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The Case of Emily: AnalystDissociation From a SystemsPerspectiveJoye Weisel-Barth Ph.D. Psy.D. aa Institute of Contempoary Psychoanalysis, LosAngelesPublished online: 14 Sep 2012.

To cite this article: Joye Weisel-Barth Ph.D. Psy.D. (2012) The Case of Emily: AnalystDissociation From a Systems Perspective, International Journal of Psychoanalytic SelfPsychology, 7:4, 508-518, DOI: 10.1080/15551024.2012.710310

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International Journal of Psychoanalytic Self Psychology, 7:508–518, 2012Copyright © The International Association for Psychoanalytic

Self PsychologyISSN: 1555-1024 print / 1940-9141 onlineDOI: 10.1080/15551024.2012.710310

The Case of Emily: AnalystDissociation From a Systems

Perspective

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

This article describes a process of mutual emotional dissociation in an ana-lytic relationship, a process characterized by the patient’s dampened affectand the therapist’s sleepiness. Through an enactment and its confronta-tion, the analyst and patient were able to expand affectivity and a sense ofenlivenment in their work. The author uses ideas from complexity, attach-ment, and relational theory to understand the creation and resolution of theenactment.

Keywords: complexity theory; connectionist sensibility; cybersex; emotionaldeadness; evasion; mutual dissociation

Complexity ideas are very useful clinically, providing a broad and

flexible lens for viewing therapeutic material. Using a dynamicsystems or complexity approach, I will illustrate my work with

a patient named Emily and examine our process of mutual dissociation.The case of Emily is deceptively simple—as though any serious encounterbetween two people could be simple—and the clinical incident that I’lldescribe is not particularly dramatic. Nevertheless, the incident, in ret-rospect, has transformed our work together. Not only did it emerge from

Joye Weisel-Barth, Ph.D., Psy.D., is a Senior Instructor, Training Analyst, and Supervisorat the Institute of Contempoary Psychoanalysis, Los Angeles; and Book Review Editor forthe International Journal of Psychoanalytic Self Psychology.

This article has been NetLinked. Please visit www.iapsp.org/netlink to view or postcomments or questions to the author about this article.

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The Case of Emily 509

all that had previously occurred between us, and not only did it illumi-nate the separate psychological organizations that each of us brought toour relationship, but it also revealed a mutual dissociative process. Eachof us, in our own ways, experienced a dissociation of feeling from thought.I believe that Emily and I jointly created the dissociation in our relation-ship. We shared its authorship. Before relating the vignette, though, I wantto tell you something about Emily and our clinical work.

Emily is what old-time analysts meant by the term “an analyzablepatient”: she’s smart, thoughtful, motivated, and able to contain herimpulses and talk about them rather than acting them out. She is nota drinker, drug user, or overeater. In spite of a casual and low-key self-presentation—she dresses down and frequently sprawls comfortably on mycouch—she is disciplined, both in her work and recreational life. Not onlydoes Emily work out—her body is toned and muscularly defined–but shealso finds time to read seriously, maintain friendships, and keep herselfand home in meticulous order. She accomplishes all this as she jugglestwo kids, a husband, and a going, if somewhat lackluster, corporate career.While I often feel a bit disorganized and unkempt next to her, I admire hercompetence and equanimity enormously.

During our year and a half together, Emily has been respectful tome—especially appreciative of my emotional understanding—and quiteresponsible to our work. However, I do not feel that she is very attachedto me—or, rather, I’d say she is avoidantly attached. Our encounters areshort on affect and expressive energy. Instead, there is some invisible bar-rier of politeness and reserve between us, a sort of pillowy barrier intowhich my efforts toward emotional contact sink lifelessly. At times, therelationship feels stifling, like the atmosphere in an airless cave, and I feelbaffled in both meanings of the word. “Hang in here,” I tell myself. “Staypresent, attentive, curious, and trust the process. Trust that the processwill help us out of the cave, help us discover new emotional vistas.” Ithink of Emily as “Sleeping Beauty,” and I want to help her awaken to life’scolor.

But participating in Emily’s therapy is sometimes damned exhaustingfor me, and I wonder how I have helped to create such an oppressive,spiritless space with her? When in the grip of the cave fantasy, I feel tiredof working so hard with little emotional reward—sort of like the scratchedand bloodied fairy tale Prince, who, having struggled in the bramble forestfor too long, despairs of ever reaching Beauty’s Castle. I wonder if Emilysenses my fatigue.

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Emily has been in several previous therapies. She is psychologi-cally sophisticated, knows some analytic ideas and language, brings infascinating dreams, and says insightful and interesting things about herself.Yet she has not spoken to me about her former therapeutic relationships,not once, not positively, not negatively. I worry that I may be a futureaddition to the unaddressed list, a dead letter, so to speak.

In spite of hard work and effort, Emily at 38 suffers from a chronic,low-grade depression. She longs for deep connection and passion, but, atthe same time, feels that such experience eludes her. Her voice takes on aplaintive, whining quality when she speaks of the intensity that is missingfrom her life. It seems clear that our therapeutic relationship reflects thissame dynamic of longing and frustration on both of our sides.

In college, Emily had an intense relationship with a boy named Mike,a relationship which did spark heat and keen feeling. Yet Mike, open, fun-loving, and deliciously sexual, kept a long-time girlfriend back home. Aftergraduation, he left Emily for the other girl with hardly a backward glance.Although downhearted, she was not surprised. Mike’s leaving confirmedfor her what her mother had taught Emily during her growing up years: thatshe is second best and must adjust her life expectations accordingly. Fromher mother’s perspective, other people—Emily’s cousins, her girlfriends atschool, the children of her mother’s friends—are more gifted, talented,clever, imaginative, and special than Emily. Indeed, her whole first family,not just Emily, but father, siblings, and mother, too, are second best.

A corollary to being “second best” is that Emily must resign her-self to failure, disappointment, and mediocrity. Although she hates thenotion, Emily believes her mother. Ever since Mike abandoned her, Emilyhas endured with little fuss her share of heavy loss and disappointment,including the loss of an infant daughter. My sense is that Emily has notsufficiently mourned this lost child and that residual sadness over the deadlittle girl suffuses and colors her life.

Emily came to me for therapy after Mike, absent for 15 years, con-tacted her. Separated from his wife, he initiated an erotic e-mail romance,full of cybersex and mutual personal disclosures. The hot correspondencereignited in Emily old longings and hopes, longings and hopes which Mikedashed when, after a few months of the correspondence, he reconciledwith his wife.

“I felt alive with him,” Emily says. And, indeed, during that period,Emily did look more sparkling and alive to me. Her everyday face has adark, shadowed look—some mixture of grief, sadness, and worry—with

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heavy lidded eyes and the corners of her mouth down turned. Yet, whileshe was corresponding with Mike, there was a shine about her, a shinesuggestive of excitement and openness. That shine disappeared into hercustomary gloom when he terminated e-mail contact, and I see it flashonly occasionally in light or humorous moments between us.

Twelve years ago, at 26, Emily married a go-getter, an energetic, ambi-tious, and controlling man. Her husband, Dave, sounds like a parody of theoverbearing American business tycoon. While cunning, extraverted, andsuccessful in the world, at home he is hyperactive, second-guessing, andcritical. Often, he comes home from work and, without so much as chang-ing his clothes, takes over Emily’s meal preparation. Of course, he knowshow to do everything better than Emily, including not only the cooking,but the domestic organization and child rearing as well. She and he agreethat, in most ways, she is second best to him—except interpersonally: inthe family and with their friends, Emily handles the affective relationships.

As one might expect, Dave is a better talker than listener, particu-larly when feelings enter a conversation. According to Emily, he becomesfrightened and defensive and invariably preempts emotional encounterswith advice giving, by walking away, or by instituting the “mine is worsethan yours” strategy. “So, you think you’ve had a bad day?” he might say,“Mine was much worse than yours.”

After the death of their infant, Dave left Emily for several months,an abandonment that was never adequately explored but which has left agaping breach in the marriage. Today, Emily admires her husband’s com-petence and his energy and devotion to getting things done. She alsomarvels—with some envy—at his self-confidence and entitlement. Yet, inour time together, she has come to recognize the absence of collaborationand emotional attunement in the marriage—on both sides. This absencetroubles her to the core, but she does not believe it is possible to changethings. More resignation.

With this background in mind, here is the vignette I’d like to address:Dave is up for a great job in a distant city. It is a prestigious job with

a very large salary. Because Emily’s company has a branch in that city, shemay be able to arrange a job transfer—but maybe not. Emily claims to haveno problems with or feelings about moving, even though her first family andbest friend live in Los Angeles.

At our afternoon appointment, I listen in a desultory way to droningdetails of the anticipated move. I hear no excitement or curiosity, no angeror resentment, in Emily’s voice, only a dry and level narration of lists of

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things to do. I think to myself, “More loss and loneliness for Emily.” I hatethe details describing the dismantling of Emily’s family, community, andprofessional life. Although I feel angry for her, I am mainly aware of beinglulled by her voice into drowsiness. I want to take a nap. To jolt myselfawake, I ask Emily how she feels about leaving our therapy and me—we’vemet twice a week for a year and a half—and she answers with a warningedge, “It’s premature to talk about it. The move is not a sure thing.”

Outside it is raining; perhaps it is the chilly grayness of the afternoon,more probably, it is Emily’s own chilly grayness, her failure to respond tomy question with even a whiff of feeling that emphasizes the existentialgloominess. It might also be the accretion in our work of many such emo-tional evasions or the fact that I have my own attachment needs andabandonment anxieties and feel existentially threatened here. After allour work, my patient, who does not seem particularly engaged with me,may now leave me all together. At this moment, I do not expect evena backward glance from her, as though I don’t exist. All these factors incombination cause me to feel emotionally suffocated. Needing some air,I say, “Premature or not, I have feelings, lots of them, about your going.”These words fall out of my mouth, and I gulp.

Emily is as surprised as I am. My statement has radically changed theemotional climate, has clearly perturbed our system. She answers terselyand defensively, “Well, unlike you, I try not to feel things if I don’t haveto.” She falls into silence and averts her eyes. After a time, she giggles andlooks back at me. I see a little gleam. Soon, she has regained her compo-sure, “I guess that wasn’t very gracious of me.” She blushes, and then thereis more nervous laughter. “Your words—they make me think of what myother therapists and even Janey (her best friend) have said about me—thatI’m inaccessible, umh. . .hard to reach, closed. I think it’s right. There’ssomething wrong with me, defective. I’m not like other people. I don’thave normal reactions. I suppose I’m flunking this therapy, too.”

“Wow! Some energy, oxygen, an opening,” I think. I guess out loudthat she felt rebuked or shamed by my comment and so answered meangrily. “No, no” she says, denying hurt and anger. “Normal people wouldfeel things clearly, would know their feelings. Why would I be mad at youfor saying what you feel? You are certainly a part of my life here—part ofthe part I like, I mean. Of course, I’d miss you. But I don’t, can’t, let myselffeel anything about it—since I can’t do anything about it anyway.”

I wait to see if she has anything more to say and then note that shehas moved quickly to take total responsibility for the shift and resulting

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discomfort between us. I say with irony, “It seems that this rift is all yourfault, Emily. Not only are you a lousy patient, you’re also an odd-ball per-son. Since you’re stuck being abnormal and can’t change that or anythingelse for that matter, the least you can do is to shut up and shut down.Certainly, you mustn’t have any feelings.”

She laughs again, “I know better than that, but I do feel responsible.”She seems very relieved that the hour is over and practically flees out ofthe office without saying goodbye.

Next session, Emily picks up where we left off, but in a very differ-ent mood. She speaks thoughtfully in almost a whisper as she watches thehardwood floor. “I’ve puzzled about why I don’t feel anything about mov-ing away. You have feelings about my move, and I don’t. It’s weird. Afterall, this is not my choice. I like my life here, and my family is here andsettled. And you’re here too. But I do think Dave deserves to have his bril-liant career. Really, he’s been quite nice about the whole thing and says if ithappens, if he gets the job offer, I can decide if we take it or not. Of course,he knows I would never say no. So why should I fret? It’s a done deal oneway or the other. Tuesday, I felt you were expecting me to have strong feel-ings, and I just don’t. Feelings like rage. I don’t like those expectations fromyou, and I don’t like feeling pushed.”

“Rather than not having any feelings, Emily, maybe you simply can’tthink about feelings of loss here with me.”

“I can think about loss, but I don’t feel it. Maybe I choose not to. Oh,I don’t know.”

“Well if you have a choice and choose not to feel loss here, are thereany ways that I contribute to or tip your choice?”

She thinks for a bit and searches me out visually. “Well, I’ll be totallyhonest. I was thinking about whether to tell you this. Sometimes you looktired on Tuesday afternoons—like this week when I was talking about themove. When that happens, I think I’m boring you. You probably have manymore interesting patients. I imagine they never bore you. I felt this sameway with my old therapist, too. She often seemed tired or bored with meand so didn’t push me enough. Hmm, I know you’ll ask how that compareswith you? You do probe and push, but I often don’t like it. I don’t want tofeel bad feelings. That’s why I snapped at you on Tuesday. I did feel bad; Ileft feeling terrible.”

“You’re right, Emily. I think I did push you Tuesday. In part, I pushedbecause I felt distant from you, distracted, and a bit sleepy. I wanted feelingsfrom you. I wanted your feelings to wake both of us up. I wanted them even

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if they turned out to be angry ones. So I am confirming your impression—although I hate when it happens, and I hate to admit it—that sometimes Idissociate when we are together.”

Emily says, “This feels strange, talking to you about all of this somatter-of-factly. I want to know more, and I also want to leave.”

“I want you to stay so we can work this out.”“You say you want to know me and to know my feelings. But it feels

dangerous to me—especially if you’re falling asleep.”“I sure understand that, and I acknowledge that you’re very angry at

me.”“Hmm.”“Emily, let’s see if I have it right so far. It’s bad enough feeling bad

feelings by yourself; you don’t want that, don’t like that at all. If you can,you minimize or erase your bad feelings. And, then, if I am tired or bored,it’s not likely that I’d care to attend to your bad feelings—that is, if youchose to have them and bring them here. If I were bored, not interested, orsleepy, then having bad feelings with me would be even worse than havingbad feelings alone. Better keep mum about them.

“What’s new here is that you’ve confronted me about my behavior.I imagine the last thing you expected is to confront me and have me comealive and be interested, to have me listen to and respond to you. Thiscomes as a surprise and is a bit dangerous. It seems that you are quiteundecided about how or whether to continue this conversation.”

“That’s right,” she says, and after a pause goes on, “To tell you thetruth, nobody has ever been interested in my bad feelings. My mother waslost in her own bad feelings. I hated that and wasn’t really interested inhearing her complain. So I certainly understand why you wouldn’t want tohear me complain. And, then, my mother had no patience with my feelingsor me. Dave just gets defensive and angry. Sometimes he gets competitivewith my feelings or just shuts down if I seem upset with him. So why inHell would I think you’d really want to know?”

The above exchange, charged with old and present angers and newtruths between us, made me very happy. It also woke me up. It felt to melike a whiff of fresh air, a small promise that together Emily and I mightactually find an exit from our cave.

In the vignette, a few central themes and questions emerge that orga-nize Emily’s relationships and our co-transference. For Emily, these ques-tions concern overarching themes of deep trust and commitment and heremotional strategies when trusts and commitments are violated. I imagine

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her asking me, “Do I have power and value in this relationship, or am I sec-ond best and powerless? Will you listen to and care about me, or will I justget dumped? Can I find and/or risk feeling and intensity here with you?”

As therapist, I, in turn, bring questions and goals from my worldsof experience that also organize the co-transference: “Can I function suc-cessfully to establish a trusting and feeling relationship with Emily? Can Itolerate what I anticipate to be the emergence of deep grief and mourningas a result of Emily’s history of abandonments and losses? Can I tolerateEmily’s emotional denials, evasions, and deadness in order to create some-thing new and alive between us? Or will I answer her emotional avoidancewith my own?”

The two of us play out these questions in many variations. Each ofus takes turns enacting the various and changing dramatic roles whichthese questions proffer. Particularly, the issues of trust and emotional vital-ity are central in the vignette. I suggest that, in the joint project of wakingup “Sleeping Beauty,” paradoxically we have together created and experi-enced a claustrophobic life space, full of longing but until this point emptyof deep feeling, passion, and meaning. This is the kind of life space that,until now, Emily has occupied alone.

Are there dynamic systems or complexity ideas which shed light onthis discussion of Emily and me? I’ll name a few. Complexity theory positsthat two open complex systems—like Emily and me—are pre-wired forconnection (see review of complexity principles in Weisel-Barth, 2006).Minds are inherently relational, interactive, and continually updated byexperience. Each union of two minds is, then, a unique and co-createddyadic system, all parts of which are mutually interdependent and mutu-ally influential. The union is unique both because of the singular historiesand experiences of the partners and because of the particular context andensuing process of their coming together.

All parts of complex systems are in a process of perpetual change,with each other and with other complex systems, a process of continualorganization, deconstruction, and reorganization. In spite of this contin-ual flux, dynamic systems tend toward ordered intricacy. In complexityparlance, this process is termed the self-organization of complex systems.While movement and change are continuous and highly context-sensitive,complex systems nevertheless often find states of stability and equilibriumcalled “attractor states.” “Attractor states” are preferred patterns of orga-nization into which systems settle and which must be “perturbed” in orderfor new movement and organization to occur. In the case of Emily and me,

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the creation of the claustrophobic cave, that space of emotional vacancy,is where our system had settled. Although I had consciously sought toinfluence her in the direction of vitality, the actual influence was toward astate of low energy for both of us. This was our attractor state.

How does complexity theory explain the perturbation and subse-quent reorganization of our system after I confronted Emily’s lack of feelingabout our work and Emily confronted my drowsiness? It pictures our sys-tem with an established history of intricate connections, connections inthe nature of budding familiarity and trust. Although settled in an “attrac-tor state” of mutual affective dissociation, the system also possessed thepotential to confront the affective deadness and to change. Dynamic sys-tems theory names this relatively open state, poised between order andchaos, the “tipping point.” In keeping with the complexity notion of unpre-dictability, I would add here that both Emily and I were surprised by thelong-term impact of our confrontation. At the time, I certainly did notknow that we were poised on any “tipping point,” or that once the two of ushad “tipped,” the resulting effects would be large changes in the energy andtone of our relationship. According to systems theory, a small perturbationmay create large effects.

By the time of the vignette, neither Emily nor I knew what sourcesin the system—Emily’s history and experience or my own—accounted forour abilities both to dissociate from and to confront each other. Rather,by that time, Emily and I were joint authors of the relationship, a circum-stance that systems theory describes as the distribution of affect across therelational landscape. Emily and I were able to read and recognize eachother and to know our relational dance in subtle, nonverbal ways. We hadachieved with each other many “implicit relational knowings” about eachother, or in Tronick et al.’s term, a “dyadic expansion of consciousness”(Tronick et al., 1998, p. 290).

This astonishing observation that affects and “relational knowings”in dyads do not belong to just one party is an important contribution ofsystems thinking. What feels like “mine” is really “ours.” Dyadic affectsand knowings become the property of both partner’s history and experi-ence. This conviction constitutes a denial of intrapsychic representation.As Coburn explains it,

Instead of experiencing the “outside world” and then “internal-izing” it, “representing” it, and arranging it in some manner for

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future adaptational use, sources of emotional experience are moreusefully pictured as distributed throughout multiple relational sys-tems. In that sense, in the explanatory sense, no one authors or ownstheir emotional experience. (Coburn, 2007, p. 142)

And so, in our confrontation, our existing system was perturbedso that Emily and I paradoxically met each other with a directness andintensity that countered our dissociation and enlivened our interaction.Subsequent to this incident, our interactions have moved in the directionof more vitality, ease, and spontaneity.

What complexity thinking has added to my understanding of thisrelationship, and to my therapeutic work generally, is an enlarged sense ofmystery and possibility. I no longer wonder whether change will occur ina given therapy, because changes are perpetual in a complexity sensibility.But I am less certain than I used to be that I can know the direction ofthat change. A complexity sensibility informs me that what I think I knowand do is always less than or different from what is actually happening orwhat is possible. What I think will happen is always provisional and opento surprise. And what I think of as personal accomplishment always derivesfrom larger relational systems.

References

Coburn, W. J. (2007), Contextualist sensibilities in psychoanalysis: A discussion of JudyPickles’s case presentation. Psychoanal. Inq., 27:139–144.

Tronick, E., Brushweller-Stern, N., Harrison, A. M., Lyons-Ruth, K., Morgan, A. C.,Nahum, J. P., Sander, L., & Stern, D. N. (1998), Dyadically expanded states ofconsciousness and the process of therapeutic change. Infant Ment. Health J., 19:290–299.

Weisel-Barth, J. (2006), Thinking and writing about complexity theory in the clinicalsetting. Int. J. Psychoanal. Self Psychol., 1:365–388.

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

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Translations of Abstract

En este trabajo se describe un proceso de disociación emocional mutua en una relaciónanalítica, un proceso caracterizado por la disminución de los afectos del paciente y la som-nolencia del terapeuta. A través de un enactment y de la confrontación del mismo, el analistay el paciente son capaces de expandir la afectividad y un sentido de revitalización en sutrabajo. El autor utiliza las ideas de las teorías de la complejidad, el apego y la teoría rela-cional para entender la creación y la resolución del encatment

Cet article décrit un processus de dissociation émotionnelle mutuelle dans une relationanalytique, un processus caractérisé par l’amortissement affectif chez la patiente et par de lasomnolence chez le thérapeute. À travers une mise en actes et sa confrontation, l’analysteet la patiente ont été capables d’élargir l’affectivité et le sentiment de vitalité dans leurtravail. L’auteur utilise des idées des théories de la complexité, de l’attachement et rela-tionnelle pour comprendre la création et la résolution de la mise en actes.

Questo articolo descrive un processo di mutua dissociazione emotiva nella relazione ana-litica, processo caratterizzato dall’attenuazione affettiva nella paziente e dalla sonnolenzanell’analista. Tramite un enactment e il successivo confronto, l’analista e la paziente sonostati capaci di espandere l’affettività ed un senso di maggiore attivazione nel loro lavoro.Per comprendere la creazione e la risoluzione dell’enactment, l’autrice si rifà alle idee dellateoria relazionale, dell’attaccamento e della complessità.

Diese Arbeit beschreibt einen Prozess gegenseitiger emotionaler Dissoziation in einer ana-lytischen Beziehung, ein Prozess, der durch den gedämpften Affekt des Patienten und dieSchläfrigkeit der Therapeutin gekennzeichnet ist. Durch ein ”enactment“ und die darauffolgende Konfrontation sind die Analytikerin und der Patient in der Lage, ihre Affektivitätund ein Gefühl von Lebendigkeit in ihrer Arbeit zu erweitern. Die Autorin benützt dieIdeen der Komplexitätstheorie, der Bindungstheorie und der relationalen Theorie alsHintergrund, um die Entstehung und die Auflösung von ”enactments“ zu verstehen.

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