Behind Closed Doors

Matt McArdle, Australian Psychoanalytical Society (APS)

Matt McArdle is a Psychiatrist, Psychotherapist and Psychoanalyst in Private Practice in Melbourne. He is the current Branch Chair of the Melbourne Branch of APAS (Australian Psychoanalytical Society) and Chair of the Melbourne Institute for Psychoanalysis. He is a training and Supervising Analyst of APAS.

Who is sitting in the therapist’s chair?

As I walk into the waiting room she is standing, agitated; expectant and walks urgently into the consulting room. The next patient is sitting preoccupied. He looks annoyed and disrupted when I greet him. He reluctantly comes into the room and slumps on the couch. She is excited, anxious and longing. Who am I to them in these moments? How does each patient perceive this strange and unique situation? Who have they become as they come to my office?

In the dream-like playroom of the consulting room I become many different characters as my patients explore the surprising relationships that emerge between us. I try to be as open as possible to what occurs and unfolds. I am allowing and creating space within myself to foster a unique atmosphere that privileges inner experience for these 50 minutes, somewhat separate from the usual concerns of external reality. Throughout the day I am a loving-mother-therapist, a cruel-rigid-father-analyst, a combined couple who attack and destroy and a thoughtful presence who facilitates growth and development of this individual in a frightening, but surprisingly interesting and beautiful world. From moment to moment, I ‘am’ a hated, rejecting, cold and uncaring presence and then an understanding and supportive presence the next. Sometimes I am becoming a bit of both, all at once.  

The greeting is usually brief. The patient either sits on the chair opposite me or lies on the couch. At any time, the patient may move from the couch to the chair or stand up or sit in the corner of the room or flee from my office.

Then, I wait; usually silently. Silence can be good and useful. It can also be felt as punishment (giving the silent treatment), persecuting, depriving and obstructive. If the silence seems reflective and meaningful, I continue to wait. I don’t just wait. I try to be in it, with it and with my own feeling-thoughts. I wonder what is emerging between us. I try not to ‘think too much’ but allow myself to float freely in my attention and my own associations to what is happening as I listen and immerse myself in whatever is developing. How do I know what is happening? I don’t! I wait. I trust that as I watch and listen and wonder with my whole body and mind meaning will accrue. Psychotherapy is a full body-contact sport. No, I don’t usually have physical contact with my patients, but my whole body, my whole self is involved and immersed in the turbulence that inevitably and necessarily develops in the analytic field between me and the patient.  

I rely on my intuition; a finely tuned, barely conscious tool that is so central to analytic work. The patient may speak or remain silent. She might be wriggling like a restless baby or lying still like someone playing dead or someone hiding from dangerous authorities. Even moments into the session so much has happened. Brief words in the waiting room, a glance, frown, smile, inscrutable look, a grunt or groan on the analytic couch and movements of the body (fast or slow, rushed or dragging themselves). There is so much data, too much. If I were a computer, I could list hundreds, even thousands of data points. I could tabulate endless possibilities of what they mean. But I am not a computer. I have a human mind to process the conscious, barely conscious and unconscious aspects of what ripens.

So, I watch and listen. I allow a part of my mind to be free from thinking about what the patient is saying or doing. I let it flow over me, in me and through me. I foster a state of receptiveness, trying to be open to something I have not seen and heard before. In some part of my mind, I chose not to know what the patient talking about. If she is talking about her husband that she has talked about many times before, I allow myself to wonder “who is this husband?” I allow a new space in my mind and the session to hear ‘husband’ differently than previously and to be without memory of who and what ‘husband’ has ever been before. I try not to foreclose on an answer, but to allow the question to develop and emerge and possibilities to grow in my mind.

(We could play together with this thought; who is the husband? What does ‘he’ represent? The one she relies on, but hates because ‘he’ makes her aware of her vulnerability and need? The one who lets her down? A split off and projected aspect of herself that she can’t tolerate and needs to deny? A needy self? An inadequate and failing self? A masculine part of herself that she envies? What is ‘masculine’? What is ‘feminine’? Why is there a battle of the sexes? Is the Handmaid’s Tale real? Are we in Gilead? Am I the Commander who subjugates this patient? How frightening. No wonder she is angry. Is she destructive or is she a freedom fighter?)

I immerse myself in the experience of the session and the experience of being together with this person now. I foster a playful and curious state of mind that allows me one foot (eye, ear, mind) in what the patient is saying and the other on my own musings, reverie and associations. But this does not always happen. Sometimes I have no thoughts, no associations, no reverie. Sometimes mind is like a desert. I don’t know what is going on. What unravels is in bits and pieces. Bits that don’t come together. Pieces that don’t make sense. I can’t make coherent sense in what is happening. I can feel the pressure to force ‘meaning’ on the words and events of the session. But this imposing and intrusive. I need to allow personal meaning for this patient to emerge in the shared process of our minds linked together. I need to trust the receptive and containing process, seeking truth in the moment and co-constructing an apparatus for feeling, thinking, experiencing and being.

I must rely on Negative Capability; the ability to embrace uncertainties, mysteries, and doubts without an irritable desire to grasp for definite facts or reason. I must tolerate not knowing. When I do characters from the patient’s life, reading, movies and (ph)fantasies can come into the analytic field (the stage of therapy) in an unsaturated way. We can then wonder together why these characters, stories and conflicts are appearing here and now and what will be the next chapter in this never before written narrative. We (the patient and I) can watch the beauty and mystery of analysis (and life) as it unfurls before us in the intimate and personal (yet also professional) analytic relationship. 

The next patient talks about the meeting at work later today. I begin to think about the seminar I will be taking tonight. Rather than banish these thoughts, I allow them space, listening to myself and listening to the patient. Reverie like Negative Capability is a central tool of my inner workspace. These tools are developed both in and outside the consulting room. (I will comment further on the outside the consulting room work at the end of this discussion).

I once thought reverie referred to almost magical “Eureka” moments where I would have a dream or image that was profound, unexpected and made sense of everything. But my experience is very different. Usually, reverie begins in the mundane day-to-day thoughts and images that I might likely dismiss. “I left the washing on the clothesline, and it is going to rain”. “Why didn’t Tom Cruise/Ethan die at the end of the ‘final’ Mission Impossible?” “Remember that time your uncle yelled at you, and you felt so ashamed”. I follow these thoughts and images in part of my mind, whilst listening to the what the patient is saying/doing in another part. A complex picture begins to emerge in the analytic field that we can ‘worked with’. It is a two-track listening to myself and the patient at the same time whilst giving myself licence to not grasp for understanding and meaning, but to promote its birth. 

I am not just trying to find what is already represented, verbal, thought and known. There is a cutting edge of experience that I am waiting for in each session, even fearing. When adequate conditions have been established the unthought, unknown, unrepresented, undreamt (even nightmares and night terrors) begin to find their place in the analytic field. This is a place of turbulence, pain and frightening uncertainty. However, this is a place of passion and potential meaning that can lead to change. If I can bear this with my patient, we might find a way together to make the undigested digestible, undreamt dreams dreamable, and unthought thoughts thinkable. These new dreams, contents and thoughts become the nutritious food of the lived experience together of an alive, containing and nourishing analysis.

Patients become enraged by what I say or my silence, even by a sudden movement in my chair. The unexpected turbulence will unbalance both of us. We are now at the cutting edge of experience. Surprisingly and unexpectedly deep fear, rage, love, loss, sadness, longing and pain enter the room. I must find a way to 'stand' while the painful traumas of past experience, neglect, early ‘unmetness’, find a place in this experience together, sometimes, for the first time. These early traumas that the patient has only ever been alone with may now have a chance in the together-work to be felt, experienced and lived in new and different, creative and en-livening ways

Why do I work this way?

This question guides all aspects of how I work as a therapist/psychoanalyst. Firstly, how I work and what my ‘goals are’ has changed over time. I hope they will continue to change as I grow and evolve as an analyst. Secondly, what I say today is only partial. These are the important aspects of how I work that I am consciously aware of currently and chose to prioritise here and now today. This will change, too. If I present this ‘paper’ next week, next month or in a decade, it will be different each time. That is because I will be different. I will think and work differently. This is how it must be if I am truly alive and able to learn from emotional experience. 

So, I am already revealing something of my priorities in the consulting room, which is to privilege emotionally alive experiences.  Overall, I currently see the ‘task’ of psychoanalysis as creating the conditions where the analytic couple (patient and analyst) in the intersubjective analytic field enable the patient to expand their consciousness and develop their mind/psyche. (What is the psyche and what is consciousness? Maybe these are questions for another day, but I will make a few comments.)

I create conditions for psychoanalysis: multiple session a week, a separate and private space, a relatively unsaturated environment without too many distractions, allowing the patients dreams, silences, associations and other communications to lead the journey, responding only when I have words to usefully contribute that I believe the patient will be able to connect with. This is all with a view to bring the patient closer to their emotional experience, inner reality and the Truth of what is emerging between us. This allows elements of experience that would usually be overshadowed by the demands of external reality and society to take centre stage. It is similar to the state of sleeping where external demands take a backseat while the body and mind focus internally. Then the dream-maker, if developed and functioning, can take us on amazing adventures with enormous potential meaning and significance. It is allowing myself and the patient to be in the dark, away from the floodlit city lights (constant unremitting demands of external reality), so we can see more of the planets, galaxies and extensive constellations of the universe of the mind. 

My psychoanalytic education has been in the traditions of Freud and his followers (Abraham, Ferenczi, Jung and Rank for a while), Klein and her followers, post-Klein thinking and the thinking of Winnicott and Bion. I have become particularly interested in the thinking of Meltzer, Bion, and Winnicott. As my way of thinking and working develops I find myself reading Ogden, Bollas, Bolognini, Eaton, Ferro, Civitarese, Grotstein, Eigen and others.

The ongoing development of my thoughts and understanding of psychoanalytic ‘theory’ is a part of the bedrock of my analytic identity and inner workspace. However, this is for outside the consulting room. If ‘I am grasping for theory’ in the session my capacity my Negative Capability has failed.

As I have argued elsewhere, I think another part of the ‘cement’ of my inner workspace is an ongoing engagement with Art. Watching films, reading, listening to music, regarding painting and sculpture are all elements of my regular diet to foster a mental gut-mind-creative inner workspace to be with and work with patients. I draw on: Fellini’s ‘8 ½’, “La Dolce Vita’, ‘Juliette of the Spirits’ and ‘I Vitelloni’, Vittorio de Sica’s ‘Bicycles Thieves’, Robert Zemeckis’ “Back to the Future”, Spielberg, Lynch, Godard, Tarantino, Visconti, the list goes on. Shakespeare’s “Othello”, “King Lear”, “MacBeth”, Camus’ “The Stranger” and “The Plague”, Dickens’ “Oliver Twist” and “David Copperfield”, Tsiolkas’ “Loaded”, “The Slap” and “Damascus” and Alexis Wright’s “Carpenteria”. Then there are the myths, fairytales and religious books. Oedipus, Theseus and the Minotaur, Icarus and Pandora. The Abrahamic creation myths, the Flood, the Tower of Babel, the inexplicable birth of the Messiah, the Death and Resurrection myth and the Great Departure/Renunciation of the Buddha from the Palace Painting: Monet, Picasso, Kahlo, Dali. But wait there’s more! Albert Namatjira, Gloria Petyarre, Clifford Possum Tjapaltjarri, Rothko, Pollock and the ancient wall art of indigenous peoples.

Why do I go into such an apparent detour? Because the unconscious wasn’t discovered by Freud or Klein or Nino Ferro. It has always existed. It can be discovered and rediscovered in the ancient and modern, high and low art of all cultures. I could begin to talk about music, but I have 20 minutes, not all day. I do not share all this to say what inspires, informs and nourishes me, should be the same for you. No! We must all find our own authors and poets of inspiration, discover our own myths and fantasies to inform and foster our own love of the beauty and wonder of art, therapy and the human condition.

I work to make the unconscious conscious, and to see with a patient how their projected aspects that can be re-integrated. I make myself a welcoming object for the patient’s projective identifications to detoxify the intolerable and make it bearable before giving it back. I ‘listen’ with my patient to their earliest communications in their projective identifications. I dream the session where possible and attempt to find the ‘enzymes’ required to breakdown hard, concretized objects that live in patients as symptoms (bodily and psychic), nightmares and night terrors. I work to see the autistic, narcissistic, perverse and other defences against painful inner and outer realities of existence. I try to support the emergence of the ever-present ever-changing infant of analysis (needing, vulnerable, creative and curious). I try to play with the characters each patient brings to the session; first in my own mind and where possible openly on the analytic playmat. I listen and look for the ‘secret passages’ to the unconscious that might be emerging and the cracks in the patient’s protective shell that might allow the light of greater contact with emotional reality and nourishment by the discovery of personal truth. I try to create containers with the patient for the most unbearable, undigestible and painful experiences.

But, in the consulting room I approach each session and each moment, where possible, without memory, knowledge or desire. Of course, memories will come into my mind, I do not expel them but note their presence and wonder about them. Of course, ideas will occur to me, but I do not actively try to link them with known theory (after all, what I think I might know, may have no relevance to this moment with this patient). Of course, I begin to desire certain things for and with the patient. But again, I try to have the inner workspace to imagine wonder and dream all that emerges from the patient, from me and in the space between us.

This inner workspace is also enriched and informed by my own Internal Objects and my real parents, family and friends of the past (who were not perfect but did the best they could) and of the present who stabilise and ‘feed me’. As well, I have my analyst and the experience of my analysis. Whilst my analysis ended years ago, it remains a richly alive experience that I continue to draw upon. Then, there are my supervisors, mentors and colleagues, as well as my Analytic Society. These can all be a rich source of foundational support in my work.

How does it unfold?

I don’t know! That is the joy and fear of analytic work. I can never know how it will unfold. If I think I do, then I obstruct the working of the unconscious in me and the patient as an analytic couple. The new births of analytic work are surprising, unexpected and awesome! I need to remain open to what can and will erupt from the depths of the human condition and human experience. I continue to make new and different discoveries about myself, my patient and the realities of the world we live in. 

Charles Dickens created a weekly journal, ‘All The Year Round’, in 1859. People would wait for the next edition to find out what was going to happen the next chapter of Great Expectations. An episode of Gilligan’s Island ends or Hogan’s Heroes or Family Ties or Star Trek and there would be the next episode. What happens next? Even, movies have sequels. Which characters will continue in the next chapter? Will there be guest appearances? What story unfold? What will happen with the ongoing and unresolved relationships and dramas? These questions present in the alive day-by-day episodes and sequels of the psychoanalytic drama.