The case of Joan : an archetypal approach

Last Updated on Thursday, 19 July 2012 06:44

The Case of Joan

A classical approach JOHN BEEBE
An archetypal approach DELDON MCNEELY
A developmental approach ROSEMARY GORDONDELDON McNEELY
An archetypal approach

In the following pages, three experienced and accomplished Jungian analysts comment on where they would focus, what they would do, and what they imagine to be the course of treatment for "Joan." Joan is a pseudonym for a patient whose printed case material each analyst received and read closely before writing a response. Each received the same case report, summarized from the actual records of a forty-four-year-old female patient at the Renfrew Center for Eating Disorders, a private hospital in the Philadelphia area. Renfrew generously made available this material, which had previously been used in the public domain at a national conference on eating disorders.

Each analyst was asked to see things primarily from the perspective of her or his "school," each one being a prominent representative of that approach. Dr. Beebe writes from the classical approach, Dr. McNeely from the archetypal, and Dr. Gordon from the developmental. The analysts did not consult with each other on the case. As you read their responses, you may note how they highlight the model sketched out by Andrew Samuels in the Introduction in which he weighs the importance of the archetype, Self, and the development of personality as well as the clinical issues of the transferential field, symbolic experience of Self, and the phenomenology of imagery for each of the Jungian schools. What he has sketched as an interpretive model for the three schools of analytical psychology (see Introduction, pp. 8-11) works very well in understanding the interpretations of these authors. It must be remembered that none of the three analysts ever met the patient and, consequently, their essays should not be seen as comparing therapeutic practice. Rather, they are designed to illustrate different approaches to a real case. Apart from a few necessary instructions for thinking about the case, the following is all the information the authors received.

 

Joan

Referred to Renfrew by her primary-care physician because he was concerned that she had an eating disorder, Joan weighed 144 pounds at 5' 6" at the time of admission to the hospital. She was bingeing and vomiting at least three times a day.

Six weeks prior to admission, Joan was extremely depressed and anxious. She said "I'd like to jump in a river." She also reported waking in the early morning hours, full of anxiety. She reported hitting herself in the head or stomach or biting her fingers in episodes of emotional pain.

During the admissions interview, Joan expressed a desire to "work with the feelings I've been stuffing down." She described herself as "really fat" and worried that her husband would leave her, wondering why he had even married her. Recently she had become more acutely aware of memories of incest with her father, something she had known continuously, never having successfully addressed it. She wanted to address it in treatment now. She also expressed the desire to eat properly, to stop her bingeing/purging addiction, and to improve her communications with her husband of four months.

Joan lives with her third husband, "Sam" (all names used in this report are pseudonyms), whom she married just four months before entering the hospital. She had become friends with Sam and then lived with him for two years prior to marriage. The couple currently live with Joan's daughter Amy, age twenty-six, and Sam's son David, age fifteen. David's mother died of diabetes when he was three years old. David is a source of conflict in their marriage because he gets into trouble at school and threatens to leave home.

Joan is employed full-time as a cashier and food service attendant in a local convenience store where she has multiple duties and responsibilities. In addition to her work, she has recently organized a women's self-help group for eating disorders and is very enthusiastic about it. Her long-term goal is to become an addictions counselor. She has plans to begin studies when she finishes treatment.

While Joan was at Renfrew, her mother, age eighty-one, became seriously ill with kidney failure. Even so, Joan found it difficult to discuss her anger at her mother's failure to protect her from an abusive father in the past. Joan's mother lived with her briefly, but Joan found it so stressful that she advised her mother to return to her home, which, being in a different state, was distant from her.

At the time of admission, Joan complained of heavy menstrual bleeding, usually every three weeks. Although she has a gynecologist, she had not scheduled an examination with him, claiming that she didn't consider her condition to be "serious enough" to warrant a doctor's help. Often when she was ill or injured, Joan would hesitate to take time off work and/or to seek the medical help she needed.

At the age of eighteen, Joan left home to marry her first husband. She had one daughter, Amy, in this marriage. Joan described the marriage as "painful and abusive." Amy has a history of chronic depression and has been diagnosed as having bipolar disorder. Joan left the marriage after two years. In her second marriage she had two more children, a son, Jack (now seventeen), and a daughter, Lynn (now twenty-one). Both Amy and Lynn were sexually abused by Joan's second husband, for which Joan feels very guilty. "I wish I could have protected my daughters, but I just didn't see the signs."

When Joan was five months pregnant with Jack, she took in a foster child named Johnnie, sixteen months old and afflicted with cerebral palsy. Eventually she adopted him.

Her second husband was unfaithful and abusive, one day abandoning the family without explanation. Because Joan was unemployed and unprepared for this sudden loss, she lost everything at the time: her home and all of her children except Lynn. Joan and Lynn lived in and out of a shelter for a year. During this time, Joan acquired a position as a waitress and prepared to reunite her family.

When she met Sam, her current husband, she found it extremely difficult to trust him, but things have ultimately worked out well.

Joan grew up in a four-room wooden house in rural Arkansas (USA). Her parents and only sibling, a sister eleven years older, lived at home. Her father was a "sanitary engineer" and was strict and emotionally distant. Most of the time, food was scarce and comfort was unavailable. Joan recalls her father being absorbed in repairing his automobile when he was at home and commented "it was more important to him than we were." Her mother was "always depressed" and very obese. Joan recalls feeling ashamed of her mother, who weighed over 300 pounds.

Joan reported that she had been sexually abused by her father, beginning in early childhood. She usually slept in the same bedroom with her mother and father, while her older sister slept in another. Her father would fondle her genitals in the morning before he left for work and when Joan complained to her mother, her mother did nothing. She also had some memories of being urged to fondle her mother's breasts during this time when they shared a bedroom. In general, Joan describes her childhood as "unsafe and full of fear."


 

 

Here I am asked to demonstrate how one person applies an archetypal orientation. At the risk of oversimplification, I would isolate three definitive marks of that orientation as I see it playing out in my clinical work. One is that I regard the patient's relationship to the archetypal material selected by the psyche as having priority over transference considerations. This is not to underestimate the essential value of intimate relatedness as a transforming crucible, but to acknowledge that the therapeutic relationship is one arena of several in which the archetypes can be met face to face. Whether the patient invests in symptom, struggle, social functioning, dreams, etc., I am inclined to see myself in a role of fellow-explorer and witness, unless the role of representative of some powerful inner figure is clearly projected onto me.

Secondly, the range of behavior that I consider "human" and soulful rather than pathological is wider than that of many of my colleagues of non-archetypal approaches. And when pathology is obvious, my first intention is to explore and understand the meaning of the pathology for the patient's inpiduation. I am dismayed at how quickly medications, hospitalizations, and direction are dispensed in today's psychological milieu, and appalled by the pressure that even I feel from every corner to do something to fix the situation, promise redemption, resolve the conflict, end the impasse, take away the pain, by some heroic intrusion on a natural process, as if there are no inner resources to be encouraged and fanned to life in the patient. I stake my purpose on the wisdom of the psyche, and trust that attention to the archetypal sources of distress will enable the psyche to align itself without strong-armed interventions. I encourage focusing on soul-searching rather than improving.

Thirdly, focusing on archetypal themes brings the analytic process through a gamut of possibilities via the imagination from the densest physiological impulses to the most ethereal psychic experiences, without any preconceived order or expectation of stages, except as determined by the flow and direction from within the patient's psyche. Theoretically we mature through developmental levels, but seldom do we as therapists see a straightforward progression through stages of growth or integration when we are very close to the patient's world; only with hindsight do we see how seemingly disparate or irrelevant experiences are linked to a larger picture. Archetypes manifest through the instinctual life of the body, its revulsions, impasses, and attractions, as well as through ideational content and spiritual inclinations. I am wary of imposing probables and shoulds into the patient's psyche.

Archetypal psychology speaks of "psyche" or "soul" with respect for the mysteriousness of human nature, which can never be reduced to simple determinants. In soul is implied a depth of association to life and death that leads beyond our personal histories and connects us with the intensity of the transpersonal - not a transpersonal that is remote, but one which is always present, the other side of everything ordinary. I imagine the analytic journey to be accompanied by Mercurius, whom Jung (CW 13, para. 284) designated "archetype of inpiduation"; also, I imagine the presence of the goddess of the hearth, Hestia, as the principle of centering and grounding that keeps the process in focus and creates a balance to the hermetic energy.

Leaving the abstract,(1) let us speak about the coagulation of theory in terms of Joan's story. To some extent, having a bit of history of Joan as we do deprives me of the kind of initial impact that I look forward to with a new patient. For the benefit of new therapists who might be reading this, I want to admit that the looking-forward-to is not entirely comfortable, as I always experience anxiety before meeting a new patient. The anxiety may last a few minutes or weeks before something in the relationship gels. Initially uncomfortable feelings on the part of either person do not mean that the therapy is unworkable, but only that deep personal material is potentially engaged.

Despite anxiety, I do anticipate the first meeting as an exceptional encounter. First impressions, gleaned through a primal animal scent, bring essential information which is soon enough overridden by words and conscious intents. Later these first glimpses into the interaction can be compared with further data to provide insight into the unconscious dynamics of the relationship, and into my shadow projections - that is, what this other person enables me to see about my own discarded selves.

Now the fact that we readers have this history about Joan has certain advantages, too, even though it diminishes my initial whole-Joan-phenomenon by coloring the encounter with prior information. Only when I meet Joan will I put these already coded impressions from others together with her physiognomic presentation and respond to her voice, gestures, postures, eye contact, odors, dress and ornamentation, etc., and only as she eventually unveils herself will I see whether the historical facts we have been given are authentic and relevant.

The difference between meeting the patient for the first time without prior information and meeting the patient within the context of her history is an important one, and is one of the issues that separates the experience of private practice from most agency work. I personally like to work with ambiguity, and as much spontaneity as possible, and do not ordinarily take any history in or before the first session with adult patients. Usually I let the story slowly unfold, trusting that the facts are less important than what has been made of them by the patient's inner storyteller. This is a point on which analysts differ, and where each must find his/her own comfort zone.

Another thing about the initial meeting: the referral person plays a significant emotional role. The patient transfers a preconception of being received to the first professional contact; whether that first person contacted is conceived of as savior, confessor, judge, healer, parent, or servant, the "fit" between the actual reception and the patient's image of therapy strongly colors the beginning work. Sometimes such a strong attachment is made by the patient to a professional person who has seen the patient first, that the fear and grief about leaving that person must be acknowledged and dealt with before anything further can be done.

All of this has bearing on Joan. What has her referring physician inferred about therapy, and what is her attachment to that physician? What is her image of psychotherapy, and what does she expect of me and of herself? Will I work with her during her hospitalization, and will I be able to continue seeing her as an outpatient, or will she then have to see a new therapist? Joan's leaving the hospital with its twenty-four-hour-a-day in-utero containment may involve a period of grief or separation anxiety to which is added the experience of loss of the first therapist. In some unfortunate treatment settings, the follow-up after inpatient treatment is scanty and takes little notice of these very powerful dynamics. Patients then experience abandonment. In any case, I would recommend intense aftercare, including long-term therapy, even after successful treatment as an inpatient.

Before making recommendations, however, let me note my initial reactions to the verbal portrait we've been given of Joan. My first impression is that Joan possesses such a stalwart spirit and an embodiment of hope that I find myself strongly in her corner, wishing her the best. After much pain and failure she actualizes her hope with a new attempt at healing, a new marriage, a new career. I respect her steadfast commitment to life, to Eros, which she demonstrates by taking the initiative to start a self-help group, to want to care for others, to continue to expect to change things for the better, even while feeling hopelessly suicidal at times. I expect to meet a strong, earthy woman, full of vitality, much of that vibrance perhaps beyond her awareness and maybe very different from her self-perceptions. If she is able to choose long-term therapy, my positive response to Joan will lubricate our work. Still, as a countertransference attitude, this positive feeling must be objectified. I cannot let my respect and admiration color my behavior so overtly as to give her a false sense of security or an impression of my seeming manipulative or condescending, nor do I wish to create in her unnecessary dependence upon me, or to expect too much of her too soon, or to covertly promise too much, or to be blind to her darker aspects.

Regarding the dark, I wonder what appeals to her about "jumping into a river," a transforming image of quite different quality than, say, strangling herself with a rope, or blowing herself to bits. Is she so hot and pliable that she needs to be plunged into water to cool and harden, or does she yearn to be dissolved into some greater flowing substance, swallowed, returned to the amniotic container? Perhaps I can plunge with her through some combination of curiosity and compassion to learn what her fantasies of transformation would be, to see what essential ingredients of Joan would survive a dissolution. Joan's image, an invocation of the alchemical process of solutio, deserves serious care. The fantasy of death by water on ego's terms carries a wish from the Self for renewal, for a spiritual baptism. In analysis we will explore this wish rather than concretize it as "nothing more than" a suicidal impulse.(2) But the dangers of coming too close to Joan! Would she allow me to collaborate with her in this exploration? Would she swallow me in and vomit me out in disgust?

Behind the initial impressions await crowds of questions like this, the answers to which I expect to learn if Joan comes to trust me. I welcome my curiosity as evidence that her story has touched me, but I will refrain from asking these questions. I will usually allow Joan to decide what we will discuss, and in what order. Once the content is chosen I may become active in eliciting more associations, pursuing and amplifying themes, confronting inconsistencies, and so on, but I like to make it clear early in the work that the patient takes primary responsibility for the stuff of therapy if she can possibly do so.

Meanwhile, those questions crowd around. Will Joan reject me as she is rejecting her new husband (through projective identification, i.e. setting him up to leave her)? Is there something too dangerous in Joan to be able to hold onto what she loves? The feminine principle seems vividly present in Joan in all of its primary ambivalence, and not refined into some harmonious selfimage (such as nurturant mother, artistic medium, sex-goddess, devoted wife, inspiratrice, etc.). Can she include under her warm, earthy cloak her husband's grieving son, or will her unconscious sadism feast on a vulnerable young male? For, as the bulimic symptom demonstrates, the need to gather into herself and the need to expel from herself coexist in contention, a theme that seems to have been with her since she struggled to survive in the hungry family of origin.

I am curious about that early family life, and the mysteries performed in those small bedrooms of her infancy and childhood. What was given to and what received from the silent, frustrated parents unable to fill the hunger in each other? What forces kept Joan's parents together, kept father rising daily and going to his arduous job, kept mother alive for eighty-plus years? I want to know mother's story, too. Was she desperate for touch, trying to elicit some gratification from her baby? If we examine our fantasies and cultural myths truthfully we cannot deny the sensual pleasure to be derived from closeness to the child's body; it is not denial that protects adults from exploiting children sexually in the face of such pleasure, but the capacity to contain and redirect the desires. What prevented these parents from managing their sensuality? What anxieties lay drowned beneath mother's fat globules, and why were her anxieties not allayed with her man? The man, pouring all of his attention into the machine, avoided some essential contact with his women in the daylight; a machine is predictable, will not bleed, gain weight, run away, insist, or dissolve in tears, but will stand firm to his ministrations and attempts at mastery. We are given a picture of this couple, seemingly trapped in mutual disappointment and resignation, with a life task to send two reasonably hopeful girls out into the world. Why couldn't the two adults sleep together and comfort each other, enjoy lust, give mutual attention? Were they afraid of having more children? Were they frustrated in some way by sexual inadequacy? Was one or both too frightened of the intimacy of being seen and known? Did they find the natural irritations and anger of everyday accommodation to another too frightening? Were they impeded by family myths and ancestral ghosts in the form of crippling self-images and unreasonable constraints?

We can only speculate about what went wrong in that little house which could have glowed with human warmth and laughter, but instead took a dark turn toward secrecy, scarcity, perversity, and fear. I try to imagine the atmosphere in that little house, and Joan's response to it. I do this because it is interesting and I am curious, but also because the information will be helpful when she inevitably tries to recreate the atmosphere in our relationship, as some part of her seems to be doing in her relationship with Sam. My sense of the ambience in that household is so sad and cold, but the confusion in our professional field about incest and false memories underlines how careful one must be about allowing the patient to expose her interpretations about her early life, and not suggesting how it was with pointed questions or inferences.

Living in such a circumscribed world as those four did certainly must have played a powerful role in shaping Joan's images and expectations of life, men, motherhood. However, it did not determine what Joan would become, as her psyche made its selections and expressed its inclinations. She was able to take from that world some essential satisfaction, emerging with a body whose desire for intimacy and generativity propelled her out of the house and into a life rich with experience. I think of the feminine principle in her as prodding her to such instinctual interests, for instance, as enjoying emotion in relatedness, mating with a man, creating a baby, giving birth to some generative project, contributing to some communal or aesthetic enterprise; and I imagine the masculine principle in her as engaging the world, determined that these interests become articulated and actualized beyond the plane of fantasy. At eighteen Joan demonstrated sufficient impetus from her masculine principle, or animus, to assert her independence from her parents and to find a partner to help her expand and differentiate her image of masculinity from the father complex. Unfortunately, as is often the case in women deprived of the experience of a wholesome father who encourages self-love and good judgment in his daughter, her way out was not to become self-sufficient, but to enter a different dependency situation, probably projecting the good and powerful father onto her young husband.

Joan's first two choices of partners reflect a lack of judgment and an unconscious attraction to the kind of dangerous atmosphere she had left behind. Only now, in mid-life, does she seem to have acquired - not by early preparation and good models, but by experience, trial, error, and suffering - a strength within herself which I think of as masculine: that is, the strength to assert her choices, to make realistic plans, to criticize and be willing to detach herself from wrong judgments, to seek out and think through beneficent experiences rather than letting herself follow only her heart's desires and intuitive choices. These functions begin to balance her strong feminine need for nurturance, attachment, and emotional intensity. Joan may now be more capable of internalizing the tensions between what attracts her to a man initially and what benefits her in the long run; and she may be more able to resolve those tensions intrapsychically instead of acting them out in relationship to actual men. I should add that not all archetypal psychologists find the gender differentiation of psychological functions useful. Some Jungians of all schools feel that the anima/animus concept is more disruptive than heuristic, for reasons beyond my scope to elucidate here. But for me the concept of feminine and masculine principles is valuable in helping me organize my perceptions of personality.

Joan may have acquired some healthy animus qualities by this time in her life, but as a young adult her life was colored more by the mother-complex as she lived and moved in a soup of concerns with dependency which overpowered discerning the personality characteristics of her husbands, or finding her niche in the world of work and independence, or developing her mind and talents. Imagine a twenty-eight-year-old pregnant woman with two young children and a troublesome husband taking on a fourth, handicapped child. What on earth was she trying to do? I can only guess it was something psychically related to weighing over 300 pounds, expressing something akin to her mother's hunger. . nurturing gone wild, nurturing taken to such excess that inevitably it must collapse, and then comes the other side: she loses it all and becomes the helpless victim. Her children are removed and she has to depend on the state to sustain herself and one child. Such powerful nurturant instincts reveal creative energy which, if submitted to processes of reflection, can serve and gratify Joan and others touched by her.

Joan's story evokes so many images of ravenous hunger that I wonder how I will react to such stimulation over a period of exposure. Surely I can expect, in addition to my initial admiration of its heroic flavor, a countertransference that is breast-dominated - whether by a need to care for, or by a tendency toward stingy withholding remains to be seen. I should watch for both these reactions, and also for the invitation from Joan to be pulled in as her adversary against perceived wrongs by the men in her life. Now that she has the protection of a husband and a therapist, I would expect her to begin to feel safe enough to allow her young needs to be felt, and that unfulfilled need for a mother to align with her against the exploitative principle (whether in mother or father, but certainly now incorporated into her own character structure) warrants repetition. Although she was strong enough to extricate herself from two arduous marriages, it sounds as if she did not meet her husbands' aggression with much potency of her own. Now she meets Sam with more self-determination, even though it seems to frighten her. I want to allow her to feel the strength of her need to make mother her savior without playing that out with her and prolonging unnecessarily that image as reality. I imagine holding and keeping in check the starving, devouring, exploitative parent, while the sacred space of the therapeutic vessel creates an opportunity for the generous, full mother to flourish in Joan.

So many alimentary images evoke and want a timeless quality that promises to allow all necessary functions of introjection and absorption to mature according to their proper schedules. Ideally I would want unlimited time with Joan, because my experience of working with such fundamental contradictions as her life exemplifies is that, despite good motivation, change is very slow and tenuous. On the level of the digestive system we meet primitive monsters of the brainstem and basic cell structures, where insight is virtually useless, so that the same ground must be taken and retaken from insidiously monstrous greed. By this I mean that the same issues and incidents must be talked about again and again, the same affects expressed, the same misunderstandings unraveled in the relationship with the therapist more than once. I would hope she could be seen daily as an inpatient until the suicidal purging was able to be contained and curtailed. Then, as an outpatient ideally I would plan to see her for one to three hours per week for several years. Provided her strength and motivation met my initial expectations, I would expect a good prognosis with this schedule.

Under the present circumstances she may not be able to afford the usual fee. This we would have to discuss thoroughly, for working out a feasible financial contract is an essential factor of the therapeutic process, setting the scene for the adult-to-adult nature of a relationship which is at the same time allowed to be infantile and regressive. In her case the financial issue could become a way of falling into the starving-mother complex with one of us feeling deprived, if money is not dealt with straightforwardly. I want Joan to consider our work together as valuable and mutually purposive, requiring of her an input of energy, financial and emotional, which I will meet with a like input of psychological sustenance and reliability, and ideally, some wisdom about the psyche which will be useful to her. If we cannot establish such a timeless mother-world in which she has frequent, reliable access to a safe, permissive therapy setting, I would have to consider a more guarded prognosis in terms of substantial change. In that case I would direct Joan to set up for herself a strong support system, including, for example, her self-help group, perhaps an educational program with access to college counselors, perhaps a twelve-step program, perhaps brief marital or family counseling, and periodic follow-ups with me or someone else in which I would attempt to support her continued interest in the meaning of her problems. The periodic follow-ups ideally would continue as long as we both deem necessary.

But suppose that an unlimited duration of treatment is possible. I know of no substitute for the kind of self-reflection that is possible only with the intimate support established by enduring contact. Anyone who has experienced this therapeutically knows the indescribable moments of transformation. Transformative happenings (which I can only call "moments" though years may be represented by the moment) hold an integration that may be most easily conveyed in images - chemical images, as the thickening of a sauce or fusion of metals or moment of crystallization; physical images, as the coming together of coordination in learning to drive a machine or a potter's wheel; mental images of "getting" the meaning behind the formula, or having the foreign language become automatic. Something like this happens in therapy when a place of readiness is reached, but it does not happen overnight. It is not the flash of insight of a breakthrough or peak experience, but is something quiet and abiding. As a therapist I have my personal image for fostering this happening, which is to follow the "aha's" which reflect the mobility and excitement of Mercurius, while remaining steadily settled before the warm hearth of Hestia, where all the flashes of brilliance come to the integrity of repose.

In Jung's theory, the language to be mastered is the communication between the conscious ego and its archetypal source in the Self, the archetype of wholeness that is being's circumference, source, and power, and manifests as an experience of being contained, centered, or guided. Natural adaptation to society requires defensive postures that cannot be felt consciously and cannot be unloosened quickly, postures which diminish the ego's awareness of its archetypal source and keep us searching for completion in the world of conscious events. Complexes outside the ego's conscious sphere of influence, however, do maintain their numinous connection with the Self, which is why they have such power over us and cannot be "controlled" by the ego's will-power. Therapies which rely on ego-strength, as all short-term and cognitive therapies do, ignore this fact that is the foundation of depth psychology. Patients may accept suggestions and interpretations in a desire for health, but eventually these cognitions are reabsorbed by the dominant complexes, unless a dialectical relationship with the complex occurs which allows it to be accepted more or less comfortably into ego-awareness. Eating disorders reflect complexes which dominate the ego and are often not able to be contained by will-power alone. In discovering the archetypal source of the complex we hope to find the key to transformation. What gods or demons in the patient drive the hunger, who is represented in the irresistible food, who withholds a sense of safety, satiety, and fulfillment? What is being compensated, and what avoided?

In the short-term therapies, patient and therapist do not stay in relationship long enough to get to the problems of trust which are the inevitable fate of any long relationship and which reflect the power of autonomous complexes to undermine our love and determination. The honeymoon of complete trust eventually must give way to doubt, and then transformation processes begin. Romantic relationships falter at this point, and the personality's true colors come forth. Similarly, in therapy, the hardest and most potentially rewarding work begins when the patient begins to question the value of the work, or the integrity of the therapist.

Let us assume that Joan has elected to participate in unlimited psychotherapy. In addition to noting my first impressions, I will want to try to establish a sense of how she perceives her situation at the moment. Of what feelings is she most aware? To what are her attention and affect being drawn? Is she able to think symbolically, and is she able to feel symbolically? The former requires an intellectual capacity to abstract an essence or universal quality from the concrete event, and is a minimal requirement for depth psychotherapy, obviously. The capacity to feel symbolically is more nebulous: to be able to hold within the accessible psyche a gratifying image which enables one to postpone impulsive, immediate satisfaction of one's tensions and desires is an asset but not a requirement for depth psychotherapy. In fact, it is often one of the weak or absent capacities that we hope will come to fruition in successful psychotherapy. In psyche are included not only mental contents and visual images, but physiological and transcendental contents and experiences. Jung referred to these as the psychoid events, those experiences on the edge of consciousness at the level of instinctual and spiritual awarenesses. Imagining is not just visual, but also kinesthetic and auditory.

Freudian, neo-Freudian, and neo-Jungian psychoanalytic theorists have given exquisite attention to the developing infant in attempting to understand how this capacity for symbolic gratification becomes part of a human being's psychological equipment, for all communal life depends on the ability of most of its members to postpone physiological gratification through symbolism. The infant who negotiates successfully the substitution of a transitional object for the incomplete and inconstant mother has acquired one of the magical tools which will make the journey of inpiduation possible. However, patients seeking inpiduation often come to us without having ever developed this capacity for symbolizing feeling, this tool or ability which will allow them to relativize and objectify their emotional needs. In such cases we hope to recreate in the therapy vessel the archetypal context in which can occur the leap of trust that allows a relatively undifferentiated psyche to anticipate and await gratification with some degree of self-reflection. This theme can be found in countless fairytales in the form of the hero's or heroine's convoluted journey toward patience and self-containment until the time for just the appropriate action is propitious.

I predict Joan to be a person who will remain long in the non-symbolic mother-world, and who will have some difficulty in translating her symptoms into psychological meanings, but who will bring an enlivening energy to her work which will gradually become more symbolic and open to creative uses of unconscious material. If she remembers dreams, can learn to do active imagination, can put her feelings into some form of symbolic process - imagining, drawing, painting, dancing, writing, or translating into music - then these psychic conduits will become rituals to channel the mythic world into the significant emotional events of everyday life and ordinary relationships. Imbued with meaning and the primal dimensions of archetypal events, everyday life and ordinary relationships become filled with spirit, passion is allowed to enter everyday life instead of stagnating in emotional impasses, and there is no reason to hide from reality behind fears and inhibited desires. We took forward, then, to encounters with both material and spiritual worlds for whatever those encounters offer, for richer, for poorer, till death do us part.

Inevitably an interplay between levels of integration occurs throughout life and within the analytic session. Patient and therapist both dip into early infantile, child, and adolescent states if the process is moving. Also, even patients with fragile integrity may move into highly differentiated or enlightened states, which could pass unnoticed if we are conditioned to expect less of that person. It is important, then, that the therapist see and recognize these enlightened states by being open to them. I am afraid that if we define or diagnose too well, we may be closed to such recognitions. Consequently, I took at each session as a potential adventure, and try not to be bogged down in expectations and predictions based on diagnoses and prognoses. Sometimes the adventure feels more like being hindered by leaden weights or buried in earth ... hardly open to the influence of Mercurius the Holy journeyer. Still, a journey it is, and subject to change at any bend in the road.

In her family of origin Joan learned an attitude of abuse toward herself, probably through a contemptuous relationship between masculine and feminine principles modeled in the family, which now manifests in a cavalier attitude toward the unusual menstrual bleeding, as well as in her forcing her body to compete with its own digestive processes. Such obstinate refusal to submit to the fundamental processes of nutrition reflects a deep fury toward her body and its wants. In whatever way the body's wants are imaged, whether as the devouring mother, poisonous breast, insatiably greedy child, implacable father, we want to discover and bring to light that image. I reject the notion that there is a universal dynamic underlying all bulimias (such as anger toward father). Such an assumption is no more valid than saying that a particular dream symbol has the same meaning for everyone. While there would appear to the observer to be a conflict between uncontrollable hunger and a repudiation of that impulse to devour, we cannot assume what the bulimic's underlying conflict consists of until her images tell us about her relationship to the symptom.

It is fashionable to treat the eating disorders with anti-depressants and anti-anxiety drugs. I am wary of medications, which may interfere with the coming to light of the images, our clues to the archetypal meaning underlying the symptoms, those very meanings which will unlock the compulsive nature of the symptoms. Some anxiety is required for the inpiduation process to unfold and for the kind of plodding, trial-and-error work of plowing over the same soul-sod repeatedly until it is pulverized to the point where something new can be planted. But repetition is two-faced. How do we know when we are in a pattern of futile cyclical compulsion, and when inching our way to inpiduation? Here therapy furthers self-reflection that enables a patient to ask the right question, examine the dream, notice the inner experience, or single out the authentic voice, that tells that ground is being broken, however slowly. Despite the evidence of self-contempt in Joan's symptoms and her disgust at her body's demands, a counter-movement toward self-care is bringing about constructive changes in Joan. I would hope that both the disgust and the self-care will have time to be explored, and that those seemingly dualistic alternatives can be reconciled.

Therapy feels most successful to me when it ends by mutual agreement of patient and therapist at a point of completion of some significant integration of complex contents. Ideally, there is a consideration of ending, perhaps dreams that confirm the decision, and an opportunity to review the process, particularly the relationship which has imparted its mark on therapist and patient to be remembered as a connection of soul.

 

NOTES

 

1. In addition to theoretical discussion in chapter 6 (above), see also Hillman, 1975, pp.170-195.

2. Images of alchemical operations are elucidated in many sources. One comprehensive overview is given in Edinger, 1985.

 

REFERENCES

 

Edinger, Edward (1985). Anatomy of the Psyche: Alchemical Symbolism in Psychotherapy. La Salle, Ill.: Open Court Publishing Company.

Hillman, James (1975). "Archetypal Theory." In Loose Ends: Primary Papers in Archetypal Psychology. Dallas: Spring Publications.

Jung, C. G. (1967). Alchemical Studies. CW 13.