This November, MHT is participating in the Miry’s List Friendsgiving Fundraising Drive. The money goes to programs that support refugee families that have been resettled in the United States. In tandem with these efforts, our clinicians are writing posts reflecting on what home means to them.

“That process of coming home to my inner world and to an expanded vision for my self in the outer world was one very much marked by stumbling and meandering.”

There was a process of coming home to my self that I was immersed in during the time that I ‘discovered’ the stack of books in my photo. I use quotations here for discovered because the books all somehow found me - through recommendations from trusted people in my life - more so than I found them. Each of their authors helped me to get in touch with my desire to become a psychotherapist after traveling along a much different career trajectory for years. That process of coming home to my inner world and to an expanded vision for my self in the outer world was one very much marked by stumbling and meandering.

I was (and will always be, I think) enamored with the idea that so much about the human psyche is unknowable - and yet since childhood I have had a hunger for knowledge about what makes us tick, grieve, or love. How does one become a person? What does it mean to be alive? What makes this life so painful and yet so rewarding at the same time? Many open-ended questions! These four books scratched some itches, but moreover, they initiated me into a deeper dialogue with ideas that had been swirling around in my head without much of a home to play in. It was a moving experience to encounter others, either from the past or present time, that were contending with these questions in such nuanced ways. It’s that sensation of finding something so right and so precise — it’s almost uncanny. Or the feeling of making a new friend when you have a moment of “No way, you too!? Wow, I thought I was the only one who _____.” Somehow the language that I found in these books reflected to me that I wasn’t alone and helped me remember that my mind was in relationship to other minds. They articulated things that I knew to be true in my gut, but unable to name with language before. This is what home signifies to me: it is a series of movements informed by resonance and reciprocity. And it’s a place to be known and understood - a place to be in dialogue - a place to be in process in a way that allows space for us to get to know ourselves and others over and over again.

Taz’s Library (left to right):

-Quiet by Susan Cain

-Far from the Tree by Andrew Solomon

-Radical Acceptance by Tara Brach

-We’ve Had One Hundred Years of Psychotherapy and the World’s Getting Worse by James Hillman and Michael Ventura

Screen Shot 2019-11-05 at 8.14.54 AM.png

HERE'S HOW YOU CAN PARTICIPATE IN FRIENDSGIVING WITH US:

Give! Visit our Miry’s List campaign page and make a donation. It's that simple and no sum is too small. Truly.

Follow! Be sure to follow us on Instagram and our blog throughout the month of November. We will be reflecting on what it means to be welcomed, received, and known.

Share! Help us spread the word. You can do this by sharing our social media posts or links to our Miry’s List Friendsgiving Fundraiser page.

******

A little about Miry’s List:
Refugee families come to the United States seeking a safe haven from violence and persecution in their home countries. They leave behind family and friends, as well as virtually everything they own. Many Americans, seeing these families in their communities, wonder: What can I do to help? Miry's List provides a mechanism for people to directly help new arrival refugee families with the things that they need to get started in their new lives – from diapers to beds to cleaning supplies and toiletries. To learn more, visit miryslist.org.

Taz Morgan, MA, is an Associate Marriage and Family Therapist, IMF #99714, working under the supervision of Gabrielle Taylor, PhD. She has trained in Depth-oriented psychotherapy and works with adolescents, adults, and couples.

M: I'm at the tail end of my analytic training and I’ve become fascinated by how my mind has shifted in the process of training. How in love I am with this process, this way of thinking but how inaccessible it feels to the masses. I don't think it has to be. My idea with my newsletter and blogs, similar to analysis, is how can we think more complexly about simple ideas and think more simply about complex ideas. Karen, I think you excel at this. You have a great ability to speak about ideas in a really clear and approachable way. Before we jump into the idea of candor, can you give us an idea of how you got interested in psychoanalysis.

K: My mother, who we did not have a college education, was naturally psychologically minded. She would observe our emotions and if it wasn't clear to her what I was feeling or why, she would inquire. She would say, “Well, Karen you seem a little down or you're not as lively coming home after school. Did something happen?” She always knew of course. She was very intuitive. She was just asking, “did I want to talk about it?” So, in a sense, my mother was psychoanalyzing me from the time I was young and inducting me into the whole notion that you don't just accept what someone says at face value, that you should trust your feelings. I think that my mother introduced me to the whole notion of trusting my emotional intuition and that asking someone about what they were feeling was an expression of love.

K: It’s been life pursuit, a way of being. I was speaking in Indianapolis a few months ago and I was pleased to hear a candidate talk about psychoanalysis not simply as a profession, it’s a calling. It’s a life.

M: Yes! I had this experience when I was developing as a young clinician where I would get around analysts and I couldn't always keep up with the terminology used but their minds were so alive to me. They had this spontaneous quality. It reminds me how you shared the origins of the word candor is candid which evokes a sense of freedom and spontaneity. There was a flexibility and freedom to explore, play and reflect that was more than the sum of its parts. And I could just feel the difference between their mind and my own. It's a way of thinking and being that that evolves overtime...

In your paper on counter-transference, you talk about how clinicians, by our nature we are often empaths. We feel, we care, we listen but we are not very good at being direct or honest both clinically and in our lives. How do prepare your client for the role of honesty in therapy?

K: Well, most people don't really understand what an analytically-oriented treatment looks like. I tell them the three basic rules are: they have to show up, they have to be as open as they reasonably can be given that no one is completely open, and they have to pay. (laughs)

M: (laughs) Good basics.

K: Then I usually explain about transference. That any of their feelings toward me are not out of bounds. Anything that comes up and particularly anything that's repetitive that they're feeling either positively or negatively toward me is important for them to express.

M: This idea of having candor, of being direct, the fear is, in speaking up, you might shut the client down. How do you negotiate this: keeping lines of communication open given that generally the analyst is in a position of some kind of power?

K: The idea is there’s candor and then there’s candor. You know what I mean? You don't just blurt out anything that you may be thinking which is like, “Boy, was that a stupid thing to do.”

M: Right, right.

K: So I take a moment to gather my thoughts and think about how it fits in the context of the person. I seek to complete the analytic task to gain perspective on their behavior historically and currently. But you know if somebody did something really stupid then I am more likely to say, “Well, it seems to me that this behavior had a pretty bad outcome for you. You know, probably not one of your finest moments.” (laughs)

M: (laughs)

K: I use humor a lot. It cuts the tension. I'm agreeing that they screwed up without saying you're screwed.

M: I'm thinking about this on two levels: what are you trying to create within your client through the use of candor; what are you hoping that they bring into their lives through this process? The other part I'd love to hear more about is, the fact that our patients don't just want empathy, or I should say, sympathy, they also crave sincerity. There's relief when we can speak directly to all parts of the self, even negative ones.

“Being authentic without being insulting or cruel. Finding a way to constructively give feedback, whether positive or negative. So the positive isn’t too over-stimulating or generate too much expectation of a repeat performance. The whole notion of not waiting until your own feelings are so intense that you have trouble managing them and being in control of them when you’re talking. It’s easier to be honest when you’re in control of how you feel. Most people white knuckle it.”

K: Absolutely. I think people want feedback. Particularly, as I wrote in “The Power of Countertransference” if they are seeking it, then I don’t understand why you would not be responsive to a direct request for feedback. I think where we get into the delicate issue is when you're not sure, or when the patient is provoking possible feedback but not asking for it directly. Then you have to explore it and make a decision which may or may not include asking them if they want feedback. I think it's a no brainer when the patient is literally saying I want to know what you are really thinking or feeling about me?

M: Yeah, yeah.

K: For example: most of my clients become much more successful as a result of their treatment and they want to know am I going to resent them? Especially if their parents were very competitive with them. If they are too successful will I try to destroy them, take it away?

M: So what do you think benefits your clients in being able to ask you those questions in terms of their growth and development?

K: I think it gives them a tremendous confidence in their own intuition because I think one of the greatest contributions of neuroscience and the whole notion of unconscious to unconscious communication, is that clients already know what we are feeling. We already know what they’re feeling. I think the art is to determine, ultimately, what's most beneficial to actually discuss to get to the bottom of what’s going on. What's important to the work and what isn't. Will some of our ideas, notions shut down the patient experience, I think inevitably yes! That's the nature of relationships, whether it's analyst and patient or mother and child or spouse. There are ways you just cannot relate to someone else or you can't promote it.

M: A client having to contend with the real you rather than just feeling it.

K: You know, I successfully treated someone with severe borderline personality disorder. That was where I first experimented with expressing rage. She thought everything was somebody else's fault. She would talk about her husband and blame the poor guy for everything. He was responsible for every feeling she ever had. She wanted me to endorse that. That he wasn’t sufficiently empathic but he was! He martyred himself for her, whatever it took. She really needed somebody to stand up to her.

M: You made a comment about our culture not leaving room for negative emotions. I see this an an epidemic in parenting. We've got the hover parent generation where parents can't give feedback to their children or they have to sandwich it with so much goodness. To me, it's about emotional clarity, right? Sometimes it's not about positive or negative. It's about being clear with emotions and our intentions.

K: Yes. Being authentic without being insulting or cruel. Finding a way to constructively give feedback, whether positive or negative. So the positive isn’t too over-stimulating or generate too much expectation of a repeat performance. The whole notion of not waiting until your own feelings are so intense that you have trouble managing them and being in control of them when you're talking. It’s easier to be honest when you’re in control of how you feel. Most people white knuckle it. Neuroscience shows us that negative emotions are rarely outside of our conscious awareness. (They are felt and known even if not explicitly acknowledged). So we need to talk about it….

M:. You alluded to something earlier that I’ve been processing for a while, personally. I have a tendency at to be effusive with my language, you spoke to how we can say something positively in a way that is not too overstimulating. Candor is about being clear in feedback. I have an awareness of my tendency to slant towards hope and it has impact. Not always negative but I have to watch it. The truth is I have these little awareness all the time in session and I think ‘bookmark’ I need to go back to that. But how often do we, have the internal candor to take a deeper look?

K: Bookmark is a great word. That’s the beauty of the whole analytic approach. You bookmark it and you're curious about it. You don’t just blurt it out to the patient. You bookmark it and think about it. You wait to see, is this more about me or more about the patient. Because transference is repetitive, it will always come up again, and you don't have to figure it out in the moment.

M: So, what I hear is with candor, there's a certain amount of measure. Working towards an internal space that is curious. Curiosity to pay attention to the tiniest movements inside, an internal honesty that translates to a clinical (relational) honesty.

So with enactments, there can be a dishonesty there. I mean, of course, we fall into things but I think you're putting more onus on the clinician to pay attention.

K: Absolutely, and I think that if you look at the literature most of the enactments are not positive, they’re negative. But if you have transcript of sessions you would see there are just as many positive enactments as negative going on, but we don't yet care about those. Because those generally are not disturbing the universe of the relationship. (laughs) I will notice with a patient that I really like or admire we do this little mutual admiration thing, you know? It is a sense a form of acting out. A little flirtation, something.

M: This is where the awareness comes in. How much of that is unconscious to the analyst?. There's a part of you that's just feeling good and maybe another part has the passing thought..I wonder if this is something?

“Be thoughtful, of course, but be courageous. If you have any anxiety when you’re practicing, that’s good...Take risks. If you’re never afraid and you’re just offering soothing, comforting things you’re probably not giving the person everything that person really needs.”

K: Right, it depends. If it’s happening too often (repeating) then it's like OK, well, wait a minute. The enactments that we talk about in literature are mostly negative ones. I have yet to talk to a therapist where they were not aware of some negative feelings before the enactment. An enactment comes typically after an impasse that’s lasted a minimum of days if not a weeks or months. The impasse is broken by an enactment or treatment is destroyed by the enactment. I think that since I started using self disclosure regularly I have almost no enactments. I currently have one patient I have regular enactments with on a regular basis because she cannot accept negative emotions mine or hers. She simply won't allow for an emotionally honest exchange. You cannot eliminate enactments with everyone.

I think if you are sitting harboring negative feelings and thinking about them, no treatment is taking place. That’s why my new line I'm going to be using a lot in my next book is, “what is the analyst’s fiduciary responsibility to the patient? (laughs) What is clinically beneficial and to what extent are we stealing their money? When we sit white knuckled and think ‘this guy is a pain in the ass.”

M: Well, it’s another aspect of coasting in the counter-transference right?

K: Yes, like what you were saying about parents being overly effusive or overly positive. Therapists do this too. They try to be super positive or uplifting and affirming. Of course we want to do that to a point but that's not really what most people come to treatment for. Most people who have a lot of positive attributes and good relation skills get reinforcement in the world. They come to us to help them work through the obstacles and the negative behaviors that they can't work out anywhere else and the pain.

K: Right. I was thinking about submitting a presentation to Division 39, “Did Winnicott kill psychoanalysis?”

M: (laughs) Oh no!

K: Of course I’m tongue and cheek but we are so enamored with good enough mother which is about always being positive, always being the cheerleader. I think most therapists are so masochistic and they allow patients in small and large ways to be abusive towards them...

M: Yeah I thought that that is what is revolutionary about your paper. In the first paragraph you talk about why as therapists we're drawn to this profession to help but simultaneously you are calling out our own masochism. The way we feed off our ability to hold pain in the service of someone, to contain, soften…

K: To be saint like. We're so overly invested in ourselves being the perfect mother to all of our patients. As if the perfect mother is somebody who would just lie down, puts up with everything. It’s not.

M: Well, thank you for jumping in with me to explore the concept of candor and your clinical practice. Your mind is so alive. It’s been a pleasure.

K: You know, I end my most of my lectures with this: Be thoughtful, of course, but be courageous. If you have any anxiety when you're practicing, that’s good.

M: Ah! I love that.

K: Take risks. If you're never afraid and you're just offering soothing, comforting things you're probably not giving the person everything that person really needs.

Karen Maroda, PhD is a clinical psychologist in private practice in Milwaukee, Wisconsin and a board certified in psychoanalyst by the American Board of Professional Psychology. In 2012, she was elected Fellow status by the American Psychological Association for her contributions to psychology on a national level. She is also a Fellow of the American Academy of Psychoanalysis. She has been in private practice for over 30 years and lectures nationally and internationally. She is the author of three books, several book chapters, and numerous journal articles and book reviews. She is passionate about the change process and has made it her life’s work to innovate psychodynamic techniques, making the process more interactive and collaborative.

Mic helle Harwell, MS, LMFT is an expert trainer, respected speaker, and licensed therapist in trauma and attachment. She is noted for her specialization in areas of development, attachment, trauma, and neuroscience, and her ability to communicate complex topics with clarity and humor. Michelle is currently completing her PhD in Psychoanalysis from The Institute of Contemporary Psychoanalysis. She received her BA in English Literature from University of Oklahoma, MA in Theology from Fuller Theological Seminary, and MS in Marriage and Family Therapy from the Fuller Graduate School of Psychology.

Blog

Home: A Process

Nature is a Gift

Clinical Candor: An Interview with Dr. Karen Maroda

213.816.4501