Bernard Apfelbaum, Ph.D.

July 13, 1926 – July 5, 2016


[ Editor note: This weblog is a new online home for the writings of Bernard Apfelbaum, which first appeared on the now-offline website: http://bapfelbaumphd.com/ ]


Bernard Apfelbaum, Ph.d.

I have been waiting for hyperlink to be invented—to make it possible to bring my work together with a few clicks.

People who know me as a sex therapist are unaware of my work as an analytic therapist, and vice versa. Within the analytic community, my contributions to ego analysis have been misidentified as ego psychology.

My analytic genealogy, for those who are still interested in such things, goes back to Otto Fenichel (Rado-Fenichel-Windholz-Weiss), especially as he presented his position in Problems of Psychoanalytic Technique in 1941. Crucial to this position is the distinction between id analysis and ego analysis.

I cobbled together my own analytic training since at that time psychologists were excluded from the Institutes. My analyst, Joe Weiss, is a training analyst and founder of Control Mastery therapy, which, if you look at it really closely has detectable links to ego analysis, although mainly on the theoretical level. In practice it resembles id analysis more than ego analysis.

At that time, like most therapists, I was doing intensive, long-term analytic therapy. However, unlike most therapists at that time I also was developing an approach to brief therapy, partly because I had been trained and then hired at a brief therapy clinic, but also because Weiss’s approach works with the moment and so can easily be interrupted.

At that time I was developing the distinction between ego analysis and id analysis, both in the literature (two long papers in the International Journal of Psychoanalysis), which began a correspondence with some major figures in the field, most notably Merton Gill, and in conducting the final seminar in the clinical training series in Department at UC Berkeley (Theories of Therapy), and a similar seminar at the Wright Institute.

I also was published in an entirely different venue, the Berkeley Barb, a popular Berkeley counterculture paper (I think the “Barb” was to puncture the establishment). It was a long interview with me, covering two issues. (The interview). I used the example of “frigidity” as one of the best illustrations of an id analytic concept, laying out the ego analytic alternative. The Barb liked it because it seemed to puncture the analytic establishment.

That led to a call from a woman attempting to work as a surrogate, on her own, after reading Masters and Johnson’s description of that work. She was having trouble and needed a consultant. The Barb interview made me look like a possible resource. I organized a group to study her cases, eventually called the Berkeley Sex Therapy Group. I had some ideas about how ego analysis could be applied here, but it was still unclear whether we had a workable approach. Then we were suddenly caught in a media blitz, with Masters and Johnson, Helen Kaplan, and us getting national and international attention.

Just as suddenly we were deluged with patients. Should we tell them, sorry but we’re not sure we can help? These were desperate men. About a third had been through long-term therapies, and another third were currently in therapy. The remaining third would never have entered conventional therapy. We couldn’t turn them away, and with this volume of patients we had an opportunity to develop an approach that worked and that created what my colleague Martin Williams called a “new laboratory” for the study of sex and sex problems.

I also spent time in St. Louis to find out what Masters and Johnson were actually doing (at one point being listed on the staff of one of their workshops, assigned to put what they do in a conceptual frame). I found that their approach looked very different in practice from the impression their publications create. Unlike anyone else in the field they were surprisingly ego analytic. Beyond that, their approach to sex was truly revolutionary, although, like Freud’s recognition of bypassed guilt and shame (see ego analysis), it has been all too easy to assimilate to the commonsense notions it so radically revised. For a thorough presentation of this perspective, see “What the Sex Therapies Tell us About Sex,” in Kleindiest (Ed), New Perspectives in Sex Therapy, Brunner/Routledge, 2001, pp. 5-28.

Of course, we also saw a lot of couples in sex therapy, but the foundation of our approach was worked out in Individual Sex Therapy, which actually was a couple therapy, with the couple being a male patient and a female body-work therapist. At the time this scandalized many therapists, naturally enough, since they envisioned the usual male dominant, female sex-object scenario (others, with the same scenario in mind, applauded us). It was too hard an idea to grasp that trying to fit this scenario was what our patients were suffering from. How people responded to our program was yet another “laboratory.” The crowning absurdity was the charge that men who could “perform” with a “surrogate” might still have a problem with a “real” woman, as if to have a successful experience under any circumstances would not be enormously relieving—or at the very least a valuable clue. For an illustrative vignette, see “On Performance-Anxiety Anxiety.”

Of course, I also saw the usual range of couples and individual patients as well, but this focus in one area. especially one as both as vexed and as revealing as sex, gave me and my colleagues, most notably Martin Williams and Susan Greene, the opportunity to unearth some truths about sex and sex therapy that would have been hard to come by any other way. My definitive presentation of this approach was published in 1984 in The Journal of Sex Research and received the Hugo Beigel award as the article-of-the-year.

It is always assumed that this work made me an expert on male sexuality, but much of the focus was on the body-work therapist’s reactions (as clues to the patient’s problem). When I mentioned in a meeting that we were doing an intensive relationship therapy, one therapist said she didn’t see how I could think of the patient and body-work therapist as having a relationship. Our patients typically had the same problem—in fact that was their problem: they didn’t think they were having a relationship with the body-work therapist. (Of course, that’s true of most patients in therapy. They don’t think they are having a relationship with the therapist. Recognizing it is called the analysis of the transference.)

This work also gave me a chance to more fully develop the ego-analytic model. Here, in a nutshell, is what I came to.

Think of cognitive therapy. It is our negative self-talk (self-reproaches, self-hate) that generates our symptoms, rather than the reverse. Another way to say this is that we feel overly responsible for what we feel and do (which typically has the effect of our denying responsibility). This makes it hard to grasp reality, much as in the extreme case, in primitive times, we thought that our feeling were put into us by witchcraft and also that our feelings could cause plagues and other disasters. A book about this might be called “How We Dismiss Reality,” or, to be more specific, “How We Dismiss Sexual Reality.”