attempting authenticity and mutual, accurate understanding. 

Let’s turn to the cast of players:

For the therapist: How well-cast is the therapist for their role with this particular couple?  I run clinical seminars with doctoral trainees where we focus on supervisions and case formulation.  There’s a common group of mistakes made when the supervisee, correctly or not, believes the supervisor expects them to speak in the supervisor’s voice –– a voice more seasoned, older, differently gendered, what have you –– than the one the trainee can get away with.  (I’m not sure that the actual supervisor felt their trainee should talk like them, but the trainee didn’t feel free to explore how it would work in their voice). 

Here the distinction between implementation and significance matters. We want trainees to speak authentically in their voice. When supervising, we may have a game plan in mind, we believe we know what we’d like to see accomplished, but we might not give the trainee the breathing space to think about how the therapeutic goal can be implemented many ways (if it can at all). To have a chance at being successful they’ll need to do it their way. The improvisational therapeutic drama is “character driven”. One size does not fit all. I’ll say more about this shortly. 

Couple therapists interpret, coach, and serve as referee.  They need to be credible playing those parts.

Here’s an image or memory.  Perhaps yours. It is certainly one of mine. I teach students in their mid-twenties. Imagine you’re that age: mid-twenties, single, no kids, no mortgage, just massive student debt. You find yourself facing a late middle-aged couple, your parent’s age, empty nesters but with financially dependent children, struggling with decades of resentment and commitment, facing a just revealed and maybe repeated infidelity.  And they find themselves with you.  Or, consider the issues of supervising this young therapist. 

As they do their jobs, I want supervisees, all of us really, to have these questions close at hand. 

1. What do I evoke in this couple and what do they evoke in me? What versions of this are being played out now?

2. Given my obvious personal characteristics, what are they likely to think I am eligible to do and able to accomplish? When I talk, will I be taken seriously, or will I be dismissed?  (Two more policies: Don’t fake authority and avoid giving advice. Rely more on variations of “help me understand?” Ask for clarity, ask how they understand what the other is saying. Young and old are eligible to ask for clarity, and to indicate how they understand what is offered.)

3. Given my less obvious personal characteristics, what will take more time and effort to demonstrate or establish?

4. What about myself do I need or appear to need validated? (Here, the counter-transferences can intrude).

5. Are the circumstances of the work validating or degrading for each individual? Am I sitting with volunteers, or is participation mandated, forced, or coerced by one or the other of the couple? Coerced relationships invite resistance, insolence, and resigned compliance. And some people are practiced at shining you on.

It is a mistake not to remain alert to these questions.  Always important:

6. What am I unable to hear or address? Does my defensiveness or intolerance look like dismissal, avoidance, or disgust? Is my defensiveness or intolerance degrading and invalidating?


Let’s move from the status dynamics of the therapist and couple, to the psychodynamics, the defensive insistence and avoidance, of each player.  

For the couple

Some basic questions: Who are they to each other? What do they actually know and value about themselves and each other? What are they willing to reveal? What are they able and disposed to change? What perspective do they have on aspiration and what can realistically be accomplished? 

Fundamentally: Given their promises and attempts to change, do they act with good faith? What gets in their way? To illustrate I’ll employ the image of “Two Sets of Books”.

Here’s the “two sets of books”. (Therapists have them, too. That’s why we need an intensive personal analysis and on-going supervision. We need to know ourselves from multiple perspectives.)

The two books I have in mind is the one easily opened, and the other, a hidden volume we are reluctant of reveal to ourselves or anyone else.  The second book presents thorny problems for the couple’s therapist. Negotiating in the manner of moral dialogue involves showing the cards in your hand, none deliberately up your sleeve. Nonetheless, in real play, some are often defensively hidden. These are wild cards that can throw everyone for a loop. You suspect them when something unexpected is triggered. More is at stake than meets the eye.

Let’s look at the first book.  The one opened on front stage. Here, we become acquainted with what each person finds relevant and tolerable to reveal: we learn obvious details, motivations, and props; the first approximation why the couple has come to see us. 

In early meetings, it can be difficult to sort out realistic aspirations from those not in the cards. Individual meetings might fill the gaps. But good luck, even then. And here’s where your peer-supervisor can help sort out yours.

In the open first book, the first act is played. The open book is composed of what our clients are aware of, can think through, and, at least in their own minds, are able to consider. In this first volume there is likely an index the players are reluctant or refuse to disclose. They know they are holding back. They conceal or lie out of self-interest. Perhaps they’ll talk to somebody about these chapters, but not in front of their significant other. The content might never be revealed, it might never feel safe enough.  Offering a few individual sessions might help. It might help to provide an opportunity to more privately confront the question of what might be relevant but not safe to reveal.

Let me say a bit about insistence.  Some personal issues are insistently hidden, while others, revealed or not, are held dear.  All motivational values are not of equal weight. In the first book are flexible priorities open to negotiation, along with those held tight, believed fundamental and intrinsic to what we need honored to be us: where our personal identity, our sense of integrity is always on the line for us to respect our image in the mirror. Tread lightly here.To the observer-therapist, the need to maintain the integrity of these priorities can evidence both sound and/or neurotic character: admirable or problematically narcissistic. 

It’s the therapist-couple’s negotiation with this first text that most of our work is done.  Mistakes are made when this content is not adequately assessed. Beyond therapist errors, when important lies are maintained, or worse, gas lighted, the work suffers without much the therapist can do. The first book might be open, but it requires an “I to Thou” empathy to be edited, revised, and understood.

And then there’s the second book. Because of the second book, the hidden ledger, mistakes, difficult to diagnose and remedy, occur. This is the content we reluctantly know, but try, best we can, to conceal and avoid. This is the domain of reluctance. In his psychoanalytic classic, Free Association, Anton Kris identified reluctance as a dynamic motivational category conceptually apart from real unconscious resistance –– reluctance is not unconscious repression but active suppression.  Our unconscious motivations cannot be reached in ordinary introspection. The stuff we are reluctant to think about can, but mostly isn’t. (In couple’s therapy, good luck ever confronting and working through unconscious resistance unless you’ve got years to play with.)

To maintain self-esteem, to keep face, people hide what they can’t tolerate, manage, or allow others to judge. One way or another, like it or not, our significant others are judgmental. They have the status to affirm or degrade our worth. With those from whom we need love, we can be unwilling to reveal these reluctances, this stuff we self-condemn and approach with fearful vulnerability.

This reluctance produces denial, conscious self-deception, and bad faith. Its content is filled with under-examined, immature, and under-socialized motivations. This is the stuff that bollixes self-regulation and intimate social engagement. Hidden and only reluctantly considered, it is not adequately practiced and exercised in ways that enhance competence. Some of these issues are acquired when we were very young, as family members under the sway of our particular parents. Never adequately mastered, they leave the impression of unresolved childish concerns. Regardless how they are acquired, these are trigger points. What we are unable or refuse to adequately consider, haunted, we tend to continue to engage with incompetence.

Some summary thoughts and an example more aptly explored in individual sessions:  

I’ve sat with people who tell me they don’t understand their transgressions because they take themselves to have a “strong moral compass.” It should be no surprise that the subject is sex. (If not sex, it tends to involve money or violence.) When caught, they act bewildered, maybe panicked, and claim their action was out-of-character, a result of seduction or coercive pressure. Except for those truly coerced, they give lip service to ideals they say guide them while not acknowledging what they’ll do when sufficiently tempted. And when the offense is repeated, they act bewildered that it has happened again.

Some claim they don’t want out of their marriage, that they love their spouse and family. I believe them. Some feel distress only when caught and tend not to feel much guilt even when sheepishly they say they should. Others become preoccupied, fear loss, and are afraid of destroying their families and hurting their spouses. Often enough, they deny understanding how they got involved in this in the first place. I’m not talking about the people who betray their vows, want to get away with it, and know damn well if sufficient opportunity occurs that they’ll go for it. They are not fooling themselves even if they make excuses or claim innocence. They know they are lying.

Here I am interested in self-deceptive people who don’t know they’re lying to themselves about their role. They’ve “two sets of books,”.  I may even tell them that. One ledger filled with the ideals they say count heavily, their “moral compass,” and the second, hidden from inspection, opened only reluctantly but carrying greater motivational weight.

The hidden ledger contains intentions that are denied but nonetheless remain in play. These motivations can’t be self-acknowledged without unmanageable guilt, anxiety, or shame. With sufficient temptation, these motivations become a loose cannon, not secured by other considerations.

All this is made worse when their actual deliberative powers are diminished; “it was the alcohol speaking.” Protesting they weren’t looking for it, they won’t admit their disposition to notice transgressive opportunity and an aptitude to find it. Acting from denied motives, it’s
unsurprising if the outcome is bungled and unfortunate.

Versions of this common drama are presented as out-of-character by the perpetrator but given enough time they seem in-character to the audience. Their significant other might see a pattern denied.

The “return of the repressed”, the repetition compulsions, the “I don’t know what got into me” and “the devil made me do it”, establish a through-line of trouble. If truly unconscious, almost never resolved. But it is a mistake to assume these motives looking for opportunity are actually unconscious; and not themes, problematic through-lines of discord, that if the therapist offers sufficient safely, empathy, and careful judgment – and gets the timing right – might be negotiated. Some awful, shameful motivations are just that, and need to be renounced. But sometimes they look a bit more like the proper way to load the dishwasher.

Given the power of the hidden motivationally significant second ledger, sometimes only individual therapy will bring it to light. Then the thorny dilemma: what to do about that. Can it be brought back to the couple’s session? What to do if it can’t? Some secrets can be worked around, some are or should be deal breakers. Here is another judgment the therapist cannot properly escape. 

This takes me back to peer-supervision. Therapists need to be very self-aware of what they find troubling to acknowledge, their own triggers and avoidances.  They need to recognize what compromises they will accept and when they are engaging in unacceptable collusion. Nonetheless, we need to be paradigms of tolerance. Our self-awareness and tolerances are foundational therapeutic competences, and our fiduciary responsibility. To cook, we’ve got to stand the heat. To do our jobs, we need to appreciate how we look as referee, coach, facilitator, confessor, normalizer. This is very hard without a trusted partner in crime.  Someone we share both sets of books. Someone who knows us well, someone empathically willing to call us out. And then hoist a beer to our failure and success.