On fixing and being fixed: Metaphors in psychotherapy - Springer Link

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Journal of Contemporary Psychotherapy, [Iol. 20, No. 2, 1990

On Fixing and Being Fixed: Metaphors in Psychotherapy Robert C. Lane, Ph.D. Saralea E. Chazan, Ph.D.

The term "to fix" is explored with its multiplicity of meanings, and its relevance to such clinical issues as transference and resistance are discussed along with positive and negative denotations and connotations of the term. Cases are also presented to illustrate both positive and negative uses.

INTRODUCTION The term "to fix" has a multitude of meanings, both positive and negative, which have significance in psychoanalytic therapy. The authors would like to address several of these meanings and their clinical application, offering two examples of how the term appears and can be handled in a therapeutic context. Perhaps the most common and popular meaning of "to fix" is to restore to a proper condition, to repair, remedy, or heal. "To fix" is also to make better, to take care of, implying protection and nurturance. Also relevant are meanings such as refuel, feed, make safe and secure. The need to fix implies that a former state of wholeness has somehow been shattered or damaged. It is also associated in childhood with the expression, "Uh-oh--something has fallen, or broken." A piece, or pieces are missing and the whole is no longer perfect. In emotional terms, the inner state of bliss, or status quo, is marred and there is a search, or directed effort to reunify, or fix it. Within this context, an addiction may occur to recurrent efforts at restoring, or recreating, the original state of unity, as was implied by Freud in the concept of repetition compulsion (1914, 1920, 1926). Thus, fixing can be both reparative and creative in serving either one of two ends: (1) making something new which feels like the old; (2) making something work, which never had previously. In the latter ease the focus is on 109 9 1990 Human Sciences Press, lnc,

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the future anticipation of something which is better, while in the former instance the focus is upon recreating the past. In either case, the outcome is never identical with the intention. In the act of fixing a new entity emerges which is never totally identical with or free of the past. "To Fix": Positive Implications To fix denotes bringing together, and in therapeutic terms it implies an interaction between healer and the one who presents himself to be healed. Thus, in a dream, a fixer of any nature is always suggestive of the analyst (Steiner, 1937). There is also an indicated reciprocity in roles. Does one become more whole oneself as one heals another? Or, alternatively, does one learn how to fix while in the process of being fixed? The latter implies the presence of mastery as part of the healing process. The former denotes that the core of shared humanity forms the basis for a never ending process of search for integrity and meaning. The repair of oneself, then, could only be conducted in the presence of another. It is the bringing together of two or more individuals, or groups, which assures the emergence of a new whole which could not be achieved without the presence of another, real or imaginary. Winnicott (1965) claims that the good mother is only "good enough," always leaving a space for the child to grow in his strivings towards integration. Within this context, the perfect mother is stifling and smothers the infant's intuitive strivings for mastery. "To Fix": Negative Implications "To fix" has negative implications when the object relations are those of a power struggle, where one party imposes his will upon another. Thus, "to fix" implies the removal of sexuality. It means to spay or castrate, to remove the sexual procreative function, to make sterile in the female and effeminate in the male by removing sexual parts, causing a loss of muscle tone and a softening of tissue (e.g., a capon is a castrated rooster who loses its muscle tone, puts on more weight, and is softer for eating purposes). Another negative implication of "to fix" is to avenge oneself, or to get even with, punish, or chastise. The sadomasochistic implication of these connotations is clear. Thus, depending upon the context, to fix means to help and to hurt, to benefit and to hinder. Still another negative meaning of "to fix" is to be paralyzed, unable to move, stuck, transfixed, or to render stiff, firm, rigid and permanent. In another negative instance, "to fix" suggests a dilemma, a difficult situation, an awkward position, and a search for smoothing, e.g., a shot, an injection of a narcotic to make one feel better. Fixated; or a fixation, suggests an arrest, or stoppage. In

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psychoanalytic terms it refers to a blockage of the drives at the early stages of psychosexual development. "To fix" implies to influence the result of an action, or of an event, to one's advantage by bribery, trickery, or other means. The act of fixing the outcome of a contest, or game, a horse race, a jury, or an election suggests the corrupt control of one party over another. Another similar meaning is "to spike" a drink, or have control over the drinker's imbibing by drugging the drinker.

"To Fix": Neutral Implications "To fix" can imply making arrangements. In this instance, it means to arrange matters, to establish definitely, to set in order. The more neutral stance implies an organization which enables movement to occur. Thus, "to fix" can mean to adjust, to go, to move ahead, to move properly in a certain way. Other conventional meanings include to provide lodgings, a mate, to offer conveniences for the necessities of life. Another meaning of the word is to attach firmly, to fasten, to direct steadily. In this sense included are, to fasten one's eyes on a target, to get a set on something, to zoom in on a position. "To fix" also means to preserve, or hold onto, like a specimen of tissue used for microscopic study.

"To Fix": Psychoanalytic Implications The Fixer All of the above meanings of the term "to fix" have their parallel in the psychoanalytic context. As already noted the analyst is the "fixer" in dreams, who restores, repairs, mends, remedies, or heals. Another similar meaning is "to arrange" or "to influence the result or action of." Thus, one might influence the analysis the same way one might influence a game, a jury, or an election. The analyst may be seen as one who tries to influence the analysand in any way he can. The patient who suffers from the "anxiety of influence" may display a "negative therapeutic reaction" to the idea of being fixed, thus reinstating the dynamics of a power struggle within the analysis (Asch, 1976; Grunberger, 1971; Harris, 1982; Limantani, 1981).

To Refuel and Preserve Another meaning relevant to treatment is to "refuel," like banking or tending a fire. Allied to this meaning is the idea of preparing and feeding, fun-

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damental to any treatment process. Thus, the analyst is perceived as the feeding object, a symbiotic object, a maternal transference object who looks after the patient and feeds him food for symbolic nurturance. Another meaning of the term "fix" is "to attempt to preserve." An example of one type of preservation would be as a specimen to be used for axicroscopic study. Many patients see themselves as under close scrutiny, with every gesture and movement being observed.

To Avenge in the Transference A very important meaning of "to fix" is "to avenge oneself and get even with, punish or chastise." In the transference this need to avenge oneself is nearly always transferred from whoever the significant object may be onto the analyst (Fine, 1982; Guntrip, 1969; Hull, Lane & Okie, 1988). The wish for vengeance denies the curative function of the analysis and often leads to marked resistance. The source of frustration may be derived from a multitude of factors, including oedipal and preoedipal conflicts. However, the end result is a fmal common pathway in the wish to "wreck" the analysis. The patient may project the wish for vengeance onto the analyst and fear punishment or retaliation from him. Patients often wish to retaliate in the transference, to humiliate as they have been humiliated, to make the analyst feel inferior to them, to control the analyst as they have felt controlled by their significant internalized objects. They may be willing to hurt and destroy themselves in order to "get back" at the analyst and to render him impotent (Lane, 1984, 1985). They may fight with, compete with, disparage, induce failure and defeat the analyst and the analysis. The need to be in control is often a defense against fusion, merger and the loss of identity, or dissolution of the ego. Patients who have a need for suffering and pain are attached to painful affects (Valenstein, 1973). These patients cannot tolerate praise or success. To them negativity has become a way of life (Lane, Hull & Foehrenbach, 1988). Experiencing pain is something they need to feel alive and they do not want to be "fixed." Instead, they often turn to having a "fix" in order to soothe themselves and regulate their internal feeling states and behavior (Hull & Lane, 1988).

Clinical Examples Two clinical cases will be described. One case illustrates the negative meaning of the term "to fix." The second case is an example of the more positive use of the term.

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Case One: "The Negative Fix" The patient, a 24 year old woman was in therapy for approximately one year with a woman therapist in psychoanalytic training. She began her hour with anxiety. She had an opportunity to double her salary in her place of employment which would enable her to leave her mother with whom she lived. Her mother disapproved of her therapy and the patient exhibited a marked inconsistency in regards to her attendance in therapy. She would miss one or more of her hours. She would withhold feelings from therapy and want to be told what to do by the therapist. She feared making a decision because she continually "messed up." She felt she had not had a good week and "everything needed to be fixed." The therapist inquired as to what the patient meant by "fixed." Initially her response focused on positive things, like making enough money to have her own apartment, leaving her mother, an ability to say "no" to her mother, curing her bulimic habit, "fixing" the unacceptable pars of herself. She soon shifted to the negative meanings of "fix." Everything "kills" her mother--noise, her anger, her therapy, her wish for independence, any change in her, her dating. Maybe she wanted to "fix" her mother, to hurt her, get back at her, cut her down to size, but she couldn't do that. She felt exhausted, lethargic, drained and depressed. She felt terribly angry at her mother, her mother was driving her crazy, and in turn she gave her mother the "crazies." The central conflict had to do with the wish for merger and the defenses erected against these wishes. Her internalized maternal object did not permit self-regulation and instead led her to bouts of sneaking food, gluttony and the desire to spit the food back up. She was afraid to change as she feared this change would kill her mother. Her though,'s were terrifying to her as she feared the unacceptable parts of herself. She lied, tried to hide and conceal her real feelings, feared castigation and punishment. She also feared the magic of others, who would "fix" her. She tried to protect herself from herself as well as from others. If the therapist intruder looked at her too closely, she felt she would be pulled into a hole and lose her sense of who she was. She felt unloved, unlovable, alienated and betrayed by others. She feared falling under the influence of others, yet could not make decisions by herself. She felt "out of control," "sick," and that she needed a "fix." Because of extreme anxiety she felt nothing was stable or permanent, she was in a constant state of needing "a fix" either from herself of from others.

Case Two: "The Positive Fix" A 20 year old young woman, a college junior, entered therapy at her own volition while at home over summer vacation. The presenting problem

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was experienced states of confusion. She felt constantly pulled in two directions. She struggled to have people understand her and yet she felt she did things to throw them off. She needed to have a "fixed" direction. At home with her family, she was told she had an attitude problem. She was considered a spoiled brat and told to get herself "fixed" or straightened out. She indicated that, when she did not feel she was doing well, she would take it out on family members, like she was "fixing them" for her defects. She said, "sometimes, I play so many different roles, I don't know who I am, maybe I do have to get my head "fixed." When she tried to think through issues, she would get struck in the middle and could tell you both sides. Drinking and binging were two avenues used to offset the effects of anxiety, and methods she used to soothe herself and give herself a "fix." She felt she would drink to feel more secure. She felt she lived in a fantasy world, but chose to ignore it and pretend nothing was going on. Her fantasy was that she was better than everyone else, that she could do whatever she wanted to, while another part of herself said, "No way." She felt she could fix others while needing to be fixed herself. Sessions with this patient were like working through a lifting mist until clarity arrived with the retrieval of an early memory. She had acted as if something was missing, that she needed to be nurtured, taken care of, fed, made to feel more secure, put back together, made whole once again. The thread of her associations ran from the recent involvement with a young man she felt struggled with human relationships much like herself, to disappointment in her father who was either unavailable or seductive, to an ill-fated childhood romance. She recalled an intense friendship with a boy down the street when she was between 3-5 years of age. One day he died suddenly of the aftermath of a concussion resulting from having fallen from his bike on the way to her house. "I could not talk to his mother after that. I could not ask where he had gone and why she would not let him come out to play. Maybe that's the reason I keep choosing guys who are not good for me. I keep trying to prove that something I want can last, and yet I choose guys who are the wrong type. I know what I want and I end up fighting it. There is some kind of fear that wants me to stand still, or go backwards." The patient felt that, with the recovery of this event and her associations to it, she was "fixed," made more "whole," and no longer mired in conflict. She felt that she now could understand the fear that led her to be frightened of losing other people. The worst thing that could happen would be "if someone would disappear for no reason and leave me confused as to why they left." These were thoughts she had in reference to her current boyfriend and then traced these feelings to those she had after the death of her childhood friend. She had many questions about the incident itself, and she felt nothing would make sense to a five year old child. "How can you justify any kid dying? .... It left me feeling scared, any time something good came in to my life, I would

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worry that it would have to leave." "Now I feel I can repair my feelings of loss." She says concerning her current boyfriend, "Even if something bad, or good, or in the middle happens, I can still have a feeling of closeness. If I have to, I can fred someone new. The fear is really gone now. I ' m not afraid to sleep with him now. I wanted to show him how I felt without being scared. I was stuck, fixed. Now I am free. If something happens and you are hurt, for a certain amount of time you try to understand what happened, to understand what you can, and then you move on and look for something else. I know now how to get help if it should happen again. Now I feel healthier, more whole, like a brand new feeling, as if I were fixed." In this case the repair was the working through of a mourning process which had been delayed and interfered with the formation of sustaining relationships. The therapist was viewed as a benign and helpful person, free from the oppositional tendencies the patient usually attributed to others. Instead, the gradual lifting of repression led to recovery of lost aspects of the self, enabling the patient to invest freely in intimate relationships. The gain in self-esteem and self-regulation was almost immediate. The confusion had left her uncertain of who she really was and what she would become. The experience was of becoming "unstuck," (the opposite of fixed in the negative sense) and discoverhag that one could be resilient and recover from trauma. This capacity "to fix" and make reparation was reflected in the patient's feelings that she could now share her true feelings without fear.

SUMMARY The term "to fix" was explored and found to have a multitude of meanings, some positive, some negative and others more neutral in tone. The significance of these different meanings was discussed in terms of their relevance to the process of psychoanalytically oriented psychotherapy, transferential issues and issues of resistance. Two cases were described, one illustrating the use of the term "to fix" in a negative sense, the second illustrating the positive use of the term. In each instance, use of the term reflected many different meanings, which had to be defined and understood within a specific context.

REFERENCES

Asch, S. S. (1976). Varieties of negative therapeutic reaction and problems of techniques. Journal of the American Psychoanalytic Association, 24, 383-407 Fine, R. (1982). The healing of the mind. New York: The Free Press. Freud, S. (1914). Remembering,repeating and working through. Standard Edition, VoL 12. London: Hogarth.

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Freud, S. (1920). Beyond the pleasure principle. Standard Edition, Vol. 18. London: Hogarth. Freud, S. (1926). Inhibitions, symptom and anxiety. Standard Edition, Vol. 20. London: Hogarth. Grunberger, B. (1971). Narcissism. New York: International Universities Press. Guntrip. H (1969). Schizoid phenomena, object relations and the self. New York: International Universities Press. Harris, M. (1982). The negative therapeutic relationship. The anxiety influence clinically. (Unpublished) Paper read at the American Psychological Association, Annual Conference, 1982, Washington, D. C. Hull, J. W. and Lane, R. C. (1988). Autoerotism in patients with borderline personality organization: A case of wristcutting and bulimia. Journal of Contemporary Psychotherapy, 18, 81-92 Hull, J. W., Lane, R. C., and Okie, J. (1988). Sexual acting out and the desire for revenge. Paper presented to the Thirteenth Annual Symposium, Society for Psychoanalytic Training and New York Center for Psychoanalytie Training, New York, April, 9, 1988. Lane, R. C. (1984). The difficult patient, resistance, and the negative therapeutic reaction: A review of the literature. Current Issues in Psychoanalytic Practice, 1(4): 83-106. Lane, R. C. (1985). The recalcitrant supervisee: The negative supervisory reaction. Current Issues in Psychoanalytic Practice, 2, 65-81. Lane, R. C., Hull, J. W. and Foehrenbach, L. (1988). The addiction to negativity. Unpublished paper. Limentani, A. (1981). On some positive aspects of the negative therapeutic reaction. International Journal of Psychoanalysis, 62, 379-390. Steiner, M. (1937). The dream symbolism of the analytic situation. International Journal of Psychoanalysis 18, 294-305. Valenstein, A. F. (1973). On attachment to painful feelings and the negative therapeutic reaction. Psychoanalytic Study of the Child, 28, 365-392. Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.