Idealization is the normal experience of a young child who puts his parents and himself on a pedestal, but in an adult it usually indicates a problem integrating good and bad aspects of self and others. My analyst had an ashtray in her office that said: "Things come in mixed packages." I haven't seen that ashtray in many years, but the message is still with me.

To read the complete article below, CLICK HERE.

Narcissistic Injury

Does your entire sense of self collapse when someone hurts you? Narcissistic injuries do not feel like your feelings are hurt, they feel like your self is being attacked.  To read the complete article below, CLICK HERE.

Was Frida Kahlo a narcissist?

Everyone craves approval and attention—that’s healthy narcissism and an important ingredient in self-esteem. Unhealthy narcissism is when other people are only used to perform a function—to mirror the specialness of the narcissist. If the other people do not perform this function, they are discarded (usually with contempt). He is incapable of reciprocity in a relationship because of his lack of concern for the other as a separate person.

To read the complete article CLICK HERE.

Apology and Forgiveness: Essentials of Intimacy

Last week I said the session was over 15 minutes before it was actually over! The patient said: "You want to get rid of me, don't you?" The truth was I did! She had been complaining about how victimized she was for the first 30 minutes of the session and I DID want to get rid of her--for the moment. I could have tried to wiggle out of it--"I got confused about when we started" or "I didn't sleep last night so..." But I knew I needed to be honest. "You're right, I think I did want to get rid of you for now because it's tiresome listening to you blame everyone else for not treating you as if you are the most important person in the world." I was holding my breath after that--not knowing what she would say or do. Would she walk out? Would she quit? No, she didn't do either of those things. To my astonishment and delight she was able to take responsibility for expecting people to treat her as special and feeling victimized by them if they didn't. I think she was able to take responsibility for her behavior because I had been able to take responsibility for mine.

For more detailed discussions of apologizing CLICK HERE and HERE.

Schizoid phenomena

Harry Guntrip in his groundbreaking book Schizoid Phenomena, Object-Relations and the Self (International Universities Press, May 2001) discussed the schizoid personality who presents in psychotherapy as withdrawn and detached. But he also discussed schizoid phenomena which can be present in a much wider range of people. The central dynamic is the oscillation between desperate hunger for a love object and the fear of being devoured, smothered or trapped. For more discussion on this topic CLICK HERE.

Healthy Ambivalence

 Llywelyn Nys/

Llywelyn Nys/

In common parlance “ambivalence” tends to have a pejorative connotation—as if it is a problem if you feel ambivalent. President Bush told the world: “You're either with us or against us in the fight against terror." President Bush’s stance allows no room for ambiguity or ambivalence. Similarly, Tom Ridge, the former homeland security secretary told Americans: “We can be afraid, or we can be ready.” Can’t we be both afraid and ready? President Reagan also had a penchant for reducing complexities to simple images of good and bad. Ambivalence isn’t American; America is the land of moral polarization. Cowboys wear white hats and black hats so that we know the good guys from the bad. And Americans love professional wrestling in which the good guy waves at the crowd and the bad guy usually has a grotesque appearance and makes threatening gestures to the crowd to elicit their booing. Yet, from a psychological point of view ambivalence is a healthy state and not being able to tolerate it is a problem. 

Setting Limits is Not Easy

If you don't want to feel angry about people taking advantage of you, you need to protect yourself by setting limits. That involves being able to say "no." 

To read the complete article CLICK HERE.

Beginning the session

 Photo by Anna Vander Stel/

Photo by Anna Vander Stel/

Patients sometimes get annoyed at me because I wait for them to start the session. "Why don't you ask me how I'm feeling?" one patient asks. "Why don't you ask me questions?" another complains. I try to explain the importance of letting the patient start the session. The patient's first words of the session, the selection of topics and the order of topics is of major significance. And what they leave out is equally important! Some patients complain because they don't want to free associate; they are uncomfortable letting their minds wander. They don't want to see what might emerge. But sometimes a patient CANNOT start the session because they have so much anxiety or feel so empty that they cannot speak. That is important to find out, but it will not become known unless, at least for a while, I let the patient begin the session.

Unconscious Conflict

Unconscious Conflict

Unconscious conflict can be like an undertow--pulling you under and preventing you from accepting responsibility, producing creative work, taking in information, or completing tasks. For example, not being able to finish things can be an unconscious way of holding on to a depressed mother while finishing represents losing her. Conflicts get displaced onto situations or people that seem to have no relationship to the original source of the conflict and that makes it difficult to connect problems at work or school with the underlying issue.

Narcissism and disappointment

People with Narcissistic Personality Disorders attempt to fight off their fear of failure with grandiosity and contempt. They are usually oblivious to the impact they are having to people around them, but when negative reactions pierce their grandiose defense, their reaction can be intense shame. 

For more discussions of narcissism CLICK HERE and HERE.

Narcissistic Personality Disorder

Psychoanalysts do not make diagnoses based on symptoms, but rather psycho- dynamics which can only unfold in the office. In the most general terms, narcissism is a continuum that we all have to more or less degrees. But a narcissistic personality disorder is diagnosed when narcissism is a defense against loss of self-esteem. Patients alternate between grandiose conceptions of self and self-contempt OR grandiosity and raging at others for failure. 

To read the complete article CLICK HERE.

Caregiving and Guilt

Caregivers often feel guilty for not rescuing their elderly parents. But rescue is not possible; we can only offerlove and support and hope they accept it. Many caregivers do offer that to their elderly parents and still feel guilty.  To hear my interview with Diane Rehm CLICK HERE.

The Empty Self


Sheldon Bach, et. al. in their article " The Empty Self and the Perils of Attachment," (Psychoanalytic Review, Volume 101, No. 3, June 2014) write about working with patients who feel empty, depleted and alone. They feel that "something is wrong with them," but they don't know what. For these patients, their early scaffolding (basic developmental functions) have never been provided or are distorted. They have difficulty feeling comfortable; they can be destabilized by noise, temperature, light or tone of voice. They have trouble sleeping and waking, eating regularly, drinking moderately. They often suffer from psychosomatic complaints such as gastrointestinal problems. These patients also have a difficult time deciding what to talk about in a session. Traditional psychoanalysts may fail with these patients because they hold to the view that the patient starts the session. But helping the patient discover what he or she wants to talk about and facilitating the patient's ability to use the interaction is actually a major part of helping the patient build a sense of self.

Adult Sibling Rivalry

A patient, Emily, is enraged at her brother for being the favorite of their parents. She has internalized a mental representation of her brother and it is unconsciously displaced onto friends, classmates, colleagues at work, etc. It is difficult for her to accept that her parents singled out her brother and treated him with obvious favoritism. He did not cause the rivalry; it was foisted upon both of them by their parents. Thus working out relationships between siblings involves working out feelings about parents as well. Sibling relationships take place in the context of a “family script” which involves a complex set of relationships between each child and each parent as well as between the children. The parents can be long gone, but the internalized relationship with siblings and parents is carried around with us--often unconsciously.

For more discussion of adult sibling rivalry CLICK HERE and HERE.

Love is not a zero-sum game

Love is not a zero-sum situation--loving your mother-in-law, for example, does not detract from loving your mother. But when we are jealous, we feel that love is a scarce commodity and there's not enough to go around. I've thought a lot about how this plays out when our children grow up and develop other relationships. One of these situations that I've written about elsewhere is competition for love with adult children's in-laws.

For more of my thoughts about competing for love, you can check out my article on Psychology Today by CLICKING HERE.

Is Your "Inner Parent" Voice Calm or Sadistic?

                I'm such an idiot!

              I'm such an idiot!

Did you ever notice how people talk to themselves when they’ve made a mistake? I am always amazed when I play tennis to hear people’s outbursts when they hit the ball into the net or over the fence. Some people throw their rackets and shout, “You stupid idiot!” Their inner parent is speaking. Psychoanalysts call it an “introject.” It’s the voice of someone, usually a parent, who was vital in our development. It’s Mom’s voice, or Dad’s voice, or maybe Grandma’s voice. It’s the voice of someone who responded to our mistakes when we were young. Sometimes it’s a sadistic voice, “Stupid!” 

If a parent was good-enough and able to love and support (most of the time) when her child made a mess (literally or figuratively) then he/she is able to internalize a calm voice, a reassuring voice. Those people can console themselves, “Okay, calm down, I’ll get the next one.”


Tolerating Ambivalence

Not being able to tolerate ambivalence is a major problem for the majority of my patients. But tolerating ambivalence is crucial for being able to maintain intimate relationships as well as for making decisions. In close relationships we always have a mix of feelings--loving feelings and angry feelings, satisfied feelings and disappointed ones.  

Similarly, when we make a decision, there are pros and cons. It's rare for a decision to be all one way--if it were, we would not have to make a decision! Many people think that they can’t make a decision if they feel ambivalent. But it is normal and healthy to make decisions while feeling ambivalent. The crucial issue is the valence of the positive and negative feelings.

For more of my thinking about living with ambivalence, CLICK HERE or on the image above to read my article on thirdAge.

Old Grievances

A friend just told me a story that made me realize, once again, how an emotional hurt can become central to your identity and paralyze you. John was in elementary school, they separated the boys into two groups—those who would be in the choir and those that were “squawkers.” John thought he had a good voice and was angry that he was labelled a “squawker,” but he never sang again.

He played guitar as a hobby, but never sang. He insisted he was just a “squawker,” until he was retired and started playing guitar with a friend who sang. His friend encouraged him to sing along—and John discovered he was not a “squawker.” Indeed, John and his friend played and sang together and started playing gigs in bars and clubs. 

John’s story made me think more about holding on to old grievances. CLICK HERE or the image above to read more about it on thirdAge.