Marcus M. Silverman, MA, LP, NCPsyA
The experiences and history of the newly licensed, post-training (quote-endquote) analyst are explored in relation to ontological notions of failure, particularly as this experience relates to psychoanalysis and the mental health field. The paper moves from an exploration of failure into the “failure” of a consultation and circles back to address the deeply-entwined relationship between loss and the psychoanalyst: the counterintuitive, “therapeutic” nature of the work, where patients fantasize about being protected, or inoculated, against loss, and the more nuanced understanding that analysis is used to process, and in a sense become quite intimate with, loss.
Thus it may lie hid until the time comes when it may safely venture into the light of day, or until someone else who reaches the same opinions and conclusions can be told: ‘In darker days there lived a man who thought as you did.’
Freud (1939/1955, p. 42)
Desire, a function central to all human experience, is the desire for nothing nameable. And at the same time this desire lies at the origin of every variety of animation. If being were only what it is, there wouldn’t even be room to talk about it. Being comes into existence as an exact function of this lack.
Lacan (1991, p. 224)
I have been thinking about failure a lot, pretty concretely since the day I heard word from the New York Office of Professions that I had received my license to practice psychoanalysis. Like the traversing of all empty spaces between being and becoming — the pupil and the teacher, the child and the adult, the student and the graduate, and, naturally, the candidate and the (licensed) psychoanalyst — getting a crinkled up form letter (there was a partial boot footprint on the envelope) was somehow the absurd, banal culmination of eight years of expensive, alienating, rewarding, heartbreaking institutional training, somewhat of a letdown.
I have been thinking about failure, and by extension, success, and what they signify within the profession of psychoanalysis, such as it is — and what those same diametric things mean to my patients, and the ways in which those things are the same and the ways in which they are different. For what seems like the entire expanse of my analytic training, these things felt deeply inverted. By that I mean, a patient, experiencing a fragment of themselves as a failure, and thus, seeking out psychoanalysis, and by extension, me, was often perceived by me as a success: “I got a new one,” or the myriad of other ways we put into language our enthusiasm at receiving a new patient. Conversely, the end of a treatment is by all accounts — I’ve become comfortable with this superficial generalization — experienced by the patient as a success at best or with ashamed relief at worst. That is, “I don’t need this anymore,” or “I got a new job so I can no longer attend our sessions,” or “I don’t think you and I are a good fit,” were experienced equally by me as failures. For the patient, not needing the analyst is a success, and for the desperate analyst, a failure, and vice versa.
A relative of mine is a psychiatrist at Bellevue. While visiting him several summers ago at his home in upstate New York — in the midst of concluding my training — a neighbor from down the street, a retired psychoanalyst, dropped in to visit. Sitting across from me in her finery, the way old, well-to-do, intellectual women dress, she said over and over again in so many words that she is not “envious of anyone starting a practice today,” and how “the field may be doomed.” She shook her head at me pityingly. I think now that I will always remember this woman. If I can make it to old age, and work in this field; if I can be confronted with a scenario in which I want to whine ruinously to a young colleague about how dreadful the field is (as if it never before was completely impossible to be a psychoanalyst, spiritually and financially); if I can feel that urge and resist it, and say something meaningful and true and enlivening — I may be able to die without regrets.
My professional life at that point was taken up with around 10 low-fee appointments per week, and a great deal of writing and reading to occupy myself, being a graduate fellow and teaching assistant at the institute where I trained, and otherwise filled with unanswered, or unanswerable phone calls or emails and stilted interactions in broken English with the Cigna credentialing representative assigned to my case. There was a lot of baleful staring at my bank balance as well. My wife had, in an effort to comfort me, developed the framework that I was single again, romantically, back on the dating scene. I was waiting for an object to reach out to me or be reached by me. Someone to desire to be in my presence. To say nothing of the fact that I was quite miserable when dating, too. It was really pathetic, actually, and not at all in keeping with what I spent 10 years learning and believing: the neutral, unconcerned concern of the psychoanalyst, the mantra -- why should I want them more than they want me? — ringing in my ears, amid the rushing of the white noise machine, as I sat in my office alone staring out the window on a rainy, winter morning.
And still, I am working hard at working hard these days. Somehow, still, perfectly so, in that nebulous way psychoanalysts “work.” Recently, I have discovered that no one who is a psychoanalyst “works” — psychoanalysts have the privilege of being psychoanalysts, in lieu of working. I am, right this moment, writing a paper on failure, and the absurdity of the whole thing makes me erupt in laughter. The killing joke: me, in my office alone with hours between appointments, writing a paper about failure. Everything to say and nothing to say and more so, the impossibility of wanting to say anything at all. The thing is, I am very much alive these days. I am meeting and listening to tens of people for the first time and yet, simultaneously, it is intuitively, mystically familiar; perhaps a kind of déjà vu or fantasy we might associate with dreamwork. That is, over time, I have somehow lived myself into my own life.
I worked for a time before I received my license at several low-fee sliding scale clinics around Manhattan, primarily at my institute’s clinic, The Consultation and Referral Service of the Center for Modern Psychoanalytic Studies (CMPS). I enjoyed the modesty of training work and more than not found it a relief to disregard the financial aspects of the patient’s treatment — I had a terrible day job doing editorial work to pay my rent. I now realize this simply complemented my own fervent idealizations of the field and the work. At CMPS, I would be doing, I thought, pure psychoanalysis. I made it clear to the graduate fellows assigning cases that I would take any patient, with any economic status. This is a kind of failure of analytic training — or, at least, my own. Charging analysands very low fees — a very real necessity for those patronizing the clinic — provides candidates with plenty of clinical experience but robs us of both self-valuation — that is, the belief that our work is deserving of a reasonable fee, something with which I ontologically continue to struggle — and the transferential resonance money brings to treatment. In some respects, it is a kind of Faustian bargain. I traded for knowledge something else of consequential value. When I would later begin private practice, I would remark upon the notion that with the wide array of low-cost therapy options, and the often very experienced and very supervised clinicians performing it, why would anyone pay a good fee for private psychotherapy in New York City? I do have a nicer, more expensive office now and a comfier couch.
Natalya (her name changed, of course) was the very first private patient who contacted me. The other psychoanalyst with whom I worked at a fee-for-service clinic on the Upper West Side was the husband of Natalya’s close friend. She had gotten my name from him. She was “always interested in trying psychoanalysis,” but never did, “for a multitude of reasons.” I was, memorably, in my undershirt sweeping the floor of my empty office at the time she wrote. I stood, broom in my hand, and read her email on my telephone, my forehead dotted with sweat. I resisted the urge to write her back immediately (see: dating) and waited until that evening. We wrote emails back and forth for several weeks. Natalya took four to five days to respond to each subsequent email. The emails were (I just this moment revisited them) extremely cautious, obtuse, and equivocal. She reminded me time and again that she was speaking to many other clinicians; an audition of sorts was taking place all over Manhattan for Natalya’s favor. Her notes were overwhelmingly and strangely formal — lots of “good evenings” and “sincerely yours” and “may I’s” and hopes that she was finding me “at my most well.” I was constantly being thanked “for my time,” despite, I suspected, our shared awareness that my time was being squandered. I became conscious of how reflexively I reached for the phone in my pocket whenever it buzzed. I resisted the urge to write her a reminder after one particular delayed reply; the phrase, “just checking in,” the blinking cursor, the nausea, the self-recriminations on my walk home from the subway.
I was then, for the first time, beginning to understand the guarded, withholding, disinterested tone one sometimes perceives from experienced clinicians. One must suffer through a great deal of aborted conversations to do this work, at every juncture. I found myself thinking about Natalya a bit, on days when we wouldn’t speak, despite having never met her — always focused on the profound gap in between emails. Perhaps she is truly that busy? Or ambivalent? Or perhaps she is quite torturing — this would prove significant. I began to have, in an absurdly comical fashion, intense, quick bursts of hatred toward my former co-worker: why would he send this withholding person to me? What is more, I began to have the idea that there was something both stalwart and pathetic about the analyst as a figure; having never received so much as a dime from Natalya, I was already hard at work imagining her resistances and secrets, as well as paying close attention to her language. Like an itinerant professional in a war-torn country, my services were no longer relevant but there I was, continuing to do my job for free, because it’s all I’ve ever known.
During these strange, early, waning days, I was constantly reminded of my own first analysis, in part because I viewed my first analyst as a profound archetype of psychoanalytic prosperity: spiritually — I adored my first analyst, although she was quite sullen, an elderly Teutonic woman — and also aesthetically. I can recall her office in my mind at will. Everything was clean, expensive, cold, and luxurious. And while I imagine some might find it lacking a kind of warmth (in the Freudian sense: there were no plush couches, rugs, dusty globes, etc.), I always left her office feeling wealthy. That is a word I choose carefully. Somehow, by becoming increasingly familiar with my own interior life, I quite literally felt “worth” — which is ironic given that I was paying her a third of my take-home pay at the time. But even that act, of paying what was for me an inordinate amount of money, at the time, left me feeling richer. I suspect this is the same material euphoria that a person spending their entire paycheck on a purse, or shoes, or a suit, feels as they leave the store. Rich and broke and elevated.
Through working with my first analyst, over the course of several years, Mondays, Wednesdays, and Fridays, I came to have hundreds of tiny, reconfiguring realizations, not the least of which was that when I allowed myself to have two particular feelings I did not want to have (rage and holy, miserable, beatific, crushing hopelessness), my panic attacks disappeared completely, never to return. This, on the surface, was the “goal,” to use a word I detest, of the treatment. And yet, when I roll these years over in my mind, the memory that contains the most affect is the profound, loving pleasure I would feel in getting my analyst — a staring, crimson-faced, silver-haired old German woman — to subtly, subtly, subtly curve her thin mouth into a marginal smile. And the playful, lilting sentences she would utter, the one line of dialogue in the dream that you remember when you awake, “Truly, there is no one else like you, Marcus.” I will hear her voice in my head for the rest of my life. And, now, much too late, of course, I realize that this was the real work of our analysis.
Several years into treatment, she remarked, apropos of nothing, that she was ill. While saying more words in one sitting than I had ever heard her utter before in totality, she insisted that I “shouldn’t worry” and that she came from “hearty stock.” About 10 weeks later, I arrived at my appointment to find a piece of paper taped to the door, written by the building’s management, notifying her patients that she had passed away. An address for a funeral home was listed, along with her request that donations be made to William Alanson White on her behalf. I will always recall the feeling of blankness I felt walking out into the blinding sun on Central Park West. She and I never discussed her illness again after that initial, unsubstantial conversation. I rode the train out to a completely ordinary place on Long Island for her wake, but I couldn’t bring myself to set foot inside the place. I sat on a park bench by the train station and wept. I would begin analytic training within the year.
This too, to my mind, is evocative of the false dichotomy between success and failure: a thing that still ties her and me together — that in her death, she didn’t die. This is hard to express coherently. She, my first psychoanalyst, is dead. And now, I, am a psychoanalyst. Somehow our failure to continue the analysis catalyzed me into becoming an analyst, a fragment of who I imagine she was. And in so doing, I succeeded in becoming a syntonic version of both myself and my fantasy of who she might have been. While writing this paper, I have had occasion to ask myself for the first time, “Would I have become a psychoanalyst if she were still alive?” Psychoanalysts might think of“success” as being able to integrate as many different experiences or selves as possible under the tent of the subject, or ego; and “failure” as a kind of retreat into the existing or the restricted self as a defense against unpleasure or intolerable experiences or stimuli. To experience a tragedy like loss in death, and transmute it into an upbuilding choice; to become the thing you have lost in an effort to mitigate that loss — this may be an outcome of a positive analysis. One might become so intimate with loss, with unpleasure, with discomfort, that one metabolizes a failure into a kind of success. Analysis itself mirrors this dynamic: by becoming safely and consistently ensconced in one’s interior life, one can temper one’s anxieties, fears, limitations, and losses.
Bona Fide Rejection Notes from Psychoanalytic Journals Delivered Without Context
Reader #1: The paper has much to offer, but the writing style is not nearly as engaging as the ideas and clinical material are. The overall concept is well developed, the clinical material shows depth of understanding, a strong theoretical foundation, and compassion, and the scholarship supports the underlying concept.
Reader #2: This paper is rudimentary in its understanding of psychoanalytic theory and clinical practice. Although I appreciate that a good amount of work went into this paper, and the fact that it is well written, there is no covering over the remarkable lack of any kind of psychoanalytic nuance.
The Beginning of Treatment
An appointment was finally set with Natalya, five weeks after receiving her first email. Natalya was tall, in her mid-30s, Russian, gorgeous, unblinkingly aloof, and statuesque. What I had originally mistaken for ambivalence now seemed to me to be a simpering, nervous disdain. She arrived at her appointment on time. She worked in interior design for a prestigious design house, wore expensive clothes, and lived on the Upper East Side. I asked her questions about what brought her to analysis, her family history, her social life, her job. She answered all of them economically, in a quiet, unfriendly staccato, foreclosing on any opportunity to associate to my questions, or share anything that wasn’t being explicitly asked of her.
About 20 excruciating minutes into the session, I changed tactics. I began to do something we were instructed to do in my fee-for-service work, something that the behaviorists call (unfortunately) psycho-education. I began, despite how perplexed I was at hearing my own voice begin to do this, to attempt to explain to her the purpose of psychotherapy — the implication being, of course, that she was “doing it wrong” already. She said little in response. Finally, exasperated, I met her gaze for a period of time. I asked, “Is this what we should be using this time for?” I felt a disintegration occurring. “I feel as though I’m interrogating you. Is this useful?” She stared back at me and said nothing for a while. “I don’t know,” she eventually volunteered. Somehow, this woman, my first private patient, had, in this moment, completely collapsed my understanding of the entire psychoanalytic endeavor. Is this coming across clearly? “How much does this cost?” she asked. I — this is not an exaggeration — chuckled ruefully aloud. “I have no idea how much this costs,” I said, having temporarily lost my mind. “How much should this cost?” “Eighty,” was the unsmiling reply. “Eighty sounds right,” I said. She stood up, walked straight over to me, and shot out her hand. I took it. “I liked this,” she said. “Psychoanalysis,” and left the room. I spent the next hour lying motionless on my couch, staring out the window, my mind forming not words, but a strange, dulled panic. This is really hard work, I finally thought to myself.
A Brief Tangent on Defecating in One’s Pants
Something a bit unfortunate began to happen to me — or rather, my bowels — in my first year of private practice. I started having a curious manifestation of anxiety with certain patients wherein I would have the fantasy that I would shit my pants during the session. This became a way to measure time in the sessions. I would become aware of and either troubled by, or gratified by, how much time was left in the sessions. This would happen solely with my morning patients, naturally, after a cup of coffee or two. I would always first have the thought: I have to go to the toilet. And then, reflexively, the awareness of time surfaced. I have 30 minutes left, or 20 minutes left, or 10 minutes left; I will, while not revealing any of this discomfort to the patient, have to physically retain my bowels predicated on this length of time.
I pondered the desire to hold in, or withhold, and more compellingly, the desire to lose control in the room with the patient. I would pass the time, while listening to the patient, and holding in my shit, playing around with the fantasy: what is to be gained and lost from “losing it” with a patient — perhaps a kind of failure? I considered: Was this a desire to be humiliated in front of the patient? Was this new feeling, after years of working in group clinics and treatment services, something to do with striking out on my own? You know, I would suggest to myself, if you want to show these patients that you are a failure, and a fraud, and a child, there are far tidier ways of doing that than shitting your pants. Perhaps if I shit my pants, these particular patients would take pity on me. At my wildest, most optimistic I considered: perhaps I am inventing, right now, an incredible new intervention. Conceivably, my shitting myself could allow these patients a new thought, a new experience, a new interpersonal configuration. Often it seems that a failure on the analyst’s part is experienced as a narcissistic injury by the patient — that the analyst is an extension of the patient, the idealized, platonically compassionate, knowing other. But I can imagine a scenario in which the catastrophic failure of the analyst, personified by the utter humiliation of going to the toilet in one’s pants, could humanize the analyst in a profoundly useful way, if the analyst and patient could survive the humiliation.
I have long sensed in myself, particularly in my work with patients, a subversive wish to lower myself, to strip bare whatever mythology or idealization or projection that the role of the analyst evokes. I have come to desire to reject the projection of knowing, or having “figured out,” as an affectation designed to protect the analyst from being human — something that seems preternatural and like an enormously useless quality for an analyst to have. This seems also to relate to success and failure. I can imagine wanting to be with an analyst who fails as much as anyone else. Or, again, the notion that what one does intrapsychically with failure is far more significant than success, which I’ve begun to understand as suspect, circumstantial, and chaotic. I am, these days, always reminded how secretly and counterintuitively undignified psychoanalysis is. After several months of this bowel discomfort, and having bashfully shared it with colleagues and friends, writing about it, thinking about it, and trying to have more toilet discipline than previously required in my toilet life, the sensation, like all anxiety formations or bowel movements, left me.
The End of Treatment
Somehow, Natalya remained a patient, albeit briefly. We would, to our credit, discuss what was gratifying and what was frustrating to her about the sessions, and what withholding in the sessions “gave” her. Very quickly, perhaps too quickly, we began to explore the notion that men in particular always wanted something from her. Certainly this was the case with her current partner, her father, et al. And I wanted something from her, too, we noted.
After about 10 or so sessions, I received another overly formal email from Natalya. “I’m no longer interested in treatment, and I’m uninterested in being convinced otherwise, which I know is a tenet of psychoanalysis. Please kindly submit an invoice to me so we may proceed with final payments. Wishing you all the best, Natalya.”
My memories of Natalya, and indeed of all patients who leave, are bittersweet. I am overwhelmingly left with a feeling of the futility of it all, as well as the suspicion that there was some fundamental thing, concept, idea, association, or formation that I didn’t have the time to understand that predicated the patient leaving. That perhaps if we could have spoken it together, Natalya might have stayed. That I didn’t make the space for her to say it. That I couldn’t communicate the importance of saying it to begin with. That this suggests some penetrating lack of my own. After each successive failure, one is left with the knowledge that one knows very, very, very little. And yet somehow, that by pretending otherwise, one is doing a far worse thing. “We can perhaps be sympathetic to those analysts who jump in and claim knowledge about what is ‘really going on’ in an hour,” Christopher Bollas (2008) writes. “After all, it is a hard place to be, the psychoanalytical position. You do not get to know much — and yet you are surrounded by the movement of meaning” (p. 31). I did something middling and feckless and inspired by failure: I responded respectfully and curtly to her email with an invoice, betraying little of my feelings.
It is the destiny of all psychoanalysts to be left. These mythological analyses I remember from training — people working together for 60 years, patients visiting analysts on their death beds, Freud having nightly dinners with his patients…No, I’m sorry, I protest these fables. We are primarily people who are left by other people. I believe I became a psychoanalyst because I have had a lifelong desire to be intimate with others. This evolved, interpersonally, into a desire to seek out withholding people, and to ensconce myself in them — to be the one who gets to know. When a person has nothing, when they turn and run from a party, a bad date, a failure, when they find themselves crying and alone on the subway, or a terrace at a bar (these were familiar feeling states to me) — who might this person turn to? I desired, perhaps more than my desire to know, to be this person. The person who gets to hear the truth, to ask a hard, substantive question when everyone else winces and looks away.
I find it really, sweetly amusing that patients, even those who seek me out because I am a psychoanalyst, never use the word analysis (and in the culture, as well). The real parlance is, and will always be, “therapy.” A truly deficient, strange word to define the exercise of talking about pain, loss, abandonment, or nothing at all, in between periods of talking about pain, loss and abandonment. I suspect that the fantasy that brings patients to analysis — or therapy, really — is that they have the idea that by entering the threshold of the treatment room, somehow, they will be inoculated against failure; against loss, pain, unpleasure, misunderstanding. I am beginning to have the idea that this particular fantasy is useful in getting a patient into treatment, but little else.
When I think of how I behave toward new patients, particularly those who seem very tender and raw, I am, in this way, succeeding via their expectations. I am giving them, without consciously trying to do this, a reparative experience. By listening to their complaints and not challenging them, I am rectifying a history of misunderstandings; by being kind and gentle, I am liberating them from the notion that objects are only capable of causing pain; and by being steadfast, consistent, available, and interested, I am salving the anxiety that all objects are lost, ambivalent, or capricious. I would hazard a guess that this is in fact a profoundly necessary beginning to treatment, and I find it difficult to imagine alternative modes of behaving with patients that feel as truthful and genuine to me. And in this way, the patient entering treatment experiences the decision to begin as a success. Inversely, this feeling that the patient is left with, this implicit promise, is what in effect I experience as a failure. Because I suspect on some level that I know the truth about psychoanalysis. That it is not a vaccine against unpleasure, or a solution to a problem, but an expression of a deep, strange, exotic intimacy with the things that cause us to suffer. A familiarization with our interior torments through which we liberate ourselves from the phantasm of thought into the reality, such as it is, of language. The old Freud yarn about transforming neurotic misery into ordinary unhappiness.
There is an epistemology called “causal determinism,” the notion that the present is formed irrevocably by decisions made in the past, that we essentially have a destiny, shaped by our intrapsychic selves. In other words, that every decision I have ever made, retroactively, could in fact be the only decision I ever could have made, by virtue of the reality that I did in fact make such a decision — as opposed to quantum mechanics wherein there could be multiple universes, selves, decisions. Thus, what makes us psychoanalysts only suits us to be psychoanalysts — or homicide detectives, or academics. We are canine, in this way — we dig up other people’s backyards, and other people (n.b., our “owners”) do not want us to dig up their backyards.
I had a realization recently that I often end emails to patients and prospective patients with, “Let me know your thoughts.”
Let me know your thoughts.
LET me know your thoughts.
LET. ME. KNOW. your thoughts.
Let me know YOUR thoughts.
Let me know your THOUGHTS.
There is something in all of this that I have spent the first several years of private practice trying to discern. Something having to do with being and becoming and its relationship to conventional notions of a fantasy regarding succeeding in one’s life and failing in one’s life, or profession, or interpersonal relationships. The dominant fantasy is that we can surround ourselves with success and reject failure — this is how we might understand the common refrain of needing to “get rid of negativity” or “align ourselves with only positive people.” This is a familiar abstraction in psychoanalytic thought: the desire to orient symbols in a polarizing fashion, as in Freud’s On Narcissism (1914/2014), where primary narcissism is understood as an unconscious mechanism in which negative identification is expelled into the exterior and positive identification is exclusively the domain of the subject.
Analysis and by extension analytic training and candidacy aspire to undo this refrain. To endeavor to be able to have and tolerate as many of your feelings, selves, ideas, and failures as possible, is an attempt to become a much larger, more plastic, more inclusive, less inhibited person. In analysis, we apply meaning to phenomena and to our interior lives; I worry that success carries with it an immutable fragment that leads to a foreclosure of this symbolization. I find that I am far less likely to have a new idea as a byproduct of a conventional sort of success. This is paradoxical: that we must fail, and be less defended against failing, in order to succeed in some deepening, meaningful way.
Bollas, C. (2008). The infinite question. New York, NY: Routledge.
Freud, S. (2014). On narcissism. Chicago, IL: IPG. (Original work published 1914).
Freud, S. (1955). Moses and monotheism. New York, NY: Vintage. (Original work published 1939).
Lacan, J. (1991). Seminar II. J.A. Miller, Trans. New York, NY: W.W. Norton.
Address correspondence to:
Marcus M. Silverman, MA, LP, NCPsyA
1115 Broadway, 10th Floor
New York, NY 10010
Marcus M. Silverman, MA, LP, NCPsyA, is a licensed psychoanalyst in private practice in Manhattan. He studied philosophy at Sarah Lawrence College and psychoanalysis at the New York Graduate School of Psychoanalysis and the Center for Modern Psychoanalytic Studies, where he is currently a graduate fellow, teaching assistant, and trustee-at-large. Mr. Silverman writes about surrealism (the art movement and the ontological experience), Freud, Lacan, and language; he is published on occasion.