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Sorry, Your Therapist Can’t Be Your Friend

Maintaining therapeutic boundaries are vital to your mental health

By Susan Kolod, Ph.D.

“There’s a force more powerful than free will: our unconscious. Underneath the suits, behind closed doors, we’re all ruled by the same desires. And those desires can be raw, and dark, and deeply shameful.”

Shutterstock/ESB Professional
Source: Shutterstock/ESB Professional

These opening lines, spoken by Naomi Watts playing the unhinged psychotherapist Jean Holloway in the Netflix series Gypsy, have great truth.  But, from the mouth of Dr. Holloway, they are a rationalization for her disturbing boundary violations of her relationships with her patients. For example, Dr. Holloway initiated a sexual relationship with the ex-girlfriend of a patient, sought out and befriended the daughter of a patient, and allowed a patient to live in a secret apartment she kept in Manhattan.

The show raises interesting questions about how much involvement therapists should have in their patients’ lives. There are times when some contact outside the session is inevitable, such as when a therapist and patient live in a small town.

However, it is a fundamental rule in psychotherapy that the therapist maintains appropriate boundaries between herself and her patient. In fact, psychotherapy simply will not work and can be potentially harmful without these boundary limitations, sometimes referred to as the frame. They are:

  1. No physical contact with a patient.
  2. No relationship with a patient outside of the consulting room.
  3. The therapist should not treat close relatives or friends of the patient.
  4. No practical advice to a patient.
  5. Maintain objectivity and neutrality toward the patient and avoid excessive worrying/thinking about the patient.
  6. Seek supervision if you are tempted to, and before you do, violate any of these rules.

Although not every violation will lead to disaster, and some flexibility may be harmless or even appropriate in certain circumstances, the failure to take seriously the potential for disaster from any boundary violation is a grave error. Trouble happens most often when the therapist is tempted to think she is above these rules, not subject to temptation, or can handle this particular situation. That is when consultation with a supervisor may be most helpful.

The therapeutic relationship is not a friendship because the therapist and patient have no relationship outside the consulting room. That doesn’t mean that the therapist has no feelings towards the patient. In fact, many patients evoke extremely strong emotional reactions in their therapist: reactions of love, lust, curiosity, envycompetition, and even distaste or hatred at times. The feelings evoked in the therapist by the patient are calledcountertransference, and the feelings that the patient has for the therapist are referred to as transference.

Transference and Countertransference:

First identified by Sigmund Freud, transference is one’s reaction to another person based on feelings and patterns of relating that were established in early childhood, often towards a caretaker, usually a mother and father. Transference reactions are not limited to the therapy relationship. In fact, we unconsciously transfer feelings derived from our earliest relationships onto many of our adult relationships.

In psychoanalytic therapy, transference is something to be examined, explored, and understood. The therapist also examines and explores her countertransference feelings as a way of understanding the effects a patient is having on her. This examination of the countertransference gives the therapist insight into the patient and protects her from inadvertently acting in ways that may interfere with her functioning in a non-judgmental and objective manner. Problems ensue when the therapist is unaware of her countertransference.

Psychoanalytically-trained therapists have themselves undergone psychoanalysisprecisely so that they can become aware of their own unconscious patterns of thought and behavior established early in life. As a professional, when Dr. Holloway realized how her patients were affecting her, she should have sought consultation and possibly gone back into analysis.

What is an enactment?:

Edgar Levenson, a preeminent psychoanalyst, notes that therapy truly begins when the therapist recognizes that the kinds of interactions the patient describes as having with other people have begun to occur in the consulting room between the patient and therapist. These situations are referred to as enactments.

For example, in sessions, Sarah often focused on her unhappy interactions with friends and family. She complained they were frustrated and fed up with her and didn’t want to listen to her problems. At a certain point, she began demanding of her therapist in a distraught tone, “What should I do? Just tell me what to do!” The therapist, against his better judgment, felt compelled to give Sarah advice, something which he refrained from doing with his other patients. Sarah never followed the advice and the therapist began to note how frustrated and fed up he felt towards her.

Sam, a handsome and engaging young man, sought therapy because he had been unable to establish a loving relationship. He reported on his whirlwind courtships with one woman after another, which inevitably led to his finding a flaw in the woman and then losing interest. The therapist looked forward to sessions with this patient, in part, because he was so pleasing and complimentary. When she noticed that she was having romantic fantasies about him, she realized she was becoming involved in an enactment of his seductions and knew where it would lead.

The ability to discern and examine the presence of an enactment requires that the therapist maintain the frame and keep clear boundaries with the patient. With Sarah, the therapist realized he and Sarah were enacting the very problem they had been discussing. Once the therapist noticed this, he was able to step back from the advice-giving and explore with Sarah the foundations of her frustrating pattern of demanding and then rejecting advice.

In the case of Sam, the therapist realized that she and Sam were enacting his pattern of seductions. She could then focus on exploring the reasons for this behavior and how it interfered with his development of loving relationships with women.

The therapy relationship can and should evoke strong feelings in both therapist and patient that are vital to effective treatment. But those feelings can only be used therapeutically if they are explored and understood, but not acted on. The rules of the frame, which prevent boundary violations, are critical to therapeutic success.  And that is why your therapist cannot, and should not, be your friend.

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What Is Healthy Narcissism?

The joy of self-love can be powerful and sustaining.swan-1282835_960_720

Narcissism is bad, right? Google search is flooded with questions: “What is narcissism?” “How can you tell if your partner is a narcissist?” “Am I a narcissist?”

So my patient Adele was surprised and intrigued when I told her that we needed to work on developing some healthy narcissism. “Is there any such thing as healthy narcissism?” she asked in disbelief, “I thought narcissism was negative.”

The diagnosis of Narcissistic Personality Disorder is indeed very negative and includes characteristics such as arrogance, preoccupation with oneself, a need for constant admiration and, most importantly, a lack of empathy for others. But narcissism itself is not positive or negative–there is a continuum from healthy to pathological.

What does healthy narcissism look like?

Adele is a beautiful, highly intelligent and creative person who does not recognize or appreciate these qualities in herself.  She mentioned in passing, that she never looks in the mirror. You may remember that in the Greek myth, Narcissus falls in love with his reflection. Adele is never in love with her reflection and this creates problems for her. When completing a difficult project at work, she experiences no pleasure or satisfaction, just a grim sense of “on to the next problem.” When people comment on her style and grace she is disconcerted. In her romantic life she is surprised and taken aback when someone attractive shows an interest in her.

Healthy narcissism is related to self-esteem and self worth but is not exactly the same. It’s taking pleasure in one’s beauty, in the workings of one’s mind, in the accomplishment of a tough job well done. It is ecstatic joy in oneself. Although the joy of healthy narcissism can be a fleeting sensation, it is powerful and sustaining.

Healthy narcissism is exemplified in the song from West Side Story, I Feel Pretty.

I feel pretty,
Oh, so pretty,
I feel pretty and witty and bright!
And I pity
Any girl who isn’t me tonight.

I feel charming,
Oh, so charming
It’s alarming how charming I feel!
And so pretty
That I hardly can believe I’m real.

The Narcissistic Phase of Childhood Development

Complete preoccupation with oneself is normal and expectable in children at a certain age. The Narcissistic Phase of development begins at around the age of two—the same time children begin to talk. During this time children start to use words like “I”, “mine” and “no”. During this phase, children frequently behave as if the world revolves around them and have little concern for the needs and desires of others.

The eminent child psychologist, Margaret Mahler described this phase as a “love affair with the world.” Picture a two-year old running down the street with a broad smile on her face, Mom frantically chasing after. If development proceeds, as it should, the child learns, through close contact with parents, friends and teachers that those people also have needs and desires. Egocentrism diminishes and the child develops concern for others.

Healthy narcissism or a “love affair with the world” is something that adults can retain, although it no longer depends on being the center of the universe. It is that joyous, euphoric feeling of taking pleasure in oneself and one’s impact on the world.

Why is healthy narcissism important?

Healthy narcissism is important for a variety of reasons: If you can experience ecstatic joy in yourself it can help you through difficult times. For example, if a person can derive narcissistic pleasure from a difficult job well done, it can sustain that person through times of frustration and failure, thus preventing the likelihood of burnout. Likewise, taking joy in one’s beauty and positive impact on others can provide resilience during times of disappointment and heartbreak.

For a variety of reasons, some people don’t retain or develop healthy self-love.  Here are some examples:

An extremely self-centered parent may demand all of the attention from the child, not leaving room for the child to revel in herself. When Carina was a child, she believed that her mother knew everything and was perfect. As Carina got older, she learned that to get attention and approval, she needed to bolster her mother’s belief in her own omniscience and perfection. If Carina asserted her needs, she got the cold shoulder—or even worse. This was not an environment in which Carina’s healthy narcissism could flourish.

Some children never develop healthy narcissism because they fear that others will envythem. If a child learns that they will be punished or treated in a hostile manner if they excel, that child will hide or diminish the impact of their excellence, even hiding it from themselves.

Does it feel wrong to accentuate and revel in your good qualities? Think about what it brings to mind: fear of envy or the “evil eye”? Worries of being conceited? If so, reframe your healthy narcissism as gratitude for what you have been given. Being thankful for your natural talents may be a way to appreciate them without feeling too egotistical. Remember that the ability to take joy in yourself is a quality that can sustain you through the rough times in life.

Susan Kolod, Ph.D., is a supervising and training analyst, faculty and co-editor of the blog Contemporary Psychoanalysis in Action at the William Alanson White Institute. She is Chair of the Committee on Public Information of the American Psychoanalytic Association. Dr. Kolod has written numerous chapters and articles about the impact of hormones on the psyche. She has chapters in 2 new books: Alike/Different: Psychoanalytic Perspectives on Identity and Difference (Routledge) and Unknowable, Unspeakable and Unsprung: Navigating the Thrill and Danger of Living amidst Truth, Fantasy and Privacy(Routledge).

Terrorists or Copycats? What’s the Difference?

Detailed coverage of attacks can lead to contagion
By Sue Kolod, Ph.D.
Yasser Arafat, the former Chairman of the Palestine Liberation Organization, famously stated in his 1974 speech before the United Nations that, “One man’s terrorist is another man’s freedom fighter.”
But there is reason to suspect that the killers in the recent Orlando, Nice and Munich attacks were neither freedom fighters nor terrorists at all, but individuals with personal grievances struggling somewhere between rage, suicide and homicide.
The “Copycat” Effect
Self-destruction can be contagious. Research demonstrate the “copycat effect” of highly publicized acts of suicide.   The news coverage of Marilyn Monroe’s death in 1962 was extensive and sensational. According to one study, the suicide rate after her death in the United States jumped by 12 percent relative to the same months in the previous year. People at risk of suicide are vulnerable.  The extensive and sensational publicity around the suicide of a celebrity can add coins to the scale, tipping at-risk individuals toward identification and imitation.
A similar “copycat effect” has been found after non-ideological mass shootings. A study in Germany of mass shootings, i.e., attacks in which an individual goes on a rampage killing people without any apparent motive, found that such attacks do not occur randomly over time.  One attack is frequently followed by others within a matter of weeks.  Research suggests that many US mass shootings, such as the one at Virginia Tech, were inspired by Columbine. Shooters who have survived their attacks have claimed they wanted to surpass the attacks in the Colorado suburb. This has been called the “Columbine Effect“.
The “copycat” or contagion phenomenon most recently has been applied to the “terrorist” attacks in Orlando, Nice and Munich.  The New York Times, in response to the spate of mass killings, questioned whether these killings by self-professed “terrorists” should be properly labeled as “terrorism” or attributed to the contagion effect. (Terrorist or Disturbed Loner? July 24, 2016) and (Mass Killings May Have Created Contagion, Feeding on Itself, July 26, 2016).
The Label of “Terrorist Attack” may exacerbate the contagion
Are these shootings, in fact “terrorist attacks” or are they more accurately described as the acts of angry, disturbed young men seeking power, fame and a sense of identity? Perhaps, such mass killings are more a problem of public health than of the “War on Terror.”
If so, the solutions are complex: finding ways to identify persons at risk of acting out such suicidal terrorist fantasies; finding ways to encourage such persons into treatment; finding ways to limit easy access to the motivating ideologies; and finding ways to limit easy access to means of mass destruction, such as assault weapons and explosives.
Omar Manteen (Orlando), Mohammed Bouhlele (Nice)  and, most recently, Ali Sonboly, the Munich shooter, all had histories of either domestic violence, petty crime, alienation, or a series of life disappointments. Unlike the perpetrators of 9/11 or the Paris and Brussels attacks, none of these men had direct ties to a global terrorist organization.  They were merely alienated and troubled young men.
ISIS, of course, is happy to claim responsibility.
Madelyn Gould, professor of epidemiology and psychiatry at Columbia, worries, “Those of us in this field, it’s the first thing we think about when we read accounts of these recent mass murders: The detailed coverage of terrorist attacks may be giving people who are vulnerable or thinking along these line ideas about what to do and how to do it.”
Dr. Salman Akhtar, psychoanalyst, has written extensively about terrorism, its causes and ways to address it. “When you sit and talk with smart people, you get smarter, when you swim with good swimmers, you become a better swimmer. The same is true in the opposite direction; if you interact with/emulate people who engage in anti-social behavior, unacceptable behavior gradually becomes acceptable.”
When an attack is linked to a powerful threat such as ISIS it can inspire an alienated young man to “achieve” even greater bloodshed and carnage. For someone who is unmoored, this can create a sense of belonging and identity. The shooter becomes an overnight celebrity. And by labeling these massacres as “terrorist attacks” we may be exacerbating the copycat effect.
The copycat effect with mass killings, as with suicide, depends on the prominence of the coverage, the ways in which the details of the shooting are reported and the portrayals of people affected by the attacks. Young men who are struggling with thoughts of suicide and homicide, may use these reports as a guide or to feed their own fantasies of glory.
Both Dr. Gould and our own Wylie Tene, Director of Public Affairs of the American Psychoanalytic Association, have been working on guidelines for journalists to reduce the likelihood that media coverage will lead to the “copycat effect”. These guidelines will be similar to those already established for limiting suicide contagion: www.reportingonsuicide.org
It is hoped that following these guidelines when reporting on mass shootings will diminish and limit the “copycat phenomenon”. When writing about these events, remember that words matter. Before you label the next mass shooting a terrorist attack, think about the potential, yet inadvertent, consequences.
Susan Kolod, Ph.D. is the Chair of the Committee on Public Education of the American Psychoanalytic Association. She is a supervising and training analyst and co-editor of the blog, Contemporary Psychoanalysis in Action at the William Alanson White Institute. Dr. Kolod was a speaker at the conference, Violence, Terror and Terrorism Today, May 12, 2016 sponsored by the International Forum of Psychoanalysis.

Will A Pink Pill Make Me Horny?

It depends what kind of sexual problem you are having

It depends what kind of sexual problem you are having

By Susan Kolod, Ph.D.

Flibanserin or “Addyi” is the first drug approved by the FDA to treat Hypoactive Sexual Desire Disorder (HSDD) in women. The drug will become available on October 17th. There has been much discussion in the media over whether the drug is pro or anti-feminist. But the really important question is, “does it make you horny?”

How Does Flibanserin Work?

Flibanersin treats desire, unlike Viagra, which improves performance. Flibanserin is not “female Viagra”–Viagra is taken before sex and it pretty much assures an erection. Flibanserin must be taken every day and is being marketed as a drug to increase desire. So how does Flibanserin actually increase sexual desire?

To find out, I spoke to the expert on rat sexuality, James Pfaus, Ph.D., and learned how Flibanserin affects female rats with the hope this might shed some light on how it affects women.

Pfaus, Professor, Concordia University and President Elect, International Academy of Sex Research, gave me a crash course on the sexual behavior of female rats. Female rats love sex and make their desires known very clearly. They pursue sex actively with partners they find attractive and avoid sex with rats they don’t find attractive. They love to have their clitorises stimulated with a paint brush. No slut-shaming among rats.

In Pfaus’ lab, rats whose ovaries had been removed were administered a low dose of estradiol and then Flibanserin. The low dose of estradiol created a sex hormone scenario similar to women going through menopause. Usually, a female rat whose ovaries have been removed and is given a low dose of estradiol will not initiate or “solicit” sex. After a

two day trial, Flibanserin restored these rats to their normal rate of solicitations. Impressive results!

However, human sexuality cannot be observed so easily, nor is it so straightforward. In the drug trials, some women were given Flibanserin and others a placebo. All were asked to keep a diary of their sexual experiences. They also met with a psychologist once a week. Self-report, especially about sex, is notoriously subjective and often inaccurate.

Diary responses were analyzed for SSE’s or Satisfying Sexual Events. An SSE can be anything from masturbation to multiple orgasms with a partner to intimate touching. It is a broad and somewhat vague concept–it just measures how many times you “did it,” the “it” being something defined as sexual. So an SSE doesn’t really capture the experience of desire.

Flibanserin appears to be a lot more effective with female rats than with women. The increase in SSE’s was only .7 per month for women as compared with an increase in sexual solicitations of 3.94 per month in the rats!!

However, human SSEs and rat solicitations may be two different things.

Appetitive and Consummatory Motivation

Pfaus makes a distinction between “appetitive” and “consummatory” motivation in sexuality. Appetitive motivation is the first phase of a sexual encounter and involves the initiation and anticipation of sex. Appetitive behavior moves the animal (human and non-human) towards an attractive potential sexual partner and is more indicative of spontaneous desire. For example, female rats will press a bar to get access to a male sex partner. This is appetitive behavior.

In humans, appetitive motivation includes such behavior as flirting, planning for a date, fantasizing about a date.

Consummatory motivation, on the other hand, leads to actual physical interaction and completion of the sex act. In female rats, lordosis–arching the back and sticking out the buttocks so the male can mount her–is a consummatory behavior. In humans, foreplay, touching and actual sexual contact, and orgasm are consummatory.

It is possible that different drugs help with problems in one phase, but not another. Pfaus suspects that Flibanserin increases appetitive motivation. In other words, it might help a woman to feel sexual desire towards a partner, to anticipate sex with that partner, and to be motivated to initiate sex.

Three other drugs, still being tested by the FDA, Lybrido, Lybridos and Bremelanotide, may effect the consummatory sytem by maintaining excitement throughout the sexual encounter and facilitating orgasm.

Who Will Flibanserin Help?

Flibanserin, Pfaus suspects, will be most effective with women who are highly organized and always planning ahead. They may find it difficult to be “in the moment.”

For example, Stacey and Linda have been together for 18 years and married for the last 5. They have 2 small children. Stacey is highly organized both in terms of the household and at her job. She often feels overwhelmed by all of her responsibilities. Although she is very attracted to Linda, she is unmotivated to initiate love-making because she is always planning the next thing. This is exacerbated by feelings of resentment towards Linda who is not helping enough with the kids and the housekeeping.

While the interpersonal issues need to be addressed, Flibanserin might help Stacey to feel spontaneous desire and to be “in the moment.” The drug could be a good adjunct to couples’ therapy.

Flibanserin might be less helpful for a woman who can experience spontaneous desire but can’t sustain her excitement. Some of the other drugs to treat HSDD such as Lybrido, Lybridos or Bremelanotide, still being tested by the FDA, could be more helpful with difficulties maintaining excitement and reaching orgasm. These three drugs do not need to be taken every day—only before having sex, like Viagra.

The best outcome would be that a number of different drugs will become available as adjuncts to psychotherapy, couples therapy and sex therapy. And that women will be comprehensively informed about the risks and benefits. Women are entitled to make the best choices for themselves about what makes them horny and helps them to enjoy sex!

Susan Kolod, Ph.D., is a Supervising and Training Analyst, member of the Faculty, co-Editor of the blog, Contemporary Psychoanalysis in Action and on the Steering Committee of the Eating Disorder, Compulsions and Substance Abuse Program (EDCAS) (link is external) at the William Alanson White Institute (link is external). She has lectured and written about the impact of hormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

Why “Eat Less, Move More” Often Fails

By Susan Kolod, Ph.D.Mountain of fairy bread

If you want to lose weight, the solution is simple: eat less and move more, right? Everyone one knows that. But eating less and moving more is a lot easier for some people than others. It is easiest for people who are in the normal weight range and have perhaps gained a few pounds over the holidays. New research explains why this approach often fails with obese individuals. And why some calories are better than others when seeking to lose weight.

The role of hormones

Feeling full or hungry, energetic or lethargic, can be traced to certain hormones—in particular, leptin and insulin. Normally, when a body’s fat cells are filled with stored fat they release the hormone Leptin, which tells the brain to eat less and move more. However, when a person becomes obese this “signaling” goes awry. Leptin is not longer released and the message to the brain becomes “eat more and move less.” Thus eating more and moving less, thought to cause obesity, may actually be the RESULT of obesity.

Sean Lucan, M.D., M.P.H, Albert Einstein College of Medicine in New York City and James DiNicolatonio, Pharm.D., Mid-America Heart Institute of St. Luke’s Hospital, Kansas City Mo., conduct research on weight loss, obesity and public health issues. They suggest that the culprit in the perpetuation of obesity is refined sugar, rapidly absorbable carbohydrates and the hormone Insulin. Refined sugar and starches cause blood sugar to rise. The rapid elevations in Insulin results in a precipitous drop in blood sugar. This causes food cravings, especially for sweets.

Over time, the overconsumption of refined sugars and starches can result in “Leptin resistance,” which leads to an inability to determine fullness. Thus, the result of a dietheavy on refined sugar and starches is increased appetite and decreased activity—a dangerous cycle, and difficult to reverse. The researchers conclude that it’s not the number of calories consumed that accounts for obesity, but rather the type of food consumed—refined sugars and starches in particular. These foods can make changes to the brain that interfere with the ability to determine fullness and cause lethargy.

The problem with “eat less, move more”

Lucan and DiNicolantonio explain why an approach that advocates eating fewer calories is inadequate and simplistic, “By this thinking, a calorie’s worth of salmon, olive oil, white rice or vodka would each be equivalent and each expected to have the same implications for body weight and body fatness.” In fact, proteins, fats, carbohydrates and alcohol each have different effects on hormones relevant to feeling full. Lucan and DiNicolantonio suggest more nuanced thinking about weight loss. That is, some calories satisfy appetite and promote energy while others promote hunger and energy storage—in other words, not all calories are the same.

In addition, if you simply eat less food and consume fewer calories, you will become more tired and hungry—therefore, less likely to want to move more. The cravings for high-calorie foods increases with deprivation, making it more likely that binge eating will occur.

What foods make you want to eat less and move more?

It is more important to consider the type of food than the number of calories consumed. Some foods make you want to eat less and move more—other foods make you want to eat more and move less.

For example, fat, which is high in calories, can satisfy the appetite and promote activity. Nuts, dairy products, oily fish and olive oil are high in fat and calories. But these foods make you feel full and energetic. This makes is possible to eat less and move more, which leads to sustaining weight loss.

Diets that simply restrict calories and pay no attention to the types of food consumed can backfire especially among obese individuals who have become leptin resistant.

In order to reverse leptin resistance, it is necessary to change the types of food to those that will re-calibrate the signaling to the brain—and will promote a feeling of fullness and energy.

A public health issue

It does very little good to blame over-consuming inactive adolescents for getting fat. The advice to simply consume fewer calories and increase exercise is counter-productive. New research suggests that overconsumption and inactivity are caused by neurohormonal changes related to a diet filled with refined sugar, starches and processed food. Promotion of whole/minimally processed food with plenty of “good” fats such as olive oil, oily fish and nuts address the cause, rather than the effect. And may also address the sense of failure and hopelessness many obese people experience when they are told to simply, “eat less and move more.”

The Pleasures and Perils of Fighting Among Ourselves

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A polarized group becomes less effective as its members become more certain
By Susan Kolod, Ph.D
Polarization occurs when people on either side of a conflict take increasingly extreme opposing positions. A new Pew Research study demonstrates polarization is at an all-time high in American politics.  Striking examples of polarization are evident internationally as well. Many groups define themselves as having a common enemy—there is agreement that those who hold the opposing view are wrong. This draws people together and engenders feelings of righteousness, virtue, clarity and certainty. Ambiguity is banished.However, polarization has very very bad consequences.The Bad NewsAs a consequence of polarization, trust and respect for the “other” group diminishes, while distorted perceptions and stereotypes emerge. Negative qualities are attributed to individuals in the opposing group, while members of one’s own camp are viewed as positive and virtuous. The disagreeing parties assume more and more rigid positions and may refuse to negotiate. Those who try to take more moderate positions are sometimes viewed as “traitors.”People are often quick to recognize and loathe qualities in others that they find repugnant in themselves–such as greed, desire for power or hypocrisy.  When groups become polarized questionable behavior, which is typically evident in both groups, is only recognized in members of the opposing group, who are then identified as bad or evil.Polarization depletes creativity and saps a group of its energy. People exclude and marginalize one another. Although this can create a feeling of safety in the short run, over time, the group loses the vitality and “cutting edge” that come with collaboration.An Example of Polarization

A synagogue in a small Midwestern city became polarized when the rabbi refused to perform same-sex marriages. The rabbi is a very intelligent, kind and perceptive person. However, he is quite conservative and unbending on certain issues.  The executive council of the synagogue was divided on the issue of same-sex marriage, but the rabbi made it clear that on this issue he would not budge.

The congregation is a diverse group of individuals who run the gamut from very conservative to very liberal. Although there is a fair amount of disagreement, people in general respect one another and there is a high level of tolerance towards ambiguity, complexity and uncertainty. However, the issue of same-sex marriage divided the congregation into two camps—“for” and “against.”

The enemy of my enemy is my friend. The regrettable wisdom of this proverb was manifested in the congregation as it became ever more polarized:

  1. People who had not been close previously began to bond with each other and against the other side.
  2. If they had opposing views, people who had been friends broke off relations.
  3. Each side accused the other of ill-intentioned behavior, but did not recognize it in themselves.
  4. Energy, enthusiasm and a sense of belonging to a single cohesive group were eroded.
  5. Both groups felt disrespected and maligned by one another.
  6. The atmosphere of fear and anxiety spread to other issues.

What Causes Polarization?

Kenneth Eisold, Ph.D., author of What You Don’t Know You Know: Our Hidden Motives in Life, Business and Everything Else, is apsychoanalyst and Faculty member at the William Alanson White Institute. One of Eisold’s specialties is consultation with polarized organizations (like businesses and charities)—he helps them reestablish a collaborative atmosphere.

Eisold emphasizes that polarization is a normal process–it often develops when people become overwhelmed with complexity and uncertainty. He notes that individuals within a polarized group think in terms such as, “I know where I stand and what I feel.” This is very satisfying when the group has just gone through a period of intense stress and confusion.

What Can Be Done?

Eisold emphasizes that working with polarized organizations is tricky: “Timing is key. When a group is in the midst of polarization, they need the simple clear version of events…they lose ability to listen to the views of the other. There is no point in trying to intervene while a group is in the midst of intense polarization.  But once a group reaches a point where they are asking for help, something can be done.”

When that occurs, Eisold uses various techniques to help the two groups come to a more moderate position, such as asking members of each group if there was a time when members of the “other” group were seen as having positive qualities. Such reflection often catalyzes a shift back to tolerance and unity.  Having members of opposing groups work together on specific projects with a common aim is an effective way to bring people back together, enlivening their interactions and recapturing the energy of cooperation.
Susan Kolod, Ph.D., is a Supervising and Training Analyst and co-Editor of the blog, Contemporary Psychoanalysis in Action at the William Alanson White Institute. She has lectured and written about the impact of hormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

New Publication in the Journal, Contemporary Psychoanalysis

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Volume 50:3, 484-491

2014

READING THE FEMININE MYSTIQUE ON THE 50th ANNIVERSARY OF ITS PUBLICATION

By Susan Kolod, Ph.D.

On the 50th anniversary of the first volume of Contemporary Psychoanalysis, what better time to reconsider Betty Friedan’s The Feminine Mystique, first published 50 years ago? This book was an important part of the Zeitgeist into which CP was born. On rereading The Feminine Mystique with the knowledge of what occurred after its publication, it is possible to appreciate how much Friedan accomplished in furthering the cause of women’s equality. In particular, her critique of the Freudian position on female development is still fresh and vibrant. But, with hindsight, it is clear what she got wrong.
My Aunt Margy, who died in 2004 at the age of 86, was a brilliant housewife. Margy’s apartment was spotless and she was an expert on cleaning products and procedures. If I couldn’t remove a spot from a blouse or get the crud off a pan, I’d call her and she knew what to do. A favorite family story about her: She got some greasy dirt on her white pants and exclaimed, “I couldn’t even Shout it out!” referencing the commercial for Shout, the laundry stain remover.
Margy once told me she would never go to a “woman doctor”—women were just not as capable or smart as men. She did not understand why I wanted a job outside the home and frequently commented on my lack of expertise regarding the removal of dirt. I was damaging the children by having a career. Margy exemplified the postwar generation of women who opted out of the work force in favor of becoming moms and housewives. These were the women Betty Friedan wrote about in The Feminine Mystique.
Fifty years after its publication, Betty Friedan’s The Feminine Mystique continues to influence how women think about what “makes them tick.” Friedan got a lot right, but 50 years later, it’s easy to see she got some things wrong as well.
Friedan’s book catapulted the Women’s Movement into the public eye. She identified the “problem that has no name”: the boredom, depression, and empty lives of educated women who had given up careers to care for home and children. Friedan tapped into the experience of a vast number of mid-20th century suburban women: “It was a strange stirring, a sense of dissatisfaction. … As she made the beds, shopped for groceries, matched slipcover material, ate peanut butter sandwiches with her children, chauffeured Cub Scouts and Brownies, lay beside her husband at night—she was afraid to ask even of herself the silent questions, ‘Is that all?’”(p. 15).
Friedan, who died in 2006 at the age of 86, graduated from Smith College in 1942 and gave up a prestigious scholarship for graduate school because of her boyfriend’s objection. The book was based, to a large extent, on her own experiences. Fifteen years later, Friedan interviewed her classmates and discovered that most had given up their career dreams. Instead, their resumes read: Occupation: Housewife.
Friedan raised challenging questions about psychoanalytic views of female development and psychology, then in vogue, and the ways these views kept women “in their place.” When The Feminine Mystique was published in 1963, the classical Freudian view of female development was still the accepted wisdom: anatomy is destiny, and normal female development includes penis envy, faulty super-ego development, masochism, and passivity. Friedan correctly pointed out how these theories kept women in a submissive role relative to men. She writes,”How can an educated American woman, who is not herself an analyst, presume to question a Freudian truth? She know that Freud’s discovery of the unconscious workings of the mind was one of the great breakthroughs in man’s pursuit of knowledge … that only after years of analytic training is one capable of understanding the meaning of Freudian truths. She may even know how the human mind unconsciously resists that truth. How can she presume to tread the sacred ground where only analysts are allowed? ” (pp. 103–104)
Perhaps Friedan’s most brilliant insight is her analysis of the way Madison Avenue employed ideas from contemporary psychology to convince women that their essential nature is to become experts in home economics. In the mid-1940s, men returning from war needed to resume their place in the workforce. During the War, women had attained a great deal of equality and autonomy, taking the place of men in the workforce during the War. Now that the men were back, this posed a problem. How could women be convinced to return to housewifery? Enter Madison Avenue. According to Friedan, advertisers realized that, “The really important role that women serve as housewives is to “buy more things for the house” and that “women will buy more things if they are kept in the underused, nameless yearning, energy-to-get-rid-of state of being housewives” (p. 207). The trick was to convince women that homemaking is creative and a career unto itself, equal to or better than going out into the workforce.
Thus, Friedan suggests, Madison Avenue teemed up with Freud to brainwash women into believing that “occupation: housewife” was a woman’s essential nature. The goal was to help women get rid of their suppressed penis envy and neurotic desire to be equal—to help women find fulfillment as women by affirming their natural inferiority. She quotes from the report of an ad executive: “The modern bride seeks as a conscious goal that which in many cases her grandmother saw as a blind fate and her mother as slavery: to belong to a man, to have a home and children of her own, to choose among all possible careers the career of wife-mother-homemaker” (p. 220).
Friedan was particularly horrified by the focus of advertisers on “getting them young” while the woman’s mind was impressionable and before she knew any better.
From another chilling report she quotes, “Properly manipulated, American housewives can be given the sense of identity, purpose, creativity, and the self-realization, even the sexual joy they lack—by the buying of things” (p. 208) … the solution, quite simply, was to encourage them to be “modern housewives.”
“This professionalism is a psychological defense of the housewife against being a general ‘cleaner-upper’ and menial servant for her family in a day and age of general work emancipation.” Capitalize, the report continued, on housewives’ “guilt over the hidden dirt” so she will rip her house to shreds in a “deep cleaning” operation, which will give her a “sense of complete-ness for a few weeks” (p. 208).
Friedan describes a generation of women in a kind of trance state. The Feminine Mystique, although melodramatic and overreaching at times, was the wake-up call.
As stated previously, Friedan got a few things wrong. She observes of Freud, “He was a prisoner of his own culture. As he was creating a new framework for our culture he could not escape the framework of his own” (p. 105). The same can be said of Betty Friedan. Without diminishing the importance of her contributions, Friedan made several serious errors that have been difficult to eradicate because of her tremendous influence and impact on the culture.
Friedan correctly pointed out how the classical Freudian view of female development kept women in a submissive role relative to men. However, Friedan went on to completely dismiss the importance of ovarian hormones and the menstrual cycle on a woman’s identity, mood, and thought processes. Friedan’s mission, or one of her missions, was to assert there was no meaningful difference between men and women, that anatomy is immaterial. Friedan’s attack on psychoanalytic views of female development, contributed significantly to the avoidance of the body in contemporary psychoanalytic thought (Kolod, 2009, 2010, 2013).
This thesis became very relevant to me while I was researching the topic of menopause, an endeavor prompted by the onset of my own. I noticed how little was written on the subject, and that women rarely spoke about their physical and psychological suffering.
Friedan thought menopause inconsequential. If a woman has a meaningful life, menopause should be a nonevent. She believed that only women whose identity and self-worth were tied to being a wife and mother, and for whom, therefore, youth and sexual attractiveness are all-important, would find menopause difficult. Other hormonal emotional experiences, such as premenstrual tension and postpartum depression, she likewise refused to recognize as physiologically determined.
Friedan, and many other feminists who are now in their 70s, 80s, and 90s, espoused the view that the miseries of menopause are solely a consequence of the repressive Freudian environment Friedan detailed in The Feminine Mystique. Friedan went so far as to say that menopause didn’t really exist—it was invented by the pharmaceutical companies!
What was wrong with me, I wondered? I had a career and meaningful relationships but found menopause disorienting and painful. The changes in body image, the physical discomfort, mood swings, and insomnia all made me wonder, “Who am I?” and “What am I becoming?” According to Friedan, I should have been immune to this distress considering my own independence outside the home.
In 2005, I invited Friedan to speak at a conference to explain her views. The conference topic was “Is There Menopause?” Friedan initially agreed, but her failing health prevented this. She did, however, allow me to videotape an interview to be screened for attendees. She died soon after the interview.
On January 12, 2005, I went to Friedan’s apartment. I had sent her a list of questions in advance of the interview: Have women’s reactions to menopause changed since you wrote The Feminine Mystique? Do women experience it the same now as they did in 1963? Do you think menopause changes the way a woman sees herself? Does it change her identity?
Friedan became increasingly annoyed, and even hostile, as I asked my questions. The very word “menopause” irritated her. Menopause does not exist—and shouldn’t be talked about. I persisted with my questions until she finally yelled, “What the fuck are you asking me?” Questions about “aging” were okay with her, so long as I didn’t use the word “menopause.” Men and women both age, but only women are alleged to go through menopause. To acknowledge the body at all was to accept male domination.
At the conference, along with the Friedan interview videotape, I presented my own paper on the impact of menopause on a woman’s identity. Much to my surprise, several feminist psychoanalysts, 10 to 15 years older than I, approached me afterwards warning me that this was a dangerous topic, a slippery slope, and that I should perhaps discontinue talking about it.
The dangerous topic is not menopause—it is the acknowledgement that female hormones make woman feel and behave differently from men. Historically, a focus on the female body, ovarian hormones and the menstrual cycle has been used to stigmatize women as moody, flighty, and unfocussed. As such, they should not hold positions of power. If a woman was president, she might start a nuclear attack while suffering from PMS!
Friedan should be forgiven for this error. She wanted to send the message that “A woman can do anything a man can do.” For the postwar women who had been “brainwashed” to believe they could only do housework, this message was urgent. So the “hormone” question was dismissed out of hand. Yet, today, the issue of a woman’s role and her power in the workplace is still far from resolved. In Sheryl Sandberg’s bestseller, Lean In: Women, Work and the Will to Lead (2013) argues that women have not, in fact, come very far. There are many more women in the workforce but for the most part, men still are in charge. As she told a group of students at the Harvard Business School in 2011, “If the current trend continues, fifteen years from today, about one-third of the women in the audience will be working full-time and almost all of you will be working for the guy you are sitting next to” (pp. 65–66).
Friedan’s critique of the Freudian view that “anatomy is destiny” contributed to an almost complete avoidance of the body in contemporary psychoanalysis and theories of gender construction. Laan and Everaerd (1995) note, “Feminists have long criticized the notion that behavior and abilities of women are uniquely determined by their biology. This criticism led to an almost total rejection of the role of biology in the construction of gender. It also contributed, unfortunately, to an image of female sexuality devoid of the body” (pp. 22–23). Balsam (2008) comments on the avoidance of the body in contemporary psychoanalytic theory. She notes that although the term “embodiment” shows up regularly in contemporary psychoanalytic theory as a metaphor for psychological containment, there has been a turning away from concrete bodily experience. She writes, “In many of the influential new psychoanalytic theories of gender, biology has been sidelined as irrelevant” (p. 102).
Betty Friedan had wanted to become a psychologist herself and was familiar with the work of the prominent psychologists of her time. She borrowed concepts freely, sometimes with attribution, at other times incorporating their ideas into her own as if she had thought of them herself. She used the “ph” spelling of the word “phantasy” rather than the more common spelling, “fantasy.” There is no way to know at this point why she chose this unusual spelling; I presume she wanted to show her familiarity with the work of Melanie Klein. However, the “phantasy” spelling in Klein’s writing indicates unconscious fantasy. Friedan used the word, incorrectly, to refer to conscious fantasy.
In some cases, Friedan incorporated psychological concepts brilliantly, as with her use of Fromm’s “marketing personality” (Fromm, 1947), which clearly informed her ideas about women and Madison Avenue. At other times, her use of the concepts comes across as exaggerated. For example, she used Bettelheim’s theme of the dehumanization of concentration camp victims to bolster her argument about the dehumanization of the housewife. “The women who ‘adjust’ as housewives, who grow up wanting to be ‘just a housewife,’ are in as much danger as the millions who walked to their own death in the concentration camps—and the millions more who refused to believe that the concentration camps existed” (p. 305).
Some of Friedan’s “psychologizing” was outright wrong and had a lasting and damaging effect on views of women. She blamed stay-at-home mothers for a wide variety of psychological and social problems in their children such as delinquency, kleptomania, and promiscuity. According to Friedan, these problems developed out of mother’s failure to self-actualize and her obsessive focus on the child. She goes on to hold stay-at-home mothers responsible for autism, schizophrenia, bestiality, and homosexuality and uses concepts from Bettelheim (1950), Frieda Fromm-Reichmann (1948), and Thompson (1947) to substantiate these claims. Although none of these writers addressed the issue of “stay-at-home-mothers,” Friedan used their concepts of the “refrigerator mother” and the “schizophrenigenic mother” to bolster her argument. In this way, The Feminine Mystique reinforced the “blame the mother” culture of the 1950s and 1960s.
The women of the Baby Boomer generation, their children and grandchildren are the benefactors of the changes brought about by the Women’s Movement. We should be immensely grateful for Friedan’s potent critique of that which oppressed women, but also cognizant of the ways in which some of her errors have negatively affected psychological understanding of women since that time.

REFERENCES

  • 1. Balsam, R. (2008). Women showing off: Notes on female exhibitionism. Journal of the American Psychoanalytic Association, 56, 99–121. [CrossRef], [PubMed], [Web of Science ®]
  • 2. Bettelheim, B. (1950). Love is not enough: The treatment of emotionally disturbed children. Glencoe, IL: Free Press.
  • 3. Friedan, B. (1963). The feminine mystique. New York, NY: Norton.
  • 4. Fromm, E. (1947). Man for himself. New York, NY: Rinehart & Company.
  • 5. Fromm-Reichmann, F. (1948). Notes on the development of treatment of schizophrenics by psychoanalysis and psychotherapy. Psychiatry, 11(3), 263–273. [PubMed]
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  • 8. Kolod, S. (2013). Why Betty Friedan threw the body out with the bath-water. Retrieved fromhttp://www.psychologytoday.com/blog/contemporary-psychoanalysis-in-action/201306/why-betty-friedan-threw-the-body-out-the-bathwater
  • 9. Laan, E., & Everaerd, W. (1995). Determinants of female sexual arousal: Psychophysiological theory and data. Annual Review of Sex Research, 6, 32–77. [Taylor & Francis Online]
  • 10. Sandberg, S. (2013). Lean in: Women, work, and the will to lead. New York, NY: Knopf.
  • 11. Thompson, C. (1947). Changing concepts of homosexuality in psychoanalysis. Psychiatry, 10, 183–189. [PubMed], [Web of Science ®]
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