Successive Approximations to An Analytic Identity

Salee Jenkins, Ph.D.

A young beautifully dressed black woman strode purposefully into my office and announced that she needed help with her fear of birds. She'd just had a narrow escape, darting into the path of an oncoming car while trying to avoid a pigeon.

It was 1975 and I'd recently begun my internship at Northwestern, a psychodynamically focused program in which Kohut was making a big splash. My graduate training, at Indiana University, was embedded in a militantly behavioral empirically based approach; I had chosen Northwestern because of my unpopular affinity for psychoanalytic ideas. They had chosen me to be the resident behaviorist. So while a treasure trove of depth psychology—Kohut, Winnicott, Fairbairn and Modell—was opening to me through my classes, clinically, I was relentlessly referred the behavioral cases, mainly phobias.

The patient mentioned above was one of them. While I was interested in trying out a new format, exploring the origins and sequelae of her fears within the broader context of her emotional life, she adamantly resisted looking at anything other than the concrete manifestations of her phobia, and even that she had a marked reluctance to do in much detail. Her inner life held no interest for her. It wasn't until much later that I realized it was what she most feared.

After a few feeble attempts to convert her into the insight-and-interpretation type of patient I desired ("None of that childhood baloney!" she told me) I settled back into what I knew best: systematic desensitization. Together, the patient and I constructed hierarchies ranging from relatively benign to frightening images of birds. As our conversations proceeded my uneasy and vigilant patient did provide some historical context for the development of her trouble—these fears originated when she was 8 years old and sent to spend the summer on her aunt's chicken farm in the South. Her parents had recently divorced and she was lonely, missing her mother and feeling rejected by her aunt who favored another cousin. And Emmett Till was kidnapped and murdered not far from where she was living, a story she heard in vivid endless detail.

The chickens were a sport on the farm. She remembered scenes of the hired men wringing their necks "for something to do when they were bored", the decapitated birds jerking convulsively, bloody heads strewn over the ground. She had a repetitive dream, persisting into adulthood, in which she found herself in a barnyard, surrounded by a tightening circle of mutilated chickens' heads from which she could not escape and would often awaken screaming.

Returning from her aunt's farm, her fear of birds persisted and expanded. Her daily activities were organized around avoiding birds in all their myriad forms. She refused to eat fowl, sleep on feather pillows or crack eggs. She side-stepped a biology course due to work with chicken embryos. She kept these fears secret from everyone.

Indeed, speaking them aloud to me, for the first time in her life, had unforeseen consequences. Although she began in a business-like way, her sole aim of sticking to a strict behavioral format softened and imperceptibly, in small increments, a bond began to form between us. As the patient described the centrality and alarming properties of the birds inhabiting her universe I began to resonate to their prevalent, atavistic qualities, and non-mammalian foreignness. Walking home from work, I found myself watching sparrows, crows and pigeons, attending more to their beaks and claws than the beauty of their flight, thinking about how my patient might feel on this particular walk, what she might see. She had become a preoccupation for me, as the birds were for her, though with a different emotional valence. In this preoccupation my empathy for her became a visceral, auditory and visually mediated experience, less descriptive, more lived.

Within this context (a harmonious interpenetrating mix-up? (Balint 1967)) the patient dared to confide a fantasy: Sometimes she felt a tingling all over her body and imagined her toes were turning into claws and she was about to sprout feathers. When I tried to inquire more deeply about this altered experience of herself she missed the following hour. I wondered if my questions had disrupted an incipient merger transference (Kohut, 1971).

We proceeded to the next stage: relaxation training. She reclined on the couch and practiced isolating, tensing and relaxing specific muscle groups. She remarked in passing that it was hard to close her eyes, that she had a long-standing fear of the dark and of sleep. She worried birds might be lurking nearby or that they would enter her dreams. She had battled her chronic insomnia by devising elaborate religious rituals designed to ward off danger and guard her sleep. Having learned my lesson about pursuing this material verbally I added a guided imagery component to the relaxation procedure, describing peaceful scenes, suggesting she let herself drift. My voice was, soft, rhythmical and repetitive, or silent. Her breathing slowed; at one point she slept. I was in an altered not quite sleepy but hazy state. She expressed gratitude, explaining she'd not felt so comfortable in years. At the time I thought she had "acquired the relaxation response easily". Later I realized that I had provided a soothing tension regulating function that was bidirectional—both of us listened to the melody of my voice and allowed ourselves to float and be supported simultaneously. As she relaxed, so did I; my qualms about her fantasies dissipated as did my eagerness to pursue them. I made a relaxation tape for her to take home; she played it at night and was gradually able to wean herself from the superstitious rites she had formerly used to induce sleep.

We were now ready to begin pairing images of birds (quiet cartoon animals in the beginning) with the relaxation response, aiming to extinguish her conditioned anxiety. By presenting these images to her I coincidentally became an active participant in her fantasy life. My role (as I reflect on it now) was to remember our work, evoke her memories and visualizations, titrate her tension and, above all, accompany her on this journey. She remained calm and peaceful as I gradually introduced slightly more aggressive imagery—until suddenly, with little warning, everything fell apart.

Birds surged into monsters with malevolent intent. My patient began startling and trembling, staring wide-eyed, convinced a bird had actually flown into the room. My efforts to back off into more benign regions of the hierarchy fell on deaf ears. Her anxiety escalated into panic and mine lost its signal function as well. I interrupted our behavioral procedure, insisting we talk about the drama unfolding in the room, grasping for some form of reconstruction or transference interpretation or empathic connection that might repair the injury I had inflicted. She interpreted this shift as a vote of "no confidence" (it was, although she got the subject wrong), indicative of her inadequacy, and she began missing sessions. When she did appear it was with a brittle "everything is fine" demeanor, uncomfortably talking about superficialities. We were tenuously connected, walking on eggshells, trying to recapture our old rapport. But I knew I had become dangerous to her, a new addition to the dangers she faced in her environment each day.

Her irritability and suspicion deepened; she wondered why I kept Wildlife Magazine, with its photos of various raptors, in the waiting room. She heard a whistling in the building and was convinced a parrot had taken up residence—had I planted it nearby in a misguided attempt to confront her fears once and for all? I had become a selfobject, but a negative one, having coalesced with the Klansmen and the handymen of her childhood, filling her with terror and tension, robbing her of a sense of competency, failing to protect the delicate tendrils of mastery that had barely begun to grow.

During a subsequent hour she asked to lie down again and attempt to relax, following the procedure we had employed during our earlier meetings, in a poignant effort to recapture the safety and tranquility she had experienced then. However, this time she began to cry, expressing with great agitation her terror of dying the moment she touched a bird. She asked me several times if I thought she was psychotic and repetitively expressed her fear of emotional breakdown. This opened the door to exploration of a series of breakdowns that had already occurred, in the past, but had remained inaccessible to any form of dialogue. I finally had the patient I had wished for, one who gave me access to a symbolic and verbalizable inner life, but in an infinitely more complex and fragile fashion than I had anticipated—but that's a story for another time.

How do I understand what happened between us, thirty years later, within a self psychological framework? It would have been simpler to explain back then, before the pluralistic proliferation in our own corner of psychoanalysis had begun. As I wrote this case I alluded to a variety of concepts that held appeal for me then: empathic resonance, selfobject transferences and functions, the negative selfobject. I certainly would have discussed the fact that two empathic ruptures had occurred, the first when I inadvertently flooded her with anxiety during the guided imagery procedure, the second when, out of my own distress, I changed our format and dealt an eviscerating blow to her self-esteem.

However, in today's world of self psychology and beyond, I now have the good fortune to be the recipient of much additional research and theory (the BCPSG, Beebe and Lachman—to name two) and have a framework that permits me to reside more comfortably within the implicit domain, which I tried to illustrate through the description of the various behavioral sequences with this patient. A legitimate depth therapeutic process is no longer exclusively predicated on verbal exchange; indeed, my preference for a free-associatively laden conversation, with this particular patient, robbed her of a spontaneously evolving sense of continuity, coherence and connection in the nonverbal realm. Fortunately she turned out to be fairly forgiving in the long run and we were eventually able to re-transcribe our insights into action, venturing out into the world together, confronting her fears in vivo (museums, zoos, etc.). An identification with me as vulnerable (my anxiety had been palpable) yet resolute (we carried on) facilitated in her a sense of greater competency in which she became more attentive to herself, less beset by fear.

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