Wearing My Tutu to Analysis and Other Stories: Learning Psychodynamic Concepts from Life

by Kerry L. Malawista, Anne J. Adelman, Catherine L. Anderson

Wearing My Tutu to Analysis and Other Stories enlivens psychodynamic theory for students, teachers, clinicians, and others eager to learn the ins and outs of practice. Sharing amusing, poignant, and sometimes difficult stories from their personal and professional lives, Kerry Malawista, Anne Adelman, and Catherine Anderson invite readers to explore the complex underpinnings of the profession, along with analytical theory's esoteric nature.

There couldn't be a more appropriate method for illustrating the dynamics of psychoanalysis than the vehicle of story, which is such an integral part of psychodynamic practice. Through their narratives, the authors, who are also practicing analysts, show readers how to incorporate psychodynamic concepts into their work and identify common truths at the root of shared experience. Their approach demystifies dense material and the emotional consequences of intimate practice. Divided into five sections, the book covers psychodynamic theory, the development of ideas, technique, the challenges of treatment, and the experiences of trauma and loss. Each section opens with a brief memoir composed by one of the authors and follows with a discussion of related concepts. Overall the presentation follows a developmental trajectory, opening with stories from early childhood and resolving with present encounters. Their unique approach allows readers to absorb psychodynamic concepts as they unfold across the lifespan.

Genres: Psychology, Nonfiction

250 pages, Paperback

First published July 1, 2011

Reviews

[Sheri · Rating 5 out of 5]

This book was on a recommended list for a class and I am glad I picked it up. Malawista, Adelman, and Anderson do a great job of relating therapeutic stories to theoretical frameworks. With this book the authors give a story in the words of a consumer at the beginning of each chapter and then relate the story to a variety of theories. The stories are in roughly “developmental” order and also deal with memory and accuracy/truth in memory as a strong theme throughout.

Personally, I think one of the most intimidating aspects of becoming a therapist is imagining how to react in the moment when there are so many possible directions to go with each conversation. This book helped me to think about all these different possible interpretations and reactions as well as highlight the important aspects of these disclosures.

Overall it is a highly read-able book about theory with examples. Might not be for general public, but certainly recommended for anyone working in mental health.

I have my favorite quotes and brief comments below for each of the stories.

Popped—In this story, an adult client comes to the realization that her memory of her sister popping her toy horse was really a “cover” for her own jealous reaction to her mother having another child. The analysis focuses on screen memories: “Screen memories contain a composite of elements that form a compromise between repressed or unacknowledged feelings and the subsequent defenses that arise against them.”

Play with Me—Highlights a story of a young child understanding changes in her life when her family moves to a new home through play: “Symbolic play is rooted in the child's secure attachment and indicates that she has begun the process of psycholoical separation and individuation.

The Calling—A young girl is terrified of the ringing phone after the nuns at her school say that they became nuns because they got a “call from God”. This story is used to illustrate the ways that magical thinking is both a normal stage of development and a way to retreat to the realm of imagination when reality is too stressful.

New Furniture—The story is about an “accidental (but not accidental)” act in which a girl locks the back of a truck containing their new couch. The authors use the story to illustrate the differences between the ego, superego, and id, especially during early development: “As they are learning to say no to themselves, they pour their aggression into their superegos, which causes them to be very severe in their judgement of others.”

Woodbridge—A young woman goes to visit her fiance's ex-girlfriend and feels very insecure; later she has a dream in which the ex-girlfriend is shot. The story highlights the way that dream condense actual events and items in the real world into new items which simultaneously can reveal and hide underlying feelings. “When we are dreaming, our mind covers up unacceptable thoughts by focusing on minor details and producing apparently innocent images”

Wearing my Tutu to Analysis—A woman has transference feelings towards her therapist and sees him as a father-surrogate. She creates an elaborate situation in order to “accidentally” see him in a fancy party dress. Transference and counter-transference along with their usefulness is discussed: “It is not the past that gets played out, but rather a persona's unconscious fantasies about the past that must be reworked in the present.” and “transference can be enacted through actions as well as words, and it can be viewed as a way to let the therapist know what is happening when words are not available.”

Ode to a Tissue—The story includes a baby's attachment to a tissue and illustrates “how babies use and create transitional objects to calm and comfort themselves.” “In the long run, what matters is not the actual object, but the particular use that the baby makes of the object.” The transitional object provides a mechanism through which children learn to self soothe; eventually the object itself will lose meaning because the ability has been internalized. However, attachment plays a part and “babies lacking strong relationships with primary caregivers” are not likely to create transitional objects, even with soft toys are available to them.

Mommy Broke it!--In this story, a toddler saw his mom break off his newborn sister's umbilical cord stump and believes that it was his sister's penis. The authors have a field day linking this to Freud's castration anxiety and the Oedipus complex.

Bumps and All—A young girl whose mother has died struggles with puberty and breast development. The struggle to have these conversations with her father require that she both acknowledge her changing body and needs as well as the missing maternal figure. “The pain and exhilaration that are chaeracteristic of the early teenage years” include “psychic 'launching'”, oscillation “between fantasy and reality”, “resiliency and negative self-image, independence and dependence.”

First Party—A young girl goes to her first teen party and plays spin the bottle. She is unprepared for the sexual encounter and flees. The analysis focuses on the competing intense desires faced by most adolescences as they discover themselves in the world, differentiated from their families. “She feels compelled to know herself, to look inward, to understand the confusing yet exhilirating changes in her body, but on the other hand she longs to be out in the world, integrated into and accepted by her peer group.” They also acknowledge that hormal responses can be overwhelming and confusing: “sexual feelings sometimes swamp adolescents, driving them to create or to submit to sexually infused relationships that are psychologically limited and unsatisfying.” The also link it to wider research: “when the relationship between teenagers and their parents is poor, hormonal variatiosn significantly affect behavioral outcoms, such as engaging in risky behavior and depression. The negative correlation disappears when teens enjoy good relationships with their parents.”

Custodial Care—A girl misses an important interview, is interviewed by the janitor and does not recognize it as “not a real interview” until later. The authors use the story to emphasize the “varying capacities for judgement, self-regulation, and future orientation” in adolescents. “Young people in their late teens and early twenties are ideally characterized by a steadily unfolding ability to live more fully in the present while simultaneously planning for the future—a capacity that is less developed in the earlier stages of adolescence.”

Nestled—Gives a woman's birth story to emphasize not only the developmental changes of infants, but the ways that mothers become in the moments surrounding birth. The authors highlight Benedek's work on motherhood as a developmental stage in it's own right. “The mother's sturggle to balance, on the one hand, her wish to gratify her own fantasies through her child and, on the other, her capacity to accept her child's individuality sets the stage for a life-long dance between monther and child.”

Graham Crackers—This story decribes the difficulty connecting with a child during therapy and emphasizes the way connection can be established simply through sitting with someone and waiting for them to be ready to connect. The authors focus on establishing connection and highlight that “the therapist's job is to provide a secure and predictable frame for the patient as he embarks on a journey of self discovery.” They also point out how self awareness is relevant and sitting with discomfort allows clients to share their experiences: “In this early, nonverbal exchange, the therapist's experience of sitting with her young patient gives her access to this child's neediness and loneliness. The access comes to the therapist through her awareness of her own yearnings for connection and her excruciating feelings of aloneness in the presences of this silent, enigmatic young boy.”

In My Eyes—This story is about the difficulties of establishing a therapeutic relationship with a boy who does not talk. The authors focus on Winnecott's term "holding environment."  The holding environment is defined as "the atmosphere that facilitates the clinical work" and goes on to suggest that "what feels safe to one person may differ greatly from what feels safe to another".  Ultimately the holding environment is one "that suits the patient's needs to the degree that is possible" and establishing a therapeutic relationship may look different with different consumers.

How to Save a Life—The story of a difficult client who works with several therapists within an agency and has a reputation. Using this story, the authors are able to show how the newest clinician found insight on a previously discussed story simply by being attuned to the patient in the situation: “the impetus for change resided within the patient—that the therapist's job was to be attunded to the patient's developmental shifts, always with an eye toward reinforcing the patient's potential for future growth.” They go on to point out Winnicott's view that the only interpretations that are “meaningful were those that emerged directly from the patient when he gained a greater capacity for self-reflection and insight.”

Friends of the Heart—This is the story of another difficult client who had frequently locked the clinician out of the room; as they near ending/last session, the clinician once again finds herself locked out. Instead of ending poorly, the client manipulated the situation to impress the clinician (this time by cleaning up the room) instead of show rejection. The authors use the story to illustrate the difficulties with ending and highlight that endings are also cause for celebration.

Joining the Pain—A clinician describes a particularly difficult client who strives to be as unappealing as she can to reject others attempting to g et close. “Her self-loathing washes over everyone who tries to help her—parents, teachers, doctors, me—threatening to drown us all”. The story is used to once again highlight counter-transference and to illustrate the importance of self-examination (what is it about this client that is particularly difficult) as well as self care to allow ourselves as clinicians to remain open and receptive in these interactions. “A theoretical framework offers an opportunity to understand what transpires in the treatment, especially when we are faced with novel or afectively overwhelming situations. As such, we can tolerate what might otherwise be intolerable.”

The Taxi—A black man describes the difficulty that he had getting a taxi to come to the therapy appointment and raises assumptions about race within the therapist. The story really illuminates the ways in which race plays out both under and at the surface of the therapeutic relationship. In order to practice with cultural humility, clinicians need to admit their own identities, when they are similar and when they are different from their clients. When working with differences, it is important to self-reflect and attempt to understand our own biases; when working with similiarities, it is equally important to refrain from assumptions as folks within the same group are also very different. “Even when race is not directly addressed or acknowledged, it has a profound meaning for both participants....Issues of race should not remain unaddressed, an unspoken presence in the room. When these issues are ignored or go underground, they exert hidden influences that gather force and may ultimately undermine or destroy the treatment.”

My Best Friend, Fiona—A woman is jealous of her best friend's therapist until she discovers they are having a sexual relationship. The story is used to illustrate the extensive damage that can occur when a therapist crosses boundaries. Not only is damaged caused to the individual patient, but these damages can reverberate across social networks and can hurt the entire profession with a loss of general public trust. “When idealization is the leading edge of the transference, the therapist is at risk for boundary violations” and “when a person is ideawlized, his or her real qualities are neither perceived nor acknowledged.” Given the extent of the therapeutic alliance, strong transference emotions can be evoked in clients; it is our job as clinicians to respect and reinforce boundaries to promote healthy growth and understanding.

Into the Kitchen—An adult client divides her life into “before” and “after” her first sexual assault. The authors again point out developmental and attachment issues that arise as a result of sexual trauma, particularly when the perpetrator is a trusted adult: “The impact of sexual abuse is often more defined by the significance of the child's relationship with the perpetrator than byt the frequency and type of abuse.”

The Bird Box—The consumer reflects on her grandparent's trauma during the Holocaust and the authors use it to illustrate the inter-generational aspect of trauma: “traumatic events are transmitted from generation to generation. Untold narratives are woven into family history and become the backdrop against which the child's emotional development unfolds and takes shape.” I thought this chapter worked well, but was disappointed that the authors did not reflect more upon PTSS (post-traumatic slave syndrome) or other groups that have experienced generations of trauma. The theory and work certainly applies to Jewish folks, but wanted to see them broaden out a bit as well in discussion. Particularly the idea that “traumatic memories shape the survivor's subsequent parenting style and the child's identification with or rejection of certain traits of their survivor parent that are linked to their traumatic experience.” seems to resonate with Joy DeGruy's work on PTSS.

Phantom Limb—Uses the story of a parent who lost a child to illustrate the different stages of grief. In this chapter, the authors mostly focus on normalizing grief and differentiating typical bereavement from excessive focus on the death. “the task of normal mourning is to preserve rather than to sever the internal relationship.”

The Question—Also uses the story of a parent who lost a child to illustrate grief; in this story the mother frequently faces the question of “how many children do you have” in new situations and is struck over and over with the difficulty of responding. The focus (in contrast to the previous chapter) is on long term recovery, rather than immediate mourning. “After the initial shock wears off and the actute grief begins to subside, there remains a lifetime of reexperiencing and bearing the pain.” They also use the opportunity to link back to the theme of memory and the way in which we use the narration of our lives to revise memories along the way. “If we consider memories to be narratives based on a blend of real events from the past and present-day feelings and wishes, they illustrate current trends of thought about the self and others.” Ultimately, “the task of mourning is to integrate one's prior sense of self with the current expereince of loss and subsequent narratives of the self.”

[Gras A. · Rating 5 out of 5]

Entertaining and thought-provoking!!! Highly recommended for anyone that is curious about psychoanalysis or therapy in general. The authors employ humor and warmth to explore serious topics, making abstract theories feel approachable and meaningful. Will read again!

[Ruth · Rating 3 out of 5]

I think this book is really more meaningful for people studying psychoanalysis, but it was interesting for a lay person too. I am impressed how the three writers could collaborate and make it work. Personally I was much more into a long novel but had to read this for a book club and was more interested in the novel, not giving it my full due. I was moved by the section on death and loss in particular.