Dr. Stanley Goldstein - Author and Psychologist

An article in the December 30, 2022 issue of The Wall Street Journal describes the chance factors leading travelers to death or survival during the recent snowstorm enveloping Buffalo. One stranded driver, twenty-seven-year-old mechanic, Jay Withey, was rejected by ten homeowners when he knocked on their door, offering the five-hundred-dollars in his wallet to let him sleep on the floor of their home. After leaving he rescued others by breaking into a nearby school. I can't imagine why the sight of Mr. Withey so frightened the homeowners that he was sent out into what might have been his death. But I'm sure those he rescued are glad that the homeowners did.

The adolescent whose acting-out behavior requires treatment in a psychiatric hospital suffers from psychological damage that occurred during their second and third year of life, the normal infant-mother symbiosis and separation having failed to occur and they not developing a secure "sense of self," sense of who they are, and  "soothing introject," ability to self-sooth themselves.

Earlier life problems and symptoms now become exacerbated from distress at their inability to cope with basic adolescent goals: separation from parents; exploring intimacy through dating; and the creation of realistic educational and vocational goals.

Revolving-door/short-term treatment cannot aid such youth who require a secure therapeutic environment within which their defective ego capacities can redevelop sufficiently for them to function in the adult world they will soon enter. For the more disturbed youth, residential treatment is needed; others can accomplish the needed psychological changes through individual psychodynamic out-patient psychotherapy.

A recent study of suicide in the American military found: (1) The more concurrent risk factors that are present, the greater the risk of suicide; (2) The greatest risk factor for suicide is the loss of an intimate relationship; (3) Other risk factors are job, administrative, or legal problems; Post-traumatic Stress Disorder, and combat experience coupled with substance abuse. It was recommended that the Defense Department's emphasis on mental health education and suport should be expanded to include spouses and intimate partners. From "Risk Factors Explaining Military Deaths From Suicide, 2008-2017: A Latent Class Analysis" by Scott D. Landes, Janet M. Wilmoth, Andrew S. London, and Ann T. Landes in Armed Forces & Society, January 2023, Vol 49, Number 1, pp 115-137.

While the psychological world that the newborn confronts is complicated they possess a biological predisposition to create a sense of who they are or, as psychologists term it, a "sense of self" from the social experiences they encounter. Beginning in their second year a profound continuing struggle exists between infant and caretaker as the child battles to establish their autonomy apart from the people who controls their destiny. But because babies are not born with instructions and parents have their own childhood-based limitations, the "good-enough" parent-child interaction needed by a child is not always gained, to the long-term suffering of both. Which is where psychotherapy may enter their lives but that is another matter.

The four basic psychotherapeutic postures, ways in which the doctor relates to their patient, are: the analytic posture, during which the patient's life is explored and understood; the relationship posture, during which the patient's mistrust is diminished and their basic trust is strengthened; the supportive posture, during which the patient's existing healthy modes of relating are strengthened; and the replacement posture, during which the patient's inadequate ego capacities are re-developed to greater maturity. Of these the analytic posture, the interpretation of troubling thoughts and feelings, has the oldest historic roots, it being Freud's mode of treatment after abandoning hypnosis. The analytic posture comprises several beliefs: that there is an unconscious conflict between different parts of the patient's mind of which they are unaware, its history deriving from childhood; and that interpretation can eliminate their distress. A process that is complicated by the therapist's need to interpret in installments as therapy proceeds, modulated by the therapist's own conscious and unconscious goals for the patient's development. The work of psychotherapy is not simple since it involves creating a patient's new life narrative, and one for which objective factual data from the past is lacking..

The historic psychoanalytic model of silently listening to patients interrupting only with an occasional cogent interpretation is rarely useful, lacking as it does much of a living experience. Nor is offering gratuituous hoary wisdoms like "all people have problems" helpful. Instead, the clinician should, by providing psychological information and enlightening anecdotes, educate their patient on the complexity of life, and the need to experience a "good-enough" parenting during childhood to avoid adult emotional difficulties, and their tendency to persist,.

A crucial fact is the power of fantasy, enjoyable even if sometimes fearful and threatening, to disrupt life, and the limited power ot the ego's defenses against the unconscious.

While brief psychotherapy is possible for a recent and isolated life problem, the treatment of deeper discontents must be lengthy (though not interminable), sometimes persisting intermittently for decades, since psychological limitations are long in development and the mind resists change, being inherently conservative.

Many patients deny the harm caused them by their parent(s), being unable to conceive they were not loved as a child since this belief serves as the bedrock of the human personality and is essential to survival. Yet there is also the mind's thrust toward psychological health and life fulfillment, evidenced by nightmares which communicate unconscious awareness of the need for change and its fear.