Jung At Heart

I read an interesting piece in the NY Times last week -- Where Can the Doctor Who’s Guided All the Others Go for Help?. Interesting because of the conclusions about where psychiatrists can go for help themselves. 

I often encounter the assumption among people I know that all therapists have been in therapy. Very few of them know that it is not a requirement in most training programs -- analytic training being the exception -- and in some, it is actually discreetly frowned upon. So for starters it is not reasonable to assume that a given therapist has ever been in therapy himself. And of course there is the question of what constitutes therapy anyway? Is what Paul did with Gina in Season 1 of In Treatment therapy? Is his short time with her in season 2? Is a brief course of solution focused therapy enough for someone who will be dealing day in and day out with the issues and lives of others? All good questions.

One psychiatrist quoted in the column --

“In my situation, it would be difficult to find someone,” Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren’t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.

Surrendering that professional identity to become a patient reverses a kind of natural order. “You can’t be a simple patient,” Dr. Buie said. “Anyone I’d go to, I’ve known.” To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).

There is also the factor of experience. It is one thing if my internist is younger than I; she is closer to the bones of medicine, and with any luck we can get to know each other for years before serious illness requires more intimate contact. It is another thing if my therapist is younger than I.

“It would be a big mistake not to turn to someone,” Dr. Buie went on, “but I might have some trouble going to younger colleagues. It’s hard to understand the issues that come up in the course of a life cycle unless you’ve lived it yourself.”

Interesting to see the assumption that a psychiatrist could only see another psychiatrist. Not someone who is known as an excellent therapist, but a psychiatrist. Though it seems to me an obvious choice to look to someone outside of one's own professional circle in order to bypass this particular obstacle. Yet it is not mentioned in the article as a possibility.

Or an analyst trained in psychoanalysis might choose to see a Jungian. Or a Jungian to see a Freudian or even an Adlerian. Why must the therapist chosen be of the same theoretical persuasion?

Excellence as a therapist is not a function of the degree the therapist practices under. It is a function of talent, devotion, ongoing study and supervision, personal work, personality and a host of other qualities. There is nothing in the training of a psychologist or psychiatrist or any other variety of therapist which leads to one being better than another. That training is the ticket to entry into the field and it is only after entering that the real work of becoming a therapist, in the best and deepest sense of the word, begins. 

Google News Alerts tossed up a link to an interesting book review this morning -- interesting enough that I pre-ordered it from Amazon. The book, Doctoring the Mind by Richard Bentall tackles some of the same issues I ruminate about here. 

Bentall's thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, "fatally flawed". He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover "better" than those from the industrialised world and the aim of the book is broadly to suggest why this might be so.

The reviewer tells us:

The first answer, he suggests, is a greater regard for the role of adverse circumstances in provoking mental illness. If bad things happen to people, this is registered in their bodies' chemistry ("a troubled brain cannot be considered in isolation from the social universe"). The second answer is a concomitant respect for the power of interpersonal relationships to ameliorate these effects. One of the concluding chapters, entitled "The Virtue of Kindness" (the subject of the psychoanalyst Adam Phillips' latest book), asks if psychotherapy can help. The short answer is yes, because a person, unlike a drug, can learn to listen to another's story.

 I have struggled with what it means that we are so willing to accept as gospel theories about mental illness that keep coming up as unsupported by research. The latest example:

New research dismisses the widely held notion that a "depression gene" makes a person facing stressful life events more likely to develop depression.  

In 2003, mental health researchers announced that a genetic variation that affected the body's serotonin levels increased a person's risk for major depression if they endured several emotional events. Yet efforts to repeat and confirm that study's findings have been inconsistent, according to the National Institute of Mental Health.  

Now, scientists reporting in The Journal of the American Medical Association say that genetic variation of the serotonin transporter gene, or 5-HTTLPR, may have no effect on depression risk.  

How is it that we, especially here in the US, are so willing to accept anything that sounds scientific even when it is not supported? Why is it that sounding technical and scientific is enough to override any and all other possibilities? 

Also this morning, following a comment on the IAJS* email group, I read a piece by Marie Louise von Franz -- "C. G. Jung's Rehabilitation of the Feeling Function in Our Civilization".** Those of you who are familiar with the MBTI know that "feeling" in the typological sense does not equate to emotional but is instead about values and is, along with "thinking" a rational function. In her lecture, she said,

"The contemporary Zeitgeist belittles feeling...

I don’t think that we can achieve much if we remain on the level of “reasonable” materialistic thinking—it it not altogether wrong; it is wrong only if we infer “that is it...

I want to reflect on this further, but my intuition tells me this is part of what is at the root of the current sorry state of affairs in mental health. Technical thinking, the dominant thinking mode of modernity, devalues thinking through the feeling function, the kind of thinking that values, for example, what Bentall refers to when he points to the currently undervalued place of listening, via depth psychotherapy, in treating the problems now considered to be "mental illnesses".

* IAJS -- International Association for Jungian Studies

** Jung Journal: Culture and Psyche, Spring 2008, Vol. 2, No. 2, Pages 9–20 , DOI 10.1525/jung.2008.2.2.9

There have been stories here and there about the upcoming DSM V for several months now. The most recent, in the LA Times, takes a somewhat optimistic view --

"Over the next 18 months, psychiatrists will hammer out a draft of the fifth edition of the American Psychiatric Assn.'s Diagnostic and Statistical Manual of Mental Disorders, more commonly called DSM-V. Nowhere have the discussions been more heated, the ramifications most vividly foretold, than here at the organization's annual meeting. 

Some psychiatrists warn that the tome runs the risk of medicalizing the normal range of human behaviors; others vehemently argue that it must be broad enough to guide treatment of those who need it. 

But all agree that the so-called bible of psychiatry is expected to be considerably more nuanced and science-based than the last edition, DSM-IV, published in 1994. 

Brain imaging and other technologies, plus new knowledge on biological and genetic causes of many disorders, have almost guaranteed significant alterations in how many mental afflictions are described."

But this feels exceedingly rosy to me. Especially when there is consideration of adding bitterness, sub-clinical bipolar disorder and other variations of what many, including me, consider to be within the range of normal experience and behavior. And I cannot believe that there is real research evidence to establish these or many of the existing diagnostic categories as anything other than descriptions of clusters of behavior. Because all of the diagnostic categories rely on observer report, not tests or other diagnostic tools, because they simply do not exist. What we have now are lists of symptoms or behaviors -- display 6 out of 10, for example, and you fit the category; 5 and you don't. But that makes no sense. What is the difference between the two such that having slightly more symptoms means you are mentally ill -- and that term is an argument for another day -- and thus appropriate for treatment? Are habits -- like gambling or excessive time online -- really indicative of pathology? And why is making them mental illnesses in the best interests of patients, especially when there is no evidence of etiology for either one?

Steve Diamond and Christopher Lane have been writing on either side of the issue of whether or not bitterness is appropriate for inclusion in the DSM V. Diamond argues

"Bitterness, which I define as a chronic and pervasive state of smoldering resentment, is one of the most destructive and toxic of human emotions. Bitterness is a kind of morbid characterological hostility toward someone, something or toward life itself, resulting from the consistent repression of anger, rage or resentment regarding how one really has or perceives to have been treated. Bitterness is a prolonged, resentful feeling of disempowered and devalued victimization. Embitterment, like resentment and hostility, results from the long-term mismanagement of annoyance, irritation, frustration, anger or rage. Philosopher Friedrich Nietzsche noted that "nothing consumes a man more quickly than the emotion of resentment."

Most mental disorders stem either directly from--or secondarily generate--anger, rage, resentment, hostility or bitterness. This is why I personally applaud the American Psychiatric Association's long overdue recognition of the debilitating and deleterious aspects of Post-Traumatic Embitterment Disorder (see my previous post on "The Trauma of Evil"). There is no question that, if left to fester unconsciously, anger, rage and resentment about having been traumatized become bitterness and hostility, which in turn give rise to self-defeating, sometimes passive-aggressive, destructive, vengeful or even violent behavior. Pathological embitterment is a dangerous state of mind that can and does motivate evil deeds. This attempt to include what I would categorize as another "anger disorder".

 He has written several times now about his view of rage and anger and where they become pathological. And in some ways I see his point, especially vis a vis violent behavior, which he has  discussed earlier. One example can be found here. But the tool of the DSM diagnosis is a very crude one and one which really does not discriminate by degree. And we have seen more disorders become spectrum disorders so that where normal behavior ends and pathological begins becomes more and more difficult to discern. Thus the concerns raised by Lane and others, including me.

Lane asks:

In its discussion of post-traumatic embitterment disorder, the APA may have correctly gauged the mood of the country, but as usual it has ignored or shunted aside most of the explanatory context, to pathologize the individual in all of her or his frustrated grievance.

"They feel the world has treated them unfairly," says Dr. Michael Linden, a German psychiatrist who labeled the behavior. "It's one step more complex than anger. They're angry plus helpless."

Linden estimates that between 1% and 2% of the population is embittered, though he didn't specify whether that percentage increased during or immediately after the Bush years. Perhaps he should. Others reviewing his work note that PTED includes "a high degree of comorbidity [and] diagnostic uncertainty . . . : 66% adjustment disorder, 40% dysthymia, 34% generalized anxiety disorder, 18% social phobia, 18% agoraphobia, and 16% personality disorder."

But adjustment disorder, a highly elastic concept, is itself a capacious term to describe predictable, largely routine responses to stress. Why, then, is the APA discussing the inclusion of a new term that not only overlaps so strongly with existing "disorders," but also has so many obvious, identifiable causes in the world?

My alarm bells go off when understandable behavior -- like bitterness about things like the reversals of fortune many have suffered in the current economic downturn or political bitterness so common in the Bush years -- is made pathological. Because once something can be tagged as mental illness, it no longer has to be taken seriously. Questions like what does it mean that a significant segment of the population feels embittered about the future, already too seldom asked, become even less likely to occur, because it's about an illness, a disease. Whose interests are served by this?

And, as is mentioned in the LA Times piece, we also have the additional problem of conflicts of interest among those serving on the panel writing the DSM.

Let me start this post by saying that I am and have been a great admirer of Elizabeth Edwards since the 2004 campaign. And, while he was in the race, I was a supporter of John Edwards also, because of his willingness to speak for the poor. But something has been nagging at me since the flurry of interviews with Elizabeth has been appearing. And that something crystallized for me when I watched the first part of Charlie Rose's interview with her Thursday night. I did my dissertation on Medea and the Medea complex, which I believe is often in play when a woman feels betrayed. And I believe that there is an element of it in play now with John and Elizabeth Edwards.

What brought this into focus for me was the following:

"I believed we had a marriage in which this could not happen" -- Elizabeth Edwards on Charlie Rose, May 14

So let's look at Elizabeth Edwards' book in light of Medea.

The pattern Medea follows to get her man—the woman who falls in love with the heroic man and gives up her independent life to serve her lover’s life—is a familiar theme among women, To Medea, the promise Jason makes to her in return for her assistance in gaining the Golden Fleece is binding. Medea is a foreigner, from Colchis. In her culture, oaths have the strength of law whereas Jason, the Greek, is from a culture of law. In essence they speak the same words with different meanings. “Medea and Jason are not members of the same speech community; coming from different communities and even different strata of history, it seems likely that they never shared the same assumptions about oaths—hence the impossibility of their successfully swearing an oath together”(Rabinowitz, p. 138).  For her, the sacrifice of her home and family  in exchange for marriage to Jason is binding and permanent and any deviance from it is betrayal of an immeasurable kind. “The oldest doctrine was that oath-breaking was twin to kin murder, these two being initially the only crimes of interest to the pre-Olympian divinities”(Burnett,  p. 13).

"We can be truly betrayed only where we truly trust – by brothers, lovers, wives, husbands, not by enemies, not by strangers. The greater the love and loyalty, the involvement and commitment, the greater the betrayal. Trust has in it the seed of betrayal; the serpent was in the garden from the beginning…Trust and the possibility of betrayal come into the world at the same moment" (Hillman,  p. 66).

The depth of the betrayal is directly related to the importance of the relationship and the degree to which one trusts the other. Medea has told us she believed in, trusted in the integrity and strength of the oaths that she and Jason swore to each other, and having fulfilled her part of the bargain, assumed and expected that Jason would also, not only while it was convenient but for the rest of their lives.

To believe that one can count on another to never hurt or betray or violate trust in any way is naïve and is to live in a bubble of unreality. Primal trust, arising from the relationship between infant and mother, even that trust, gets broken as the mother does not come immediately to soothe the infant or fails to correctly identify the source of difficulty. Development requires betrayal in order to develop tolerance for the frustration of ordinary failures in relationship and the resilience to not only survive but learn from them. “The broken promise is a breakthrough of life in the world of Logos security, where the order of everything can be depended upon and the past guarantees the future.” (Hillman, p. 71) Medea’s belief in the inviolability of the oath sworn by Jason is her own Apollonian aspect come into play, a vesting of power in word. It calls forth the chaos of Dionysus in Jason with his betrayal, which smashes open the fragile vessel of their marriage.

Edwards, in her conversation with Rose, talks about the reality that some 70% of marriages do not survive the death of a child and that she thought because they had, they did not have to worry, that they were over the worst thing that could happen.

Betrayal, in breaking trust and breaking open the vessel, affords an opportunity for increased consciousness and understanding. However, we cannot assume that betrayal alone brings increased awareness as “marriages are full of betrayals committed but not comprehended—in which case, there can be no transformation.” (Carotenuto, 1996, p. 76). Marriage offers the opportunity, through the process of engaging with another and dealing with the negotiation of differences, to retrieve and make conscious that which has been projected out onto the partner. This is a painful and deflating process, as it requires the increasing awareness of one’s own dark side or shadow. 

Neither Medea nor Jason changes much in their marriage, except that they become more of what they were to begin with. Rather than becoming deeper and fuller through the process of being married, they each become more one-sided. Jason becomes even more ambitious, more out of touch with his feelings and the feelings of others, as we see in his response to Medea. While the deeds committed by Medea for him were hers, she did them explicitly for Jason and thus, they belong to him as well as to her, though he claims no responsibility for them. Jason, through his willful blindness, remains unaware of his own shadow and believes himself unsullied by his wife’s actions. Medea, though more aware of herself than Jason, changes only in that the enchantment with her hero is broken and her trust in their oaths shattered. There is no indication that she learns from this experience that at the point of choosing Jason, the wanting to be wanted by him, is the beginning of her responsibility for what has happened. Blinded by her rage at having been betrayed, she sees only Jason’s guilt and none of her own.

In his play, Medea, Brendan Kennelly has her say:

Do you believe that men and women

are now living under a new heartless, mindless morality?

Unhappiness is the willful forsaking of the proven ways.

An oath is an oath.

Break an oath and the agile demons

of unhappiness leap through your

eyes and mind

and consume your soul.

As Carotenuto (1996) points out, a near-inevitable point in the process of dealing with betrayal is “Why did he do it?” or “What did I do wrong?” The betrayed feels that the act was personal, aimed directly at the one betrayed, a deliberate attempt to wound in a most vulnerable place. Medea is no different. In her mind, Jason’s betrayal is personal because she does not want to see that foremost for him all along has been his ambition, his quest, that the oath was sworn to achieve his goals, the marriage made because of business more than desire. The impact of betrayal is devastating, shattering the foundation of the relationship. The betrayer and the betrayed have been locked into an impossible relationship, a state of fusion in which each is expected to remain perfectly true. The one betrayed is as one abandoned. The pain is visceral – Medea laments, “A lost woman is a problem. Jason, answer me this. Where am I to turn?”(Kennelly, 1991, p. 37). For Jason, that Medea would experience his choice to marry Glauke as a betrayal, as pain never entered the equation. In this, as in all of his choices, benefit to Jason has been the determining factor, not love. “All things considered, having asked everything of our partner, we are also convinced we have given everything. We do not realize that it is precisely in that request and the absolute surrender of ourselves that the seed of imminent abandonment lies, one of the possible forms of which is betrayal.” (Carotenuto, p. 88)   

"Every psychological extreme secretly contains its own opposite or stands in some sort of intimate and essential relation to it. Indeed it is from this tension that it derives its peculiar dynamism. There is no hallowed custom that cannot on occasion turn into its opposite, and the more extreme a position is, the more easily may we expect an enantiodromia, a conversion of something into its opposite" (Jung, para. 581).

Certainly, we can see this in Medea, as her love for Jason turns to hatred and rage. Even in this, the potential for forgiveness is not lost, if the partners, in confronting their own previously hidden dark and negative feelings, can own them and integrate them into the relationship. However, to do so is to forever forego the paradise of the idealized relationship, where love and harmony are valued above all else and where hatred and rage are experienced as alien and demonic. The confrontation with what has previously been projected outward – which means becoming aware of and owning shadow aspects that have been projected onto the partner – expands consciousness and offers the potential for the kind of marriage that Jung envisioned as the coniunctio. Neither Medea nor Jason succeeds in this.

There can be no doubt that revenge is the path that Medea’s response to betrayal takes.  In her final encounter with Jason, after the deaths of the children, Medea shoots her last arrows at him.

                                                I have done it: because I loathed you more

        Than I loved them. Mine is the triumph. 

     I would still laugh…I’d still be joyful

     To know that every bone of your life is broken; you are left

hopeless, friendless, mateless, childless.

        Go down to your ship Argo and weep

beside it, that rotting hulk on the harbor –beach

Drawn dry astrand, never to be launched again – even the weeds

and barnacles on the warped keel

Are dead and stink: --that’s your last companion—

    And only hope: for some time one of the rotting timbers

Will fall on your head and kill you—meanwhile sit there

and mourn, remembering the infinite evil, and the good

That has turned evil... 

You had love

and betrayed it; now of all men

You are utterly the most miserable. As I of women.

     But I, a woman, a foreigner, alone

Against you and the might of Corinth—have met you throat

      for throat, evil for evil. Now I go forth

Under the cold eyes of the weakness-despising stars: --not me   

  they scorn. (Jeffers, p. 189- 191)

Revenge can be quite satisfying because it allows one to feel that a score has been settled. However, revenge does not lead to anything new or to expanded consciousness or relationship. Medea wants to even the score with Jason, to strike him where he will hurt, as she has been hurt.  Kennelly tells us, “Medea, as I imagined her, plans to educate Jason in the consciousness of horror; she destroys his world but leaves him intact; and she instructs him very calmly and lucidly in the appalling consequences of this intactness…Medea, as I see her, inflicts on Jason the ultimate cruelty: she sentences him to life.”(Kennelly, p.8) In not leaving John but choosing to remain married to him and in talking about what a good man he is at the same time that she reveals with a surgical precision the details of what happened in their marriage, Elizabeth, like Medea, destroys his world while leaving him intact. 

Jason’s part of Medea’s story ends with him sitting on the beach under the hulk of the Argo, now wrecked and decaying. Unlike other Greek heroes – Herakles for example—Jason does not become an immortal but instead dies when the oak timber which was carved into a figurehead from his ship falls upon his head (Graves, 1944, p. 370). Jason’s failure to move out of his one-sidedness and commitment to his ambitions leads finally to his death.

There is no question that Elizabeth Edwards' anger is justified. But in making this sad chapter in their marriage a focal point in her book, she manages to step into the web of the Medea complex. Though she told Charlie Rose she wrote the book because she wants her children to know about her marriage and her husband from her, that really doesn't work as a reason given that she could have written about it all just for them. But in publishing it, she opens them to having to deal with gossip and innuendo in addition to the death of their mother, which may well occur before the children are old enough to apprehend any of this. And the book conclusively eliminates all but the remotest possibility of a political future for John, no matter how far in the future he might try. So in her way she leaves John sitting on the beach next to the wreckage of his career much as Medea left Jason. And much of the public will see his fate as deserved and her as the innocent. But is it ever that simple?

Burnett, A. (1973). Medea and the Tragedy of Revenge. Classical Philology, 68, 1-24.

Carotenuto, A. (1996). To Love, To Betray. Evanston, IL: Chiron Books.

Hillman, J. (1976). Loose Ends. Dallas Spring Publications.

Jeffers, R. (1970). Medea. NY: New Directions Books.

Jung, C. G. (1967). Collected Works of C.G. Jung, Vol. 5 2nd ed. Princeton, NJ: Princeton University Press.

Kennelly, B. (1991). Euripides' Medea, a New Version. Newcastle upon Tyne, UK: Bloodaxe Books.

Rabinowitz, N. S. (1993). Anxiety Veiled. Ithaca, NY Cornell University Press.

It's always nice to see some way that the insights of Jung are finding new applications. This week the NY Times reported that actors are turning to Jungian dream work methods to help them develop characters --

"In the last decade, dream work, as it is known, has spread into actors studios and classrooms across the country, taking its place among the ever expanding techniques of actor training and in the long-running debate over what leads to the most authentic performances.

Dream work grew largely out of Method acting, and it is now being taught at the New York home of the Method, the Actors Studio, and by several teachers in Los Angeles and elsewhere.

Teachers say that at least 1,000 actors have been trained so far and that interest is growing in the technique, which is inspired by the theories of Carl Jung, who believed that dreams are the expression of the unconscious, and the images and symbols in them communicate crucial information to the conscious mind."

As background for my reflections on this week's sessions, I want first to explore the mother complex and then the father complex.

The mother complex is a potentially active component of everyone's psyche, informed first of all by experience of the personal mother, then by significant contact with other women and by collective assumptions. The constellation of a mother complex has differing effects according to whether it appears in a son or a daughter.(The Jung Lexicon)

It isn't possible to escape the influence of mother in the development of any and all of us.

Jung tells us of several forms the mother complex can take in a woman --

 The exaggeration of the feminine side means an intensification of all female instincts, above all the maternal instinct. The negative aspect is seen in the woman whose only goal is childbirth. To her the husband is . . . first and foremost the instrument of procreation, and she regards him merely as an object to be looked after, along with children, poor relations, cats, dogs, and household furniture.(Jung, CW 9i., par. 167.)

and in another variation, what Jung calls the feminine instinct is inhibited or wiped out --

As a substitute, an overdeveloped Eros results, and this almost invariably leads to an unconscious incestuous relationship with the father. The intensified Eros places an abnormal emphasis on the personality of others. Jealousy of the mother and the desire to outdo her become the leitmotifs of subsequent undertakings.(Jung,CW9i par. 168.)

This inhibition can also be expressed in another way, in which the woman identifies with the mother.

As a sort of superwoman (admired involuntarily by the daughter), the mother lives out for her beforehand all that the girl might have lived for herself. She is content to cling to her mother in selfless devotion, while at the same time unconsciously striving, almost against her will, to tyrannize over her, naturally under the mask of complete loyalty and devotion. The daughter leads a shadow-existence, often visibly sucked dry by her mother, and she prolongs her mother's life by a sort of continuous blood transfusion.(Jung, CW9i, par. 169.]

And then there is the negative mother complex, the stuff of novels and films, where there is tremendous resistance to mother and all that she stands for.

It is the supreme example of the negative mother-complex. The motto of this type is: Anything, so long as it is not like Mother! . . . All instinctive processes meet with unexpected difficulties; either sexuality does not function properly, or the children are unwanted, or maternal duties seem unbearable, or the demands of marital life are responded to with impatience and irritation.(Jung,CW9i., par. 170.]

This kind of daughter knows what she does not want but is usually completely at sea as to what she would choose as her own fate. All her instincts are concentrated on the mother in the negative form of resistance and are therefore of no use to her in building her own life.

"As we know, a complex can be really overcome only if it is lived out to the full. In other words, if we are to develop further we have to draw to us and drink down to the very dregs what, because of our complexes, we have held at a distance.

This type [the woman with a negative mother complex] started out in the world with an averted face, like Lot's wife looking back on Sodom and Gomorrah. And all the while the world and life pass by her like a dream -- an annoying source of illusions, disappointments, and irritations, all of which are due solely to the fact that she cannot bring herself to look straight ahead for once. Because of her unconscious reactive attitude toward reality, her life actually becomes dominated by that which she fought hardest against...But if she should turn her face, she will see the world for the first time, so to speak, in the light of maturity, and see it embellished with all the colors and enchanting wonders of youth, and sometimes even of childhood. It is  a vision that brings knowledge and discovery of truth, the indispensable prerequisite for consciousness. A part of life was lost, but the meaning of life has been salvaged for her."(Jung, CW9i)

Complexes  differ from introjects, (the unconscious adoption of the ideas or attitudes of others) in one important way. According to Jung, every complex has at its center an archetype.  Complexes are "feeling-toned ideas" that over the years accumulate around archetypes, like "mother" and "father." When complexes are constellated, they are invariably accompanied by affect. So the mother complex is not only informed by experiences with the personal mother, but also by the universal pattern of "mother" imprinted in the psyche.

Hold these in mind as you reflect on Mia, on April, and on Paul.

Yesterday I mentioned that the boundaries of time, place, fee are elements of the therapeutic frame. These days, outside of the psychoanalytic literature, no one talks much about the therapeutic frame. But I have always found it to be one of the most important and useful concepts in the practice of psychotherapy. The frame is the container for the therapy, the fixed elements that form the boundaries for the work. The frame has three elements: time, place, fee. Optimally these three elements remain the same throughout the duration of the therapy, changed only after careful consideration, because changing one element alters the whole container. Keeping these elements fixed makes it easier to identify when either patient or therapist is acting out and facilitates working through whatever the issue is that gives rise to the acting out.

The frame is for both the patient and the therapist. It provides a structure for the basic elements of the work. There is plenty going on all the time so it is helpful to have something be stable and predictable. The weather changes, mood changes, how we look or feel changes. People in our lives change. And so on. Of course sometimes it is necessary to change the time for meeting or the place, as when the therapist moves or changes offices. But the frame as that structural skeleton still exists.

I was in analysis with my analyst for a long time. The time for my sessions changed once and he moved once within that time. The fee stayed the same the whole time. He always started and ended on time. There was something very comforting knowing that those things would stay the same -- even when I was furious with him or when my life was falling apart, that piece of my life was stable and there and reliable. It made for a space where I could explore the least explored parts of me, the parts I felt least comfortable with -- a safe space.

 In an excellent article on the frame, Robert Maxwell Young writes:

"the analytic frame is not confined to the room where the therapy is done. It is ideally tacitly in the minds of both therapist and patient all the time. It is there when you open the door or speak on the phone. It is carried with the patient (or not) between sessions: it is internalised. It is conveyed by the therapist’s demeanour, tone of voice, pauses, silences, grunts, the wording of any note or letter which it is appropriate to send to the patient. It is evident in pauses. It is all aspects of analytic space. To maintain the frame is to maintain the analytic relationship. Its essence is containment." 

So the frame is more than just the physical setting. It is the larger notion of the therapeutic space, that space in which both therapist and patient relate to each other in support of the therapy. It includes sessions on the telephone, or in writing, or in other ways that the two engage in their work together. 

"Acting out is a substitute for verbal expression. It is expressive, symbolic communication, but it is not relfective. The patient is acting rather than reflecting. Where acting out is, thought cannot be.

One feature of acting out is that the therapist is usually put under pressure to do something he would not otherwise do — to go after the patient in some way, e.g., to write to the patient or phone, to reveal something, to move, to change a session, to press the patient, to relent about a decision or take a firm line, even to lose his temper."

Young writes elsewhere:

"the room, its furnishing, its stability, one’s demeanour, absolute confidentiality, the forms of abstinence dictated by professional ethics, e.g, refraining from physical, sexual or social contact –- all these are designed to facilitate speaking in an exploratory way about matters which it is difficult to reflect upon in ordinary life. Along with what the therapist says and how it is said, they constitute the containment that makes change possible, though in no sense inevitable. The therapeutic frame is a safe place to take risks, to regress, to confess, to repent, to embark upon acts of contrition. "

There are purists who hold to a highly structured and idealized sense of the frame. Robert Langs is one and there are others as well. Frame becomes elevated to an almost absurd level so that ordinary human interaction becomes almost impossible -- like offering a tissue to a patient who is crying. But within the therapeutic community there are variations in how the frame is constructed and maintained. For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need. 

The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about.