Many Little Deaths

This contribution to the current special issue addressing psychoanalytic perspectives on grief and mourning began with a call for papers from E. D. Bland, T. C. Tisdale, & A. L. Sorenson, (personal communication to the Society for the Exploration of Psychoanalytic Therapies and Theology, May 25, 2016) that included the following description:

   Despite its universal and unavoidable
   presence, grief and mourning
   are by no means uniform. Each person's
   grief bears the stamp of a particular
   loss as it is revealed in
   relational attachments, cultural affordances,
   faith tradition, and inner psychological
   dynamics. Further, the
   challenge that loss brings to our faith
   and our understanding of God's
   work in the world is deeply seen in
   the processes of grief and mourning.

This provocative call raised questions of enormous import. Do grief and mourning require "letting go?" If so, how might this process unfold? How does complicated grief impact our relational world? How do grief and mourning manifest in psychoanalytically oriented psychotherapy or psychoanalysis? What is the function or purpose of grief and mourning in treatment? What fruit might grief and mourning yield? What hinders the capacity to grieve and mourn? How might individual and cultural differences impact the intrapsychic and relational dynamics of grief and mourning?

With these thoughts and questions ringing in my ears, I (Shawn) found myself thinking of my patient Matthew. After some consideration, I presented Matthew with this call for papers and told him that when I read it he immediately came to my mind. I wondered aloud with him if he might be open to my sharing our work together in this way. He came back a week or so later and said that he would be good with my sharing, but with one condition--that I use his real name. "I have been afraid and in hiding for too long, it is time for my story to be told and for it to be mine."

As a result, this cooperative effort between Shawn, Earl, and Theresa considers the "many little deaths" that permeate the engagement of grief and mourning in a psychoanalytic treatment. After some brief theoretical scaffolding, Matthew's journey in treatment with Shawn is offered as an example of how engagement in the Christ-like relational love embodied in the sacred rhythm of incarnation, crucifixion and resurrection as described by Hoffman (2011) facilitates grief work.

Our use of case material echoes Geist's (2009) description of connectedness as "a deeply felt presence in one another's life" (p. 165), in which the safety of the therapeutic relationship opens space for spontaneity and improvisation (Ringstrom, 2001). The idea of "playing one's cards face up" (Renik, 1999, p. 521), was adapted by Barsness and Strawn (2014) to include promoting the use of theories and theologies as handmaids to our relationship with the patients.

In the case of Shawn's work with Matthew, theory and theology serve a holding function and provide explanatory notes for Shawn's work with Matthew as they enter painfully dark and terrifying terrain. In the murkiest of clinical moments, how we think about our work and our faith help us to stay grounded, thoughtful, and hopeful amidst the inevitable disorientation and disturbance, which Hoffman (2011) associates with crucifixion.

As a way of orienting the reader to engagement with Matthew's story, we selected three unique psychoanalytic contributions that dealt specifically with mourning and loss that we believe have particular relevance to Matthew and Shawn in their work together over the last 12 years and 1,108 sessions. First, we look at Freud's (1917) classic paper, "Mourning and Melancholia" as well as "Remembering, Repeating, and Working Through" (1914) to explore disturbances in self-regard and the compulsion to repeat actions or patterns. Next, we will present salient ideas from Winnicott (1965) and Bromberg's (2012) description of trauma articulated in his article, "Credo." Lastly, we will reference Hoffman's (2011) work as a primary source to discuss the role of love as foundational for healing when working with patients.

Theoretical and Theological Context

Disturbances in Self-Regard and Repeated Action

Freud's (1917) observation of self-hatred as the key distinction between mourning and melancholia (depression) became central to understanding complicated grief work and psychoanalytic treatment. He wrote,

   The distinguishing mental features of
   melancholia are a profoundly painful
   dejection, cessation of interest in the
   outside world, loss of the capacity to
   love, inhibition of all activity, and a
   lowering of the self-regarding feelings
   to a degree that finds utterance
   in self-reproaches and self-revilings,
   and culminates in a delusional
   expectation of punishment. This
   picture becomes a little more intelligible
   when we consider that, with
   one exception, the same traits are
   met with in mourning. The disturbance
   of self-regard is absent in
   mourning; but otherwise the features
   are the same. (p. 244)

Freud continued by observing that in melancholia the veracity of one's self-reproach is not really the important question, rather Freud believed the patient was giving a "... correct description of his psychological situation. He has lost his self-respect and he must have good reason for this" (p. 247). Although similar to mourning, what separates persons with melancholia is not a lost object, but "a loss in regard to his ego" (p. 247), meaning a loss in a person's capacity to effectively navigate through life. While much grief work is straightforward in its mournful progress, for patients like Matthew, grief work is often complicated and accentuated by torrents of self-criticism. Though not factually accurate, these thoughts and feelings are in fact a correct description of how our depressed patients may experience their situation, seeing their judgments as perfectly reasonable. Freud extended his thought by locating the origin of the melancholic's self-reproach,

   If one listens patiently to a melancholic's
   many and various self-accusations,
   one cannot in the end avoid
   the impression that often the most
   violent of them are hardly at all
   applicable to the patient himself, but
   that with insignificant modifications
   they do fit someone else, someone
   whom the patient loves or has loved
   or should love. (p. 248)

With this in mind, one way to describe working with depression is the identification and understanding of how self-hatred displaces unconscious anger and aggression meant for another. Yet even with this possibility, how do we account for self-loathing in its embodied, repetitive, almost compulsive form?

Another of Freud's contributions that may guide us here is his observation that patients will tell their stories first via action. From his paper "Remembering, Repeating, and Working-Through" Freud (1914) stated,

... we may say that the patient does not remember anything of what he has forgotten and repressed, but acts it out. He reproduces it not as a memory but as an action; he repeats it, without, of course, knowing the he is repeating it. Above all, the patient will begin his treatment with a repetition of this kind. (p. 150, italics original)

It is here where Freud's description of treatment reflects a perilous and somewhat paradoxical dimension. Although embodied, repetitive action in the form of illness or symptom is a combatant, an adversary that cloaks the very reason or pulsation behind its existence, it is not an enemy to be destroyed:

   He [the patient] must find the
   courage to direct his attention to the
   phenomena of his illness. His illness
   itself must no longer seem to
   him contemptible, but must become
   an enemy worthy of his mettle, a
   piece of his personality, which has
   solid ground for its existence and
   out of which things of value for his
   future life have to be derived. The
   way is thus paved from the beginning
   for a reconciliation with the
   repressed material which is coming
   to expression in his symptoms,
   while at the same time place is
   found for a certain tolerance for the
   state of being ill. (p. 152)

Freud's language here is striking. He creates an image of invitation not eradication, respect and curiosity rather than disdain and humiliation. Painful repetitions are experiences seeking a hearing, the success of which may be gauged by the nature and content of our relationship with the patient. For instance, we know treatment is going well when transference attachments become sufficient or "serviceable" (p. 153) enough "to prevent the patient from executing any of the more important repetitive actions" (p.153). When the transference is serviceable, the patient begins to talk about his intentions to repeat or act out "in statu nascendi" (p. 153, italics in original), in their nascent form, before repetitive action obscures the pain. Perhaps this is the basis for a not uncommon clinical observation: if treatment is going well, relational dynamics will become worse in the room and better everywhere else.

Trauma

From Winnicott (1965) we catch more nuanced glimpses of complicated loss and mourning as fallout from threats to embodied continuity. If our sense of existence, a "going-on-being" (p. 97) as it were, is held within responsive environs, our developed sense of reliability expresses an enduring suppleness that preserves being in the midst of loss and disruption. Absent these developmental conditions, when holding is inadequate, erratic, or peppered with horrifying intrusions, we become reactors. "The alternative to being is reacting, and reacting interrupts being and annihilates" (Winnicott, 1960, p. 591). Bromberg (2012) articulated the experience of annihilation as an overwhelming physiological event, "an autonomic hyperarousal of affect that cannot be cognitively schematized and managed by thought" (p. 274). When trauma, in any expression is severe enough, psychological survival is at stake as terrifying affect states put our very being in jeopardy. Bromberg goes on,

The mind's normal capacity for dissociation as a process is then enlisted as an overarching evolutionary defense, and to the degree it is successful, the process of dissociation itself will then, for some individuals more than others, be transformed into a central mental structure that renders it a fiercely protected constellation of relatively unbridgeable self-states, each rigidly holding its own truth and its own reality "on call" and ready to come "on stage" as needed. (p. 274-275 italics original)

Because these dissociated self-states engage automatically when internal or external threat looms, little reflection is possible as psychic operations mobilize for self-protection. Our interpretations often clang as hollow attempts to understand until the relational connectedness between analyst and patient can sufficiently hold and endure these increasingly painful emotion states.

A Cure Through Love

Finally, we understand that psychoanalysis is ultimately, as Freud wrote to Jung in 1906 (Jones, 1955, p. 485) "a cure through love," but whose love? A provocative question maybe, but as Barsness (2017) discovered during an in-depth qualitative study of relational psychoanalysis, much of what we actually embody with our patients can be effectively captured by the word love. Strawn (2015) in his summary of Hoffman's (2011) poignant work on the transforming power of God's love said:

She [Hoffman] finds parallels of the Christian narrative in her understanding of a psychoanalytic transformational model of identification, surrender and gratitude. For Hoffman, the relational therapist identifies with and embodies this Christian narrative (whether they know it or not). Just as God identifies with humanity through the incarnation, therapists identify with and are transformed into individuals from the patient's past. As Christ chooses to surrender to crucifixion even though he is without guilt, the therapist too surrenders to the process in which clients must engage in destructive acts toward them both as transference stand-ins and during the client's struggle toward mutual recognition in accepting the therapist's separate subjectivity. And finally, just as Christ's resurrection offers new life, the therapist and patient who survive the destructive acts of crucifixion and surrender too are resurrected into new experience and mutual gratitude. This process is undoubtedly an act of love, deeply bathed in love. (p. 18, italics in original)

The Dyad of Matthew and Shawn: Embodied Tradition and Context (2)

Matthew is a 6'4" Caucasian American straight man who began therapy with Shawn in his early 30's. He grew up in a small town in northeastern Minnesota near Lake Superior. He is the oldest and only child of his parents (who later divorced), and was mostly raised with his father, stepmother, and their three sons. His mother also re-married and had one son with her second husband. At an early age, Matthew was introduced to football, basketball, baseball, track, and hockey. He loved watching, playing, announcing, and coaching various sports. He is a Vikings, Twins, Wild, and high school hockey fan. He had a conversion experience in high school and began attending a Lutheran church. He developed a close relationship with the senior pastor whom Matthew came to love in large part because of his focus on the primacy of the Christ's death and resurrection in all of life and faith. During our treatment, he attended primarily relatively conservative evangelical churches, although at times he attended the Lutheran church of his childhood. He attended and graduated college at a small state university in rural South Dakota, and completed all of the course work for an MBA in Management. He sought treatment because he was struggling with severe anxiety and depression. He had been hospitalized twice in the previous three years for anxiety and depression that manifested in suicidal thoughts and plans. Matthew reported having a good though brief experience in outpatient therapy.

I (Shawn) am a 6'2" Caucasian American straight man who grew up in a small town in northeastern South Dakota. I was introduced to basketball, baseball, football, and track at a young age. I am a Vikings, Rockets/Timberwolves, and Twins fan. I am the second of three children raised by Mennonite German parents. While I was growing up, we attended Baptist and non-denominational evangelical churches. Currently Anglican/Episcopal faith and Ignatian spirituality are my faith traditions. I attended a small private Christian college in St. Paul MN, and graduate school at Rosemead School of Psychology at Biola University.

With respect to my psychoanalytic education, I was raised in the British Independent or Middle Group, of object relations (e.g. Winnicott, Fairbairn and Guntrip) along with foundational formation in contemporary relational psychoanalysis, which was informed and influenced by more East Coast (Mitchell, Aron, and Bromberg) than West Coast (Stolorow, Orange, and Atwood) relational analytic thought. Currently, I am an advanced candidate at the Minnesota Psychoanalytic Institute, an affiliate of the American Psychoanalytic Association. My institute is largely comprised of Ego and Self psychoanalysts, however there is also a mix of various folks from other traditions.

My first analyst was a Winnicottian relationalist, trained at the Institute for Contemporary Psychoanalysis in Los Angeles. My most recent training analyst was foundationally a contemporary Kleinian, but was influenced later in his career by a more hopeful relational analyst. My control case supervisors have primarily been from the traditions of American Ego and Self psychology.

The Treatment: Also Known As #twobigwhiteruralchristiansportsguysanalysis

Many Little Deaths: Phase I--On Being Killed and Becoming Good

The notion that treatment cannot begin until you become a good object is a well-established principle in psychoanalysis with some emendations along the way (Greenberg, 1986). In my work with Matthew, I refer to this initial need for establishing me as a good person in his life as the Tony Dungy phase. In the context of our mutual love for sports, Tony Dungy was his and our way of giving shape to his longing for and pursuit of a good object (not only good people, but good that is inside him and is him). Someone who, like Tony, was strong and accomplished, but also kind, articulate, reliable, and invested in helping him grow. Our most difficult work could not commence until I became his personal Tony Dungy.

In April 2005, a trusted colleague referred Matthew to me for treatment. Previously, Matthew had a couple of short stints of psychotherapy. In the first session, through tears and nearly unbearable agony, Matthew told me of sexual abuse by his grandmother. The intake ended with scheduling an appointment for the following week. He no-showed for the appointment and did not return my call. I mentioned this in consultation with his previous therapist and he reported that Matthew had always had difficulty staying in treatment for more than a few weeks at a time. For a number of reasons, I found it very painful to be left by Matthew in this way. Connecting with this colleague helped me hold my/our pain and begin to understand Matthew's behavior as a repetition and therefore communication that I would need to work with him to understand (Freud, 1914).

He eventually called back and came in for a second session, when he began to share more about his abuse. I interrupted him (unusual for me) and I framed his experience of sharing so much during the first session and then not being able to bear even calling to cancel as a reflection of conflicting desires. He had a desire to be close, so he shared everything right away, but he also had a desire to feel safe and have me earn his trust. The part of him that needed trust felt violated and needed to stay away. I offered an analogy to gambling; that he had in a way come in to the casino and bet his life savings on one hand of blackjack, which felt good to one part of himself, but violating to the other part. In order for him to be able get what he wanted out of treatment, we would have to find a way to accept and engage with both aspects of himself. I suggested that we might try making smaller gambles so that both his desire to be close and his desire to feel safe could have a voice. He seemed to find this helpful. He did not show up for the next session, but he called to cancel. I understood that as progress.

We then progressed slowly to a point where he would come for a couple of sessions in a row. I began to stop him, at times mid-sentence, and we would assess what sort of gamble he was about to make, which was at times relieving for him and at other times very painful and frustrating. Matthew slowly and bravely began to remember.

As the next few years of treatment unfolded, we painfully began to understand the many and varied repetitions that expressed themselves within our relationship (acting in) and in his life outside of treatment (acting out). Slowly, as he was able to tell to me all that he feared would happen if he expressed his feelings to me (especially the ones that were about me), his fears became less fearsome (Busch, 1993). We began to understand some of the relational configurations that we cycled through, sometimes very rapidly. During one session in year four, we could finally put all the pieces together ... we were able to count with a kind of dread that he had seven different caregiver situations before the age of five.

First, he lived with his mother and father, who were teenagers when he was conceived and married before he was born. After Matthew was born, they quickly divorced. He then lived with his mother and her twin brother. Matthew remembered this as a safe, peaceful time, but he was devastated when his uncle went away to graduate school.

Next, he lived with his mother and her mother. Matthew remembered this as a terrifying and violent time. His mother's boyfriend threatened to drive Matthew and his mother into the lake so they would drown. One day, in a desperate effort to protect them from violence, Matthew's mother shot her boyfriend and was sent to jail.

Matthew then went to live with his father and paternal grandparents. He remembered this as another safe and happy time. He recalled sitting on his grandfather's lap watching sports on television. He also remembered snuggling with his father, touching his beard, sleeping in the same bed with him, and feeling he was a special buddy who rode in the front seat of the car with his dad. At the same time he was living with his father and grandparents, Matthew was in daycare with his aunt, uncle, and cousins. He recalled this as a terrifying time. His cousins constantly bullied him, including waking him up out of a sound sleep to destroy his blanket, which was the only tangible connection Matthew had to his mother. When Matthew told his father and aunt what was happening with his cousins, his father told him to toughen up. In the future, one of his cousins shot and killed someone.

When his father re-married, Matthew went to live with him and his new wife. He recalled this time as less terrifying, but later described this as a time when he was living as a kidnapped child being raised in captivity. His stepmother was dutiful and provided for him; however, he felt both violated by her when she required that he call her mom, and rejected by her and his father when they put pictures of their children on the walls, but never any pictures of him.

We could now give names to the feelings he experienced with me. At times, he felt a fleeting sense of safety and peace, as I was experienced as his good uncle, but at the end of each session, I became the uncle who left him to the terrorizing, tormenting boyfriends and cousins that still haunted him (Bromberg, 2003).

At times, I was the dutiful stepmother who provided for him, but was cold and unaccepting. Often, I became the boyfriend who terrorized him at the exact moment when he was in touch with feeling small, vulnerable, and longing to be held.

Our shared language of sports was invaluable during this time. He could describe through analogy what was too difficult to say directly. One example of this was his use of a basketball analogy to explain how inevitable it felt to him that I would betray and humiliate him. He described the experience of being pressed and harassed by the other team and that he finds me willing to help and passes me the ball only to find that I had switched jerseys and immediately dunk on him to his shame and humiliation.

Matthew remembered being in a courtroom where he was asked if he wanted to be with mom. He said no, but really wanted to say yes. He was mad she had been absent from his life while in jail. Later, he believed it was his fault she was sent away.

At one point, Matthew quit treatment and abruptly moved back to the town where he grew up. A few weeks later, he called me and said that he wanted to work via phone. We eventually understood this as a complex acting out/in of his desire to get away from me in order to be close to me, as well as a need to be close to his childhood home and be near what was both comforting and overwhelmingly painful.

Matthew was hired to work at a group home, which we came to understand was both "safe, warm, and more home than he had ever experienced," but at the cost of the intrusive, painful, scary, and familiar aspect of, on occasion, being awakened in the middle of the night by a resident. While working at the group home, Matthew also felt sexually harassed by a large-breasted woman who would get too close to him while performing tasks in the kitchen.

Near Christmas, I forgot about a phone session we had scheduled. Matthew was very upset and could tell me so. However, soon after Christmas, he began to express a desire to end our work. He felt that he had accomplished what he could and was ready to try life without me. Because he had quit treatment abruptly so many times, he wanted this to be a planned ending so that he would not feel the humiliation of having run away, and so that we could have a chance to say a meaningful goodbye.

Initially, he/we understood his desire to terminate as an experience similar to going off to college. He wanted me to stay put if he needed me, but he wanted to leave and see what he could do on his own. As the date drew nearer, we also under st ood t hat th i s was in part a wa y f or Matthew to express how infuriated he still was that I had missed the session near Christmas. He wanted me to know what it felt like to be left or forgotten. We talked through much of what this ending meant to him, said a very meaningful goodbye, and ended our treatment relationship.

Many Little Deaths: Phase II--La Petite Mort (the Orgasm), the Body, and Being Alive

Treatment cannot end unless you become a bad object (Greenberg, 1986). Matthew, and our relationship, experienced so many excruciating and humiliating little deaths during this phase of treatment. His penis and orgasm became a central focus of our work together.

Following a six-month termination process, culminating in ending the treatment, Matthew called me a few weeks later asking to begin treatment again. After years of not having a single date, he had begun dating and wanted my help with the feelings that were stirring inside him. What unfolded during this phase was a season of difficult but steady progress as we were able to stay connected and worked through the dual terrors of intimacy for him: intrusive presence and desolate abandonment. What was different for Matthew this time was that he could maintain a consistent sense of my good enough-ness (Winnicott, 1965) so that we could face together these feelings without him breaking up with me or his girlfriend. As he was able to experience her as the good enough companion that she was, he was able to commit to her and they were married. At the same time, as his sense of mastery with these aspects of his life increased, he began to experience expansive, aggressive, productive, and reproductive urges. He was terrified of both success and failure. These phallic urges found expression in three primary areas of his life: work, sexuality, and treatment.

Early in this second phase of the treatment, Matthew had what I called the Bromberg (2003) dream. He described a house that was exactly like my actual home, though I was fairly certain he had never seen it; there was a scary clown guarding the back door. In the living room of this house were a number of alive but inanimate people sitting in chairs. He was in the driveway trying to figure out how to get past the scary clown to the people in the living room because they needed him. Via his associations, we came to understand these as parts of himself that were so painful they had to be put to sleep, though now he wanted to re-enliven them. We explored the ways in which I was the clown because it was scary to collaborate with me, and at the same time, he and I were in the driveway together trying to figure out how to understand the clown and why he was guarding access to these other selves.

In times of great distress, Matthew would go to a bar or occasionally visit a strip club something he disclosed to me with much grief and shame. While there, when the women smiled at him, he experienced spontaneous ejaculations. Over time, we understood his desire to be pursued by a woman he considered slutty and sexual primarily as a means to feel aroused and wanted without the possibility of being touched. Unlike his wife, these women would not pursue him past smiling and flirting. He was safe. We explored this experience to understand what was being repeated through acting out, rather than being remembered. Exploration yielded some chilling memories.

When Matthew was 12 years old, riding a bus home from a visit to see his mother in prison, which was a two-and-a-half-hour ride, a man sitting next to him reached over and grabbed his penis. When Matthew became upset, the man said that he had mistaken him for his wife. Matthew started to get up to go to the front of the bus to report the man to the bus driver and sit near him when the man pointed something in his jacket pocket at Matthew, telling him it was a gun and that he needed to stay where he was. Immediately after he got off the bus, Matthew told his father and stepmother who were waiting for him, and they said it must have been some kind of misunderstanding on Matthew's part.

Around this same time, Matthew spent large parts of the summer at his paternal grandparents' cabin. He began to describe how much he loved the cabin. Matthew recounted early and very positive memories of his grandfather allowing him to drive an all-terrain vehicle as fast has he wanted with only very reasonable restrictions: "don't go past the top of the hill and don't use fifth gear." His grandfather also introduced Matthew to his friends who were dog sled drivers.

Matthew remembered feeling very loved and special to his grandmother; she called him her "Prince Charming." We both came to consider her role as more of a mother to him than a grandmother. However, as he grew older, his grandfather spent the summers in Alaska and winters in Arizona, leaving him alone with his grandmother. His "Prince Charming" status began to feel very dark and confusing to him as her actions towards him became increasingly and overwhelmingly sexual. She introduced him to pornography at a young age and encouraged him to jump off the dock naked and skinny dip in the lake. Both of these were a confusing mix of arousal, excitement, and violation. He also had vague memories of her touching his buttocks as well as feeling vague but substantial dread about a night when he was eighteen and on his way to college when they shared a hotel room. She later admitted later that she drugged him without his knowing.

Soon after his marriage, Matthew began reporting that not always, but too often, he would have difficulty maintaining an erection during sex. His wife was understanding, but also frustrated with him. She felt ugly and rejected. Matthew reported that if he thought about other women who he described as slutty, he could usually maintain his erection. However, he felt terrible and guilty about this solution. Initially, he felt so much shame and fear while sharing this with me that he could not say much about either his physical or internal experiences during sex. During these times of struggling to express himself, Matthew often experienced me as his grandmother who was pushing him to be sexual in front of her. As we were able to make this connection and talk directly about his fears of my reaction, Matthew was more able to share what was happening and how he was feeling. What emerged during our exploration was that his fantasies about other women usually occurred during the transition between foreplay and intercourse as he was beginning to feel the sensation that he was going to have an orgasm and ejaculate. Matthew also reported that his wife could reach orgasm very easily; however, her orgasmic state terrified him. She felt to him to be dangerously out of control and overwhelming.

We had two important sessions that markedly increased Matthew's ability to remain present, erect, and enjoy sex. The first was a session during which he was able to lose his temper with me. He reported the next week that he had had the best sex of his life. He described it as "a triple-decker home run." During the other, a particularly difficult session, Matthew's associations led him to recall and then relate to me that during his suicidal depression he had paid a massage therapist for a "hand job." Through tears and nearly unbearable humiliation, he began to connect how this was a repetition of his experience with his grandmother when he briefly felt special, but was also dangerously naked and vulnerable. After these two sessions, Matthew reported that while he did not often have triple-decker home runs, he was consistently hitting doubles into the gap.

Overlapping with this time in treatment where we explored his sexual relationship with his wife, we also worked on Matthew's feelings about his work. He was working a job that did not pay well or utilize his skills, in an industry in which he found almost no satisfaction. At the beginning of this season, Matthew often had feelings of being attacked by co-workers and humiliated by bosses. As our work progressed, in a way similar to his experience of his sexuality, Matthew became more spontaneous and free to grow. His upward movement began when he did not receive the raise and promotion he was promised. Much to his own surprise, Matthew looked his boss in the eye and said, "I guess there are other jobs." He was so proud of himself and what he had said to her, and at the same time he was terrified that she would retaliate. She did not. In fact, she was noticeably more accommodating and pleasant with him. The best part of this story is that three weeks later Matthew was hired for a job with a more established and larger company and higher salary. He has continued to get better paying jobs and promotions to positions. However, any conversation about exploring a different career path led to a flood of terror about me attacking him.

Satisfaction and success in his love and work life led Matthew to a desire to have children. However, after trying for around a year, Matthew and his wife were unable to conceive. When they went for testing to uncover the reason, Matthew learned that he had a low sperm count, which was a source of humiliation for him. After much deliberation and consternation, the couple decided they would try artificial insemination, but not in vitro fertilization. However, artificial insemination was challenging and ultimately unsuccessful. Therefore, the couple decided to adopt. Through an agency recommended by a number of friends from church, Matthew and his wife adopted two African American brothers from Mississippi.

Adopting the boys was an occasion for Matthew to revisit the pain of his own orphan experience as well to celebrate the joy of my having "adopted" him. He was able to revisit our previous connection to the lineage of Jesus in the book of Matthew, adding his sons' names to his own lineage as he experienced me adding his name to mine. Initially, the adjustment was difficult for the new family, but at the time of this writing, they were all doing very well. A few months after adopting the boys, Matthew's wife became pregnant, which was a source of much joy. However, joy turned to heartache when she miscarried at eight weeks. Matthew called me crying so we could mourn the loss together.

In the spring of 2016, Matthew's wife became pregnant again, and nine months later their son Theodore was born the day before Christmas. The occasion of Theodore's birth led us to revisit Matthew's early life feelings and experience of an absent and traumatic family and his not feeling wanted. We were also able to celebrate his experience of having a family of his own.

At the time of this writing (Spring 2017), our mutually understood goals about what is left to do before Matthew is finished with treatment, are that he wants to be less scared and even more present during sex. He also wants to move from his job to a vocation. Both of these goals are fundamentally related to becoming comfortable with his more aggressive and expressive self as well as mastering his automatic emotional recoil that occurs in moments of surrender. In physical terms, becoming comfortable with his erect penis and with the surrender and intensity of orgasm.

One Particular Day: 23 November 2016

We have explored analytic contributions to grief work from a theoretical perspective and followed Matthew's journey through his analytic treatment. What follows is an invitation to the intimate and often murky embodied reality of a particular encounter between Matthew and Shawn that demonstrates how they struggle together to face and remember (Freud 1914) what was and is true. Included below are verbatim session notes as well as reflections. Matthew's words are italicized. Shawn's words are in regular font. Shawn's reverie during the session is enclosed in brackets.

Matthew begins:

I want to talk more about work and still feeling harassed by smiles, but not too much ... also I want to focus on sex ...

   [I feel some pleasure and a bit proud
   that he can put me in my place ... I
   also feel sad because he is still afraid
   to just launch into what he wants to
   say ... I am also kind of aroused or
   tense because he rarely talks this
   directly about sex, so I understand he
   is feeling some combination of
   desire/pain and/or guilt about sex,
   and also feels strong enough and
   safe enough with me to address it.

   I remember this is often how he
   begins session in the last year or
   so. He begins by setting the
   agenda. Not exactly a free association,
   but we have come to understand
   it is as a combination of his
   feeling afraid of how I will respond
   to what he wants to talk about, so he
   has to keep some of the power. At
   the same time, it does represent a
   new found/earned capacity and freedom
   to have a kind of ownership of
   the session where he is the head
   coach and I am the assistant coach
   rather than the other way around.]

I still feel harassed by my co-workers who smile at me.

What comes to mind?

Stupid grins ... like they are better than me ... like they want to humiliate me ... we've talked about this so many times I'm sick of talking about it ...

   [I feel frustrated because this is a core
   experience we have not as yet been
   able to modify.

   I think about his past associations to
   these sorts of grins; images of his
   scary uncle, cousins, and his father. I
   am wondering what he is feeling and
   whether he might be projecting these
   past relational experiences onto his
   colleagues, which often results in a
   kind of paranoid process that we
   have begun to understand is related
   to how upset he is with them (others
   both present and past), not the other
   way around. I also understand his
   persecutory musing as added weight
   to his feelings of fear about me.]

... I don't want to talk about them anymore ... I want to talk about sex. I'm not aroused by my wife ... have to go to someone more slutty more sensuous in my mind to stay erect ... she's the house wife warm version ... like 95% of me wants her but 5% wants someone else ...

[I am a little bit irritated ... feeling like he has gone back to an old framework after we have collaborated on a new one that is more helpful. I am also feeling scared ... tentative ... I know this is hallowed ground and very tender.

I am thinking we need to re-visit the new framework in order to make room for his more vulnerable and overwhelmed feelings ... but this usually leads him to a stalled-out sort of guilt. Also, I want to bathe him in my words (Rizzuto 2003).]

I disagree with your framework ... I don't believe that the problem is that you are not aroused by your wife and you have to find someone in your mind more slutty ... I'm thinking about it more in terms of near and distant ... alive, very present, and in the moment is scary while going to someone more slutty in your mind is more in your control and feels safer ... or maybe you feel a tension between spontaneous versus scripted ... being friends with your penis initially, and then scared of your penis.

Yes, middle innings are trouble and the first few and the last few innings are ok ...

   [I feel relieved ... we can use new
   Framework ... I am thinking he is
   scared so he is using his displacement
   language ... I am curious.]

Can you be more specific and non-baseball? Why!?! (His tone here is panicky and angry)

   [He scared and startled me, he is
   often very quiet and thoughtful with
   these sorts of questions ... I am thinking
   that I have pursued him too much
   so I have become like his wife or coworkers
   who he is frightened of.]

You are afraid in this moment of my getting too close ... you are bringing this to me to help you make friends with, and be comfortable with, your penis, but the very act of bringing this to me is scary because bringing your penis is the very thing that

(he begins before I finish my sentence) I don't want anyone touching my penis. Not my hand. Not hers.

   [I am feeling a bit relieved. We have
   a usable positive thread of connection.
   We can collaborate. I am thinking,
   keep going, but more gently ... I
   don't want too much silence here]

Exactly ... what do you feel? My hand is gay and her hand is grandma-ish!

   [I am feeling near to him ... painful ...
   still on the same team. I am remembering
   his previous association to
   "gay"--scary man on bus, comfort of
   father's beard when he was three
   years old, and me. Like the man on
   bus when I pursue him too much
   (like I just did) and when he feels
   attraction to me through longings to
   be emotionally and/or physically
   close. I am thinking ... seems like
   any sexual aspect of his longing for
   me are not present right now ... disavowed?
   Only safe if neither of us
   has a penis, just a beard. I want to
   see if I can get him more in touch
   with experience rather than words.

   I think now that I seem a bit perpish ...
   I have more of an agenda
   that is usual for me/us ... typically
   would just keep trying to help him
   free associate]

Really big words and concepts for something that I believe is more lived

What do you mean "lived"?

Lived in your body ... like some kind of automatic reaction some ... clenching of your face or a feeling in your gut, or like a pulling away to avoid being touched.

I don't know

   [Thinking now, yeah, I'm working too
   hard here ... ok with the initial lived
   comment, usually would leave more
   open ended and in the moment.]

End of session

Though not a particularly exemplary session in many regards, my hope is that this narrative accurately represents our struggle to bear the pain of remembering and mourning. Of note are both Matthew's courage and willingness to engage with the disturbing feelings related to being smiled at, of wanting and not wanting to be touched (sexually and otherwise), as well as the terror he faces as he moves toward these aspects of himself and toward me. Thankfully, our journey together continues so this terror is not the end of the story.

Closing Thought

In Shawn's work with Matthew, the phrase "many little deaths" uniquely captures the experience of a sacred rhythm of mourning that is foundational to both psychoanalysis and Christianity. To move from melancholia (depression) to mourning and from self-hatred to the capacity to love, Shawn and Matthew painfully walk the path of remembering the "many deaths" of his childhood, live together the "many deaths" in their relationship, and now together live the "many little deaths" of surrender required to be loved and to love.

Note

The title of this article is an adaptation of the French la petite mort (translation "the little death"). The Oxford English Dictionary 3rd Edition (2005) defined the phrase as, "The brief loss or weakening of consciousness. The sensation of orgasm as likened to death." Retrieved September 1, 2017, www.oed.com.patris.apu.edu. This phrase and the accompanying ideas express the essence of Matthew's unconscious conflicts and needs related to bodily aspects of his sexuality, longings for intimacy, expansive urges, and relational connection.

Conceptualization of the dyad was informed by Bland & Strawn (2014).

References

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Authors

Shawn L. Hofer (Ph.D. in Clinical Psychology, Rosemead School of Psychology, Biola University, CA) is a licensed Clinical Psychologist in private practice St. Paul, MN. He is an Advanced Candidate at the Minnesota Psychoanalytic Institute (MPI) where he teaches in the Psychoanalytic Psychotherapy Program. He is also on faculty of the Brookhaven Institute for Psychoanalysis and Christian Theology (BIPACT). His academic and clinical interests include psychoanalysis and Christian Spirituality, training and development of psychoanalytic therapists, and non clinical applications of psychoanalytic theory and practice.

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.

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.

Shawn Hofer

Private Practice, New Brighton, MN

Earl D. Bland

Rosemead School of Psychology, Biola University/Private Practice

Theresa Clement Tisdale

Azusa Pacific University/Private Practice

Portions of this article were first presented at the 2014 International Conference of the Christian Association for Psychological Studies, Atlanta, GA. Correspondence concerning this article should be sent to Dr. Shawn L. Hofer, 900 Long Lake Rd., New Brighton, MN 55112; hoferphd@gmail.com