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The Rupture of Serenity

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What happens when the outside world enters the psychoanalytic space? In The Rupture of Serenity: External Intrusions and Psychoanalytic Technique, Aisha Abbasi draws on clinical material to describe some of the dilemmas she has encountered in her work with patients when external factors have entered the treatment frame. She considers analytic dilemmas that range from how to deal with patients' unusual requests regarding the conduct of an analytic treatment to the question of how to handle events in the analyst's personal life that, by necessity, must be addressed in the analysis. As a Muslim of Pakistani origin, Abbasi is also able to discuss, frankly and with compassion, the role that ethnic and religious differences between patient and analyst can play in treatment-differences that, in the aftermath of 9/11 and the search for and killing of Osama bin Laden, became a palpable presence in her consulting room. Abbasi also explores the deeper meanings of waiting-room interactions and how analysts can view the entrance of the "iWorld" into the psychoanalytic space: not as an unwelcome third party, but as a tool with great potential. Abbasi shares with us her inner struggles to understand and to keep working analytically. She acknowledges that her ability to do so can be strained when external events give rise to internal destabilization within her. She believes that this type of unexpected internal destabilization within the analyst is not only human and unavoidable, but also necessary-and, frequently, therapeutic. The book is deeply rooted in existing analytic literature and will be a useful resource for clinicians at all levels of education and practice. At the same time, it is written without technical jargon, so that the clinical material that forms the backbone of each chapter will be easily accessible to nonclinicians as well-who will find it to be a moving and lively account of what goes on in a psychoanalyst's consulting room.

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7 Chapters

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Chapter One - The Analyst's Infertility and Subsequent Pregnancy

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Introduction

Significant events occur in every analyst's life. Some of these may never directly affect the analyses we are conducting, and thus there will likely be no reason for the analyst to discuss them with patients. Others might enter our analytic work indirectly—as I will discuss in Chapter Three—because a patient has been informed by others about events in the analyst's private life. Still others might be events that directly affect the frame of an analytic treatment, such as the analyst's illness (which could include ongoing treatment); the illness, death, or impending death of a family member; and events that necessitate a major change in the schedule or require a flexible schedule. In the latter case, the analyst must decide how to best deal with “telling” or “not telling” her patients about what has caused, is causing, or will cause a disruption in their regular meetings.

Whether one tells or doesn't tell, the analyst also has to be on the lookout for the meaning of the telling or not telling, as well as patients' reactions to the disruption itself; their feelings, if they have been told, about the events; and their feelings about what they imagine is happening if they have not been. No part of this is easy. Nor are there easy answers to the questions, “Should I tell my patients about this?”, “When should I tell my patients about this?”, or “How much should I tell my patients about this?” In addition, the answers may be different for each analyst-patient dyad. We are all guided in general by our foundational concepts of theory and technique, but these become interwoven, over time, with our individual personality styles and what comes naturally and feels right for each of us. Each analyst also has to take into account each patient's needs, strengths, and vulnerabilities, given what she knows about the patient's history, while being mindful of where the analysis is at that point.

 

Chapter Two - Waiting-room Dramas between Patients

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Introduction

Although much has been written in psychoanalytic literature about the analyst's waiting room, most writing has focused on suggestions about the physical setup and arrangement of the room and its impact on the patient (e.g., Sugarman, Nemiroff, & Greenson, 1992; Goldstein, 1998; Armstrong, 2000; Hollender & Ford, 2000; Akhtar, 2009a).

Freud's writings include two descriptions of his observations about patients who expressed powerful wishes and conflicts through the way in which they negotiated their entry into his office. In the first, he writes (Freud, 1917):

I have had the ordinary door between my waiting room and my consulting and treatment room doubled and given a baize lining. There can be no doubt about the purpose of this arrangement. Now it constantly happens that a person whom I have brought in from the waiting room omits to shut the door behind him and almost always he leaves both doors open. As soon as I notice this I insist in a rather unfriendly tone on his or her going back and making good the omission—even if the person concerned is a well-dressed gentleman or a fashionable lady. This makes an impression of uncalled-for pedantry—for anyone who behaves like this and leaves the door open between a doctor's waiting room and consulting room is ill mannered and deserves an unfriendly reception. But do not take sides over this till you have heard the sequel. For this carelessness on the part of the patient only occurs when he has been alone in the waiting room and has therefore left an empty room behind him; it never happens if other people, strangers to him, have been waiting with him. In this latter case he knows quite well that it is in his interest not to be overheard while he is talking to the doctor, and he never fails to shut both the doors carefully.

 

Chapter Three - “Have you Heard?” Revelations Regarding the Analyst

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Introduction

An issue that has rarely been addressed in the psychoanalytic literature is that of patients hearing from others about issues in the analyst's personal life or aspects of the analyst's personal or professional functioning. While searching the PEP (psychoanalytic electronic publishing) database, I tried various approaches, including “patients discussing their analysts” and “patients learning about their analysts from others,” which came up empty. “The analyst's personal life” yielded a handful of articles—but none that specifically dealt with patients who were in treatment hearing, from someone else, something about their analyst. Finally, I searched for “gossip about the analyst” and retrieved several useful papers that discussed this possibility.

The authors of these papers (which will be discussed later in the chapter) acknowledge that this is inevitable, caution the analyst about revealing too much, and suggest, wisely, that such “revelations” shared with the analyst regarding what has been “revealed” to the patient by others should be dealt with in the same way one deals with all analytic material. Other important aspects were largely ignored, however, such as how such knowledge gained from others might come up in a treatment and function to help or hinder the analysis. The only exception to this approach is Phillips's 1998 paper, which I will discuss later.

 

Chapter Four - A Patient's Tape Recording of Analytic Sessions

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Introduction

Historically, psychoanalysts have claimed that they could best treat patients who communicate by saying whatever comes to mind—the fundamental rule of psychoanalysis. The patient who insisted on action in an analytic treatment was seen as not quite suitable for such treatment and given a poor prognosis. While it is true that certain actions cause great disruption in an analytic treatment (e.g., addictive behaviours, self-mutilation, violence toward others, and suicidality, to name a few), I find that there is hardly any patient who does not communicate via action in one form or another—and that an analyst has to be able to pay attention to, and be interested in, action and actions, both big and small, for this mode of communication to be treated as a source of important information. Child analysts, who accept the usefulness—indeed the requirement—of the child's actions and play as the method for transmission of information in the analytic setting, have much less difficulty, even in adult analysis, with action. Adult analysts have struggled much more with this notion. This chapter addresses the issue of action in analysis and the value of creating an analytic space that houses not only the words our (adult) patients use to express their innermost worlds, but also the actions.

 

Chapter Five - From an iPhone, through an iPad and an iMac, to the Cloud: The Evolution of a Sense of “I-ness”

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Introduction

In this chapter I will present clinical material from a psychoanalytic treatment in which various “iMachines”, now so readily available, became a conduit through which my patient's concerns about his sense of self (his I-ness) came into the analysis and could be worked with effectively. His associations about the iWorld allowed us deeper access into what he believed kept him from functioning more cohesively and solidly as a person, and enabled us to begin the process of working through the pain and sense of deprivation that had kept him stuck where he was.

In November 2008, in a cosy meeting room at La Sapinière—a charming resort in the Laurentian Mountains north of Montreal—I was presenting clinical material at a meeting of the Group for the Study of the Psychoanalytic Process (GSPP). The clinical material was from a session in which my patient was laughing at me about the way I pronounce certain words and my inability to pronounce certain letters of the English alphabet, such as “v” and “w”, correctly. My patient then homed in on the fact that when I referred to his daughter Alicia, I emphasised both the “i” after the “l” and the “i” after the “c”. This was incorrect, he added, but he had never told me this before because it tickled him to hear me make that mistake repeatedly. I asked what tickled him, and he replied that it made him feel I was not all together—that I too had certain foibles and problems, so that I made “Alicia” into Al-i-ci-a, which he pronounced “Al-i-sha”, with the second “i” remaining silent.

 

Chapter Six - Sadistic Transferences in the Context of Ethnic Difference: Before and After 9/11

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Introduction

In each analytic dyad, the analyst and the patient can differ in numerous ways. Even when they belong to similar racial, ethnic, or religious groups, significant differences can exist that sometimes never get talked about. To understand the meaning these dissimilarities have for a patient and how he or she uses them, starting with the most superficial and accessible and moving toward the deepest underpinnings, is one of the tasks of an analysis. In this chapter, I will discuss sadistic transferences expressed toward me by three male patients. These transferences were superficially linked to my ethnicity (a Muslim from Pakistan), their feelings about it, and the difference it created between us. In each analysis, however, the deeper and more personal meanings of this sadism were revealed over time. I will focus both on how my analytic functioning changed and deepened in the aftermath of “9/11”1 (which allowed me to recognise and work with my patients' sadism more helpfully) and how the material patients brought into their analyses with me was profoundly affected and altered by the events of 9/11 and the regional and world events that followed—a sociopolitical reality that became woven into patients' expression of personal conflicts.

 

Chapter Seven - Osama Bin Laden's Death and its Impact on the Analytic Process

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Introduction

On the night of May 1st, 2011, U.S. Navy SEALs flew helicopters into a fortified compound in a town outside Islamabad, Pakistan, and, shortly after midnight on May 2nd, killed Osama bin Laden. When President Obama announced the news in a special broadcast from the White House, I was shocked to learn where Osama bin Laden had been found: in Abbottabad, where I had spent many years of my childhood and teens with my family, and where my family's home, atop a beautiful hill overlooking the Abbottabad Valley, is still my destination on my twice-yearly trips to Pakistan.

The compound in which bin Laden had been living was about twenty minutes by car from my family home, close to the golf course where my father used to play. My sister and I would often accompany him on his golf outings, so that we could play on the golf course and have lunch with him in the club's restaurant. I felt that a place that had so many happy memories for me had been violated, both because of bin Laden's presence and the SEALs' invasion. Most disturbing were the questions raised in my mind about the possible involvement and complicity of the Pakistani government/military in arranging shelter for bin Laden in the shadow of the Pakistan military academy (the Pakistani equivalent of West Point).

 

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