One of the best features of the Behavior OnLine case conference is that we get a chance to "hear" an acknowledged expert talk about the process of psychotherapy. Jim Pretzer looks for the way thoughts are linked, offering his patients (among so many other things) a whole series of new ways to think about critical issues. Jessica Broitman thinks in terms of schemas, what I would call scripted ways of handling affect that are linked to events and relationships. Using the language of cognitive therapy, she states clearly that "patients come into treatment to get help to overcome the false and constrictive beliefs that they have developed in reaction to traumatic experiences." Observing (with Weiss) that people do not make great changes in their personality structure unless they trust the bringer of change, she reminds us often that patients test therapists to make sure they do or do not fit the schemata to which they have become accustomed. Ernest Wolf looks for the alterations in self-structure caused by deficits in the early relationship with those who were supposed to provide nurturance, whereas I focus on the hardware, firmware, and software of the affects that are expressed during a session. Good, successful, kind, and nurturant therapists, all of whom are justifiably proud of the work they bring to our attention.
Now comes Johanna Tabin, a psychoanalytic psychologist whose clinical experience with anorexic and bulimic patients led her to study the toddler era of development (see especially her marvelous 1985 book "On the Way to Self" for Columbia University Press) and to ferret out entirely new patterns of psychosexual development. Time and again I shake my head in wonder at the number and significance of the insights her work has made possible for me and my patients. Laura is introduced to us through the device of a clinical anecdote that alerts us to a number of elements of her case: 1) Laura sometimes uses emesis as a way of controlling intense emotion. 2) This device operates as far more than a method for the lysis of unpleasant and overwhelming affect. 3) Laura's sense of herself as a sexual person is somehow intertwined with food, with her mother, and what seem like awesomely powerful links to both father and mother. 4) Dr. Tabin's ability to muse calmly and out loud about issues that for Laura are explosive seems to be a powerful force in Laura's life. 5) Loyalty seems a far more powerful pull than whatever we adults call "mature love."
"Power" comes lightly to mind this evening---just a few hours ago my wife and I were on the "Maid of the Mist," cruising slowly immediately below Niagara Falls on the thunderously noisy teeming river it then becomes. I really did pull my wife aside, point at the foaming maelstrom, and say "This is how Johanna Tabin views the toddler era of development." I know a 45-year old woman who has with great success come through her own problems with a less-than-nurturant mother, an eating disorder, and a host of confused ideas about her own sexual power, who is hard at work writing the libretto for an opera about the scientists who first harnessed hydroelectric power.
Don't think for a moment that any one of us would have approached Laura exactly as has Dr. Tabin; all of us would have interfered differently and turned the case into something other than what we will learn here. Yet no matter what our orientation or our personal style, we have embarked on a rich voyage through the seas of psychosexual development known better by no pilot.