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Response to Hazel Ipp's“Nell—A Bridge to theAmputated Self”Joye Weisel-Barth Ph.D. and Psy.D. aa Institute of Contemporary Psychoanalysis , LosAngelesPublished online: 04 Oct 2010.

To cite this article: Joye Weisel-Barth Ph.D. and Psy.D. (2010) Response to Hazel Ipp's“Nell—A Bridge to the Amputated Self”, International Journal of Psychoanalytic SelfPsychology, 5:4, 400-406, DOI: 10.1080/15551024.2010.508200

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Response to Hazel Ipp’s

“Nell—A Bridge to the

Amputated Self”

Joye Weisel-Barth, Ph.D., Psy.D.

This paper identifies some of the complex therapeutic treatment issues andnarrative techniques that make Dr. Ipp’s paper a model case presentation.

Keywords: complexity; countertransference; cultural dislocation; identifica-tory processes; narrative techniques; PTSD

am an extremely picky case evaluator and writing critic, but HazelIpp’s lovely presentation of her work with Nell leaves me hungryand frustrated. I find no delicious therapeutic error to savor, no

spoiled opportunities to trash, and not even a morsel of disgust to chew on.I long for a critical “pig out,” but here is a case as fully realized and bur-nished as a skillfully prepared and risen soufflé. Drat! Therefore, I feel awave of nausea: Why did I agree to write about such a perfected cake—oops—case? There are not even crumbs to pick at! What helpful things canI possibly add to Ipp’s work in all its complexity: complexity in terms of thepatient’s issues; the therapist’s resonance and dissonance with those issues;the therapist’s careful balancing of cognitive observation and clinical un-derstanding, on the one hand, with emotional monitoring of both her pa-tient and herself, on the other; the ways in which all of these factors interact

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International Journal of Psychoanalytic Self Psychology, 5:400–406, 2010Copyright © The International Association for Psychoanalytic Self PsychologyISSN: 1555-1024 print / 1940-9141 onlineDOI: 10.1080/15551024.2010.508200

Dr. Joye Weisel-Barth, Ph.D., Psy.D., is Senior Training Analyst, Supervisor, and Instruc-tor, Institute of Contemporary Psychoanalysis, Los Angeles; and Book Review Editor, Inter-national Journal of Psychoanalytic Self Psychology.

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and play out in the evolution of the therapeutic relationship; and, finally,Ipp’s narrative description of it all? No crumbs at all!

Therefore, I doff my critic’s hat and play with Ipp’s piece instead. Iconcentrate on two things: (a) the excellent way in which Ipp tells her storyand (b) the intensity of identification and curiosity that Ipp develops forand with her patient. I want to show some of the ways in which Ipp helps usto experience the profound change process that defines her work with Nell.This discussion has four parts: (a) the opening themes; (b) the patterning ofthe therapeutic relationship, including some of Nell’s background material;(c) two therapeutic vignettes; and (d) Ipp’s personal resolution.

The opening of Ipp’s piece is a model of good writing. Beginning herstory with strong, visceral feelings—frozen tension, “hatred,” and “rage”—she immediately pulls us into her emotional world. We learn a number ofthings in the first paragraph. The caller’s accent somehow renders thecaller a depersonalized enemy, a no-named “Africaner,” not a person. Thedistasteful accent feels like an assault on Ipp and a vehicle that hurls herback to her native, abandoned South Africa—a terrifying world of “divi-siveness, hatred, pain, suffering, horror … angst and terror.” In aposttraumatic self-state, one in which time has collapsed, Ipp is unable tothink and, emotionally destabilized, vows to do a decidedly untherapeuticthing: “Of course, I would not respond to this message.”

From a few short opening paragraphs, we realize that this will probablybe Ipp’s painful personal story of memory and history. She is the likely pro-tagonist, a survivor of trauma, but still vulnerable to traumatic triggers andtraumatic self-states. She is also vulnerable to conflicted feelings about herhomeland; not only is it a “land of pain and suffering,” but it is also one of“incredible beauty and diversity” that causes “longing deep in my bones.”At the beginning of the article, I am already wondering what will occur forIpp in the therapy.

The opening also establishes and foils some expectations for thereader. For one thing, we expect case presentations to be primarily aboutthe patient. Although the analyst’s subjectivity is always important; and, al-though we often ask how an analytic encounter may change the analyst, itis rare that the analyst’s experience actually takes center stage. Yet, if thiscase unfurls as introduced, I expect to learn primarily about Ipp: about howin working with this particular Africaner and in confronting the traumatichistory of South Africa’s apartied system—including her own early re-sponses to it and then her choice to emigrate—she might change. Paradoxi-cally, I am also primed to expect that this case, if pursued, will be a hopeless

Response to Hazel Ipp’s “Nell—A Bridge …” 401

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misalliance. Ipp sets these contradictory expectations out quickly: thepower of good writing!

What follows is a narrative of upended expectations. Most important,the story turns out to be not mainly about difference and enmity but, rather,about complicated identifications and similarities. Ipp finds aspects of her-self in Nell’s life story, some known and some sequestered; and as Ipp’sgrowth proceeds in the crucible of the therapeutic relationship, we alsolearn a great deal about Nell and about the process of the analysis. Al-though from different cultures and with different personal styles, Ipp andNell are “bound in commonality of experience and feeling.” Both have emi-grated from the same “lunatic” place, a place of passionate opinions “whereone is bonded in intensity and purpose with like-minded others and pittedin hateful enmity with those who don’t share one’s views.” Each womanlongs for the sense of aliveness that she felt in South Africa and chafes atthe blandness and safety of Canada.

Ipp portrays the therapeutic partners in two different ways: First, sheanimates Nell for us through external description; and second, she illumi-nates herself by carefully tracking her own internal world. She describeshow Nell looks, what she does, and what she says. At the same time, Ippgives us her own personal inner monologue, one that conveys her affectsand subjectivity. We learn of her smallest, fleeting internal feelings,thoughts, and self-state shifts. This narrative, filtered through Ipp’s subjec-tivity, moves back and forth not only between both women’s pasts and pres-ents, but also between the personal and the political. Cultural, political,physical, cognitive, and affective concerns contextualize Ipp’s relationshipwith Nell; and as a writer, she makes this high-wire act look easy!

In fairly short order, Ipp discovers not only that she and Nell sharesimilar political sensibilities, but that Nell has tested her convictions incourageous and risky action. Ipp’s initial stereotypes of Nell and herAfricaner world “bite the dust.” Then, her own cascading memories,thoughts, and feelings come flooding forth and cause Ipp to link her emigra-tion with the decision not to engage in risky political action. She feels cow-ardly: “I felt a deep sense of shame that I had not stayed and fought the bat-tle I so believed in but had been too afraid to engage at the deeper levels.”These thoughts deepen into a meditation on the consequence of emigra-tion, what Ipp terms “the amputated self”:

… the land of our birth continues to reside deep with us long after wehave exited. Bridging the experiences of there and here, then and

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now is daunting, often impossible. … [S]omething vital is left behind,lost, encapsulated in the complex and multilayered world of the landof one’s birth.

In the second section, we learn about Nell and her family. Parentaldeath, rape, and terror color the family history for several generations. Theproduct of this transgenerational trauma and loss is Nell’s troubled firstfamily: an anxious, depressed, and schizoid-like mother; a self-referenced,compulsive father, who often explodes in rage; a sickly sister; and a mon-strous, fascistic uncle. Nell grew up in this family, unprotected and unseenemotionally but feeling great responsibility to redeem the family.

She initially presents as a beautiful, avoidantly attached woman, cool,calm, rational, and dispassionate. Ipp also suspects that Nell may have en-dured her own personal trauma—perhaps at the hands of her uncle—in ad-dition to suffering from the family heritage of multilayered trauma and thepolitical terror in South Africa. Although mostly affectively detached, Nellis sometimes capable of flashing a warm and radiant smile, a smile that sug-gests to Ipp a potential capacity for personal engagement and emotionalpresence. During the first part of the therapy, however, Ipp struggles withNell’s monotonic and dissociated tone, her lack of personal response, andher resistance to therapeutic empathy. She comes to understand that Nellis more psychically injured than she initially thought, probably emotionallydissociated from or numb to such basic human responses and motivators asfear, anger, and curiosity.

After the failure of her efforts to use mirroring empathy to infuseNell’s narrative with increased emotion (e.g., “How frightened you musthave felt!”), Ipp uses sustained inquiry to expand Nell’s “curiosity about herown experience, her choices, her own mind.” She makes many guesses toexplain the development of Nell’s political bravery and absence of fear—guesses about which Nell is vaguely interested but mostly noncommittal.Only when Nell reports a dream that delineates her mother’s incompe-tence, lack of protection, and imposition on Nell of impossible responsibil-ity does she finally express convincing anger. Ipp observes the strength ofher affective expression in the dream, and Nell agrees.

In this second section, Ipp weaves elements of her growing awarenessof her amputated self into the therapeutic dialogue. The use of dialoguehere allows Nell to come alive for us and enhances the quality of this sec-tion. It also enables us to observe the intersubjective process by which newunderstanding emerges for Ipp about her own choice to emigrate. She

Response to Hazel Ipp’s “Nell—A Bridge …” 403

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shares with Nell contradictory and oscillating feelings about the lure andthe danger of South Africa. She shares also in terrible memories of the po-litical terror, and thereby comes to accept her own understandable fearful-ness. She hints that this realistic fearfulness impelled her choice to emi-grate: “the only choice I could have made for me.” This section ends with aheightened affective moment when the personal and political merge. Ippand Nell identify and then laugh together over Nell’s subversive pleasure incausing discomfort and embarrassment for her loathsome uncle, an officerin the apartheid military apparatus.

Two trips in the third section, Ipp’s to Israel and Nell’s to South Af-rica, offer us a bit of literary symmetry, as well as a glimpse of both Ipp’s ther-apeutic technique and the pair’s therapeutic progress. The first vignette be-gins with a disruption. Ipp returns from Israel, and Nell asks her—from anobviously dissociated place—“What was it like to be amongst such a trau-matized population?” The question startles Ipp because it is, at once, thefirst time Nell has ever asked Ipp a personal question, because it is abouttrauma (a word Nell has previously avoided), and because it relates to Israel(a long-standing target of Africaner anti-semitism). Ipp responds sharply,automatically, and defensively. She says, “No different than being amongthe traumatized population in South Africa.” Nell begins to tear.

What follows bears witness to the value of disruptions in a relativelystable and established relationship. After the disruption, the two sit quietlyand, as we say in the trade, “reregulate.” Ipp apologizes for her sharpness,which has both jolted Nell in unexplained ways and has generated in herimaginative images of suffering, traumatic faces. Nell remembers that suchfaces had provided motivation for her dangerous political work. Obviouslymoved, Ipp brings the process quietly back to the personal. She shows curi-osity about Nell’s mind: “I wonder if any of those images include you andyour suffering?,” she asks Nell. This feels to me like a moment of surprising,unanticipated intimacy—the kind of unpredictable moment that some-times happens after system disruption. It reflects a deeply connected andempathic therapist in a thick and resilient relationship. The session ends.

The second vignette occurs after Nell returns from South Africa. As aresult of her work with Ipp, she has been able to change her patterned inter-action with her mother. She has said “no” to “fixing” her mother; and themother has resorted to old, coercive emotional threats. Nell has resisted thecoercion and tells Ipp in an emotionally charged way, “So much of my lifehas been about ‘YOU HAVE TO’,” including rescuing the mother and en-

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gaging in dangerous political activity. The section ends with a return toIpp’s inner monologue and her comforting and affirming insight about her-self: “I have been less governed by ‘YOU HAVE TO’.” Because less coercedin her life, Ipp has luckily had more connection with basic emotions, likefear—emotions that have provided her with motivating life directions.

The meditation that closes the article is earned, literarily and hu-manly. It is one that the narrative naturally leads to and one that articulatesan important value of the therapy for the therapist:

Nell has been my gift. Apart from providing me with the opportunityto dismantle many of my own prejudices and stereotypes, she has en-abled me to reconnect with that part of me that I refer to as my ampu-tated self, to grieve my losses and open new spheres of reflective space.… Locating oneself within the other, with all the struggles and angstthat that stimulates, is perhaps the essence of what we need to grapplewith as contemporary psychoanalysts.

“Locating oneself within the other!” … hmm … Ipp’s case has alsobeen my gift. It has reminded me of all the complexity in the work we do. Ithas reminded me and reinvigorated me to explore how, in fashioning withour patients analytic nets of associations—nets constructed of multiple ma-terials and operating on multiple levels—we therapists not only create tap-estries of change in our patients’ lives, but in our lives as well.

Joye Weisel-Barth, Ph.D., Psy.D.4826 Andasol Ave.Encino, CA 91316818–986–4098dr.joye@sbcglobal.net

Translations of Abstract

Este artículo muestra algunos de los temas de las complejidades terapéuticas así como lastécnicas narrativas que hacen del artículo de la Dra Ipp un modelo de presentación de caso.

Cet article identifie quelques-uns des enjeux et des techniques narratives de ce traitementthérapeutique complexe qui fait de la présentation du Dr Ipp un modèle de présentation decas.

Response to Hazel Ipp’s “Nell—A Bridge …” 405

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Questo articolo mette a fuoco alcuni complessi concetti del trattamento terapeutico e delletecniche narrative che fanno del lavoro della Dr.ssa Ipp un modello per la presentazione diun caso.

Diese Arbeit macht einige der komplexen therapeutischen Anliegen einer Behandlung unddie narrativen Techniken erkennbar, die Dr. Ipps Arbeit zum Modell einer Falldarstellungwerden lässt.

406 Joye Weisel-Barth

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