When working at the crossroads of psychoanalysis and spiritual formation, we may witness or be party to various types of collisions or collusions that lead to impasses or ruptures that may or may not be worked through or repaired. To traverse these crossroads in a constructive way that facilitates healing, we believe it is crucial to consider how both psychoanalysis and spiritual formation contribute to the process and outcome of psychodynamic psychotherapy or psychoanalysis. The particularity and integrity of each discipline's models and methods must be respected and kept in mind so that points and principles of resonance and dissonance may be identified, integrated, and applied to clinical encounters as they unfold.

This article will begin with a summary of what we believe are some key areas or points of resonance and dissonance between psychoanalysis and spiritual formation. These are not intended to be exhaustive lists, but rather serve as a backdrop for discussion of a clinical case so that nuances and complexities of the case may be explored.

For purposes of this article, the articulation of resonance is based on a historical understanding of the roots of psychoanalysis; evolutions in theory and practice will be noted when relevant. Spiritual formation is conceptualized as a process initiated and sustained by grace from God, resulting in progressive transformation of the whole person (internally and interpersonally). Following presentation of a clinical case by Anita Sorenson, Theresa Tisdale and Earl Bland will offer reflection on, and discussion of, the case utilizing and integrating concepts from both psychoanalysis and spiritual formation.

Areas and Points of Resonance Between Psychoanalysis and Spiritual Formation

Both psychoanalysis and spiritual formation share, in some form or expression, the following principles, methods, and/or practices:

* Both are processes that potentiate deep change

* Both acknowledge the holistic nature of human beings (all aspects in mutual, reciprocal relation)

* Both are mediated through relationship

* Both require the skill and guidance of an other

* Both have time-honored rituals, methods, and practices considered to facilitate deep change

* Both require surrender

* Both acknowledge conscious and unconscious mental life

* Both require self-awareness and a willingness to become aware of what is unconscious

* Both involve knowing and being known at a deep level

Areas and Points of Dissonance Between Psychoanalysis and Spiritual Formation

At the same time the resonance between psychoanalysis and spiritual formation is considered, distinct difference or areas of dissonance must also be acknowledged. While these distinctions are substantive, we do not consider them impediments to engaging both psychoanalysis and spiritual formation when working clinically. Rather, we strive to identify whether, when, and where the two may be brought together in mutually animating and constructive ways for the benefit of our patients whose suffering inevitably is both internal and interpersonal as well as physical, psychological, and spiritual in nature.

Some key areas of dissonance we have identified are:

Psychoanalysis as established by Freud (1927) defined health as being free of religion, which he understood to be the product of the wish to avoid the grim realities of existence in favor of escaping to a benevolent other who would remedy all ills and cure all injustice. This foundational belief by Freud has gone through extensive revision within psychoanalysis, beginning with some in his inner circle, most notably Jung (1933). In sharp contrast to dismissing God and religion, the central focus of spiritual formation is connection to, and relation with, God. Spiritual formation results in ever-increasing depth of communion with God.

The goal of Christian spiritual formation is to bring every area of life into relation with God (Willard, 2002). Individuals and communities of faith will reflect in unique ways the character of Christ and the fruit of the Spirit. Psychoanalysis has no particular vision for the human person beyond developing the capacities for purposeful work and meaningful love; a more recent addition to this formula first articulated by Freud, is the capacity to play (Winnicott, 1968).

When Freud (1893) first conceived of psychoanalysis, he articulated a key purpose as the transformation of neurotic suffering into ordinary everyday unhappiness. In stark contrast, spiritual formation is intended to make manifest the abundant life described by Jesus and the fruit and gifts of the Spirit described by Paul.

Psychoanalysis was not designed with an eternal perspective in mind or with a view of persons as spiritual beings who are having a temporary physical experience (de Chardin, 1955). Spiritual formation is predicated on an ecclesial and eschatological vision of humanity and creation with an eternal purpose and existence.

Finally, psychoanalysis and spiritual formation diverge with respect to understanding the purpose and meaning of suffering. In psychoanalysis, working through trauma and suffering requires a willingness to become aware of unconscious conflicts, memories, fragments of experience, to confront defenses, resistance, transference, and countertransference. The relationship between patient and analyst, as well as the field between them (articulated by a number of analysts as the analytic third, e.g., Benjamin, 2004; Ogden, 1994), is the medium through which suffering is encountered and change may occur. Therapeutic action resulting in change involves: increased understanding or insight so that previous scattered or jumbled bits of narrative may be brought into a cohesive and coherent whole; provision of new experiences that fill in deficits in personal capacities, self-esteem, or internal structure that resulted from early life neglect; and authentic engagement so that repeating cycles of interpersonal rupture may be repaired. Some analysts do view transitional space (Winnicott, 1975) or the analytic third (Tummala-Narra, 2009), or Bion's (1965, 1970) concept of O as constructs that leave open the possibility for Divine involvement, but this is unique to particular theorists and practitioners rather than a mainstream view within psychoanalysis as a whole.

Spiritual formation may indeed require processes and methods quite similar to those articulated above. However, spiritual formation offers a profound contextualization of psychoanalytic processes within the Christian experience. Through spiritual formation, suffering has the potential of deepening one's connection with God. Suffering is an opportunity to enter into the sufferings of Jesus and experience the solidarity of knowing He suffered in every way humanly possible and, conversely, that we may know first-hand what He suffered. For example, Jesus was the child of a woman who was pregnant before marriage, betrayed by friends, physically beaten, humiliated in public by being spat on and crucified naked. The co-mingling of experience, of knowing and being known in the fellowship of suffering and sorrow, is unique to Christian spiritual formation.

Undoubtedly there is much more that could be said about the resonance and dissonance between psychoanalysis and spiritual formation. However, with these broad brushstrokes we prepare the canvas for the artist's hand to paint for us a picture of her work with Jane.

Pilgrims Together in Suffering: The Case of Jane

My (Anita) patient, Jane, came to our first session in December, with the presenting issue of wanting to work through a protracted and complicated grief after the difficult death of her twin sister from lung cancer the previous April. Jane was in her sixties, a professor of psychology, and had lived with her female domestic partner for over 25 years. Jane had a challenging developmental history, as well as chronic mental health issues and physical health concerns that contributed to her destabilized current experience. A friend of hers had recently consulted with me for treatment but chose instead to be a control case for an analyst in training, and she recommended Jane see me, reportedly saying, "Anita is your person. She loves God and will be your home." Quite a referral.

Jane's family history

Jane and her fraternal female twin Jamie were born to a teenager who gave them up at one year old to the Home for Little Wanderers orphanage. At this point, they were separated from their birth mother and her family (their mother went on to have nine children and four marriages). Father was unknown. Both girls were adopted at 18 months into a "troubled family, a marriage that was poor and very conflictual." Their 40-something adoptive mother had lost a stillborn baby before the girls' adoption and, according to my patient, she never recovered from the loss. She memorialized that baby's things in the attic, often visiting the attic for hours, leaving the girls alone to fend for themselves in the house. Jane described her adoptive mother as "dominant and mercurial, not able to enter into others' experience, so neither comforting nor safe." She was simultaneously socially dramatic and flamboyant, as well as privately condescending and vicious to her husband. Their adoptive father was a "1950's father--distant but dependable." Right after Jane and Jamie were adopted, he went to France as a Member of Parliament, leaving their mother alone and overwhelmed by the twins. Jane describes them as "fundamentally mismatched non-communicators," saying, "we knew that as kids" and "we have to bear it on our own in this world." Both parents abused alcohol regularly--"They didn't drink just to do it; it's right out of the viscera"--and fought constantly, vilifying each other. Mother called dad "little boy", threw things at him and was out of control a lot, very unhappy. Very little emotional attention was paid to the girls, thus their household was "a gathering of strangers."

Jane and Jamie grew up in western MA and had some extended adoptive family, including cousins and two spinster aunts. From age 18 months until five, the girls and their adoptive parents lived upstairs with one of the spinster aunts. When the girls were five, dad, a contractor, built them a home of their own. They were told they were adoptees in 2nd grade and were called "our chosen children." However, mom often threatened to take them back. Jane, by her account a clever and resourceful child who was good with words, had "a mouth on her" and talked back to mother a lot. She went to the library to research whether return was possible, and came home and reassured Jamie that it was not and that she would always look out for her.

Their mother had breast cancer in her early 50's and a protracted, severe depression afterwards. She stayed in her room for a few months and the girls were not allowed inside. During that ordeal, mother's other sister came to stay with them and provide care.

Jamie was the larger twin physically. They were born 13 minutes apart, but it is unknown who was born first. Despite Jamie's size, Jane always acted as the protector and parentified child. From a young age, Jane sensed Jamie's fragility and instability. They were both distant and close across their lifetime. Jamie was a graphic artist with an unstable work history, often chronically unemployed, and always in financial trouble. Over the years, Jane sent large amounts of money and material provisions to Jamie, unable to enjoy her own financial success if she knew Jamie was suffering. An alcoholic for decades, Jamie finally sought treatment in her 40's after years of badgering by Jane. Jamie was also a lesbian and had a faithful partner at the time of Jamie's death.

Jane's medical and psychiatric history

Jane suffered from Major Depression in her twenties. She had married a man at age 26: "I wanted to not have to go to a gay lifestyle. The 70's were very unforgiving, and I wanted marriage and a family." Her husband had her involuntarily hospitalized following raging, suicidal episodes that led to her cutting down all the curtains in their apartment and threatening to harm herself. She had ECT and spent 6 months in residential treatment. They divorced after 5 years, yet remained close friends. Jane stated that others thought that her depression was due to her sexual orientation but it was, in fact, "due to genetics and a miserable childhood catching up with me."

Jane had another raging episode in the 1990's; she was suicidal, with accompanying severe anxiety. On and off anti-depressants after her first depressive episode, Jane had one previous stint in outpatient psychotherapy, largely cognitive behavioral management of stress and symptom reduction. She was given a maintenance dosage of Zoloft which she discontinued after leaving treatment.

At my recommendation, Jane saw a new psychiatrist and was prescribed Lexapro for anxious disorganization/panic/mood disturbance. She responded well to the medication and appreciated her psychiatrist's "diagnostic acuity, impressive intellect and kind, crinkly eyes." It should be also noted that Jane was diagnosed with thyroid cancer fifteen years ago, had a successful surgery, and was on Synthroid.

Clinical observations

Thus began our relationship: blessed by a referring friend, informed by contemporary psychoanalytic theory, and guided by inner promptings by the Holy Spirit to address Jane's deepest sense of loss of ongoing being-in-the-world. I began seeing Jane twice a week and was immediately drawn to her emotionally saturated life of suffering. The prominent clinical issues concerned her being a "twinless twin" in a complicated bereavement ("Singularity is impossible for me"), a lifelong sufferer of panic as a reflexive response to uncertainty and poor affect regulation, and her profound search for an emotional home.

In the first few sessions, when she shared about the death of her twin sister (the story was grim and her five-month cancer journey was unrelenting and savage), she told me that she had Googled me before coming and found out that my husband Randy had died the year before. She looked him up on the Rosemead School of Psychology site and said, "What a beautiful man he must have been. I have always loved the name Randy. I expect there is a certain symmetry between you two, as you are obviously such a deep and rich woman of faith and words. God must be up to something here with us." I chose to disclose honestly with her about the enormity of the loss, and the deep challenge for restoration and recovery for me. I, too, felt a sacred significance to our working together. Initially, because of our mutual journey of recovering from a catastrophic loss through death; then later on, as we walked together towards Jane's own death.

In one session early on, Jane commented on a bronze plaque I had on the wall by my desk, with the words "Bidden or not bidden, God is present." These were the words Carl Jung had over the doorway to his office and engraved on his tombstone (Jung, Michel, Gerber, Ganz, & Ruegg. 2009, p. 62). They intrigued her, and she expressed curiosity about their origin. This prompted a rich exploration of her Episcopal roots at a church camp in New England, where she experienced the presence of "a mysterious, undeniable Other, something unseen and beyond." This camp was a haven for her each summer, as she escaped the conflicted desolation of her home life. She convinced her mother to drop her and her sister off at the local Episcopal church and attended fairly regularly throughout her childhood and adolescence. As an adult, she was a participating member of a local Episcopal church and maintained a close relationship with her rector.

Despite the differences in our faith traditions (the 'tribes' we identified with and belonged to) and personal practices, we were able to develop a lingua franca between us that communicated our mutual awareness of a Holy Other who was real and present. Jane said, "This is holy ground here with you. The great sacramental nature of this relationship is inviting me into relationship with myself in a new way; a second rapprochement." And, "This is a new way of being with myself that I have not done before; I've never had a pastoral sort help me with my inner life that has been so scarred as to be unrecognizable. Therapy is like taking a living Eucharist that transforms the dead." Jane vigorously searched the Internet upon discovering I attended an Evangelical Covenant church, puzzled by what she found an apparent contradiction: "I resist the certitude of your evangelicalism, or what I presume are your commitments---it all seems so unyielding and rigid, even if a comforting place to reside. And yet you are an evangelical shelter for me--for the first time since [name of her earlier love "Claire"], I feel known and understood and deeply loved. A whiff of Jesus is nearby, the One I have not been able to make peace with in the great liberal enterprise of social concern and bells and smells. This scent intrigues me. I cannot believe I am saying these things!" Following a vacation trip to Carmel, and a visit to an art gallery, she brought me a card with a favorite photograph on it from a local artist, Roman Loranc, titled "Absolution." It featured a black and white image of a priest in a confessional booth, legs stretched out, relaxed, with ethereal light streaming in through a back window. We attached ourselves to the hopeful and redemptive image of our therapy relationship as an opportunity for reconciliation and freedom from a disastrous developmental beginning of life and subsequent lifelong search for a relational home.

Across the years we worked together, I became aware of my private twinship with Jane and its many dimensions beyond the parallel journey of recovery from a traumatic death. It was uncanny how many interests and passions we shared. Jane sought out what she called 'exemplars,' fine and beautiful things that were a delight to appreciate and savor. She was a foodie who kept me updated on her personal rankings of local bakeries she ate at before sessions. She was a discerning consumer of fine pens and meticulously produced journals and letterpress stationery, a lover of great writing and excellent turns of phrases. She brought in or emailed to me many articles she thought were rich and worthy of sharing so we could talk about their significance to her. She was a fierce Red Sox fan and could scarcely abide the Manny Ramirez trade to the Dodgers. She researched deeply anything that caught her interest and we had many conversations about minutiae that became precious to me also, as she invited me deeper into her inner life. Despite enormous emotional vacancies internally, she had managed to cultivate a wide garden of pleasures and pastimes that were infectious.

Two years into our work and after months of back pain, Jane had surgery for a degenerative disc disorder. Her post-surgical course was very problematic, with unremitting pain, GI problems, huge weight loss, and anorexia. I visited her in the hospital several times over the three weeks she remained there. On the last visit before she was released, I brought her the "Bidden or unbidden" plaque and offered it to her as a transitional object and icon upon which to focus her thoughts and concerns. We were both tearful as she unwrapped it and held it aloft.

She was unable to come to my office for appointments so for months we had our sessions by phone. During these conversations, Jane's thoughts and words were obsessional and circular. Her panic returned full force, and she worried about gastric cancer or various autoimmune diagnoses that would leave her immobilized. Four months after the surgery, Jane called and asked me if I would be willing to make a home visit to be with her when her doctor came to tell her what would surely be bad results of a recent CT Scan. This was the first time she referred to me as her therapist and her pastor. Sensing the import, I agreed to do so. I sat in her living room in the circle of her important women friends as her physician told her that she was diagnosed with a large pancreatic tumor that had an artery running through it so it could not be resected. The best they could hope for was to extend her life through chemo and radiation treatment that would be difficult because she was already underweight and malnourished. Her treatment would begin on Maundy Thursday, a detail not lost on either of us. We were entering an unwanted extended Lenten season.

The advanced cancer altered everything. Like Dorothy Parker's (Keats, 1970) famous saying, "What fresh hell can this be?" (p. 124), for Jane the question about her cancer was not "Why me?" but rather "Why not a break??" The diagnosis virtually swept away the remainder of what our work might have been, and forced us into a slow march towards her eventual death. Psychotherapy became a hospice, primarily focused on palliative care and spiritual/existential crises and reconciliations. It became imperative that I respond to her unique therapeutic needs, relinquishing standard technique for the creation of a facilitating environment that was efficacious for the balance of our work.

I began driving to sessions in her home twice a week, seeing her in her bed, meeting and interacting with her partner and the friends who kept her company during her months of treatment. She was a shadow of her former self, emaciated, struggling to find ways to put on weight, while enduring the ravages of potent chemo. Pancreatic cancer, as a wasting disease, is especially disheartening to observe. Yet, Jane was reflective, wry, and resolved to her fate, though not without great grief and sorrow. Jane spoke of the lamentations she was now experiencing, feeling "like Moses, who at the edge of the Promised Land, has to hear from God, 'You are not going in.'" After all this treatment and work

on her self, when she was finally achieving competence and an equanimity, she would not be able to enjoy its fruits. She dreaded thinking about her partner moving on in life, finding a new love, replacing her. She became curious about heaven, if it existed, asking if it was okay with me if she introduced herself to Randy and got to know him, if that was possible. She wrote me numerous letters when she could not sleep in the middle of the night, asking about Biblical texts, previous interpretations I had made to her, and requesting that I write down certain phrases that I always used so that she could hold onto them, even as her mind was cloudy from chemo--"You make me feel that I can meet whatever comes." We reiterated again that grace had led her to my door.

Those were locust times, with plague after plague of secondary side effects and symptoms that threatened to shorten her life even more than expected. The cancer metastasized rapidly to multiple organs and the chemo was destroying her stomach lining. It was a frighteningly similar journey to her sister's aggressive lung cancer that killed her in four months. Yet Jane continued to persevere, finding online community in the pancreatic cancer network, befriending many on a similar journey. Our sessions were poignant examinations of the meaning she had made of her life, and rehearsals of the conversations she was having with many friends about her illness and the prospect of death that was now certain. The panic that had so dominated the clinical picture in the recent months was virtually gone, replaced by a clarity and cohesion of self.

In May, I traveled to visit my daughter in the Boston area and, at Jane's request, visited her favorite childhood beach on the North Shore to gather up some of the "singing sand" to bring home to her. It was my privilege to make a final trip on her behalf to that beloved beach. She had another surgery in the summer to attempt to repair her stomach damage and I did not hear from her in August or September, as she was weak and fading markedly. I saw her in late October, in what I did not know would be our last visit. She was confined to her bed, and we looked out at the view from her window across the valley, as we had many times before, this time speaking few words. As I left, she gave me an envelope with a poem inside:

Whatever happens to me in life
I must believe that somewhere,
in the mess or madness of it all,
[t]here is sacred potential--
a possibility for wonderful redemption
in the embracing of all that is.

For in the unfolding of my journey,
in all its soaring delight
and crushing pain,
I may be sure that God is there--
always ahead, behind, below, and
above, encompassing all that befalls me
in a circle of deep compassion.

And there,
above the darkness
that wraps me round
the bright wings of the Dove
hover and beat
in gentle, healing love
and invitation to
New Rising.

Edwina Gateley (1998, pp. 22-23)

Jane died early the following year.

Reflections

Retrospectively, I found Robert Stolorow's (2007) book Trauma and Human Existence enormously helpful in giving understanding to my relationship with Jane. He highlighted two central themes in emotional trauma. First, the contextuality of emotional life, that "affect ... is something from birth onward that is regulated, or misregulated, within ongoing relational systems" (p. 1). Trauma is, "in essence, an experience of unbearable affect ... constituted in an intersubjective context in which severe emotional pain cannot find a relational home in which it can be held" (p. 10). In Jane's life circumstances, the essence of her emotional trauma was a catastrophic loss of innocence that permanently altered her sense of being-in-the-world. Multiple traumas shattered her experiential world and subjectivity and fractured her sense of a unitary self. She was, indeed, one of the Little Wanderers from her orphanage in Boston.

Stolorow's (2007) second theme is drawn from Heidegger's existential analytic, that by virtue of our finitude, the possibility of emotional trauma constantly impends and is ever present (p. 47). We are deeply connected to each other by virtue of our common finitude. Just as the possibility of trauma is always present, we also share an existential "kinship-in-the-same-darkness" (p. 47) that makes it possible to form bonds of deep emotional attachment "within which devastating emotional pain can be held, rendered more tolerable, and, hopefully eventually integrated" (p. 49).

"Kinship-in-the-same-darkness" (Stolorow, 2007, p. 47). Randy's sudden death the year before Jane arrived at my office made me especially attuned to the catastrophic dislocations that can come with the loss of a loved one. My own disastrously traumatized inner landscape became the Ground Zero out of which I could offer Jane my own broken self as a relational home. Our common finitude as sisters-in-darkness became a precious crucible for healing, reintegration, and at least some semblance of shalom. For both of us.

Stirrings from the Deep: A Response to the Case of Jane (Tisdale)

When I first read Anita's case I sat in silence for several minutes caught up in the awe and mystery of these two pilgrims who had met each other by Divine appointment and become companions on the way as they both journeyed toward wholeness. I share my reflections using three concepts, one from anthropology, one from spirituality, and one from theology.

From anthropology, I draw the concept of liminality, which refers to a state of ambiguity or disorientation that occurs in the middle phase or stage of a rite of passage. In the midst of a transitional or transformational process, a person is in a liminal state or stage when she is not who she once was nor is she yet who she will become. While originally developed to refer to transition rituals within small-scale aboriginal societies or cultures (Turner, 1967), the concept has undergone broader application to individuals and well as whole countries or cultures.

Liminality may be brought on because of a passage of time (for example initiation rites around crossing into adulthood) or because of a change in status or life situation. For individuals this may occur because of loss, death of a loved one, retirement, or divorce. For societies, this may occur because of invasion, war, or a change in regime. Moving through the liminal phase of a transition or transformation process involves three stages.

The pre-liminal stage involves a metaphorical death of some kind; life as one knew it is no more. In the liminal stage, a blank slate is created and all notions of self and self-in-relation are examined; this is a time of destruction, reconstruction, and new construction. During the post-liminal stage, one is re-incorporated into society with a new identity or as a new being. There are some obvious connections we might make here to Christian spiritual formation: undergoing death to the old self, transformation, and becoming a new person in Christ, but the association I had to Anita's work with Jane was more personal.

When Anita and Jane met, both were in a liminal state brought on by death and loss. Life as they knew it was over. Their internal landscape was devastated and desolate. I am profoundly moved by the grace and mercy of God to bring them across each other's paths for such a time as this. The word liminality comes from a Latin word meaning "a threshold." Both Anita and Jane were on a threshold; whether, when, or how renewal would come remained to be seen.

Historically, rites of passage were governed by a carefully constructed sequence of steps and overseen by a master of ceremonies who vigilantly monitored the process and progress. In their work together, Anita was the identified guide although as she has noted, both she and Jane were undergoing transformation at the hands of the Living God. The poem Jane gave Anita at what neither knew would be their final meeting, provided an indication of the newness of life that Jane experienced as she moved through the chaos, disorder, and disorientation of liminality to an experience of integration, peace, and groundedness.

From spirituality, the ways of Christian perfection (Garrigou-Lagrange, 2016) also came to mind as I meditated on Anita's work with Jane. The purgative way, illuminative way, and unitive way were once thought to mark the sequential phases or stages through which a believer passed while on the way to Christian perfection. Now, these are understood as reciprocal and cyclical rather than linear (Thompson, 2002).

Purgation is the way of the beginner; the new believer who, though justified, needs to actively contend with passions, sinful inclinations, and temptations. Mastering unholy desires and growing in purification is achieved through active surrender to God and cultivating virtues, especially love and humility. Purgation may be sought by the believer or be the result of dark nights of the soul (St. John of the Cross, 2003), which are allowed by God.

Those on the illuminative way have moved to a place where their mind is more enlightened to God's movements. Less energy and focus is spent on contending with unholy desires and is therefore free to pursue and experience God. Turning attention to thoughts and sentiments that move the self toward God is a mark of the illuminative way. On the illuminative way, consolations and desolations will both occur along with periods of aridity that may be worse than those endured during purgation.

A hallmark of the unitive way is contemplative prayer. In contrast to emotions and experiences associated with the purgative and illuminative ways, on the unitive way is peace of mind and relative freedom from the agitation of unholy desires or passions that would draw one away from union with God.

Jane's life struck me as one long and unrelenting purgation with few if any consolations. Growing up, her summer respites at church camp were notable exceptions. In the sacred safety and stability of the consulting room, as Jane unburdened her soul of the weight of profound suffering, space opened up for the experience of illumination. Jane's comments about the sacramental nature of the relationship, the invitation to know herself in a new way, her experiencing a whiff of Jesus nearby illustrate the illumination that was reaching the dark and desolate corners of her soul. One statement that profoundly reflected her experience of encounter with Anita was, "Therapy is like taking a living Eucharist that transforms the dead."

The agony of purgation cycled again through Jane's soul when she had back surgery. However, in Anita's portrayal of that time I detected a palpable difference in how Jane journeyed on and through that purgative way because of the community that surrounded her and the presence of her therapist and pastor, Anita. "You make me feel that I can meet whatever comes" were Jane's poignant words, reflecting the experience of consolation in the midst of desolation.

As Jane neared the end of her life, the peace of mind so central to the unitive way emerged. Confusion and panic were replaced with clarity and calm. The poem, her parting gift to Anita, eloquently expressed the new Sacred story, the anthem of their work as well as Jane's epitaph.

One final concept I would like to mention is from 13th century philosopher, theologian, scientist, and mathematician Cardinal Nicholas of Cusa (1440), whose work entitled, De Docta Ignorantia, translated On Learned Ignorance focused on the limits of what human reason could achieve in understanding God. Cultivating wise unknowing involved encountering the union of opposites, which was a common doctrine in medieval mysticism. The coincidence of opposites creates a logical confusion about how two opposing realities can exist at the same time. For Cusa, only God can fully bear the tension of opposing realities. Steiner (1988) has noted that Freud may have been influenced by the philosophical concept of coincidence of opposites when he developed his ideas on dream interpretation.

I would like to describe Anita's work with Jane as exemplary of wise unknowing. From the day their relationship began, there emerged a dialectical tension between certainty and mystery. God had certainly ordained their paths to cross, but it was a mystery as to how the journey would unfold. Both Jane and Anita were in a liminal state brought on by devastating loss. The sojourn to healing took them through experiences of purgation, illumination, and union. Moments, seasons, and cycles of consolation and desolation were woven into their joint emerging story, at times occurring at the same time during the same event, an example of the coincidence of opposites. The consolation of deep connection to God, self, and each other co-occurred with the desolation of pain, recurrent illness, and Jane's diagnosis of pancreatic cancer when they faced together the imminent loss of their earthly connection.

In her work with Jane, Anita exemplified a Spirit-enabled skillful holding of the dialectical tensions between certainty and mystery while at the same time bearing the weight of the union of opposites when new found joy in connection was laced with physical and psychological sorrow. Her willingness to live the questions with Jane ushered them both into a new season when the winter of devastating loss turned to spring of new life in relation with others. Together Anita and Jane moved across the liminal threshold into a deeper encounter with God as well as new understanding of the mysteries of healing.

When Anita met Jane, she hoped that their time together would be a gift to Jane, a cup of cool water to quench her thirsty soul. From the details of their narrative, it is clear to me that Anita was indeed a gift to Jane. It is equally clear to me that Jane was a gift to Anita; a companion in sorrow and in so many interests they had in common and new ones they grew to enjoy together. Their faithfulness to each other and to God's unfolding mystery in their relationship enabled them to receive the gift God had for both of them: transformation.

Me Too: A Response to the Case of Jane (Bland)

Although much can be stated in response to Anita's heart-rending and profound work with Jane, I want to respond to the clinical material from an orienting theme of twinship as a way to understand the experience of Jane and her relational connection to Anita. In this twinship relationship, each grappled with the enormities of personal grief and the dislocation one always feels when losing a beloved.

Let us begin with an outline of twinship. Early in Kohut's (1971, 1977) writings, as he was attempting to understand the nature of transference engagements, he came to understand that the patient's transference was more than just a recapitulated drama of previous unresolved conflict, but a striving to complete thwarted developmental longings that activate when one experiences a deep emotional tie. Called self-object needs, the patient seeks in the transference relationship to grow, complete, enhance, and sustain self-experience through connection with another. Needs for a stable sense of self, self-esteem, and the affirmation of one's goals and ambitions are typically met through the empathic mirroring of parental figures and the idealization of admired others whom the patient feels a desire to emulate. In addition to these idealizations and mirroring needs, Kohut (1984) defined twinship as a critical selfobject need involving the "need to experience the presence of essential alikeness" (p. 194). Here is the very human need for a sense of similarity with others, a longing for the experience of seeing ourselves in the life and experiences of those we deem important. In therapy, allowing this something less than merger and something more that mirroring connectedness, allows for a profound sense of understanding; and as I hope to show in the case of Jane, was an essential thread that wove through treatment in a way that facilitated healing and the lessening of her suffering.

In his important work on the development of Kohut's (1971, 1977) ideas around twinship, Japanese analyst Koichi Togashi (2009, 2012) identified several faces or dimensions of twinship that alternatively arise and diminish in the course of analytic treatment. In her work with Jane, these include Anita's twinship as belonging; twinship as silent communication; and twinship as a humanizing connection in the shadow of trauma (Togashi & Kottler, 2012).

Before we begin however, it might be useful to see the twinship selfobject function on two planes or axes of experience. First, twinship involves the horizontal function in that patients seek what Togashi (2009) calls the "like-to-feel-we-are-alike" (p. 22, italics original). This is the axis alluded to earlier wherein our patients want some degree of similarity with us as therapists. Often taking the form of similar race, religious beliefs, nationality, or life experiences, the patient hopes the therapist is enough alike me to get me, because I can see myself in my therapist. Perhaps not addressed enough in our literature is the notion that effective therapeutic relationships often hinge on this unconscious dimension in which patients hold to the notion that in important ways the therapist is similar to them. Not identical, as is desired in the more primitive merger experiences, (Kohut 1971) but enough like me, but not in the same boat as me. The desire is that the therapist would have essential parts of me but arranged in a way that is healthier or together. As Kohut stated, the therapist operates as "a separate carrier of his [the patient's] own (repressed) perfection" (1971, p. 123). Differentiating from the notion of idealization, the patient essentially does not expect a perfect human, but one in whom he or she can hope to find understanding and as one of my patients said, "has their shit together enough." The experience is one of sameness and difference and neither of these collapses into itself or its polar opposite. As Togashi (2012) says "we yearn to find ourselves in the person who is potentially like us, but basically different from us; we yearn to find not-ourselves in the person who is potentially different, but essentially alike" (p. 355).

Secondly, the vertical axis recognizes and affirms the asymmetry of the treatment relationship and speaks to the patient's question "Can-you-find-yourself-in-me" (Togashi, 2009, p. 22, italics original)? Here the experience is one of access to the therapist's mind in such a way that the patient can experience the therapist as seeing him or her self in the patient's experience. Different from the deep affirmation that comes with empathic attunement, this you-in-me is more than the experience of being understood, and closer to Geist's (2009) notion of connectedness with permeable boundaries.

In many ways Anita's experience with Jane does not just bend the rules of formality in the treatment relationship, it downright shatters them. Reading this case, I was struck by the many ways Anita invited herself, and was invited into, the life of Jane. However, watching my reaction I was also able to identify a strong part of me that said, "of course, how else would you care for Jane?" In Geist's (2009, 2013) understanding of connectedness, the patient and therapist enter the process of deep empathic connection in which the patient-therapist boundaries are permeable enough to allow each to include the other in their self-organization. Within the mutually regulating exchange, patient and therapist maintain a felt presence of the other in which there is a freedom to share internal worlds. Even though we recognize the asymmetry of a therapeutic relationship, each person's self experience is shared but not co-opted by the other. In Herzog's (1998, 2016) language, there is a shared affective experience, but not the imposition of a burden. This yoking of experience links therapist and patient in the mutual process wherein the individuality of each does not lose vitality but is allowed to exist within the overlapping self-organizations of each person. I want to stress here the degree to which both Geist (2009) and Togashi (2012) speak to the patient's need for access to the mind of the therapist --especially aspects that relate to how connected the therapist feels to the patient.

In her work with Jane, Anita opens her experience of grief for observation and mutual gaze, allowing grief to play an overlapping orienting role in their relationship as both Jane and Anita find a mutual internal process that simultaneously holds and validates the self within the catastrophic and unintelligible loss of spouse and sister. I suggest here is the exemplar of what Togashi (2012) call the essence of twinship: "mutual finding" (p. 252). Finding one another through the disorder of grief, when the anchors to self-experience have been cut and one is confronted with that most devastating of psychic dreads--singularity. The your-grief, my-grief, our-grief launching of this relationship shares the enormity of the loss; contains, clarifies, facilitates, and modulates overwhelming feeling states; and helps to symbolize the unformulated affect. All of this is the work of Jane and Anita's grief, which transforms the internal relationship with the lost beloved without the loss of differentiation.

I want to recognize Anita's willingness to loosen the ties of her personal grief, the essential my-ness of grief where one feels the sense of alienation and strange dislocation of self--the shattering of absolutisms in Stolorow's (2003) words. Anita allows for a bridge between herself and Jane, a linking where both are able to find a sense of belonging. It is here where I think our notion of twinship redefines our experience of countertransference. What seems clear in this exchange is that with Anita, Jane can experience a "markedness" to her overwhelming affect (Fonagy, Gergely, Jurist, & Target, 2002, p. 9). The sense that it is understood and communicated back to her by someone who knows what it is like to be shattered by grief, but communicated in a way that does not overwhelm Jane with an unbounded chaos. I think key here is the reactivation of Jane's longing to belong. A belonging that was not established in her adoptive family because of its contingent nature. The experience of conditional acceptance inhabited the very organizational patterns of her relational attachments. More than a narcissistic injury, which requires the mourning of a lost belonging, Jane faced the daunting task of creating her own home and a home for her more vulnerable and less resilient sister, whereby an intimate attachment bond formed around the experience of rejection and every impending threat of desire withdrawn.

We see this when Jane mentions that the relationship with Anita is "inviting me into relationship with myself in a new way ... this new way of being with myself that I have not done before ..." Here we see an essential statement of the overlapping interpenetrating subjectivities best captured by the connectedness of selfobject experience. In her statement, Jane is awakening or finding aspects of her herself through the living Eucharistic of Anita's subjective availability. I also want to point out that this is done not only through the empathic understanding, validation, and containment of intense affect, but also in the granular and grounding experiences of seemingly common conversations about the Red Sox, bakery goods, fine pens and the like. All of these dialogues and silent moments of meeting speak to an interpenetrating discovery as Anita and Jane find themselves within the other's experience.

Finally, within the twinship experience Jane finds what Kohut (1984) stated was the "confirmation of the feeling that one is a human being among other human beings" (p. 200). It is, perhaps, difficult for us non-adoptees to understand the enormity of the question mark that haunts some adoptees--specifically Jane and other's whose birth parents still live. What was wrong with me? Will you be my mommy? The incessant internalized little wanderer whose sense of being fully human remains unformulated. The trauma of not feeling human among humans is multiplied for Jane in her adult identity as a lesbian and the sociopolitical and religious controversies to which she would have undoubtedly been exposed.

What we find in Anita's response to Jane is the extraordinary whiff of Jesus, the olfactory excitation that draws her closer to a fuller experience of herself. In his book Incarnational Humanism Jens Zimmerman (2012) identified that the most powerful expression of Christ within a person's life "does not entail a mere 'aping' of Christ, asking naively, 'what would Jesus do' but a genuine interpretation--or even better, enactment--of the gospel ..." (p. 272). Asking ourselves how fully alive and human we become in light of a Christocentric anthropology moves us to points of deep emotional engagement. Connected within this relational sphere of love and affirmation, Jane is able to lean more fully into a comforting place that is not defined by sociopolitical and religious categories --but by the attuned and affirming love of shared intimacy.

References

Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness. Psychoanalytic Quarterly, 73, 5-46.

Bion, W.R. (1965). Transformations. London, UK: Tavistock.

Bion, W.R. (1970). Attention and interpretation: A scientific approach to insight in psycho-analysis and groups. London, United Kingdom: Tavistock.

Cusa, N. (1440). De Docta Ignorantia. Kues, Germany.

de Chardin, T. P. (1955). The phenomenon of man. Glasgow, Scotland: William Collins. (First published in English, 1959)

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York, NY: Other Press.

Freud, S. (1893). The psychotherapy of hysteria from studies on hysteria. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud, volume II (1893-1895): Studies on hysteria, (pp. 250-305). London, United Kingdom: Hogarth Press.

Freud, S. (1893). (see above)

Freud, S. (1927). The future of an illusion. In J. Strachey (Ed. & Trans.) The standard edition of the complete psychological works of Sigmund Freud, volume XXI (1927-1931): The future of an illusion, civilization and its discontents, and other works, (pp. 1-56). London, United Kingdom: Hogarth Press.

Garrigou-Lagrange, R. (2016). The three ways of the spiritual life. London, UK: Aeterna Press Gateley, E. (1998). A mystical heart: 52 weeks in the presence of God. New York, NY: Crossroad Publishing Company.

Geist, R. A. (2009). Empathic understanding: The foundation of self-psychological psychoanalysis. In N. Vanderheide & W. J. Colburn (Eds.), Self and systems: Explorations in contemporary self psychology (1st ed., pp. 63-74). New York, NY: Wiley-Black.

Geist, R. A. (2013). How the empathic process heals: A microprocess perspective. International Journal of Psychoanalytic Self Psychology, 8, 265-281.

Herzog, B. (1998). Optimal responsiveness and the experience of sharing. In H. Bacal (Ed.), Optimal responsiveness: How therapists heal their patients (pp. 175-190). Northvale, NJ: Aronson.

Herzog, B. (2016). Establishing the therapeutic impact of empathy through "affect sharing." International Journal of Psychoanalytic Self Psychology, 11, 152-168.

Jung, A., Michel, R., Gerber, I., Ganz, D. Ruegg, A. (2009). The house of C. G. Jung: The history and restoration of the residence of Emma and Carl Gustav Jung-Rauschenbach. Asheville, NC: Chiron Publications and in Zurich on behalf of C. G. Jung Institute.

Jung, C. G. (1933). Modern man in search of a soul. New York, NY: Houghton Mifflin Harcourt Publishing.

Keats, J. (1970). You might as well live: The life and times of Dorothy Parker. New York, NY: Simon Schuster.

Kohut, H. (1971). The analysis of the self. Madison, CT: International Universities Press.

Kohut, H. (1977). The restoration of the self. Madison, CT: International Universities Press.

Kohut, H. (1984). The self psychological approach to defense and resistance. In How does analysis cure (pp. 111-151). Chicago, IL: The University of Chicago Press.

Ogden, T. H. (1994). The analytic third: Working with intersubjective facts. The International Journal of Psychoanalysis, 73, 3-19.

St. John of the Cross. (2003). Dark night of the soul (Dover Thrift Edition). Mineola, NY: Dover Publications. (Original published between 1577-1579)

Steiner, R. (1988). Paths to Zanadu ... Some notes on the development of dream displacement and condensation in Sigmund Freud's 'Interpretation of Dreams. ' Interna tio na l Review of Psych o-Analysis, 15, 415-454.

Stolorow, R. D. (2007). Trauma and human existence: Autobiographical, psychoanalytic and philosophical reflections. New York, NY: The Analytic Press.

Stolorow, R. D. (2003). Trauma and temporality. Psych oa na lytic Psychology, 20, 158-161.

Thompson, C. P. (2002). St. John of the Cross: Songs in the night. Washington, DC: Catholic University of America Press.

Togashi, K. (2009). A new dimension of twinship selfobject experience and transference. International Journal of Psychoanalytic Self Psychology, 4, 21-39.

Togashi, K. (2012). Mutual finding of oneself and notoneself in the other as a twinship experience. International Journal of Psychoanalytic Self Psychology, 7, 352-368.

Togashi, K., & Kottler, A. (2012). The many faces of twinship: From the psychology of the self to the psychology of being human. International Journal of Psychoanalytic Self Psychology, 7, 331-351.

Tummala-Narra, P. (2009). The relevance of a psychoanalytic perspective in exploring religious and spiritual identity in psychotherapy. Psychoanalytic Psychology, 26, 83-95

Turner, V. W. (1967). The forest of symbols: Aspects of Ndembu ritual. Ithaca, NY: Cornell University Press. Willard, D. (2002). Renovation of the heart: Putting on the character of Christ. Colorado Springs, CO: Navpress.

Winnicott, D. W. (1968). Playing: Its theoretical status in the clinical situation. The International Journal of Psychoanalysis, 49, 591-599.

Winnicott, D. W. (1975). Through paediatrics to psychoanalysis. London, UK: The Hogarth Press.

Zimmerman, J. (2012). Incarnational humanism as cultural philosophy. In Incarnational humanism: A philosophy of culture for the church in the world (pp. 263-325). Downers Grove, IL: IVP Academic.

Authors

Anita Lehmann Sorenson, Ph.D., practices, teaches and writes at the intersection of theology, psychoanalysis and spiritual formation. In addition to her position as Pastor for Spiritual Formation at Pasadena Covenant Church, she has a private practice in psychoanalytic psychotherapy in Pasadena, California.

Theresa Clement Tisdale, Ph.D., Psy.D. is a clinical psychologist and psychoanalyst in private practice in Glendora, CA and a Professor of Clinical Psychology at Azusa Pacific University in Azusa, CA. Dr. Tisdale is an associate editor of Psychology of Religion and Spirituality and on the editorial board of five other academic journals. Her academic, research, and clinical interests are psychoanalysis, spiritual formation, and religion/spirituality and clinical practice; she presents and publishes regularly on these topics.

Earl D. Bland, Psy.D., is a Licensed Clinical Psychologist & Professor of Psychology at the Rosemead School of Psychology, Biola University (CA). He maintains a private practice and is a candidate in psychoanalysis at the Institute for Contemporary Psychoanalysis in Los Angeles. Dr. Bland's academic & clinical interests include psychoanalysis, theology and religion, training in psychoanalytic therapies, and virtue development.

Anita Lehmann Sorenson

Private Practice, Pasadena, CA

Theresa Clement Tisdale

Azusa Pacific University/Private Practice

Earl D. Bland

Rosemead School of Psychology/Private Practice

Portions of this article were presented at the 2014 International Conference of the Christian Association for Psychological Studies, Atlanta, GA. Correspondence concerning this article should be addressed to Dr. Anita Sorenson, 251 S. Euclid Avenue, Pasadena, CA 91101; anitasorenson1@gmail.com

Caption: "Absolution" by Roman Loranc