Living Longer; Practicing How?

Photo: Samuel Eisenstein, M.D.

Before Labor Day, we ran a paper documenting that analysts live longer than other related professions. Click Here to Read: Analyst Living Longer, but How Do We Practice.

But, what about what and how well we practice in these later years? Fisher and Hoffs bring us Samuel Eisenstein’s paper on the aging therapist. Eisenstein, like his colleague Alexander, was a refugee; the first Rumanian, the second Hungarian. They brought wisdom with them that flourished in Los Angeles’ soil.

Here is a short introduction followed by Eisenstein’s reflections.
Nathan Szajnberg, MD, Managing Editor

INTRODUCTION TO SAMUEL EISENSTEIN’S   “THE AGING OF THERAPISTS”

By David James Fisher, Ph.D. and Josh Hoffs, M.D.

     Samuel Eisenstein’s evocative paper, previously published in George L. Pollock’s collection of essays, How Psychiatrists Look at Aging (1992), was written in the late 1980’s or early 1990’s, when the author was in his late seventies.  The Rumanian born Eisenstein (1913-1996) was educated in medicine inItaly during World War II,  undertaking analytic training inItaly after the war.  He was a highly respected figure in the Los Angeles Psychoanalytic community; he served as dean of the Southern California Psychoanalytic Institute (now theNewCenter for Psychoanalysis) from 1969 to1977 and strongly sponsored an innovative initiative by Peter Loewenberg to train academicians in the clinical and theoretical methodology of psychoanalysis.  Eisenstein’s work culminated in the California Research Psychoanalyst Law of 1977, the nation’s most successful arena for humanists engaged in psychoanalytic  training, interdisciplinary scholarship, and practice.  Having inspired the Research Training Program, he inaugurated a unique fellowship fund to help defray the costs of the training analysis.  This fund still exists and carries his name.

     Eisenstein remained very much a European presence in the Los Angelesmilieu.  His style of doing psychoanalysis included a strong identification with Freud, including Freud’s skepticism, as well as an appreciation of the Ego Psychologists who dominated American psychoanalysis from the 1930’s through the 1960’s.  He was creative, ironic, self-deprecating, lovable, suspicious of idealization, while at the same time able to speak to patients and colleagues in a direct, non-jargon ridden fashion—a style of thinking that was common sensical, pragmatic, and clinically grounded.  An adept listener, he was known to say that although understanding the “past”  tends to be dominant in our work, attention to the “present” and the “future” is sometimes more important.  He was skeptical of the trendiness of psychoanalytic theories, especially the enthusiasm that emerged around Kleinian analysis, self psychology, and certain versions of intersubjectivity theory.   Sam was open to serious innovations in theory and technique, continuing to study contemporary perspectives—perhaps as a way of maintaining a sharp mind and of being au courant.  As the readers of this essay on aging will discover, he was naturally “empathic” without privileging that position, oriented toward the feelings of patients and analysts without constructing a theoretical scaffolding around “affect attunement.”

     Eisenstein’s essay “The Aging of therapists” is intentionally impressionistic, written with a light touch.  He makes his points, illustrates them with a brief vignette, then moves on.  It is not written with a strong argument or polemical bent.  It is the work of an introspective clinician who, toward the end of his life, had developed a relaxed and realistic outlook on life.  He recognized the strengths and limitations of analysis, advocating an elasticity of mind and flexible approach on the part of the practitioner.  It contains illuminating self-disclosures and a number of statements of uncertainty, of genuine not knowing.  There are many questions in the piece, more questions than answers (perhaps an aspect of Sam’s Jewish heritage which savors the answering a question with a question).  Possibly the uncertainties point to the need for more rigorous research on the “aging of therapists” given the multiple problems that aging raises, including the narcissistic injury to the older analyst facing decline, retirement, disease, and death.

      It is possible that Sam wrote this paper as a mournful reflection on the loss of youth, while determined to see  the compensatory and adaptive value of reflecting on life experience, and on the quest for wisdom and serenity.    Eisenstein’s recognition of the value of the journey itself regardless of the goal reminds one of the often misread poem by Robert Frost, “The Road Not Taken.” Ultimately the poet and analytic clinician know that it doesn’t matter what road is taken in life, the process itself is to be embraced, including a recognition of the obstacles and losses that will have to be negotiated along the way.

     Eisenstein was an early historian of psychoanalysis, editing a volume of essays (with Franz Alexander and Martin Grotjahn) called Psychoanalytic Pioneers (1966, reprinted 1995), and coauthored a book with Norman Levy and Judd Marmor entitled The Dyadic Transaction(Transaction, 1994); this text was an extended commentary on an analytic case by Franz Alexander witnessed by Eisenstein, Levy, and Marmor through a two way mirror.    It was designed to illustrate the clinical efficacy of the “corrective emotional experience,”  a controversial technique in this era.

Click Here to Read:  The Aging of Therapists by Samuel Eisentstein.

 

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2 Comments on “Living Longer; Practicing How?”

  1. Sherwyn M. Woods, MD, PhD Says:

    This essay demonstrates so well how and why Sam’s teaching and clinical acumen (regarding both self and others) lives on in so many patients and colleagues. Such a wonderful reminder of his importance to psychoanalysis and to our Institute.

  2. William D. Bauer, Ph.D., Ph.D. Says:

    First I would like to thank Jimmy Fisher for bringing this paper to my attention and inviting me to comment. Sam’s “voice” in the paper is loud and clear and I enjoyed hearing it again.

    I was in analysis with Sam Eisenstein between 1988 and 1994: approximately the same years during which Sam wrote the paper under discussion. Though I eventually undertook and completed psychoanalytic training at the Southern California Psychoanalytic Institute, at the time I began treatment with Sam I sought his consultation for personal psychotherapy and not due to an intention to undergo either psychoanalysis or psychoanalytic training.

    Two years prior to consulting Sam, I’d completed postdoctoral fellowship at the University of Rochester School of Medicine. My interests at that time were obviously psychoanalytic, but I was not convinced of the value of psychoanalysis per se over the more focused and briefer forms of psychoanalytic treatment. When consulting with potential analysts I was looking for a psychoanalyst with two qualities: high competence and low dogma.

    In the late 80’s, I was an Associate Professor of Psychology teaching courses in Self Psychology, Personality Theory, Psychodynamic Psychotherapy and Contemporary Psychoanalytic Approaches to treatment. During my consultations to choose an analyst, I assumed I would naturally gravitate towards someone with a more “modern” approach to treatment and that such a person would be more “empathic” and less likely to listen to me through the lens of their pet theory.

    I gathered a list of potential analysts from colleagues and friends and went about seeking consultations with several prominent psychoanalysts in Los Angeles. I had positive impressions of all those I consulted with, but – with the exception of Sam – those I spoke with were all easily identifiable as devotee’s of one school or another. If they didn’t outright declare their identification to a particular school of psychoanalysis, it was evident from their comments to me that they were adherents of a particular analytic group and theory. In other words, most scored high on my “dogma” scale.

    Sam was the only person I met with who had interest and expertise in the form of analytic psychotherapy I was specifically seeking at that time (Short Term Psychoanalytic Psychotherapy) and had collaborated for years with a pioneer in that field (Franz Alexander). Ironically, to many of his colleagues Sam was a “Freudian” while to many “Freudians” Sam’s interest in the “corrective emotional experience” meant he was an analytic heretic. I know that Sam considered himself neither a “Freudian” nor a “heretic”, but an independent and critical thinker who sought and utilized valuable theory and technique wherever it’s pedigree. He valued the same qualities in others.

    Sam stood apart in other important ways: Interpersonally, he had what I can only describe as a spark in his eyes and there seemed to always be the faint trace of a smile in his expression. He listened for long periods of time in silence yet never felt remote or distant. When he did make a brief comment, they were often more in the way of clarifications or casual remarks which had the effect of accelerating my own associations, emotions and memories. I don’t recall Sam ever making a single “triangular” interpretation.

    It is not easy to describe in ordinary terms how it feels to be deeply introduced to one’s own unconscious. Suffice it to say that for me Sam’s listening style created an evocative space and a strong invitation for communication from and to the unconscious. I began to dream profusely and to remember my dreams. Forgotten dreams reappeared in the fabric of my associations within sessions. Long forgotten experiences returned with immediacy and vivid emotions. It seemed that my unconscious mind “knew” I was in a time-and-place-and-with-a-person who was ready and able to hear and speak itself. It was the power of this experience which motivated me to increase the frequency of my sessions and eventually form an intention to do formal analytic training.

    It was while discussing analytic training per se, the issue of Sam’s age was presented for the first time. The topic was introduced by Sam. It never occurred to me that Sam might be “too old” to be my analyst. On the level of transference: during my childhood, two great aunts and my paternal grandparents were very important and generative people in my life. They were all in their late 60’s and early seventies during my early childhood and all but one lived into their mid 90’s. Secondly, I presumed Sam to be in his mid 60’s. I was surprised to learn he was actually in his late 70’s, especially as I’d spotted him jogging around a local park one morning on my drive to work.

    Though Sam assured me he was in good health and “putting very sincere effort and intention into remaining alive”, he reminded me that nature has a way of making it’s own decisions in this regard and that it would be denial to refuse to consider his advanced age. Furthermore – he pointed out – in the interval consumed by application and acceptance for analytic training followed by “starting the clock” on the mandatory 300 hours of analysis after acceptance, it would likely consume the next four years time. We both decided to “risk” it, but Sam took the initiative to inform me that after I began formal training, he intended to sign off on my “required hours” at the earliest possible moment.

    Sam’s explanation was twofold: One part consistent with his concerns about the role of his age in relation to finishing my training requirements, and one part an interesting disclosure of his opinion about the potentially negative effect of formal training upon analytic therapy. In Sam’s view, the overlapping roles and formal requirements of a “training analysis” per se, subtracted from the quality of the analytic experience for the patient by “undermining the natural motivation and rhythm for analysis by counting sessions” and by creating too many opportunities for multiple role relationships with one’s analyst at too early a point in the development of the transference. I appreciated his candor and felt he was taking my needs into account on multiple fronts. We both agreed to “risk” moving forward.

    Not long afterwards, the themes of illness and death did occupy center stage but in unexpected ways. A bright young female candidate at the institute was suddenly taken ill and died shortly thereafter. Her unexpected death was a shock to many and a reminder that it is not only the elderly who can be taken from us suddenly. I can still recall the look of grief and pain on her analysts face at her memorial service: a reminder of the mutuality of “risk” of loss in both the analytic relationship and in all important relationships regardless of the age of the participants.

    Six months later, I was suddenly on the receiving end of acute appendicitis. Since my appendix actually ruptured while being removed the situation escalated from unpleasant nuisance to medical emergency. There was the additional complication of infection which necessitated more than the usual modest incision and an extended stay in the hospital with continuous intravenous antibiotics and pain medication. To my surprise, on my third day in hospital, Sam ambled into the room and stood by my bedside with his usual warm smile. “I’m sorry to be here unannounced but you haven’t been answering your phone” Sam quipped. I was grateful for his visit and his humor and his dedication.

    About a year later, Sam broke his hip when he took a fall off the side of a staircase while introducing Otto Kernberg at a psychoanalytic conference. Any denial I may have allowed myself was gone. I knew the seriousness and mortality risk of a broken hip in a man of Sam’s age and braced myself for the possibility of his death – or more likely – his sudden retirement from practice.

    I spoke with him on the phone during his time in the hospital and he accepted my invitation to return his gesture by visiting him in recovery. There was a kind of strangeness and role reversal of course to sit by his bedside discussing the particulars of his injury and surgery but he seemed to appreciate my interest and concern and I expected the visit was more for my benefit than his. I knew this interruption would take some work to recover from and to re-establish the analytic space we both valued and had taken pains to preserve.

    Happily (and impressively) Sam made a complete recovery and was back in his office within six weeks. In just about the same amount of time, the analytic setting seem to recover for me as well and analysis preceded as before. I have little doubt that just as the setting of a time limit in an analysis can “concentrate” the work, the brush with both my own and Sam’s mortality intensified and concentrated the “work” of my analysis. Another two years of intensive five time per week analysis later, the quality of the sessions began to shift and we discussed plans for termination. We set a date and the analysis came to a “natural” end later in 1994.

    To my dismay, I later learned through colleagues that Sam was having a problem with his voice. I called to inquire about his health and he seemed upbeat but somewhat concerned that it was difficult to find the source of the problem. A few months later, Sam was diagnosed with ALS and began a process of physical decline. As the disease progressed his mind was tragically as clear and sharp as ever within his failing body. During a visit to with him at home Sam knew he was near the end and we said our goodbyes to one another.

    One of the costs for me in working with an older analyst was the knowledge that I could not return to Sam in the future should I need or want to continue my analysis with him and this may be of special importance for some to consider in making their own choice. For me, I hope the benefits of my choice to work with Sam Eisenstein are by now obvious to the reader. His intelligence, vast experience and educated kindness will forever be a source of inspiration and gratitude to me.

    William D. Bauer, Ph.D., Ph.D.
    Encino, CA

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