New YouTube Channel
I'll have more to say about the recording of this video later in the week, but for those of your who've been reading me for a while, here I am on camera.
The Development of Mind and Meaning (Part I)
We've all heard people say things like, "I felt completely overwhelmed" or "I just couldn't take it"; they mean that the emotions arising for them in a given situation were more than they could tolerate at that time. In psychodynamic psychotherapy, we often talk about the ability to "contain" feelings, where the mind is thought of as a kind of holder or container for experience. People have differing abilities to contain their emotions: some can continue to think in the presence of powerful feelings while others explode under pressure and "lose their minds." Some of us "over-contain" our feelings, flattening or deadening them, and others get carried away by an emotion and have no capacity for thought or self-reflection. Wilfred Bion, a British psychoanalyst, originally put forward these ideas. Based on his understanding of early mother-infant communications, he elaborated the relationship between the mental container and the contained experience, using it to explain what goes on between client and therapist in the consulting room.
Of Puppies and Parenting
Meet Alice, the latest addition to our family. We picked her up from the breeder when she was only eight weeks and now she's almost three months old. After Maddy died (see my post about grief and the grieving process), we decided not to get another dog until the fall; but some members of the family found the grief and loss so painful that we began looking around for a new pet earlier than planned. A couple of rescue dogs fell through, then we found an ad for a litter of white labs from a breeder two hours away; five days later, we were driving home with little Alice.
The experience of having another small creature to take care of -- the joys as well as the sacrifice involved -- has taken me back to those times when my kids were very small. In particular, it has reminded me of the sleep deprivation: for the first several weeks, Alice was waking up a 4:30 a.m. I'm an early riser but that hour is extreme, even for me. Though she sleeps later now, the early morning demands have cut into my personal time and I've been feeling a tad resentful.  Taking on Alice has by and large meant giving up hiking this summer, because you can't leave a puppy alone for too long. I think she's adorable but I would rather have waited until the fall to get another dog. I'm tired a lot of the time, trying hard not to to be too grouchy, struggling to make peace with this personal sacrifice for the family good.
The Biological Roots of Basic Shame
In one of my earliest posts on this website, written nearly a year ago, I introduced the concept of "basic shame." Although I often link to that piece in later posts, many site visitors may not have read it. As an introduction to the current post, I invite you to do so now by clicking here.
Yesterday, a reader sent me a link to an article from the New York Times, about "evolutionary psychology" and an interesting theory concerning the possible value of
depression for the survival of our species. I'm not sure about that theory, but the article did set me to thinking in a physiological mode, about the biological roots of shame. I'm not a biologist and I can't support my ideas by reference to hard science, but this theory comports with my clinical experience. It helps me to understand and explain what I've learned about shame in the last 30 years. Bear with me while I take a detour into Freud at his most speculative.
Most people know that Freud wrote about instincts and the importance of the sex drive; other than psychoanalysts or students of Freud, few people know about the transformation of those ideas toward the end of his life. While Freud's model of the mind always involved the idea of conflict, in his later theories, he focused on conflict between what he called the life and death instincts. As a translation of the German Trieb, "instinct" is a problematic word; the idea that there's an "instinct for death" is difficult to grasp; it sounds counter-intuitive. In my view, Freud was talking about two different principles that govern human biology -- one that promotes life and the preservation of the species, evolving toward diversity and larger unities; the other that represents a tendency of things to deteriorate or fall apart, the biological equivalent of entropy. In Beyond the Pleasure Principle (1920), he says that the purpose of the death instinct is to "lead organic life back into the inanimate state."
The Question of Sliding Scale Payment in Psychodynamic Therapy
Due to the number of requests I've received for psychotherapy via telephone or Skype, I've begun to reconsider my decision not to engage in those practices. I haven't made up my mind, but the question has raised the issue of fee setting and how to handle it should I take on new clients. I think there's a lot of confused emotion about payment for psychotherapy services rendered, on the part of both therapists and clients. I'd like to give my view on the subject; my policy is not the standard, nor is it particularly popular, but it's the only one I have found that works for me as a practitioner engaged in emotionally difficult and highly demanding work.
Let's begin with some questions: If your car broke down and you needed it for your commute but couldn't afford the repair, would you ask your mechanic to cut his charges? Would you ask your dentist to reduce her fees if you needed a bridge and paying for it would present a financial hardship? How about your accountant?  Would you ask him or her to work for less than the standard fee because paying full price would wipe out your meager savings? I suspect the answer to all these questions is 'no'. Even if you did ask, you'd likely be told something like, "My fees are in line with the profession," or "I charge what I need to charge in order to cover my own costs." These seem like perfectly reasonable positions; why then do we expect therapists to work on a sliding scale?
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