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The Consulting Room and Beyond: Psychoanalytic Work and Its Reverberations in the Analyst's Life (Psychoanalysis in a New Key Book Series)

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One of the transformative moments in my analytic education happened in a class on analytic writing when I was exposed to the advice of Stephen Bernstein (1995). Describe what happens, Bernstein (p.7) advised, show how you the analyst helped it happen and how you understood what occurred by selecting and integrating "verbal activities, affects, experiences, and responses by both the patient and the analyst over time." Bernstein provided a light-bulb experience for a not-so-young new candidate: something happens in analysis for both patient and analyst; I as analyst have something to do with what happens; I as analyst can feel it and learn to see it and possibly write about it.
Therese Ragen does all this in The consulting room and beyond, but she also breaks the rules. Ragen begins her book by describing a patient who wonders if he could possibly have killed his twin brother when he climbed into his crib during their naptime. Something clearly happened to Ragen as she listened to this patient and yet we do not hear about this patient again and we do not hear what happened between Ragen and the patient. Instead Ragen takes us into her psychoanalytic process and tells us the story of her soul.
Ragen titles this opening chapter "Legacy" and it is statement of her writing's impact on me that I found myself wondering about the meaning of legacy - for Ragen, for our patients, for ourselves. The chapter is in many ways a meditation on and association to the meaning of legacy. Ragen describes how her musing on whether her patient could have murdered his brother sent her into a fragmenting, dissociative state that she could only make sense of months later when she found herself crying over pictures of a murdered man when she is called for jury duty. Ragen uses her affects, experiences, and responses in communication with her consult group and family and the psychoanalytic literature on transgenerational trauma to make sense of her reaction.
Legacy, according to my dictionary, means either property or money left by will or bequest or anything handed down from ancestor to descendent. Ragen's patient has a legacy of trauma, not yet resolved, and Ragen describes how she discovered her own legacy of trauma.
When there is little communication about the parent's trauma, children split off what they do not know along with the fantasies they have generated to fill the gaps into a dissociated part of themselves. Later events in their own life can break open what's split off and throw them into bewildering and upsetting feelings and images that flood their bodies and minds.
For psychoanalysts, these later events importantly include the events that transpire in psychoanalysis with patients. What is unnamed or unresolved in patients `goes in search of an echo, in this improbable other [the analyst], of what official history has marginalized or trivialized, evoking in the analyst details and anecdotes that have been unclaimed, even in his or her own analysis' (Davoine & Gaudilliere, 2004, p.11). A remnant of something that I hadn't fully claimed was stirred in the consultation group. It took full form in and after my day in the courtroom. (Ragen, pp.13-14).

If trauma echoes on in our lives, as Ragen has demonstrated, what then is our responsibility for ourselves, our children, and our patients after the trauma of September 11? Having been traumatized ourselves, how do we work and do no harm? This is a question that runs through the remaining chapters of Ragen's book. As she listens to her patients and herself, she is willing to ask how psychoanalysis works with this sort of trauma.
Indeed, her second chapter is titled September 11, 2001 and in it Ragen describes listening to office workers close to the World Trade Center and her patients in the days following the attack. Trauma echoes in these passages and Ragen works to help her patients connect what they are feeling with what is happening in the world. She listens to herself as well, noting when her back and legs ache at the end of a long day of listening. In her entry for September 27 at 4 am, she writes of her longing to speak from a raw core into a quiet space where it is simply received and absorbed by someone who sits with her. And it struck me that Ragen was both describing what she was doing - providing a quiet space where patients' primitive feelings were simply received and absorbed - and identifying a need in herself that she has not yet figured out how to meet. By the end of the chapter, she has found that quiet space.
In her third chapter, "Longing," Ragen (p.36) makes clear that she longs for more than quiet space:
Love...souls...these are not words in my psychoanalytic vocabulary. These are not realities through which we work and speak and have our psychoanalytic being - not often, anyhow. I miss these words, these realities. I miss them in and with my patients, in my colleagues and myself. Rank talked about love. Freud talked about the soul. How and when did we lose these parts of ourselves?

Ragen tells us of the younger self, named after Therese of Lisieux, playing being a priest performing the Eucharist with her brothers and sister. It is not only trauma that has been split off but access to spiritual and religious experience. And once again Ragen breaks the rules. Love and souls are not in the psychoanalytic vocabulary, she writes, but then she extends the psychoanalytic vocabulary by finding analysts who will talk about them. And even in stating that love and souls are not in the psychoanalytic vocabulary she uses words that echo from the Book of Common Prayer's collect for guidance: "O heavenly Father, in whom we live and move and have our being."
Ragen had acknowledged Carole Maso, author of Break every rule: Essays on language, longing and desire, and her continuing influence on Ragen's writing. Now as I experienced Ragen breaking rules by talking about herself rather than a patient and by using words that she was saying were not in the psychoanalytic vocabulary, I got curious about what Maso had meant by breaking every rule. "If language is desire," Maso (p.158) had written, "if syntax and rhythm and tone and color create worlds of desire, if we see, if we live out on the margin, then how come we so often write between the lines?" Maso encouraged her audience to write outside the lines, to break that language contract and to "refuse to accept our limitations" (Maso, p.159).
Ragen (pp.43-44) writes about her patient Ben seeking a breakdown that is also a breakthrough and it strikes me that breaking the rules also seeks this sort of breakthrough, for both writer and reader.
Thomas Ogden (p.117) has written that analytic writing is "equal parts meditation and the experience of wrestling a beast to the ground."
As a meditation, writing constitutes a way of being with myself and of hearing myself coming into being in a way that has no equivalent in any other sector of my life. This "state of writing" is very similar to my experience of reverie in the analytic setting. (Ogden, p.117)

Ragen's writing, like Ogden's sends me into an experience of reverie. Perhaps breaking the rules can break open experience and allow us to discover and recover split off experiences.

In commenting on a paper by Barbara Pizer, Donnell Stern wrote:
So there are two kinds of good psychoanalytic writing, and the kinds of reading they require are, in a way, mirror images of one another. In the first kind, you have to work hard to read well, and then, later on, you finally arrive at an understanding good enough that you can go back and allow the words and meanings to wash over you. In the second kind, you have to allow your imagination free rein; you have to begin by letting the words wash over you; and if you read well and imagine deeply, you may be able to think hard about it later on and understand something different. (Stern, pp. 87-88).

Ragen's writing falls in to this second group: it is very accessible and I found that when I sat down to read, I could not stop until I had read the whole book. The words washed over me and it was only at the end that I could begin to wonder what had just happened to me. It was at this point that I went back to read again, this time as poetry or sacred text, the way teachers and colleagues and students have helped me to read Freud and Winnicott, Bromberg and Ghent and Ferro: line by line, aloud to a listening other. This sort of close reading is also a close living of the text. Ragen's writing invites this close reading and close living.
In breaking the rules, Ragen reclaims the tradition of other psychoanalytic mystics like Jung and Milner, Ghent and Eigen and Ulanov. She is in good company and she invites her reader to join her.

References
Bernstein, S.B. (1995). Guidelines: Comments on treatment report writing and describing analytic process. In The American Psychoanalytic Association Committee on Certification of the Board of Professional Standards, Procedures and Guidelines. New York: American Psychoanalytic Association (internal publication), pp.7-12.
Guilbert, C.M. (1977). The proposed Book of Common Prayer. Kingsport, TN: Kingsport Press.
Maso, C. (2000). Break every rule: Essays on language, longing, & moments of desire. Washington, D.C.: Counterpoint.
Ogden, T.H. (2005). This art of psychoanalysis: Dreaming undreamt dreams and interrupted cries. London: Routledge.
Stern, D.B. (2005). Commentary on paper by Barbara Pizer. Psychoanalytic Dialogues, 15, 85-93.

This is an amazing book! I was deeply moved, emotionally involved, and freshly educated. I am a psychologist, but I found myself understanding theory I thought I already knew in an entirely new way, from the inside out. You won't have to be in the profession to get totally immersed in these very personal stories by somebody who is clearly a very thoughtful and courageous therapist.

The consulting room is a book that speaks to both the professional and the lay reader. Dr. Ragen speaks to the universality of the range of human emotions. I highly recommend it!

Therese Ragen's The Consulting Room and Beyond is a wonderful book. Via her exploration of her patients' experiences, and of her own, she sheds light on the profound nature of clinical work when engaged in with mindfulness, curiosity, and a rigorous commitment to personal honesty. While this book will surely appeal to people interested in the consulting room, it goes way beyond, and it stands on its own as a literary work.

Alexandra Woods, PhD

Therese Ragen makes accessible to the untutored the very hard work of therapy. Her generous sharing of her personal stories draws the reader into the consulting room and demonstrates the complexity of both the psychoanalytic process and the effect of life's experiences on each of us. It is the lucky prospective therapist who reads this. Those of us who will never be therapists will gain insight into that world.

Psychoanalysis has come a long, long way since the founding of this medical system for understanding and treating mental and emotional dysfunctions both organic and social. But rarely has it had such an accessible commentator as Therese Ragen who deftly draws upon her many years of experience and expertise in a series of articulate, engaging, informed and informative essays on the general subject of psychoanalysis and its impact upon both patient and practitioner in "The Consulting Room And Beyond: Psychoanalytic Work And Its Reverberations In The Analyst's Life". The ninth volume in the outstanding Routledge 'Psychoanalysis in a New Key' series, the essays comprising this 150-page compendium combine elements of a professional memoir with case studies and illustrative examples. The result is a highly recommended and unique contribution to the growing library of psychoanalytic literature in general, and a compelling, recommended addition to academic and professional collections, as well as student and non-specialist reading lists, in particular.

This amazing book of essays showed up in my Amazon recommends for some reason - unknown to me - and I am very glad it did. I recommend this to all with an interest in analysis, the psyche, grief, the soul, recovery from trauma, what else? - for all who have an interest in life, in living fully. Make no mistake, Ragen is well versed in her subject matter, she is an intellectual, a thinker, but it was heartening to read words that also made reference to the soul. She addresses the difficulties a person can face when trying to realign oneself with life, with living as opposed to fear. Anyone who has experienced trauma in childhood or in adulthood will understand how one's own instincts can thereafter lead one astray. One's instincts can lead to a shutting down. I have sought through analysis a way to counter this shutting down, to learn how to be in relationship to others, to the world. To love - one wouldn't assume this to be a terrifying prospect and yet this is simply what is, in terms of the aftermath of trauma.
Ragen presents the idea of how a person can re-form relationship(s) with others through the analyst/analysand relationship. I realize this will be old news to anyone versed even a bit in psychological knowledge. But reading about this from the analyst's viewpoint was both eye opening and very touching. Much analysis is tinged with coldness. Not so for Ragen. I was incredibly moved by the way she depicted her care and caring for her patients. The essay entitled "Longing" was a revelation and I thank her for her words. I have often thought of a breakdown in the psyche as in fact a crisis of the soul. Ragen explicates this as well, and beautifully.

This book is a collection of personal essays written by Dr. Therese Ragen, a psychoanalyst with a private practice in Manhattan. In each essay (there are a total of seven in this slim volume), Dr. Ragen shares a combination of case histories, personal reflections, and private insights. In general, the essays tend to center around particular themes--for example, the first, "Legacy," relates to the murder of Dr. Ragen's grandfather by the mob, and the last, "Kate," addresses death. Dr. Ragen also typically features a single patient in every essay, with the exception of the second essay, "September 11, 2001," in which her experiences with many different patients are discussed.

The case illustrations are interwoven with brief forays into psychoanalytic theory. This lends a fairly rambling quality to Dr. Ragen's writing--her stories are interesting, but they do wander quite a bit. Overall, however, I think that fellow therapists will appreciate Dr. Ragen's reflections, finding them to be validating of their own experience, whereas others are likely to enjoy the behind-the-scenes glimpse into the mind of a therapist which her essays provide.

Dr. Ragen engages the reader on many levels-therapist, patient, and person. This book is not only highly informative for anyone interested in the psychoanalytic process, it is beautifully written in a deeply personal manner. Dr. Ragen outlines some of the core teachings of the founders of psychoanalysis in a real life, applied, human narrative. Perhaps the most interesting example of this is her review of the work of S. Ferenczi and how she applies this in her practice. The book takes the reader on an informative and deeply moving journey with Dr.Ragen and her patients in such a way that we can understand and feel the impact of our "collective family experience" on our lives.

The Consulting Room and Beyond speaks to a universal audience. The therapeutic dialogs documented by Dr. Ragen reveal the reality that psychoanalysis flows both ways. The revelations of her own experiences draw the reader into the dynamic that exits between doctor and patient. I highly recommend this genuine work.