Illness in the Analyst and its Impact on ths Psychoanalytic Process

Click Here to Read: Illness in the Analyst and its Impact on ths Psychoanalytic Process by Jacob Arlow.

 Introduction by Sheldon Goodman to Jacob Arlow’s Illness And Its impact On The Psychoanalyst Process
                      
               Most discussions of illness in the analyst during the course of psychotherpay or psychoanalysis emphasize the effect of the analyst’s illness on the patient, it’s relationaship to the transference and how the analyst manages it. Less frequently pondered is the reaction of the analyst to their illness and how it affects their conduct in the ensuing sessions. A point I would like to attend to is the role of denial. To accomplish this I would like to share with our readers Jack’s sharing with me how proximity to death he experienced while speaking with his wife on the phone.  He lost consciousness and fell to the floor. He had become subjest to a coronary episode. In retrospect he related to me the effect of the illness on his therapeutic technique. There was a definite tendency to repress or disregard the most subtle reminders in the patient’s material on his recent illness. He stated he had to constanly remind himself that he may not be paying sufficient attention to the subtle hints in the patient’s material concerning his illness.  He felt he rationalized to himself as he became aware of it that he did not wish to interfere with the progress of the treatment. It was an unwelcome intrusion of reality but he came to realize that the patient’s transference were confused with the here and now realities of the situation, a reality that he did not wish to be reminded of. He realized that he looked upon the illness as an unwelcome intrusion into his therapeutic work and, on investigation, realized that the illness had been an asssault upon his imperturbable professional stance– illusions of omnipotence that the analytic situation readily imposes in the analyst.  For example, he noted how reluctant he was to answer his patient’s direct questions about the illness and used the technical precept about transference to avoid direct confrontation with the reality of his illness. On the other hand he suggested , one could withold information with the rationalization that it would skew the flow of associations. He emphasized to me that one of the most important things is that compounding the all too real medical problems for any practicing clinician who becomes a patient is the diffulty in balancing the demands of one’s own medical problems with the simultaneous need to take careof others, i.e., one’e own patients. These two roles can conflict with each other. To steer a course between the rockof one’s own physical and psychological needs at a time of severe stress and the hard place of well developed superego and ego ideal demands can substantially add to the burden of illness in the analyst.
                   As analyst’s an effort to be anonymous is supposed to allow the patient greater freedom to associate, the opposite is often the case.  Far from diminishing the analyst’s presence, a stance of non self disclosure tends to place the analyst center stage. It makes the analyst into a mystery and paves the way for regarding the analyst as an omniscient sphinx whose ways cannot be known and whose authority, therefore cannot be questioned. It is also crucial as has been often stated that it is inevitable that the patient ses more that the analyst thinks they are showing. Whatever is there will be registered in some form or another, and its unprocessed aspect will be enacted. The ideal of the anonymous analyst is a myth.
                  There are no easy solutions to these problems of truth and its consequences.We must begin to talk more openly and honestly about these troubling issues. As Maimonides has said ” Ease destroys bravery while trouble creates strngth.”  I have felt privileged to take part in this discussion. I thank you for your attention and am eager to hear your comments.
Sheldon M. Goodman, Ph.D.

 

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One Comment on “Illness in the Analyst and its Impact on ths Psychoanalytic Process”

  1. nathan szajnberg, MD Says:

    Let’s keep thinking on this. Let’s for the moment consider another stance: that if we consider the UCs as timeless, and hope an ingredient that catalyzes treatment (hope carrying a sense of future), then keeping as much of one’s illness outside the therapeutic frame also keeps an atmosphere of timelessness and hopefulness. There is a balance or complemental series that may vary with patients: giving the basic facts (especially about a terminal illness), yet not sweeping unnecessary debris in the path of the patents work. One could even express that: how to balance the patient’s need for feeling his or her Ucs timelessness and the hope for the future, with the necessary reality testing about the analyst’s mortality. This might even be the case when we are nowhere near death, but simply aging: an analysand who worked in adolescence through young adulthood and now returns as mother of three, worries that my grey and wrinkles put a time limit on her returning work. This becomes a part of her very specific work, even as there is truth to this also.

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