Commentary on Chessick

That “psychoanalysis is an old man’s game” may well be true, but in Richard Chessick’s cautionary article he alerts us to vitally important but relatively unnoticed aspects of the game. He won’t let us flinch or blink as with thirteen brief clinical vignettes he rivets our attention on the effects of how the analysand may perceive the senility ¹ of the analyst, and on the inevitable effects of those perceptions on the analytic process. At first this story seems long familiar from our literature, but it is not. While many before have commented on the need for the analyst to recognize and deal with the diminished and diminishing capacities that accompany aging, these useful observations have been viewed exclusively from only one side of the looking glass—the analyst’s. But the analysand too is a participant-observer in the treatment, the one who sees the signs of the analyst’s aging even if the analyst does not, cannot, or doesn’t want to. Inevitably an analysand has reactions to these perceptions, reactions he too may deny or otherwise attempt to bury in what Chessick deems a dangerous “silent collusion” with the analyst that can “lead to destruction of the treatment” (p. 67).

It may be difficult or impossible for some analysands to share their unflatterng observations with their analysts as readily as Lewis Carroll’s persona does in this famous interchange:

“You are old father William,” the young man said,

“And your hair has become very white;

And yet you incessantly stand on your head—

Do you think, at your age, it is right?”

Stephen Firestein (1994) warned of the usefulness of a professional last will and testament (cited in Goldberger 1994, p. 360 n). Many others have commented on the vulnerabilities, diminishing powers, and declining health of elderly analysts. This is a well-plowed field. By now we analysts ought to stand sufficiently warned to try to recognize our denials of our mortality, vulnerability to illness, and disability. Still, these are hard tasks, not the least because our defenses against these observations operate unconsciously.

One of my patients was a woman whose previous analyst had died after a long battle with cancer. He had never told her he was ill, despite frequent absences for bouts of his illness and its treatment. Years later she told me that when the end finally came she realized that she had suspected something worrisome had been going on, but she had put these observations out of her mind. She had noticed, she told me, that he had developed the habit of frequently pulling up his socks, so wasted had he become. She never mentioned her concerns to him.

The problem of the analyst’s denial and its near-impossible remediation intersects with contemporary discussions of the analyst’s self-disclosure. Like aspects of the analyst’s personality—and like Aschenbach’s stigma of old age in Thomas Mann’s “Death in Venice” —the signs of our own aging cannot be concealed, as much as we might wish to hide them. They are there—often standing elephantine—in the consulting room.

If one intersection of this problem is with contemporary discussions about self-disclosure, another is with the graying of our profession as a whole. Recent surveys of APsaA’s membership have revealed an increasing proportion of members moving into their sixth, seventh, and eighth decades while relatively few younger analysts are entering the field. Moreover, the average age of incoming candidates is near fifty, according to some estimates. These facts tell us of the timeliness of Chessick’s observations.

A third point of intersection of Chessick’s argument is with discussions of the impact of other features and behavior, subtle or obvious, of the analyst: pregnancy, manifest illness, dementing processes, and even love toward the patient. The literature on pregnancy comes perhaps closest to the issues concerning Chessick: analysands will notice signs of the analyst’s pregnancy but often keep their observations—and private elaborations of those observations—to themselves. Illness of the analyst has for the most part been discussed from the analyst’s point of view; dementing processes much less so; and even less so the analysand’s perceptions of the analyst’s love. The small number of exceptions notwithstanding, the importance of Chessick’s perspective is that it switches the figure-ground relationship of our attention from the usual collection of problems of the analyst to those created by the analysand’s perception of those problems. In fact, Chessick goes further, telling us that he is not concerning himself with patients’ reactions to obviously problem-ridden aging analysts. We have enough to think about in the case of an analyst of sixty-five to eighty years who is aging uneventfully, gracefully, one with “no apparent serious chronic health problems . . . [or] infirmities” (pp. 67–68)—only the aging process itself.

Chessick’s point seems indisputable. Yet what is to be done about it? How can an analyst protect himself and his patient from the “dangers” Chessick identifies? Constant countertransference observation, he says, is necessary and is our ethical responsibility. And yet, given the knowledge of and respect for the power of unconscious motivation and defense that is the common property of analysts, how can we let it go at that? After all, it is true that “the only problem with self-analysis is the countertransference.” In other words, our best instrument for self-correction is at its best undependable. We can—and should—be grateful to Chessick for having alerted us to attend to our analysands’ perceptions of the outward signs of our aging. The impact of those perceptions on the analytic process can be powerful indeed. Yet this is a set of problems not essentially different from those arising from the analyst’s unavoidable self-revelations. Surely an analysand’s perceptions of an analyst’s youthfulness will have their effects as well; similarly for a strikingly beautiful or notably unprepossessing one. Duly warned, we can only try to do our analytic best with our imperfect tools.