Neetu Sarin is a psychoanalytic psychotherapist and faculty member at Ambedkar University, New Delhi. She is interested in issues regarding the body, the unconscious intergenerational transmission of trauma, and is deeply invested in relationships and plants.<\/p>\n
Tanisha Chadha, who interviewed Neetu Sarin says, “Psychoanalysis is an approach of psychotherapy that looks at boundaries in a manner that can inform the therapy process beyond just the purpose of maintaining a professional relationship between the therapist and the patient. I wanted to explore how sexuality and boundaries come together or work tangentially in a psychoanalytic clinic through the lens of the therapist, and understand how and why it may or may not be different from patient to patient.”<\/p>\n
Tanisha Chadha:<\/strong> What is meant by \u2018boundaries\u2019 in a therapy setup, both in terms of the setting involved and therapy as a process?<\/strong><\/p>\n Neetu Sarin:<\/strong> The initial discussions on how often one would meet for therapy, the time and duration of the session, the discussion of fee, etc. are a way of starting off the therapeutic setting (like rules of the game) and they become boundaries once the patient starts to imagine or explore how much they can\/want to bend the rules. The purpose of boundaries needs to be clear and is person-dependent. They are not just arbitrary rules.<\/p>\n Boundaries range from behaviours like not meeting the patient outside of the therapy setting (avoiding a dual relationship), not encouraging gift-giving too much and distinguishing between one\u2019s own needs and that of the patient. Also, boundaries do not have a meaning until you know who you are dealing with. Someone who visits a clinic for psychological help like self-exploration, may have higher psychological resources (there are always exceptions) to deal with boundaries than someone who may have undergone acute crisis (for example, a suicide attempt, domestic violence, a child who has been rescued from an abusive family, etc), in which case the boundaries would be far more flexible. When people are very ill or have undergone acute crisis, there is a high chance of them dealing with distance as being too violent, and so the therapist has to make oneself more available. Therefore, boundaries are dependent on what level of development the patient is at. I would therefore, decide on the basis of the patient\u2019s psychic organisation how I would like to approach boundaries with them.<\/p>\n A therapist constantly keeps two states of subjectivity together. One is the here and now of what the patient is saying in therapy, and the other of what the patient is not saying, not thinking and not doing. In psychodynamic therapy, keeping the possibility of fantasy<\/a> alive is crucial. So, for instance, if the patient has a fantasy of stalking you on Facebook, you do not tell them upfront not to stalk because that would mean bringing in a prohibition without the desire actually being talked about. But I would address it, if the patient sends me a friend request. A therapist has to think at every step who the boundaries are for. Anything that is too easy, would stall the work. If a difficult patient who is very demanding asks their therapist to come for their child\u2019s birthday party, and the therapist obliges \u2013 giving in here seems the easy way out for the therapist to avoid conflict with the patient. But in dynamic therapy, conflict and the inability to deal with it is very much a part of a person\u2019s difficulties. In such a case, a boundary violation is what can help the therapist understand that this is an area where the patient is struggling. The content of the boundary violation, at what moment in therapy a boundary violation comes up and how the client deals with your saying \u201cyes\u201d or \u201cno\u201d, is important information about the patient\u2019s psyche that serves to inform the therapy process.<\/p>\n Tanisha Chadha: You identify as a \u2018psychoanalytical\/psychodynamic psychotherapist\u2019. Could you briefly describe here what that means and how it is different from other therapeutic approaches?<\/strong><\/p>\n Neetu Sarin:<\/strong> I think it\u2019s very important to mention here that psychoanalytic psychotherapy is a dying form of therapy, as otherwise boundaries become difficult to talk about. A psychodynamic<\/a> (a form of therapy that derives from classical psychoanalytic therapy but has evolved in many ways over time) therapist is anybody who believes that the developmental years of a patient are important. So, if a patient brings up issues with their boss, it is about their boss but it is also about the difficulties with authority that they may have faced in their growing up years. A\u00a0psychodynamic therapist needs to already have their own narcissism in check\u00a0and know that it is not about them but about the patient. They need to be\u00a0comfortable with being silent and speaking lesser than the patient, and are also\u00a0trained to induce what is called transference, which means that in a therapeutic\u00a0relationship one tends to become a significant other from the past of the patient.<\/p>\n For example, if a patient was to feel exaggeratedly angry at me for being late for\u00a0the session by two minutes, I would not try and defend myself that it was only\u00a0two minutes. Instead, I would try and understand which disappointing caregiver\u00a0did I become for the patient in that moment and then try to re-evoke that image.\u00a0I also use dream-work a lot. It helps to see the significance of what the patient is\u00a0thinking when they are not thinking. And of course, the significance of\u00a0unconscious processes in how one makes decisions.<\/p>\n Tanisha Chadha: On a lighter note, Freud is commonly understood as having been \u2018all sexual\u2019 in how he perceived and understood the human psyche. How would you comment on this?<\/strong><\/p>\n Neetu Sarin: <\/strong>I\u2019m glad that you asked this question. Because, if I were to be asked if psychoanalysis is about Freud, I would say a big \u201cNo\u201d! It started with Freud, but analytic and\/or dynamic work has come a long way. And more than sexuality, understanding how our attachments (avoidant, ambivalent, clingy, impulsive, etc.) shape us has become an area of focus (called the object-relations approach). This determines our relationships and how we deal with the world around us.<\/p>\n Additionally, I also feel that the reading of Freud is hugely misinterpreted. Freud talked about eros<\/a> and sensuality, more than \u2018sexuality\u2019 per se. I have a problem with equating psychoanalysis with Freud. I feel more influenced by people who have years and years of clinical work experience with children and adolescents like Donald Winnicott and Wilfred Bion, and feminist psychoanalysts like Juliet Mitchell, Nancy Chodorow, Muriel Dimen and Judith Butler. So, saying that your issues with your mother are because you have feelings for her, is incorrect as that is only a part of one\u2019s attachment with their mother.<\/p>\n Tanisha Chadha: Is touching\/hugging\/going out to a different location for a session to show support to a patient considered all right in a therapy setting? (This was much talked about after the release the 2016 Hindi film Dear Zindagi.) Why or why not?<\/strong><\/p>\n Neetu Sarin:<\/strong> It is crucial to distinguish between things that are therapeutic and things that are psychotherapy. I think Dear Zindagi is a creative person\u2019s take on what therapy can do and how it can help people. I don\u2019t think sessions like that happen in real life. Touching and hugging need to be put in the context of who the patient is. It is important to look at the mental and psychological level of development of the patient. Touch becomes an important tool in the case of psychotic states<\/a> where the mind is fragmented and mental faculties collapse. So, for a psychotic patient who is paranoid and feels that all the food being given to them is poisoned and\/or that the world is out to get them, physical boundaries need to be loose and flexible, to develop trust. In cases of such psychotic functioning, which is commonly understood in psychoanalysis as the state of the baby (examples would include psychotic disorders where the person loses touch with reality, like in schizophrenia), touch and hug become extremely important. I might use touch to soothe and calm down a very manic patient; but with neurotic<\/a> and adult-like states wherein the patient is mainly dealing with relational difficulties, touching and hugging need not be a part of the therapy process.<\/p>\n Tanisha Chadha: Are erotic transferences (patient falling in love with the therapist and\/or vice-versa) common? What can it mean and how does a therapist approach these boundaries?<\/strong><\/p>\n Neetu Sarin:<\/strong> Let us first look at why this would happen and what is understood as \u2018erotic\u2019. Erotic is that which is sensual and intimate. It is the imagination of being next to a person in one\u2019s psyche and one\u2019s being. Erotic is not the desire to just have sex with someone, but the desire to get close to someone. When a patient falls in love with their therapist, the latter may choose to encourage or discourage it depending on their therapeutic approach. Cognitive behaviour therapy<\/a> (a form of therapy that focuses on changing negative and dysfunctional patterns of thought) does not work with transference<\/a>, but psychoanalysis does.<\/p>\n To be a good therapist, it is essential to have an in-depth understanding of one\u2019s own sexuality and sexual desires and to be able to separate them from those of the patient. When a patient falls in love with the therapist, it also about falling in love with being heard and the safe space that the clinic provides where the therapist understands their needs and sees legitimacy in the patient\u2019s conflicts. This process of the patient falling in love with the process of therapy needs to be encouraged while also being careful to not violate boundaries and prevent the erotic from becoming sexual. So, if a therapist feels that the patient is in love with them, they can help the patient make sense of what this may mean for the patient. Does the patient feel the need to be in love with someone who makes them feel heard and accepted? What are the needs that the therapist is fulfilling for the patient that is making them feel this way? This helps the patient to develop a vocabulary for their inner life, and this process becomes therapeutic.<\/p>\n Also, as a therapist one has to be careful not to be seductive. If one\u2019s own needs of acceptance and desire are unfulfilled, therapists may also tend to turn to their patients, which should not happen. The therapist needs to therefore look at whom the encouragement is helping \u2013 the patient or their own need for validation, and accordingly take a call on how to tackle the transference.<\/p>\n Tanisha Chadha: Is it always easy to maintain boundaries by being able to distinguish between the therapist\u2019s and the patient\u2019s needs?<\/strong><\/p>\n Neetu Sarin:<\/strong> It becomes easy for anybody who has done years and years of psychotherapy and work on themselves. It makes them more cognisant and aware of their own needs and feelings. Self-work is a mandate for the training of a psychoanalytic psychotherapist. It is essential for every therapist to undergo self-work to understand the meaning behind their own attachment patterns so that they are able to distinguish them from those of the patient.<\/p>\n Tanisha Chadha: Does psychoanalysis lay out any kind of guidelines regarding what kind of sexuality\/sexual act is right\/wrong?\u00a0<\/strong><\/p>\n Neetu Sarin: <\/strong>Oh no! Why? (laughs) Anything that is too correct is not sexuality!<\/p>\n Tanisha Chadha: While Freud was also one of the first people to say that sexuality is a continuum and everyone is inherently bisexual, it is also commonly understood that Freud did not see a homosexual orientation as a \u2018healthy\u2019 resolution in his theory. So, how are \u2018controversial\u2019 desires (like desires for same-sex or BDSM sexual acts) understood by psychoanalysis? Have things changed since Freud in this regard?\u00a0<\/strong><\/p>\n Neetu Sarin:<\/strong> There is a large space within psychoanalysis (Donald Winicott, Jessica Benjamin, Adam Phillips, Joyce McDougall to name a few analysts) where theorists post-Freud have worked in-depth in the area of the body and opened up the space to fetishes, bondage and play-acting. What I would call therapeutic would be to see what a certain sexual act\/desire means to my patient.<\/p>\n Be it in a heterosexual relationship or a homosexual one, the concept of one partner being the female and the other being the male (or, butch and femme) is hugely challenged. Psychoanalysis recognises the masculine and the feminine, but it sees them as parts of a person. A woman may have masculine and feminine aspects and so may a man, and people of other genders. This is also interchangeable and reversible. Such ways of thinking easily allow for a non-heteronormative understanding of sexuality within the clinic. I believe that a thorough reading of Freud is hugely needed. When I think of Freud, I think of a homosexual man for whom all of his theories came out of his relationship with men (his father, Wilhelm Fliess, and S\u00e1ndor Ferenczi). In this way, psychoanalysis came out of a homosexual project.\u00a0 While working on his theories, Freud realised how attached he was to men and how these relationships had a deep impact on his own attachments and consequently, his theories.<\/p>\n