Article: ‘Ontological Psychoanalysis or “What do you want to be when you grow up?”‘ by Thomas Ogden (2019)

In his 2019 paper, ‘Ontological Psychoanalysis or “What do you want to be when you grow up?”‘, Thomas Ogden describes two dimensions of psychoanalysis: epistemological psychoanalysis and ontological analysis. He is careful to point out that these dimensions frequently overlap, and neither ever exists in pure form, but that they do nevertheless involve quite different modes of therapeutic action. Epistemological psychoanalysis, as practiced by Freud and Klein, has to do with knowing and understanding; while ontological psychoanalysis, in Winnicott’s or Bion’s hands, is more concerned with being and becoming. The titular question, ‘What do you want to be when you grow up?’ is the key (but probably often implicit) question posed by the ontological analyst, and Ogden implies that the analysis is only approaching its goal once the patient is able to answer the question truthfully and wholeheartedly: ‘Myself’.

Though he never states it explicitly Ogden leans very heavily towards the ontological analysis side, which we infer from his wonderful descriptions of the ‘playing’ that both analyst and patient engage in. This conception of ‘playing’ Ogden gets from Winnicott, who describes it as a transitional experience, somewhere between fantasy and reality, whereby the child/patient and mother/analyst engage in an interaction in which it would make no sense for the mother/analyst to ask of the child/patient: ‘Did you conceive of this object or was it presented to you?’. Ogden suggests that therapeutic healing happens when the patient and analyst are able to play together from within the patient’s transference-countertransference enactments.

This is a very appealing idea, and Ogden describes some beautifully sensitive clinical cases to elucidate what he means by this joint form of playing within the analytic sessions.

I also loved Ogden’s description of the end goal of psychoanalytic therapy, what sounds to me like ideal psychological health:

“…for Winnicott and Bion, the most fundamental human need is that of being and becoming more fully oneself, which to my mind, involves becoming more fully present and alive to one’s thoughts, feelings and bodily states; becoming better able to sense one’s own unique creative potentials and finding forms in which to develop them; feeling that one is speaking one’s own ideas with a voice of one’s own; becoming a larger person (perhaps more generous, more compassionate, more loving, more open) in one’s relationships with others; developing more fully a humane and just value system and set of ethical standards; and so on.”

But I couldn’t help having the nagging thought that such a strong emphasis on ‘being and becoming more fully oneself’ might resonate more with Western audiences with their freedom- and self-actualisation-oriented moral compasses than other groups, and that it might be missing something as a result.

Listening to Distress

In his paper ‘Managing distress over time in psychotherapy: guiding the client in and through intense emotional work,’ Peter Muntigl (2020) explores how difficult it can be to respond well to clients’ disclosures of distress in therapy, but he focuses on the distress as experienced by the client, rather than what reactions this might provoke in the therapist. It assumes that the therapist is perfectly able to listen openly and evenly to the client’s distress, without having any subjective responses to it that might interfere with the therapeutic process. This is imagining the ‘ideal’ therapist; unfortunately, most therapists practicing today are far from this ideal – they are human, after all. Of course it goes without saying that it’s the psychological well-being of the client that takes priority in the therapeutic encounter, but I don’t think that goal will be reached if we ignore the challenges that face the therapist. If we don’t prepare ourselves for these challenges, we will be poor therapists! A study by Da Silva & Carvalho (2016) found that intense emotions experienced by medical clinicians while in the presence of their patients impacted the physical-patient relationship, so this is surely the case with mental health professionals (but I can’t seem to find the research outside of psychoanalytic case studies?).

The two difficulties identified by Muntigl are 1) The difficulty that therapists may have in responding to the client’s past or present feelings in an appropriately congruent manner – the therapist’s responses may not necessarily fit with client’s understandings of their distress. And 2) The therapist having to manage distress as it is occurs on potentially two levels: as it is reported (when the client tells of a distressing experience that happened in the past), and as it is expressed in the present (e.g. the client crying whilst telling of this past experience) – this 2nd difficulty being, should the therapist attend to the presently felt distress, or explore what the past feelings of distress meant?

But I think more needs to be said about the first challenge that Muntigl identifies. He describes the difficulty that confronts the therapist as being, how to respond accurately to the client’s distress? How to find a way to validate their distress without seeming to confirm the helplessness that the distress might also signify for the client? “Therapists may sometimes need to individualize their response to best suit their client and to know when empathy is called for and when it is not” (pg. 2). And he writes of a related issue being: “The difficulty for therapists … to offer clients enough security through which they may risk more directly confronting their upsetting experience” (3). But while he describes the conversational tight-rope the therapist must tread in avoiding provoking the client’s displeasure or disagreement, we never hear about the countertransference responses that may or may not be occurring in the therapist. What internal conflicts might the therapist be dealing with as they listen to their patients distress? We must not pretend that these don’t exist, even in the best therapists who have been through years of intensive psychotherapy themselves.

I would be interested to read about how clinicians remain open to listening to reports and expressions of distress. We all know it’s hard to listen to someone telling us about a difficult experience – it provokes all kinds of reactions in us, both empathetic ones and those that are less so. I’m guessing, or hoping at least, that most therapists go into the profession because they want to support a patient’s healing process. So that initial motivation should be there, but that doesn’t necessarily make it easier to do so…

Has anyone read any good research on this subject? Nancy McWilliams, in her book Psychoanalytic Diagnosis, writes of the various countertransference feelings that frequently arise in response to different presenting problems (e.g. clients with narcissism provoking feelings of boredom or frustration in their therapists), but I would love to read further on how exactly therapists overcome these countertransference reactions…

I’m guessing that alongside having had your own intensive psychotherapy, another answer to this question might be having regular supervision – a place where you yourself can go to ‘off-load’. But I think other, micro things must be going on in the therapists’ minds to regulate these difficult countertransference reactions, and I would love to know more about them!


Da Silva, J. V., & Carvalho, I. (2016). Physicians experiencing intense emotions while seeing their patients: what happens?. The Permanente Journal20(3).

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press.

Muntigl, P. (2020). Managing distress over time in psychotherapy: guiding the client in and through intense emotional work. Frontiers in psychology10, 3052.

Schopenhauer’s Porcupines – by Deborah Anna Luepnitz

For anyone wanting to understand how psychoanalytic psychotherapy works from within the consulting room, this book is brilliant. Whilst telling the intimate and detailed stories of work with her patients (who have all consented to her doing so, of course), Dr Luepnitz also draws on and elucidates complex psychoanalytic concepts from Winnicott, Freud, and Lacan, without it feeling tacked on or dryly pedagogical.

It is quite clear that these concepts are no longer cloistered within psychoanalytic circles. I am sure that most experienced practitioners, of all psychotherapeutic types, are fully aware of and sensitive to the ‘transference’, ‘splitting’, and ‘projective identification’ dynamics (to name a few…) that arise in their therapeutic work.

But what I think makes this book so special is how it demonstrates how psychoanalytic work not only brought to light and labelled these processes, but how the bulk of its therapeutic power lies in directly working with and through those processes as they arise within the therapeutic encounter. Dr Luepnitz guides us through not only what happened in her work with her patients, but also gives us the most admirable and diligent example of self-reflexivity by the therapist. Nothing she felt, said, or did, with her clients was left un-considered. And we see in each example, especially, how precisely that care and thought that she gave these experiences was what lead to the therapeutic ‘breakthrough’ and resulted in significant benefit to the patient.

For an example, with a Black female patient called Pearl, Dr Luepnitz finds herself wanting to break her policy of requiring patients to pay for missed sessions, with the thought: ‘How can I charge this poor black woman?’, but with reflection she then realises that this was more of a counter-transference problem on her behalf, a ‘simple rescue fantasy,’ and not one that she should act on, for the mutual benefit of both parties. I will quote at length now, as I don’t think these dilemmas could be worded more clearly:

‘As we have seen in other cases, a “resistance” to making the unconscious conscious belongs to the therapist as well as to the patient. For both, there is a yes and a no, always. I saw my not charging Pearl as a bit of resistance to doing the work. That is, sensing that Pearl was expressing anger or resentment through her no-shows, I nonetheless chose to let them pass, rather than invite her criticism. It was an act of self-protection. […] All therapists at some moment with every patient construct a kind of protective lining to shield themselves from what is going on in the patient’s head. One wants to know and yet also does not want to know… Unique to psychoanalytic training is the emphasis on disciplining oneself to face rather than disavow one’s resistances.’  (193-194)

Undoubtedly, and as she herself admits at the beginning, the limitation to this case-study approach is that she’s only describing the ‘positive cases’. It is unlikely that someone who got no benefit from her treatment and had a terrible experience would then agree to her publishing the details of their analysis. So, this book doesn’t go any way in proving or even supporting the idea that psychoanalytic psychotherapy is better or worse than any other kind. But I think we all have much to learn by seeing such honest and detailed therapeutic work between such a remarkable analyst and her equally remarkable patients.

Working towards What?

Do you know what your goals are? And if so, are you certain that if you achieved them you would be happier, or more satisfied, than you are now?

I think many of us might answer negatively to at least one of those questions, and I’m surprised that CBT thinks that most of us know what our goals are, but that we just have difficulty working towards them.

I’m closer to thinking that most of us would be able to work towards goals that we have identified that are meaningful to us (they would be inherently aligned with us and therefore more likely to be motivating), but our difficulty is more often rather in identifying what is important to us.

So while CBT sounds like it’s a therapy that believes in the agency of the individual, I think more exploratory approaches like psychoanalysis or psychodynamic approaches have more faith in the individual’s agency to achieve their goals.
CBT assumes that we know what our goals are, just need help achieving them with a boost of willpower.
Psychoanalysis assumes that we are pretty good at going after what we want, but we often need help clarifying and unearthing those ‘truer’ or more authentic values and goals.

What sparked this thought was a guilty feeling, because I have recently started twice-weekly psychoanalysis, whilst clinician-me delivers six 30-minute sessions of Low Intensity CBT to clients suffering from similar (if not far more debilitating) mental health difficulties than patient-me. I know that if I switched roles, if I approached myself as PWP, and was told by PWP me to identify ‘Goals’ to work towards across 6 weeks in ‘therapy’, I’d be stumped. It would be totally meaningless, and potentially even distressing. What I am beginning to identify – slowly, tentatively – in psychoanalysis, is that sometimes seeking and going after goals is a blind race towards, or perhaps more accurately away from, something else as-yet-unidentified. And we don’t necessarily know what we should be striving towards or moving away from until we have stopped for a moment to reflect, and I don’t mean for a matter of moments or even days, but a stretched-out kind of reflection that happens best in the presence of a non-judgemental other. I think I am learning that healing (sometimes) can come from a moment of pause, or stillness, where for a couple of times a week you don’t need to press forward towards an unending improvement.

Admittedly, this will not apply to everyone. Despite my belief to the contrary, many of my clients say that they have found our sessions helpful and they even seem to ‘recover’ as according to the PHQ-9 and GAD-7. So, clearly, the approach taken by psychoanalysis as opposite to CBT is not for everyone, sometimes we do just need that boost of motivation, or a few handy techniques for stopping worrying so much. But maybe it’s a question then of time of life, sometimes we need CBT goal-oriented help, and at other times we need just a space to think and speak.

Book Review: ‘The Adolescent Psyche’ by Richard Frankel

This book is filled with wisdom, and I think it would be helpful for any mental health professional working with adolescents (regardless of their preferred brand of therapeutic approach) so I’ll attempt to summarise its main points:

The Freudian psychoanalysts were wrong to treat adolescence as primarily a return to infantile id drives/impulses (only with different conflicts against a more strongly developed superego), and instead it should be seen on its own terms, as a distinct developmental period. We should take the transformations of puberty and the tumultuousness of the experience as meaningful in itself, and with its own progressive functions (telos), rather than as some kind of a backward step. And to do this we should use a phenomenological approach, staying close to the actual experiences of adolescents, rather than theoretically hypothesising what we think is happening…

The best starting point for understanding adolescence is seeing it as time of paradox and conflict – the adolescent is pulled in both ways at once: back towards its childhood, but also towards adulthood and the wider social world (beyond the family unit). This paradoxical position, or point of tension, defines what it is like to be an adolescent. Adolescents are both a child and an adult at once, and they are constantly negotiating between the archetypes representing these: the puer (youth) and the senex (older adult). What I think Frankel takes from Donald Winnicott is also the idea that the boldness and bravery of adolescence is something society needs as a creative and refreshing force; we should appreciate their ‘fierce and stubborn morality’ and their way of refusing ‘false solutions’. Winnicott wrote somewhere that ‘Infinite potential is youth’s precious and fleeting possession’. What typically society tends to dislike about adolescence is something that we should rather appreciate and value in itself – ‘Could we imagine that the instinctual turmoil of adolescence creates a special sensitivity and receptivity to the world and that this can manifest in the pleasure with which ideas are entertained, engaged and undertaken?’ (98)

Adolescents in our era have a particularly difficult time also because there are no, or few, community-organised initiatory rites designed to mark the transition period. Primitive societies usually did have some kind of ritual/initiation designed to mark the young person’s entry into the adult world, which meant that it could be a fairly quick and organised process. Frankel quotes Michael Ventura here: ‘Tribal adults didn’t run from this moment in their children as we do; they celebrated it. They would assault their adolescents with, quite literally, holy terror: rituals that had been kept secret from the young till that moment – rituals that focused upon the young all the light and darkness of their tribe’s collective psyche, all its sense of mystery, all its questions, and all the stories told both to contain and answer those questions’ (69). Because these initiatory rites are an ‘archetypal human need’, our adolescents can’t just skip them, but rather must invent a kind of replacement for these community-organised ones on their own, and evidence of their attempts can be seen in youth gang culture, self-mutilation, substance-abuse, and impulsive/risky sexual behaviour.

Frankel offers Jung’s insights as more helpful and relevant to working with adolescents than Freud’s, primarily because Jung sees the self as a ‘self-regulating system’ (5), in contrast to Freud’s Id which is always in need of externally-imposed prohibitory forces. If parents and clinicians of adolescents remember that the best way to stop someone – particularly an adolescent – doing something unhelpful is to speak to with their own ‘inhibitory’ sense, and get them to arrive at the desire not to do it themselves (rather than simply acting as that external prohibitory force), then they’ll be better able to help them.

Final point that I want to share is Frankel’s suggestion that art and cultural artefacts should have a much larger role to play in clinical work with adolescents. In connection to the idea that inhibitory forces must be engaged with adolescents having a particularly difficult time, Frankel writes that: ‘The inhibition of action produces imagination. Experiencing an inhibition is feeling into the imaginative pattern that contains the impulse towards action. Engaging an instinctual impulse imaginally, feeling where it is rooted in the body, may reduce the need literally to take action. Thus imagination is one of the most effective tools we have in working with adolescents who are prone to impulsive behaviour.’ (169) In order to connect meaningfully with adolescents, we must be prepared to meet them on their own level, which might not necessarily be the ‘literal’ adult world. We must instead stay empathetically attuned to the deeper meanings in their narratives – and art might provide that fruitful meeting-ground.

Quotes from Freud (Standard Edition, Complete Works, Vol. XXI)

The Future of an Illusion (1927)

‘There are two widespread human characteristics which are responsible for the fact that the regulations of civilization can only be maintained by a certain degree of coercion – namely, that men are not spontaneously fond of work and that arguments are of no avail against their passions.’ (8)

I don’t agree with the above quote, I would counter that human beings are spontaneously fond of meaningful work, and that there are countless examples of men forgoing passion for legitimate reasons.

‘So long as a person’s early years are influenced not only be a sexual inhibition of thought but also by a religious inhibition and by a loyal inhibition derived from this, we cannot really tell what in fact he is like.’ (48)

Civilization and its Discontents (1930)

‘If we want to represent historical sequence in spatial terms we can only do it by juxtaposition in space: the same space cannot have two different contents. Our attempt seems to be an idle game. It has only one justification. It shows us how far we are from mastering the characteristics of mental life by representing them in pictorial terms.’ (71)

^ This quote felt relevant as an argument against the reductionist drive to explain everything in terms of neuroscience! But I’m probably stretching it a little...

‘Happiness, in the reduced sense in which we recognise it at possible, is a problem of the economics of the libido. There is no golden rule which applies to everyone: every man must find out for himself in what particular fashion he can be saved.’ (83)

‘In this respect civilization behaves towards sexuality as a people or a stratum of its population does which has subjected another one to its exploitation.’ (104)

The following two pessimistic quotes I am sorry to say that I think he’s right:

‘In abolishing private property we deprive the human love of aggression of one of its instruments, certainly a strong one, though certainly not the strongest; but we have in no way altered the differences in power and influence which are misused by aggressiveness, nor have we altered anything in its nature. Aggressiveness was not created by property.’ (113).

‘It is always possible to bind together a considerable number of people in love, so long as there are other people left over to receive the manifestations of their aggressiveness.’ (114)

‘And now, I think, the meaning of the evolution of civilization is no longer obscure to us. It must present the struggle between Eros and Death, between the instinct of life and the instinct of destruction, as it works itself out in the human species. This struggle is what all life essentially consists of, and the evolution of civilization may therefore be simply described as the struggle for life of the human species. And it is this battle of the giants that our nurse-maids try to appease with their lullaby about Heaven.’ (122)

‘Just as a planet revolves around a central body as well as rotating on its own axis, so the human individual takes part in the course of development of mankind at the same time as he pursues his own path in life.’ (141)

‘Epistemic Injustice’ in Therapy?

Most of the time I spend scrolling through Twitter is probably time I won’t ever get back, but the other day I ‘overheard’ an interesting conversation between two academics on what one said was psychological therapy’s primary aim: constructing a sense of dignity, and the other academic voicing the opinion that in fact, therapy often risks having the opposite effect. It also introduced me to the work of philosopher José Medina on ‘epistemic injustice’ – which I will write about in another blogpost.

I will quote Nev Jones’s Twitter thread before adding my thoughts:
“I fear I’m still not great at this in Tweet form but let me try. Again very important to my argument is that these are risks, not inevitabilities. (1) when, to quote José Medina, “the epistemic agency of an informant qua informant is…subordinated to that of the inquirer’s” Or, as he continues “at the service of the inquirer’s questions, assessments and interpretations” — in which case there can be no full & equal “epistemic cooperation”. [Here one might discuss at length how this does/doesn’t play out in eg in CBTp-style ‘reality testing’]. Then there is the issue of communicative “reversibility” and “reciprocity” which JM frames as central to equal epistemic exchanges. Reciprocity seems more fundamentally absent from the traditional therapeutic relationship but again a point one could debate at length…JM then underscores the interactional relationship between hermeneutic & testimonial injustices, viz “interpretive gaps are formed & maintained [when] those who are struggling to make sense are persistently not heard & their inchoate attempts at generating new meaning… unanswered”. To continue “because of difficulties in hearing and interpreting certain things — because of hermeneutical I sensitivities — people’s credibility gets undermined. Testimonial and hermeneutical insensitivities [thus] converge and feed each other.” “[Once] hermeneutical gaps are formed…they handicap our communicative lives and are hard to eradicate.” I will stop there and say that said gaps of course emerge at multiple levels of discourse—dyadic exchanges and also the more macro levels of clinical knowledge generation.” (bold font added by me)

I’ve recently started my own therapy, and this was something I felt almost immediately – the quite unsettling one-sidedness of the therapeutic relationship. Nev Jones and José Medina raise the possibility that this inequality might be more damaging than beneficial, if it perpetuates the sense that the patient is ‘at the service of the inquirer’s questions, assessments and interpretations.’

I can think of two things that might reduce the risk of this happening:
1) The therapist should undergo their own in-depth therapy so that they truly understand how it feels to be on the other side of the power structure. Only then can they properly empathise with how their patient might be feeling during this organised, and often expensive, form of self-disclosure.
2) We can think of Jessica Benjamin’s psychoanalytic Recognition Theory (also see her book ‘Beyond Doer and Done To‘) which describes how analyst and analysand can meet and speak as equals joined by the ‘Third’. Benjamin’s work centres around achieving that ‘reciprocity’ that may or may not be present in the therapeutic encounter.

To expand on Benjamin’s theory – she argues that the therapeutic encounter should be understood as dynamic, and with a two-way directionality, both analyst affecting the analysand, and vice versa. One way the analyst could highlight this ‘two-wayness’ would be by telling the analysand how what they are hearing is making them feel. Only when the analysand starts to see themselves as a being who makes an impact on other people’s subjective experiences can they regain the sense of agency that will help them recover. The risk this runs is that the analyst must make sure that they don’t then steer the conversation too much onto their own thoughts and feelings – it should always be based in the intersubjective encounter.

This is related to what I think might be the fundamental hurdle and balancing act implicated in the therapeutic encounter – the therapist must somehow help the patient regain a sense of agency, while at the same time not ‘blame’ them for the problem they came in with in the first place. The therapist needs to communicate: that what happened to you wasn’t your fault, but now you must find the strength and agency towards repairing that ‘damage’. It aligns with an interesting and complex picture of free will and responsibility, that I am yet to understand fully…

Michael Polanyi on the Arts

I have recently become interested in how the scientist-turned-philosopher Michael Polanyi’s understanding of the arts can help us theorize how creating or appreciating the arts has a role to play in clinical psychology, in particular psychoanalytic or psychodynamic approaches.

In his 1958 book Personal Knowledge, as he leads up to a discussion of ‘indwelling’, Polanyi sets forth a theory of the arts. He compares the abstract arts (music, abstract painting), to pure mathematics, describing both as ‘appreciated for the beauty of a set of complex relations embodied in them.’ Like mathematics, music ‘articulates a vast range of relationships for the mere pleasure of understanding them’ (193).

He continues: ‘Laments for the dead and songs of love are likewise formulations of earlier shapeless emotions, which are refashioned and amplified into something new by words and music.’ (194). If the arts give words to ‘shapeless emotions’ which are then ‘refashioned and amplified into something new’, is this not what psychoanalysis is trying to do within the psychoanalytic encounter?

How the arts differ from mathematics or science is that they do not try to map precisely what those underlying formulations are. The scientist is trying to construct a framework which will handle experience on our behalf, while the artist is content to allow that framework to remain such that allows us a ‘contemplative experience’ of those shapeless emotions. At the other extreme is mystic experience, which attempts to ‘dissolve the screen [which separates us from experience], stop our movement through experience […] we cease to handle things and become immersed in them.’ (197). Appreciating artistic works, we are able to contemplate those ‘shapeless emotions’ in a position that is at once immersive and detached:

‘Music, poetry, painting: the arts – whether abstract or representative – are a dwelling in and a breaking out which lie somewhere between science and worship […] Owing to its sensuous content a work of art can affect us far more comprehensively than a mathematical theorem […] Art, like mysticism, breaks through the screen of objectivity and draws on our pre-conceptual capacities of contemplative vision.’ (199).

This intermediate position of the arts reminds me of psychoanalysis as a discipline caught somewhere between a science (as holding universal ‘truths’) and an art (as always coloured by our ‘personal’ or  ‘tacit’ knowledge, that lies beyond the grasp of scientific propositions). And so, if the two share this liminal position, might they both have interesting things to teach each other?

Recovery in ‘Will and Testament’ by Vigdis Hjorth

‘I expected to become psychotic, but I didn’t, so somewhat surprised I got up, looked around, and then I left, what else could I do? It was a clear and sparkling August day, I hadn’t noticed that until now. The air was warm, I hadn’t noticed that before. I walked down Bogstadveien, what else could I do? I was surprisingly calm. It was late summer, the air was warm, the weather lovely, I hadn’t realised that until now, three weeks without analysis lay ahead of me, I turned into another street, what else could I do? I walked past a shop front and saw someone who looked like me in the window, but it couldn’t be me because she looked well. I stopped, retraced my steps and studied myself, a seemingly functioning woman. Could I see myself through her eyes? You’re clever, I said to her, and you don’t look too bad, I said to her. Shouldn’t you be out in the world doing things?’ (120)

This paragraph follows the moment when the narrator, a middle-aged theatre critic called Bergljot, realises that she has come to the end of the psychoanalysis which she is undergoing in the hope of recovering from childhood sexual abuse. The repetition of ‘what else could I do?’ marks an interesting phase of recovery – a kind of exhaustion with her pain. As humans we are designed to recover, to continue, to survive, despite hardship. Our self-preservation instincts kick in, and eventually (most of the time), we find the strength to simply continue, and find again a new kind of normality.

It seems that here, after undergoing an intensive 4x-week therapy, Bergljot was tired with reliving her pain (an aspect of psychoanalysis that has received criticism over the years), and because of this she ends up reaching the point at which she is able to move on. This is related to the idea that we must first accept our pain, confront it face-on, and only in doing so are we able to then move on from it. There are counter-arguments that suggest that in acknowledging our pain we give it too much attention, and run the risk of becoming trapped in it. But I find this situation equally plausible and worth noting, that there is only so much sadness a human can enduring, and in getting it out in the open we at least allow ourselves the opportunity of then exhausting it and ridding ourselves of at least its most debilitating aspects.

Once Bergljot accepts that she won’t be seeing her psychoanalyst that day, she finds a freedom that allows her to notice things she wasn’t able to before therapy. What strikes her is something as mundane as pleasant weather, a ‘clear and sparkling August day’. It seems that psychoanalysis worked precisely by returning to her pain so forcefully, and then once it stops, her mind was free enough to enjoy the world outside of her. It is as though the therapy absorbed all of her trauma, enveloped it so entirely, that once it ended, it took those feelings along with it. The assumption is that if, to the contrary, we avoid difficult feelings, they remain with us, subtly colouring everything we do. I thought that this was a really beautiful and poignant depiction of one aspect of recovery, the realisation that there is a whole world outside of us that does not have to do with our inner turmoil, and that our eyes have been opened to it. Trauma, in its invasive and all-enveloping character, can often overwhelm us, and make other parts of life hard to enjoy. Here, we see the narrator finally open up and start to appreciate life anew.

This book is predominantly about how to both live with and move on from traumatic and painful histories. It is most skilful in showing both how our past experiences inevitably shape us into the people that we are – and so, we are never truly ‘free’ from them – but that also, with time, eventually they become things that we can build on and recover from in creative and positive ways. Just because something forms us does not mean it has to trap us.

The book begins by describing the narrator before this healing process has taken place. At that earlier stage, her past is something that drags her down: ‘it was how I felt, how deep it went, how it pushed me into the abyss, how it weighed me down, how I started to sink’ (15). But through gradual unearthing and understanding, and when the narrator starts to insist that other people in her life join her in confronting these difficult memories, eventually, she is able to incorporate them into her life in productive ways. She describes a growing sense that the dark past must be seen and heard, it must be given space for insight and growth to occur: ‘What I was experiencing, I came to realise once I started to understand my life, was that a moment of insight was approaching like the tremors that precede an earthquake, and like an animal I could sense it before it happened’ (21). This ‘moment of insight’ will not be easy or pain-free, but it does bring with it a brightness and optimism.

Throughout the book the narrator speaks in terms of development, she fears ‘turning into a child again’ and often expresses the wish that she could feel and behave like an adult. Adulthood apparently represents clarity and understanding, while childhood is the dependent, naïve state where we are under the sway of others wishes and desires. This is a useful metaphor with which to think of this developmental growing process that occurs over time, and though it of course doesn’t map so neatly in real life, I think we can all appreciate the feeling that adulthood brings with it agency and independence, and it is this that she is seeking.

Another important contribution to the narrator’s recovery is that precisely with this ‘adult’ agency she starts to take her own wants and needs more seriously, and does not give in to the needs of others at the expense of her own. This is a valuable part of her recovery, her realisation that she must in some way stay true to herself in order to feel better:

‘Jung saw things the way his instinct encouraged him to. If he didn’t his snake would turn on him. I tried to look at things the way my instinct encouraged me to. If I didn’t, my snake would turn on me. My mum and sisters had acted in ways and said things which my snake disagreed with. I travel along the path my snake prescribes, I thought, because it’s good for me.’ (318).

Why Dora?

In 1905 Sigmund Freud wrote his ‘Fragment of an Analysis of Hysteria (Dora)’, as a case study hoping to substantiate his earlier theory of hysterical symptoms and their psychical/sexual basis.

His chosen case study was Dora, who we now know to be Ida Bauer (1882-1945), and his analysis with her lasted a grand total of 3 months before she ended it.

Ida Bauer

Though I want to be a clinical psychologist, not a psychoanalyst, psychoanalytic theory has contributed major insights for all forms of psychotherapy, so of course I had to read Freud. These days people don’t take everything he said very seriously, but some of his insights have seeped thoroughly into the cultural mindset and are pretty much taken for granted. We all know what a ‘Freudian slip’ is, and aren’t too shocked by the idea that people might unwittingly ‘marry their mothers/fathers’.

But when I read this case I was horrified. So much of it felt completely wrong, misguided, and to a truly dangerous extent. I felt overwhelmingly sorry for Dora having to listen to him and having to suffer his arrogant and all-knowing tone, disregarding her account of the events and her experience of her problems so entirely.

Reading the case made me vow to be a better, more open-minded, flexible, clinical psychologist in the future, and make sure that no client is ever treated so badly as Dora was by Freud. The case of Dora is also an example of something else I feel very strongly about – the problem that society seems to have with believing women’s accounts of sexual assault and trauma. I will write a separate post about that issue, but alongside my work as a psychologist I always want to work at improving the situation of sexual assault survivors, and finding ways that we can better listen to their experiences and learn how to help them.

Back to the case.
While there is a lot that is still worthy of interest in the study, i.e. the psychosomatic explanation of her physical symptoms, and his first explanation of transference; I think mainly the study is interesting in a ‘how not to be a psychologist’ way.

Freud was called in by Dora’s father to treat his daughter of her hysterical symptoms. Freud understood Dora’s physical symptoms as stemming from unresolved psychical and sexual trauma, which he first posited as resulting from Dora’s father’s friend (Herr K) declaring his love to Dora and trying to kiss her when she was 14. This was especially traumatic because Dora’s father was having an affair with Herr K’s wife (Frau K), and so Dora’s father joined Herr K in denying that the sexual assault ever happened in the first place, because in supporting Herr K he would himself be allowed to continue his illicit affair with Frau K. Dora’s father essentially chose his new mistress over his daughter.
Hearing this story we are probably likely to agree that his situation would cause Dora some distress, which of course could reveal itself as physical symptoms! (I like the case for how it connects the psychological with the physical). But Freud twists it further and further, unable to let Dora remain ‘innocent’ in the events. He says that she was only negatively affected by the proposition from Herr K because she actually loved him, and was pleased by his advances. Freud writes: ‘That was surely a situation that should have produced a clear sensation of sexual excitement in a fourteen-year-old girl who had never been touched by a man.’ (452).

Oh really!

Because Freud can’t believe that Dora wouldn’t have been sexually excited by Herr K’s advances, he claims that ‘affective reversal’ must have happened, which served to hide her enjoyment of the situation. He goes on to say that Dora was complicit in wanting Herr K’s affection, because she actually had homosexual feelings for Frau K (linked to her wanting to be Frau K and gain her father’s affection), and then even adds himself into the mix and says that Dora had sexual feelings for him too which was why she disagreed with his interpretation of the events and her underlying issues.

Another frustrating part of the case: Freud even has the temerity to write, ‘I shall pass over the details which proved all these hypotheses completely correct…’ and then just expects us to take his word for it.

But, unfortunately, though he seems to me to get all of Dora’s ‘motives’ wrong, I think his suggestion that physical illnesses can sometimes have a psychological motive to be an interesting one. I am not wholly against the idea that at least some of her physical symptoms were cries for help or attention, in a world where no one seemed to be taking her account of the events seriously. No one believed her when she said she wasn’t sexually attracted to Herr K, Frau K, her father, and Freud. Instead they (mainly Freud) fabricated all sorts of elaborate sexual fantasies for her, and made it impossible for her to deny any of them. In that kind of situation it seems to make intuitive sense that she might have developed some kinds of physical ailments which might have been ‘medically unexplained’. If words can’t speak for her, perhaps her body might be able to?

So when Freud writes: ‘illness becomes the only weapon with which she can assert herself in life’ (466), I can’t help but agree with him, but I think he was horribly and painfully clueless about what Dora might have been trying to assert. She clearly found that the case too, and I hope we are now as a world much better at listening to women and taking their trauma stories and physical complaints seriously.