We’re all familiar with the warning not to open a Pandora’s box of troubles – crack the lid and who knows what disasters might ensue? And yet we shouldn’t forget that Pandora herself – having opened the lid and let loose a swarm of calamities – found a surprising gift at the bottom of the box: Hope. Hope at the bottom of Pandora’s box of dreads is a useful and beautiful metaphor for our patients’ deeply buried yearnings for growth that lie hidden under their more immediately exposed struggles and traps. Our job as self-psychological psychoanalysts is to welcome and nurture those hidden hopes in the service of both quieting the noisy symptoms and facilitating growth and transformation. And yet, it doesn’t always work so smoothly. Pandora’s story tells us that not only are hopes to be found among the dreads, but dreads are intricately connected to the hopes. What then does it mean to be a self-psychologist focusing on growth-promoting yearnings for new beginnings when patients’ much-needed defenses and resistances keep them mired in frustrating repetitions? What does it mean that hope and dread are ever interconnected?
These are some of the questions I’ll pose at the TRISP workshop on April 4th, 6pm, when I’ll also invite you to share your thoughts about working with hope and dread.
And for good measure, TRISP invites you to our annual Open House which will follow immediately after the talk. You’ll hear about our programs and training opportunities, you’ll meet colleagues and friends from the community, and you’re invited to share refreshments and conversation with us. I hope to see you there.
Please see the Events page for details.
Posted by Aviva Rohde
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When someone is entangled with both hopes & dreads, I can initially feel almost unable to do anything – as if both have equal power. However, once I/we can begin speaking about even a tiny bit of the hope or particularly the dread for myself or the patient, it begins unwind. Being with another person helps in the “mess” and finding words also helps.
Louisa – Your comment exactly illustrates the inevitable interconnectedness of hope and dread. And, as your words suggest, the self psychologist’s empathic attention to the patient’s subjective world moves the discussion toward an exploration of whatever’s most in the foreground, whether it’s hope or the dread that threatens to overwhelm.
Aviva, The concept of hope and dread is one of the most powerful tools in Self Psychology’s intellectual and clinical toolkit, I think. It’s a powerful way of understanding human woe and success, and yet there is no clear agreement within Self Psychology about how to use it.
Some within argue for following the hope as far as possible, paying scant attention to the dread; some for a greater emphasis on the dread. I believe that you are suggesting here the inevitability of hope wherever there is dread, and vice-versa, and advocating a utilization of both in the treatment. Is that right?
Yes, Gordon, that’s exactly right. While there are certainly treatments in which tending to hope – and only hope – moves things forward with grace, I believe we limit ourselves and our patients by assuming that such a stance is more uniformly applicable. In fact, I wrote this paper in part as a response to a trend in our field toward a more radical tending to only hope in treatment. To my mind, hope takes on meaning exactly when dread lurks in the background. There’s no dealing with hope without acknowledging the dread. And when the dread threatens to overwhelm, well attention needs to be paid. Thanks for your thoughts about this, Gordon. I’m looking forward to our discussion on the 4th!
I really like the discussion that’s unfolding here. I too belong to the camp that believes that the work with the dread is as important and necessary as the work with the hope. They are equally important. When dread is in the foreground, the repetitive transference is engaged and with it all the character defenses that have protected the self all along. These structures need to be transformed via interpretation or the person remains a captive of them. And when hope is in the foreground, then this theme has to be responded to and permitted to unfold. Aviva, you seem to raise the stake here by suggesting that hope and dread are interrelated, that deeply buried in our dreads we find hope and vice versa.
Is that so?
Yes, Peter, that is what I’m saying. Hope may be forward-looking, but we need hope when full success is not yet assured; there’s still reason to fear loss. Dread may prevent forward movement, but with dread, full defeat has not yet taken hold; there’s still reason to aspire. This is what I mean by the inevitable interconnection of hope and dread. Perhaps this sounds like nothing more than semantics, but there are clinical implications: We can’t tend to one without awareness of the other just around the corner. How close or how far away will vary widely. But our awareness of what might be just out of view gives us the opportunity to broaden the horizon. Looking forward to discussing these ideas together on the 4th!
Such an interesting discussion here. I do find it incredibly useful with patients to remember that, when one of the two, hope or dread, is so in the foreground that it blots out the other, it is my job to keep a placeholder for the other. When a patient is sunk deep in the dread, I hold onto the hope where I can, or at least the possibility. And when my patient is overjoyed, to remember that the dread is still there. Often it isn’t necessary to say anything. what I often wonder and would be interested in exploring, is how this fits in with the empathic stance, as this means that I am not fully behind my patient, or at least that is what it feels like. I look forward to the discussion next week!
Karen – your question gets right to the heart of it. I love your idea about your minding the hope or dread that lurks in the background as a “placeholder” that you keep for the patient. To my mind, noting that placeholder, even if you choose not to address it in the moment IS being empathic. You are being empathic to the whole of the patient’s experience, even as you may judge that responding to hope and not dread – or the reverse – addresses the selfobject need in the moment. I look forward to taking this up in our discussion next week.
That was a terrific open house! Thanks, Aviva, for a really interesting and intelligent paper. And thanks to everyone who attended and made for a stimulating and enjoyable evening.