or, Locating the Missing Ego in Psychodynamic Therapy
A terrific example of the prevailing model of psychodynamic therapy is Glen O. Gabbard’s 2002 book, The Psychology of the Sopranos: Love, Death, Desire and Betrayal in America’s Favorite Gangster Family—specifically his discussion of the sections of the script covering Tony’s therapy (pp. 46-58).
What makes this so useful are Gabbard’s comments on the case, since he presents it as an accurate representation of contemporary psychodynamic psychotherapy (and a lot of other therapists apparently agree—see endnote).
This makes it a nice opportunity not only to show how the ego gets overlooked, but also to show what the “ego” in ego analysis means. I am indebted to Al Domian, PhD, for sending me copies of these pages (in 2009). www.domianpsych.com
HOW THE EGO GETS LEFT OUT
Tony is offended when Dr. Melfi suggests that he has “negative feelings toward his mother,” says “Fuck you,” and stomps out of the office. Gabbard tells us that Tony
ends many of the sessions by stomping out. Once he shouts, “I don’t want to talk to you anymore. Hate your mother?” When Dr. Melfi suggests latent or unconscious meaning may be at odds with Tony’s conscious views, he is outraged and declares, “You shrinks think everyone is lying to you.” This statement is followed by, “Fuck you,” … as he storms out of the office.
Gabbard continues: “It’s difficult for Tony to see himself as a collaborator in a process of exploration, a recurring problem in the therapy.” Why is it a problem? Because so much of this kind of therapy is confrontation. The patient is supposed to stand still for such exposés. He needs to realize that being confronted with what is “at odds with his conscious views” is for his own good. Put another way, the patient is supposed to see the therapist as objective.
Understood from the later, ego-analytic model, Tony’s reaction means, not that he is being a difficult patient, but that the therapist has tripped over something and needs to back up and find out what happened. My guess is that what Tony heard was that he was being called out: that he shouldn’t hate his mother; he feels accused of having negative feelings toward his mother.
Seeing it this way, you would feel much less patronizing about his being so aggrieved. Far from being unable to see the therapist as a collaborator, he is reacting in an understandable way to feeling misunderstood, judged, disrespected. Even if he were less of a firebrand, he would still feel preached at.
Were Tony to have confronted Melfi in this way, the typical response would be to correct him: to tell him that she is not being critical or accusatory, certainly not preaching, that she was not telling him he shouldn’t hate his mother, that she was just being objective (all of which is doubtlessly true, but beside the point). And, of course, he would have the same take on that, feeling accused and preached at for seeing her that way.
Going back to her original intervention, rather than confronting Tony with feelings about his mother—that she knew he could not accept—Melfi needed to say that she thinks he has some complaints about his mother and that that could be really upsetting.
THE BIGGEST THERAPEUTIC LAPSE GENERATED BY THIS APPROACH
Gabbard (and Melfi) understood Tony’s tantrum as his being disturbed by being confronted with what is “at odds with his conscious views.”
Lets take a closer look at Tony. He feels accused, probably deeply wounded—what kind of a person does she think I am? He doesn’t say “That’s ridiculous! Where’d you get that idea?” He doesn’t demand that she prove it. He is nowhere near asking if she means he shouldn’t have hostile feelings toward his mother.
Tony might have argued with her, or he might have scolded her: “Wait a minute, do you think I’m lying to you? I resent that accusation.” He could even have just said that he found her interpretation offensive.
But he blows up and runs out of the office. Tony’s tantrum, just as is true for a batterer, was an expression of impotent rage. (Gabbard tells us that Tony complained at greater length, bitterly, to his wife.) He has this humiliating and unsettling loss of dignity, of self possession, the scary experience of not being unable to function as a spokesperson for himself.
It looks like he doesn’t experience himself as Melfi’s equal, that he relates to her as an authority and is intimidated by authorities, perhaps by his mother, perhaps by women. He would be surprised (more than surprised) to realize that he has to be the good boy who can’t openly dispute Melfi or hate his mother, which would make the relevant interpretation clearer: that he can’t hate his mother (the more precise—experience near—form of Melfi’s interpretation).
In fact, in the most primitive version of psychoanalysis (which still exists vestigially in Melfi’s interpretation) analysts would even say that Tony really hated his mother.
In other words there is a lot to going on that get skipped over by what the writers and Gabbard take as simply what happens when an unconscious feeling is “at odds” with “conscious views,” and certainly many therapists would be okay with that. To treat his tantrum as no more than his reaction to Melfi’s interpretation skips over the tantrum itself; what it means that his reaction took that form, that is, the nature of his executive ego.
Bringing all this out could make him feel included in the analysis, but it would have to begin with: “It looks like you felt you had to accept my interpretation.” Melfi and Gabbard just don’t go there.
What is the effect on Tony of this lapse, of not analyzing his tantrum, not making it understandable to him? After all, Tony himself can only think that he exploded and ran out because he was being called a “liar.” In fact, this kind of transaction could not be more common; a partner explodes and it is never talked about, as if it never happened.
Tony misses the chance to better make his own acquaintance, which should be the goal.
A MORE TELLING EXAMPLE OF OVERLOOKING THE EGO
Next we are told that, “Just when the situation begins to look hopeless, however, Tony gets the hots for his therapist.” Odd choice of words; this jock-talk trivializes it, a hint of how his feelings will be treated.
Tony has a dream in which Dr. Melfi acts seductive. Gabbard comments that “the message is clear. Tony has fallen in love with his therapist…We see Tony regularly experiencing erotic dreams about Dr. Melfi.” Gabbard continues:
Finally, Tony can no longer contain himself. He tells his therapist that she is “soft, like a mandolin,” and he walks over to her and tries to kiss her. She places her hand between her face and Tony’s to fend off the kiss and then stands up. She notes that their time is up and suggests that he might come back in the afternoon so they can discuss what just happened. Tony declines and leaves with his tail between his legs, feeling unloved and unwanted.
When Tony returns for his next session, he explains to Dr. Melfi, “I’m in love with you. I’m sorry. That’s just the way it is. I dream about you. I think about you all the time. I can’t get excited about any other woman.” Jennifer’s [Melfi] response is professional rather than personal. She explains to him that he feels that way because the therapy is going well.
Tony rushes her and he explains it as just being carried away by love for her. It is a familiar line, and usually is sincerely meant (when it is not strictly a power play), as if the woman should take it as a compliment.
Gabbard even says (above) that Tony “can no longer contain himself” (look, he’s got the hots). Melfi goes right along with this logic, explaining—not why he tried to grab her—but why he was feeling that way about her, as if the two are the same. This is that all-important lapse: the ego is ignored. This is analysis as a remarkably blunt instrument.
I’m beginning to feel like I’m taking on a straw man. But this at least shows how far one can spin out if caught in the logic we inherited from early psychoanalysis. How the patient relates to his feelings was treated a irrelevant.
(It also created the precedent for telling the patient how he feels, rather than doing some detective work, in this instance, interviewing Tony about this experience; of course, that would lose viewers, but I’m thinking about all the therapists who assured the public that this is representative therapy.)
What especially lends itself to this from-the-hip approach is the focus on motives, wishes, feelings. If the focus is on the ego—on how the person relates to these contents—the self-talk about them, interpretations are inevitably more precise.
Back to Tony. We all know that when a man puts an unwanted move on a woman, he will say, and sincerely believe, that he was just carried away, that, as Gabbard put it, he couldn’t contain himself. So, of course:
Tony is hurt once again . . . Why can’t she see his love as simply what he feels in his heart?
It gets worse. Gabbard goes on:
Here Dr. Melfi makes a common but fundamental error. She implies that the love Tony feels for her is not “real.” From the patient’s perspective, love for the therapist feels extraordinarily real, and the therapist’s failure to validate the patient’s experience of it can be experienced as a devastating dismissal. Feeling misunderstood, some patients will decide not to bring up their longings ever again, whereas others, like Tony, will make a beeline for the door.
Okay. Tony said “I’m in love with you,” and both Gabbard and Melfi think they know what that means, but don’t we all know that it can mean a variety of things, including “I objectify you”? In fact, we learn that when he dreams about Malfi, she is going down on him.
(Freud’s conception of sex normalized objectification—which is at least partly why analysts were among the last to recognize the validity of feminist complaints, as I discuss in “The Persistence of Layering Logic.” Contemporary Psychoanalysis, 2005, 41, 159-181; under the subhead, “Libidinal Drive as Inherently Objectifying”.)
Isn’t it pretty obvious that this dream reverses the power relationship? After all, this is the woman whom he believes accused him of hating his mother.
Tony is erotically excited by knocking Dr. Melfi off her pedestal—the image of her servicing him. I’m sure that would occur to most therapists, and Gabbard may even have been indulging the writers here. The very idea of a mobster in therapy is an entertaining conceit, but Gabbard owes it to the reader to point out when therapy is sacrificed to drama.
On the other hand, Gabbard declares that Tony responded as a patient would to “an analyst who listens quietly and empathically,” the same interpretation that Melfi made. Let’s accept, for discussion purposes, that Tony’s feelings have to do with gratitude. Is this the only way they could be expressed?
The writers do have Tony openly declaring his feelings (in the quote above), but then they serve as an apology and justification; that way he doesn’t feel exposed or vulnerable. It isn’t humiliating. That logic would be a path ego analysis could take.
(Melfi’s way of dealing with Tony is seen as “professional” by Gabbard, but is it? She doesn’t announce, not only that the session over, as it apparently just happened to be—but that so is the therapy, unless he can observe proper decorum. True, the writers apparently wanted to work in the dramatic tension that she was conflicted, being tempted by Tony, but even so, to be professional, as Gabbard claims, if not to preserve her integrity, would require her to instantly set limits).
In the following session, as by now you might expect, Melfi did not get into how Tony felt about making his bold move. She should have said something like, “That must have felt pretty daring. How did it feel? You must have worried about how I would take it.”
She doesn’t ask how long he has had these feelings about her, and how long he had been ruminating about what to do about them. She could have brought up how it must have been hard to say anything about having this urge to kiss her, given the risk of getting rejected. After all, he had been dreaming about her, and she apparently said nothing about his not telling her that, let alone telling her the dream content. (Of course, if he had done that it would have made him feel even more in her power, one-down and vulnerable, exposed to further humiliation.)
When Gabbard declares that Melfi invalidated Tony’s feelings of love for her, what does he mean? He pretty clearly is implying that she should have taken Tony’s feelings at face value, just as Gabbard himself did—as if analyzing them would inevitably be demeaning rather than encouraging. That is the legacy of early psychoanalysis, that analyzing means deflating. Remember, it requires maturity to stand it.
Freud thought of himself as shattering illusions. If you met an analyst at a social gathering, you felt you had to be careful; “I bet you’re psychoanalyzing me!” That didn’t mean you would be helped to feel better about yourself. It isn’t surprising that the public turned on analysts with a vengeance and Freud bashing became widespread—which was too bad, because Freud had worked his way out of the early model, although it was pretty late, less than ten years before his death. He accomplished an astonishing revision, although he was reluctant to acknowledge all the implications, keeping both versions going side-by-side (see “Analyzing, Not Psychoanalyzing“).
All the analyst could do was not invalidate by not analyzing; the idea that analyzing means validating never could have arisen even as a possibility; it requires including the ego. Analyzing Tony’s feelings as validating them would mean helping him to experience the validity—in the sense of being eminently understandable—of his feeling onedown, perhaps humiliated, and his helplessness to cope with that experience (as demonstrated by his tantrum)—and consequently, how exciting it could be to imagining reversing the power relationship.
POSTSCRIPT: A CAUTIONARY TALE
Gabbard includes a vignette that puts it all in a nutshell (it’s on pp. 131f of the book):
When I was in training, a crusty, irascible supervisor of mine interviewed one of my patients in my presence. He asked the young man why he wasn’t working. My patient offered a long-winded explanation, replete with myriad excuses for his unemployment. When he finished his rant, my supervisor looked at him squarely and said, “Sounds to me like you’re a lazy bum.” I cringed and waited for my patient to explode in anger. After a brief silence, the young man responded, “No sir, I am not.” My supervisor was unfazed: “Then prove it,” he said. The interview ended, and I tried to patch up the damage by explaining to my patient that my supervisor was just being provocative. (I was secretly beginning to wonder if I should have specialized in ophthalmology.) But something happened during that interview and my patient had a job two weeks later.
Instead of being a good patient and asking for help, this man launched into a prolonged, self-justifying “rant”—which would get him called “a difficult patient,” and probably was why he was selected for presentation to the consultant. It doesn’t take an ego analyst to notice that he is feeling ashamed or, more precisely, is fighting off shame. But what does the consultant do? He shames him. It probably was irresistible—as this man went on with his cockamamie excuses.
(The consultant was also grandstanding—seems like a medical school tradition to have the old man come in and deliver his opinion ex cathedra—but that’s a separate issue…or maybe not; the original rule of interpretation was simply to be tactful, which easily accommodated the idea that there are times when you need to cast aside tact and cut through the crap, confronting a patient with the truth.)
The effects of shame came very late on the analytic scene—for a variety of reasons, foremost among them being the way its effects are so difficult to detect. Notice how Gabbard “cringed;” he’s sharing the experience of the patient being shamed, but does he know that? He didn’t have it in him to commiserate with him, to say, “Boy, he really let you have it.”
Instead he tells the patient that the supervisor “was just being provocative,” i.e., really meant well. (This was not a patient who would reply with “How was that supposed help?”) Gabbard even entertains the idea that getting a job was somehow a desirable outcome.
You can shame a person into doing almost anything.
No wonder cognitive therapy is so popular; at least this man would be helped to realize that he was accusing himself of being a lazy bum and so would be less preoccupied with fighting it off. You can see where the need for cognitive therapy came from; it focuses on an essential aspect of the ego, although without going on to use it as a basis for analyzing. “Analytic cognitive therapy,” as an alternative label for ego analysis is an attempt to suggest that cognitive therapy does not fully exploit its basic insight.
In December, 2001 the American Psychoanalytic Association presented the producers and writers of The Sopranos with an award for “… ‘ the artistic depiction of psychoanalysis and psychoanalytic psychotherapy.’ Lorraine Bracco received an award at the same event for creating ‘the most credible psychoanalyst ever to Lorraine Bracco received an award at the same event for creating ‘the most credible psychoanalyst ever to appear in the cinema or on television.’”
From a review of Gabbard’s book in the journal of the Division of Psychoanalysis of the APA: “Gabbard skillfully and deftly makes the case for a psychoanalytic approach to emotional problems… Gabbard has authored 17 books and published over 200 papers and chapters…Many of his books and papers are classics in the contemporary psychoanalytic literature…The lay reader can obtain an experience near idea of contemporary two-person psychoanalysis.”
Sarah Boxer, New York Times December 29, 2001: “So when an actress comes along who is, as Dr. Gabbard put it, actually doing a credible job of psychoanalytic therapy, is it any shock that real psychoanalysts adore her? Is it any surprise that they try to make her one of their own? Is it any wonder that they welcome her into their society, as they did at the conference, by presenting her and the writers with awards that look remarkably like the diplomas they hang in their own offices?
“What, are they crazy?” Ms. Bracco reportedly exclaimed when she found out that she was going to get an award from the American Psychoanalytic Association.
Of course, not all therapists share this adulation, e.g., Margaret Crasnapol in Slate: Dr, Melfi “makes me squirm! Her stiffness and the formulaic quality of many of her interventions suggest that it’s time for her to retool…” But none of the criticisms have to do with how the technique of interpretation is represented.