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Some Clinical Illustrations: Inquiring Deeply and the Mind-Object

Inquiring deeply provides an opportunity to gain insight into mind-object functions. I have found this perspective to be very useful in my work, and it has come to be one of the cornerstones of my clinical thinking. The following case examples will, I hope, show how valuable the mind-object concept is within the paradigm of relational-psychoanalytic psychotherapy.

These vignettes are fairly representative of how mind-object issues “show up” in inquiring deeply. They are also intended to show how self-reflective practice can be used within this therapeutic framework. With patients, I sometimes frame this as inquiry into how mind is held in mind. An analytically oriented clinician might regard it as exploration of the mind as internal object.

In any event, the following clinical illustrations summarize selected aspects of my work with two long-term psychotherapy patients who happened also to be practitioners of mindfulness meditation. The patients were very dissimilar in terms of their presenting problems, but each struggled with mind-object issues. Some general characteristics can be gleaned from the descriptions given earlier in the series of patients reported by Corrigan and Gordon. The emphasis in the clinical summaries reported here is on patients’ self-reflective observations and insights.

Clinical Illustration 9.1: Daniel

Daniel was referred to me by a dharma colleague for help with “personality issues” that came up in his efforts to learn how to meditate. Despite a lot of reassurance and the fact that he “knew better, intellectually,” Daniel felt defeated by his difficulties with concentration and considered himself a bad meditator. Mindfulness meditation was the latest in a long series of situations in which Daniel fell short of his own standards of performance.

Daniel was a 50-year-old man, a successful technical writer. He described himself as a hard worker and a chronic worrier; he suffered—among other problems—with a painful degree of shyness, social awkwardness, and a sense of isolation from others. He tended to be very perfectionistic about everything he did in life. It seemed quite clear to me from his presenting problems and the psychological history associated with them that Daniel was chronically depressed. His negative self-assessments in regard to meditation seemed to reflect a deep vein of negativity toward himself. While we would need to explore the dynamic origins of this, my first intervention was to focus clinical attention on the harsh self-criticism.

At the time he first came to see me, Daniel viewed his self-assessments as “true” and completely justified. (The pattern was quite egosyntonic.) Since he was eager to apply his meditation practice, I suggested to him that mindful noticing and self-reflective awareness of his “report card mentality” would be a good place to start.

It was not difficult for us to discover that the bad marks that Daniel gave himself for “monkey mind” in meditation (and many other things) were associated with a deep-seated belief he had developed during his school years that he was stupid. This belief had roots, also, in comparisons frequently made to his older brother, who was (according to Daniel) smarter, a better student, a better athlete, and preferred by their father.

I made some suggestions in regard to Daniel’s mindfulness practice: When he found himself unable to concentrate, what actually was going on? In addition to the frustration, tension, and “squirmy antsy feeling” he reported, what else did he notice? What were the psychological themes that pre-occupied him?

(In place of working so hard at concentration, I suggested, perhaps he could try to simply observe “monkey mind is like this” (Sumedho, 2007).)

Daniel noticed that most often when he was highly distracted he found himself ruminating about things he had said/done or not said/done in his connections with others. He worried continually about what kind of an impression he had made, or what he might have done wrong. The obvious clinical question that emerged was whether he had those same concerns in his relationship with me. (He did.) This line of inquiry brought Daniel’s anxiety and insecurity alive in the here and now of our experience together. The work focused on the vicissitudes of the transference, as it would in any analytic treatment, but with the added element of meditative/experiential focus on the relational connection.

In working with Daniel’s felt sense of all of this, a couple of things struck me. First, in response to the probing questions I asked, he would most often first close his eyes and take a long pause. Only then would he share his thoughts, which he tended to speak slowly and meditatively. Second, I found in working with him that my own state of mind quickly settled into one of stillness and presence. Third, a ritual developed between us of sitting silently for the last three minutes or so of each session, and this shared meditative space felt very deep to me.

I shared these observations with Daniel and commented that I found all of this quite curious given what he had reported about his typical meditation experiences. He readily agreed that yes, the feel of this experience was different for him. There was a quality of spacious quiet he felt in our connection, which was exactly what he felt was missing when he meditated alone.

As we explored this further, Daniel shared something else he had noticed: his concentration always tended to be better when he was meditating with others.8

I wondered aloud about whether perhaps he felt alone or lonely when he was sitting by himself. He was intrigued by this idea and could hardly wait to “try it out ” the next time he was meditating at home. He quickly discovered that, yes, he did feel rather lonely. Soon after he had a powerful thought/ insight while doing his sitting practice: “I think maybe monkey mind is a way I keep myself company in my mind so I won’t notice the void at the core of my being.”

Relational themes were central in Daniel’s psychotherapy. As the work progressed, we looked together at the dimension of intimacy and connection in his life. Here, I am emphasizing only what he discovered in his inquiry regarding anxiety and “monkey mind.” In the context of our ongoing conversation about this, I made the comment to Daniel that I supposed it only made sense that we have monkey minds because, after all, we humans are primates at heart. The deep laughter which ensued felt like a deeply connected and mutual Now Moment, which I punctuated by saying, “Well you know, it takes one monkey mind to know another!”

Inquiring deeply in the therapeutic space brought into sharp focus Daniel’s pervasive sense of aloneness. We looked at this in terms of the environment of harsh judgment he grew up in and the way this had colored his relationship with himself and significant others. As we talked about the importance of connection, Daniel began to focus mindful awareness on the experience of connection (and/or the lack thereof), and in our work together he discovered the embodied feeling of having an open heart. This led him to an interest in and focus on the practice of mindful self-compassion.

Ironically—given his conviction that he is cognitively defective—Daniel’s mind is his strong suit. In place of feeling his way through his challenges, his approach to every situation has been to work harder to figure it out. Part of his attraction to meditation is a strong drive to find freedom from the prison of his own mind-object. The blend of psychotherapy and dharma practice in our work together, and our therapeutic connection in particular, has provided a structure which has allowed Daniel to develop a greater gentleness toward himself.

Clinical Illustration 9.2: Nancy

Nancy struggled with chronic anxiety. Aided and abetted by natural perceptiveness and keen intelligence, her defensive posture was one of hypervigilance. She was quick to notice any and every change in my office, my appearance, or my facial expression.

Exploring these patterns in psychotherapy, Nancy spoke of the pressure she had felt while growing up to try to know everything ahead of time. Her strategy to stay safe in life had been to collect information and suss out what was going on. This defense protected her from mental surprises: “When I don’t sense something in advance,” she reported, “I am apt to feel flooded by feelings which are too much to bear.”

As we explored the relational dynamics in her family of origin, the psychodynamic underpinnings of Nancy’s hypervigilance became very clear. I understood Nancy not only from her psychological narrative, but also by identification—from the inside out. Nancy’s experience resonated with my own personality. In the beginning of our work together, I would often find myself pressuring myself to know and understand things and had to remind myself to slow down and let things unfold. This countertransference reaction relates to an embedded aspect of my character which is seldom present in my recent clinical work.

Among the various integrative insights that crystallized, one which stood out for me was that hypervigilance forecloses the opportunity to discover that things can settle out organically and find their own way to clarity. In mindfulness practice, learning to relax into experience begins to reopen that possibility.

Since childhood, Nancy’s way of coping with overwhelm had been to retreat into a subjective fantasy space she called a “tunnel,” which came into focus in the clinical dialogue between us. In current day, she observed, she was apt to retreat there whenever something was particularly upsetting emotionally. As we explored Nancy’s reliance on this fantasy for self-soothing, she began to understand the functions of this space; in her words, “I go into the tunnel to protect myself to try to hold onto myself; or to hold onto you.” Gradually she internalized our connection in a way that began to supplant this experience of being alone and underground. As her psychotherapy progressed, she seldom went to the tunnel anymore.

Concomitantly, Nancy’s mindfulness practice deepened, and she saw that there were many layers to her familiar experiences of anxiety/agitation. She noticed an essential disquiet she experienced when she had free time at home by herself. “I don’t know how to get comfortable in my own skin.” In this self-state, it was hard for her to be with herself; instead, she typically chose to escape into being compulsively busy. I suggested that she make it a mindful practice to simply try to just be with—observe and allow—the felt sense of disquiet. Over time, it became clear to her that the disquiet had deep roots in her discomfort with being alone.

I learned a great deal about the function of mind-objects from the therapeutic inquiry we engaged in together and from Nancy’s penetrating insights into herself. For example, we were speaking one day about the false self she presented to the world, how put together she thought she probably seemed to others. This was at odds with the “anxious mess” she sometimes felt herself to be on the inside. She said:

“I used to have only two choices: either I would go into the tunnel and hibernate with fear and mind-entanglement ... or else I would push through whatever it was and look fine on the outside while, all the while, feeling crappy. Neither place allowed me to be freely me.”

The relationship to her mind-object, represented in her fantasy of the tunnel, stood in place of Nancy being able to tolerate the experience of overwhelming feelings. The tunnel was a way for her to batten down the emotional hatches, relating only to her own mind when being connected outside felt unbearably stormy or intense. The retreat into fantasy stood in place of experiencing what her feelings actually were (i.e. in place of being).

This shared understanding Nancy and I developed deepened my insight into the mind-object as a defense against intimacy: Nancy retreated exactly when—and to the degree that—there was a pull (and fear) of getting more involved. In her words, “These bombardments create a set of feelings/ stories/experiences in my systemit’s hard to disentangle and trust that it’s safe to be close.” In the typical irony of psychological symptoms, the mind- object defense precludes any possibility of getting the very nurturing one most needs.

Nancy gradually integrated these experiences into a new sense of self which was calmer and more confident. She learned to be more deeply present with her experience and experimented with trusting that if she articulated her needs she would be able to get them met in a good-enough way.

Exploring how mind is held in mind is one of my principal points of focus in psychotherapy—which it is, too, in dharma practice, albeit from a different point of view. I typically introduce the concept of exploring how mind is held in mind as an explicit premise of psychotherapy, explaining why it is important to pay attention to how we relate to experience. I also frame this inquiry by analogy with interpersonal relationships, which may sometimes be harmonious and at other times fraught: the idea is to observe in an ongoing way what kind of relationship one is having with oneself (or with one’s mind) at different moments. In those who are meditation practitioners, I may “prescribe” this as a self-reflective practice.

By exploring relational psychodynamics within the psyche, the patient develops a new understanding of their experience and a more compassionate self-awareness.

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