Emotions Concealed and Revealed: Contributions to a Common Ground in Psychoanalysis

Posted by | December 27, 2014 | Uncategorized | No Comments

I presented this in San Francisco June 2011 at the American College for  Psychoanalysis with Paul Ekman. There, our work was well-received. (In fact, Dr. Ekman was invited to teach for the day.)

But this paper has been hibernating for two years. Then, I wrote what I thought was a straightforward summary of Emotions research, a field birthed by Darwin, but empirically developed by Paul Ekman and colleagues. I’ve known Paul first as colleague, then dear friend since 1996. After years of discussions both about his research and later watching his meetings with the Dalai Lama, I thought it wa time to summarize and present the implications of emotions research for psychoanalytic work.

Emotions researchers are like physicists who work on the basic laws of the universe: analysts are closer to engineers who try apply the rules of physics to improve our lives.

Or, emotions researchers are like basic scientists in medical school; analysts, the docs who apply new knowledge. Of course, sometimes, the engineers or clinical docs participate in new discoveries or question old ones.

Yet, I found that analysts were either not knowledgable or even opposed to findings of four decades of empirical work on emotions. Emotions researchers have established basic facts about discrete emotions — such as happy, sad, angry, fear, disgust, contempt: they are universal (across cultures, as Darwin hypothesized), that we have micro expressions which conceal and reveal our true inner states. These scientists have a consensus about these basics and have shown physiological (including fMRI) correlations. Further, their work is accepted and applied by the U.S. Defense of Defense in wartime, the CIA, the French and British secret services and the Mossad. Even Pixar used their work to make their characters more “human.” Yet, I found that psychoanalysts are either unacquainted or even contest their findings. This opposition does not bother emotions researchers (nor the CIA, the Mossad nor Pixar); it should bother us. If emotions are not cross-culturally universal, then we do not have a common language about them; if they are universal (as these researchers have established), then, at some level, ” Alle Menschen sind Brüder ,” we are brothers (and sisters).

 I present this here both to inform and to raise discussion about this research in a related  field — emotions research — that should be integrated into our thinking and clinical work and training on identifying emotions in practice: both one’s own and one’s analysand’s.

Nathan Szajnberg

Emotions Concealed and Revealed: Contributions to a Common Ground in Psychoanalysis

Nathan Szajnberg, MD (Presented in San Francisco June 2011 at Am College for Psychoanalysis)

 Emotions, a core concept for psychoanalysis, has been studied avidly by Paul Ekman and colleagues for more than four decades. Yet, its empirical study was initiated by Charles Darwin (1872). I review the researchers’ fundamental contributions, particularly 1) the universal expression and interpretation of basic emotions, 2) the presence of fleeting microexpressions, and 3) non-conscious attempts to cover-up emotions. Then, I present objective assessment of emotion recognition accuracy for several basic emotions, and discuss the implications of this work for psychoanalytic training and practice, such as accurately reading both one’s own and one’s analysand’s emotions as a component of empathy. If a fundamental area of practice is along the transference/countertransference continuum, then improving candidates’ (and our) emotional accuracy within this continuum is both desirable and feasible. Improved accurate emotion recognition, like playing on-key for a musician, is one approach to a “more transparent assessment of psychoanalytic competence…” (Tuckett, 2004). This offers a bridge to an adjacent and potentially collaborative, discipline, emotions research.

Infrequently, studies at the fringes of psychoanalysis become woven into our fabric, enriching its pattern. For instance, attachment research — although founded by Bowlby, a psychoanalyst — was carried into an almost forty year productive “exile” by academic psychologists such as Ainsworth, Main, Waters and colleagues. Recently, psychoanalytic researchers recaptured and applied attachment theory to psychoanalytic thinking (Fonagy, 2001). Attachment theory may guide transference technique (Szajnberg and Crittenden, 1996).

Here, we view another such cloth woven outside of psychoanalysis: Paul Ekman and colleagues’ four decades’ work on emotions. The aim: to explore its application to training and clinical work. Emotions is one common tapestry covering psychoanalytic ground, a juncture where psychoanalytic cultures may meet (Wallerstein, 1990, Green, 1999). This is only an introduction to the idea of emotions as a common area of clinical discussion, an introduction to assay its usefulness in daily clinical work and collegial dialogue. Linking psychoanalysis to emotions’ research serves at least three functions: 1) it gives a basis for a more universal language of discourse; 2) it returns us to the more bodily experiences and origins within which emotions are embodied and from which we have been estranged (Stern, 1985; Green, 1999); 3) it offers a more objective platform for candidate training and evaluation (Tuckett, 2004).

To begin, we need a common vocabulary, a challenge as we move across the many languages of psychoanalysis.

Darwin emphasized emotion expression, focusing predominately — for humans — on the face, with which Ekman began his studies (Darwin, 1872; Ekman, 2003). Here is Ekman’s working description of emotions: ” … a(n) automatic appraisal influenced by our evolutionary and personal past, in which we sense that something important to our welfare is occurring… set of physiological changes and … behaviors … (begin to) deal with the situation …. We… use words when emotional, but we cannot reduce emotion to words.” (Ekman, 2003).

Ekman articulates six qualities of emotions’ mental state. It is
1.a signal that “lets others know what is happening inside us” (2008, p. 37); which is
2. “triggered automatically in under a quarter of a second.. (during which it is) totally opaque to consciousness ”;
3. we are typically not aware of our emotions as they occur;
4. other animals have emotions (40);
5. emotions are short-lived (as brief as a few seconds), unlike moods; 6. Each emotion has a set of sensations.

Further, emotional arousal has individual-specific profiles — onset rise, idiosyncratic duration and a refractory period — during which we “read” our environments through the lens of that emotion. In the refractory period following fury, for instance, it may be difficult to perceive affects or entreaties other than anger (p. 47 ff.) (In psychoanalytic terms, an overwhelming experiencing ego interferes with observing ego.) This “profile” — rise, duration and dissipation — has the conformation of a volcano, but with durations that vary for each phases depending upon the individual. Intriguingly, for an individual, the emotional profiles of anger, fear and anguish are similar. Profiles can vary across individuals with more rapid or gradual rise in onsets; shorter or longer durations and variable lengths for dissipation of emotions. Individuals with, for instance, more explosive onsets of negative emotion, appear to be more resistant to reconfiguration of their more impulsive emotional onsets (Ekman, personal communication), a finding with implications for clinical work and familiar to those who work with severely borderline characters (Giovacchini, 2000).

That is, emotion is a signal, an automatic quick appraisal of what is happening, that “lets others know what is happening inside of us“. One must develop the skill to gain consistent consciousness of emotional awareness (both of self and others); emotions are not unique to humans and involve physical sensations. (Dalai Lama and Ekman, 2008, p 40).

In psychoanalytic literature, we are challenged by the variegated, even contested
meanings for “emotion” terms both across languages and even within language. In German, Freud used Affekt, Empfindung, and Gefuhl (LaPlanche and Pontalis, 1973). Strachey’s confounding English translations are: Empfindung is “feeling” or “emotion”; and Gefuhl is “feeling” or “emotion,” with Affekt usually translated “affect.” Even Freud complicates: when he wrote “Obsessions and Phobias” in French (1895), he translated Affekt as the academic sounding “etat emotif,”; this is later translated into English as both “”affect” and “emotion.”

In French, Green discusses the dilemmas of translating Affekt (1999). He describes two categories of terms connected with “feelings.” First, those words close to “affect”: Affecter (to affect), affectif (emotional), affection and affectivite. Second words with progressive gradation of tone: “When dealing the emotional life, the French … usually distinguished … emotion, an acute transitory state; sentiment, a more attenuated, more durable state , and passion … violent, profound and lasting.” (Green, 1999).

LaPlanche and Pontalis (1973) ground us with psychoanalytic terminology and translations. They define “Affekt” as “any affective state, whether painful or pleasant, whether vague or well-defined and whether .. a massive discharge or … general mood. According to Freud, each instinct expresses itself in terms of affect and… ideas (Vorstellungen).”

In fact, Freud’s distinction between affect and ideas fits closely with what Ekman and colleagues were to confirm about Darwin’s theory about universal emotions and how emotions and ideas are separable: while emotions are universal, the ideas that evoke them
may be culture-specific, as Ekman comments in the re-issue of Darwin’s Expression of Emotion in Man and Animals (Darwin, 1998).

Etymologically, Emotion comes from emotionem, “to move out.” Listen to both emotion’s archaic and contemporary definitions. “1. A moving out, migration, transference from one place to another (obsolete) (author’s italics); 2. a moving … perturbation in a physical sense (obs.); 3. A political or social agitation… 4. Any agitation or disturbance of mind … any vehement or excited mental state; (b) a mental “feeling or affection” (e.g. of pleasure or pain … etc…) as distinguished from cognitive or volitional states …”

When Ekman and the Dalai Lama first approximated a common working concept of emotion (lacking a Tibetan term), it was this sense of “being moved” (for better or worse) that worked (Dalai Lama and Ekman, 2008) (3).

Here, we use “emotion” rather than “affect” for two reasons. First, “emotion” is the researchers’ term; second, “affect” has such a rich, variegated, and voluminous scientific literature; even summarizing the latter would be onerous.

Further, I focus on the discrete emotions – such as sad, happy, angry — rather than what Stern calls vitality (1985) — such as lively, phlegmatic, zest, although we will return to this in connection with some of Ekman’s early work on gesture and deceit. (4)

Emotions Revealed

Ekman made two major discoveries about human emotion. First, he demonstrated definitively that emotions are universal, as Darwin theorized. Second, he described micro-expressions (both facial and gestural) — brief, emotional displays that generally occur out of our awareness, particularly in moments of (self- and other-) deceit.
Darwin suggested that we have evolved eight emotions: happy, sad, angry, disgust, contempt, reflection, surprise and shyness (Darwin, 1998). But by the mid-twentieth century, cultural anthropologists such as Margaret Mead, argued against the idea of universal display of emotions.

Ekman took on the challenge of emotions’ universality/cultural specificity in the early 60’s. He chose and studied a remote tribe in New Guinea, who had no exposure to photos, television or film (5). Natives could identify at least six affects in the same manner as Westerners: happy, sad, disgust, anger, surprise, fear. In years of ongoing studies of facial expression alone, Ekman confirmed and revised these findings. Culture does not determine the expression nor interpretation of most emotions (6) . However, disguise or attempted suppression of certain emotions are culturally-influenced: Japanese in the presence of an observer try to suppress anger (with a tight, obicularis oris “smile”) in contrast to Americans. Yet, Japanese sitting alone (being filmed via one-way mirror), do not suppress anger or disgust.

Further, Ekman described a series of additional emotions for which we may not have words in English, but recognize emotionally: for instance, Schadenfreude (the “pleasure” we may take in someone’s downfall), or the Italian, fiero, the pleasure we take in having achieved a difficult goal, or the Yiddish, naches, the pride we have in the achievements of those we love. While we may not have simple English words, most people can identify the feeling state.

We have EEG and Galvanic Skin Response evidence of emotion, before we are conscious of it (Emotions Revealed, Ekman, 2005) While much of his early work focus on facial expression, he also pioneered work on gesture and emblems (8) (Ekman, 2005; Goffman, 1990), which are much more culturally determined –as Darwin predicted
(Darwin, 1998). The latter research is being applied to anti-terrorism efforts, precisely because facial expression (and physiology) of emotions are so rapid and more difficult to suppress.

Ekman’s second major discovery is micro-expressions of emotion and deceit. Patients who in fact were suicidal (unknown to the interviewer) and were trying to suppress the information, made gestures or had brief facial micro-expressions (lasting about 1/25th of a second) revealing an attempt at cover-up (9).

Telling Lies (Ekman,1985), gives detailed examples of facial features of micro- expressions associated with deceit (asymmetries of facial expressions; eyebrow shifts), and gestural features, including that such gestures are generally made outside our usual “frame”: that is, between the neck and waist. He disproved previously held ideas about deception-revelation, such as “neurolinguistic” gaze aversion: this doesn’t work reliably. In addition, he and colleagues demonstrated the inaccuracy of lie detectors: trained humans do better. His work is reminiscent of Erving Goffman’s The Presentation of Self in Everyday Life, but with greater detail. “Lies” or deceit are more difficult to cover when the issues are emotionally more charged. (10) One can also use this method to determine when people tell the truth (Ekman, 1997).

Recently, Ekman and colleagues have expanded work on negative emotions, working with Tibetan Lamas, celibate men who have meditated daily for several decades. They have mastered a form of internal scanning to monitor and control emotions. One finding will be presented here. During EEG and physiologically monitored experiments in a laboratory, while the Lamas were exposed to adverse experiences, they showed initial EEG evidence of negative emotions, such as anger; this was quickly squelched electroencephalographically and before the Lamas could become conscious of the emotion (Lutz et. al., 2004). Ekman, their recent book, speculates that someone who has focused on controlling (via meditation) usually-unconscious (or preconscious) act, such as breathing, walking or eating, may also be able to extend this radar-like screening for “incoming missiles” of negative emotions, thereby foreshortening the overt response. Whether this is closer to suppression or repression needs further study.
Read my lips (and my brows and my cheeks)
Even limiting our study of emotions to facial expression, matters are not simple. Professionals whom we would expect to read hidden (facial) emotions accurately, do no better than chance (psychologists, police, judges, and others, except for the C.I.A.). The research group has devised a computer program to assess, then train viewer’s accuracy on reading facial expression of emotion (Microexpression Training Tool; METT-2, 2008) (11). For instance, a senior psychoanalyst achieved 84% overall accuracy on pre-training for micro-expression of seven emotions; but, he ranged from 75% on three emotions to 100% on four. After reflecting on his inner inhibitions to more accurate perception of these three emotions, he took the 30-40 minute training session and achieved 100% accuracy on all seven emotions. That is, a trained analyst did not achieve enhanced accuracy on reading facial emotions until examining why he missed certain emotions, then training up to improve performance.

The METT-2 measures accuracy of reading only seven emotions. In analysis we deal with many more and with combinations and without reading the face. How much more challenging, how much more expertise in both reading oneself accurately (including blocks against reading certain emotions) and reading the analysand accurately; all this before we can be prepared to make an observation, let alone an effective interpretation. Imagine, for the moment combinations of emotion in the consulting room: the tears of joy or relief; the mix of anger and contempt (the only unilateral facial expression of emotion); the laughter in a moment one expects sadness.

Here are several considerations for psychoanalysts from Ekman’s findings. Why do people tend to miss certain micro-expressions, particularly deceit or negative emotion? In general, we elide, edit-out, quite simply miss these clear signals in order to maintain a sense of believing the speaker, or sustaining politesse. An extreme example of this is a study of Munchhausen’s-by-Proxy, where there is a long line of professionals who “miss” life-threatening abuse. Szajnberg et. al demonstrated that when two observers are present, with one interviewing the known perpretrating mother, the engaged observer does not believe that the mother is guilty, an as-if personality inducing countertransference confusion (Rusakow, et. al. 1993; Deutsch, 1942). But, analysts can extend this work on self-deceit, using our understanding of repressed unconscious, whether due to wishes, phantasies, fears, representations, or signifiers. Emotions research simply sharpens our ability to notice when self-deceit occurs; the analytic work then pursues the why and what is being held back.

Our work is enriched (both complicated by and enabled by) gauging emotions via gesture, body shifts, vitality emotions, vocal prosody and of course, words, including whether the content fits the tone (as in irony or sarcasm). Our personal analyses prepare us to read ourselves more accurately; evenly hovering attention, or reverie (Ogden, 2005) gives us breathing space within which to attend to both our emotions and what is evoked in us during our work. Words in particular, as Stern suggests in his developmental study of self, may distance ourselves from our earlier selves (1985, 2005).

Analysts may be concerned with patients deceiving us about emotions: however, our greater challenge is self-deceit (the analyst’s and the analysand’s), particularly if this is
unconscious. At those moments, we need be more accurate about “reading through” the self-deceit and re-presenting this to the analysand.

For example, a young mother in analysis had for some weeks complained about her intrusive, jealous and denigrating mother-in-law. The analysand recognized her anger. But, as we listened, there was a tone of quiet terror in her voice, one familiar from earlier in her long analysis. When the analyst mentioned that there seemed to be also a tone of fear, she silenced, then whispered, “She gets under my skin.” This, we both knew, referred to early molestation by a relative. The anger had been present and more conscious; but it was the terror intruding into the present that evoked past fears.

In more familiar analytic terms, one of our basic analytic tools is empathy (Einfuhlung — “feeling into”). As such, we need be as accurate as possible at identifying the patient’s feeling (Gefuhl) into which we are trying to feel.

Child work is more face-to-face. Child analysts learn to read the child’s face, body, posture, gesture, in order to understand the child’s feeling states. While E. James Anthony wrote of trying to achieve the ideal “sessile position” (Anthony, 1977) for the analyst — trying to stay seated for much of the session — most of us know the bodily feeling of tuning our physical responsiveness to the child’s cues. (Paradoxically, child work may be more challenging, in that it permits the analyst less time, less space to guage what is happening with emotions.) In this sense, reading and responding to children’s feelings brings us closer to Freud and Hoffer’s concept of the first ego as a body ego — and that body ego endures, Piaget suggests, as a framework for all earlier phases of cognitive development (Piaget and Inhelder,1969) and Stern for self development (1985).

After laying-out the apparent simplicity of Ekman’s study of the basic emotions, I have layered and imbricated the complex challenges we face: psychoanalytic work on reading,
feeling, responding and interpreting emotions — both our own and the analysands — over the course of an hour, and over an analysis.

What Does this mean for Psychoanalysis?

So what? Some analysts argue that all work done outside the consulting room, outside the frame of transference/countertransference is irrelevant to psychoanalysis (Green, 20005). But, let us think further.

When Wallerstein asked whether we could find a common ground in psychoanalysis, a meeting place, an agora, where we can join in discussion, find a common ‘language,’ he did not stop at this appeal. Rather, he proceeded, using consensus from international colleagues, to find: that we can agree that “character” is a major clinical focus in psychoanalysis; that we hope and work for change in troublesome aspects of character; that we can come to reliable agreement about seventeen aspects of character. (12) He first achieved reliable cross-cultural agreement about seventeen aspects of character. Then, Leutzinger-Bohleber and colleagues (2003), in a landmark study, demonstrated that character shifts post-psychoanalysis could be documented. That is, we have the ability, should we desire, to discuss character as a phenomenon about which there may be consensus. (13)

Here, we try to present another area of consensus: emotions and their embodiment. Emotions are the same across cultures. This we share. What differs culturally to some degree is what ignites certain emotions and, to some extent, which emotions do certain cultures try to suppress (or emphasize). In the first case, we know from Ekman’s work that specific events also universally elicit certain emotions. Shown a sad face and asked to tell a story about what might cause this expression, the New Guinea stone-age man
cites the death of a child, maybe a wife. But, other emotion elicitors are culture-specific: shown a face displaying disgust, this same man will describe coming across a rotting boar in the jungle: while we may understand the look and smell of disgust, few of us would cite spontaneously boar putrifaction as a disgust evoker. Skewered, roasted scorpions in a Beijing street market evoke lip-smacking among natives and disgust among (some) visitors. As usual in matters human, things are not so simple. This is an example of how ideas (roasted scorpions) may evoke different emotions in different cultures, an elaboration of Freud’s distinction between emotion and idea mentioned earlier.

Another significant objection: Ekman’s observations are on facial expressions; how is this relevant to adult analysis: we don’t use faces to assess emotion?

At least two responses: first, the face is perhaps our most articulate instrument of emotion expression to others (Darwin, 1998; Ekman and Rosenberg, 1997). This makes evolutionary sense: well-muscled, well-vesseled, the face is built to “tell” others what we feel, and do so rapidly, efficiently and (perhaps unfortunately) despite ourselves. Developmentally, this is certainly true: infants express basic emotions (such as happy, sad, disgust, fear, surprise) well before they have the words to say it. The face is but an expressor of the feelings within; psychoanalytic technique is built upon transforming both feelings and thoughts into words. The process of this transformation alone may be therapeutic, shifting us towards greater symbolization, literally towards better articulation. Psychoanalysts care most about the emotions, not the muscles of the face nor the blood-vessel nor the galvanic skin responses associated with the feelings. We learn from Ekman about emotions, not simply what “facial action systems” are being activated. In fact, one of his most technical books is entitled, What the Face Reveals (Ekman and Rosenberg, 1997), emphasizing that the subject here is emotions not grimaces. Put
simply, to describe Ekman’s research as only about facial expression, is like describing psychoanalysis as only about “words”: both settings — emotion research and psychoanalytic research — use the best available signs to guide us on the roads and the detours of inner life.

Second, while Ekman grasped that the face, our physiology, gesture and emblems.(14) One of Freud’s major contributions is to show the deep correspondance between our inner lives and our bodies; Erikson’s elaboration of Abraham’s ideas about development can be understood as how our psyche makes sense of the changes in our bodies, at least through adolescence (and then into pregnancy and senescence). Frankly, at some level, learning from Ekman about bodily articulation of emotions brings us back to our psychoanalytic, bodily origins. This paper does not imply that analysts need learn or use physiological measures to understand emotions: quite the contrary, Ekman’s overall aim is to permit us to read ourselves and others more honestly and accurately in vivo. Ekman’s oevre is about emotions, not simply faces, nor even gestures.

Emotions Heard and the Present Moment

Words help interpretation, how we transmit what happens in the consulting room, between analysand and analyst, within our minds. But, as Stern demonstrated (1985, 2005), prosody — the sing-song, the sine waves of our voice — underlie words. Stern demonstrated a logic of prosody with parents and infants. When a mother asks, “You hungry, tired?” she does so with uplifting half sine waves. To quiet or reassure, mothers use descending half sines, “That’s O.K. Mommy has food for you. O.K., O.K.” And when mothers recite and want to keep the baby’s attention, a serious of continuous full sine waves emit: “Yessss. We’ll get dressed, then the stroller, the with auntie Lily we’ll go the park and watch the swans….” This is early. Babies begin their “speech” before words with sing-song. So too, to some degree we hear this in our voices or our analysands. Imagine for a moment giving an interpretation in a flat monotone. Prosody too can be somewhat cultural: when we were studying affect attunement among mothers and infants, we found that the attunements tended to be more toned-down among British Isles mothers as opposed to American-Hispanic (Stern, personal communication). Or, in the U.S., a Minnesotan’s statement of fact may end in an upward cadence; this is heard as an interrogatory along the Northeast, lending a touch of ambiguity in a Manhattan analytic office.

Prosody is connected with feeling-tone, part of what Stern called “vitality affect” — liveliness, enthusiasm, phlegmatic, calm — as opposed to the “discrete affects” about which we have a more familiar vocabulary (sad, happy, angry, etc..) and unlike mood, which has a longer-duration quality (1985). While this paper focuses on the more discrete emotions, we don’t ignore the degree to which daily speech transmits, via prosody for instance, feeling-tones that explicitly or implicitly slip into our consciousness or unconsciousness. Freud (1915, p 194) asked how the unconscious of one person reacts to that of another “without passing through consciousness.” Prosody, the feeling-tone, the emotion, let us say of the music beneath the words may be one route. Robert Pinsky described poetry writing and reading as a very physical act (Pinsky, 2008); perhaps so too there is a poetry of the soul that we call psychoanalysis. Stern, in The Present Moment (2005), painstakingly elaborates how we can construct meanings from a three to ten- second episode in the consulting room, provided we attend to the feeling tones and the content of what is said. Psychoanalysts can extend Ekman’s findings on discrete emotions with Stern’s elaboration of vitality emotions to help identify more clearly what is going on in the session — within the analyst, within the analysand and between them.
A first step — this is the intent of this paper — is that we more accurately identify the emotions hovering in the office.

Freud’s three criteria for a decent interpretation are almost Aristotilian: content, timing and delivery (1915). Delivery includes the emotional tone beneath the words, how they are borne. This vocal tone is related to Stern’s study of prosody and vitality, the sing- song beneath or even delivering our words. this sing-song is closer to the body physicality of feelings, as is true of poetry (Pinsky, 2008). We embody our words with feelings; our feelings are very much embodied.

What is true of interpretation may be true of the analysand’s own interpretations or observations. For instance, the words of this analysand following the birth of her first child, when read, may partly explain the analyst’s reaction; when heard, they are clearer: “I would not have lived long enough to become a mother without my work with you,” said by a woman some 15 years after beginning five times weekly treatment at seventeen with an extensive delusional system, self-cutting, self-burning and eating-disordered. The reader can imagine the prosodic, whispered but felt tone of the sentence that resulted in the analyst feeling a poignance, touched with inner tears. Freud, a man of science, insisted (1915, p. 168), “No physiology.. or chemistry can give us a notion of (latent states of mental life).” But, the emotions that evoke the physiology may begin to explain, particularly as we can connect them with mental content (Vorstellungen). Ekman’s work, particularly when collated with Stern’s dissection and exploration of what occurs in a consulting room in a tree-to-ten second exchange, gives us purchase on how to teach the more abstract phenomenon “empathy” in more discrete steps, such as learning how to read our universal emotions.

Here is an example of this brief “present moment” and the opportunity that evenly hovering attention offers us to read ourselves. This example will sound familiar to many analysts. At the end of a session, in which the analysand — with a long history of borderline traits — continued to talk, then spent time gathering her belongings, then folded the Matisse blanket on the couch, then fluffed the pillow. Finally, she turned to the analyst and said coldly “You hate me!” (Winnicott, 1977). The analyst realized that he felt irritated (that the patient ran over and he had a young child waiting to see him), but did not feel hatred — a different set of sensations than irritation. He could tell this woman that he was irritated that she delayed leaving, but did not feel hatred towards her.

We have a common felt vocabulary. That is, identifying discrete emotions and how we try to both suppress and reveal them facilitates our work. Because our emotions are universal — the analyst in Argentina understands fully well emotions such as joy, anger, sadness, even awe, as does the analyst in France, America or Germany, even if the word representations are different — “joy, alegria, joie, Freude“. When we listen, we also hear emotion, we even may feel it.

A Training application: a transparent assessment of clinical work
Tuckett’s article, “Does anything go?: Towards a framework for the more transparent assessment of psychoanalytic competence” (2005) is a disciplined attempt to find methods to assess candidate clinical ability in a pluralistic field. His group evolved three areas of consensus to assess ability: 1. participant-observer stance; 2. conceptual framework that is not over-intellectualized; 3. interventional frames, which include emotional tone, coherence and non-intellecutalized intervention. Tuckett’s group assessed balance of the analyst’s interpretation’s affect/intellectual illumination and “appropriate emotional tone.” Knowing that emotions are universal, means having greater agreement about reading and assessing emotions, including emotions denied or hidden.

Emotion reading is done quickly, done often. Yet, ironically — from Ekman’s work and from our rich clinical work — emotions may be missed or misinterpreted. In Telling Lies (Ekman, 1985) and “Why don’t we catch liars,” (Ekman, 1996), he showed that we often miss subtle, but present signals of “deceit”, particularly in intimate situations for various reasons: to “protect” the relationship rather than see, hear, feel the true emotions expressed. We expect psychoanalysts to be experts in reading such (self)-deceit; it is the substance of our clinical work. Yet, emotions researchers have shown the that psychologists, among others, are not so adroit at reading “deceitful” emotions. How do we help the analysand have a true reading of oneself, not continue to live with a predominately false self, rather, to be and feel as true to ourselves as humanly feasible? The psychodynamic reasons for self-deceit in particular, can be multiple; but these can be pursued only after we are better able to read the underlying emotions.

This paper leans on emotions research to suggest basic forms of clinical supervision and training closer to Stern’s method in the Present Moment (2005). But, rather than Stern’s recounting and reconstructing the internal events that occurred over a three to ten second “present moment,” we focus on identifying the emotions present in the consulting room — both those in the analysand and those evoked in the analyst. With defensive processes, we would anticipate and analyze more surface “deceits” and the underlying emotions. In a sense, this would be a form of analyzing false social and true selves, using emotions as markers (Winnicott, 1974; Giovacchini, 2000). We could use the emotional profile (for instance, reaction formation overlaying anger) as a road to identify, explore and explain the multiple false/true selves with which we live (Giovacchini, 2000). This
brings us closer to emotional empathy, that subjective phenomenon, which now can be more objectively identified.

Others — including Bion (2005), Ferro (2009) — have explored the transformation from emotions to thoughts: this goes beyond this paper, which is an appeal to begin with basic emotion recognition. We can have greater certainty about teaching the transformation from emotions to thoughts, once we have some consensus about identifying the emotions in the consulting room. Further, embodying emotion raises the further exploration of the traumatic origin of cognitions and fantasies about the reason for our suffering. This extends beyond the fundamental aims of this paper.

Returning to Tuckett’s challenge — finding consensus on judging clinical work — psychoanalysts could agree upon reading emotions accurately, one’s own and one’s analysand’s. This ability is very basic, like singing on-key for a performer. Reading emotions well should lead to clarity. This would be one among other aspects to assess the quality of clinical work, such as: those outlined by Tuckett; the consensus about character structure demonstrated by Leutzinger-Bohelber and Wallerstein et. al.; assessing the transference/countertransference via attachment (Szajnberg and Crittenden, 1995; Fonagy, 2001). Of course, accurate emotion reading is not just to assess candidates’ abilities; it is part of our daily work. Assessing, reading, feeling emotions accurately — particularly those which are hidden form ourselves or mixed with other emotions — is where we can have more grounding in the bodily origins of our emotions, and agreement across cultures, in our “body analytic,” our pluralistic psychoanalytic “cultures.”

Anthony, E. J. (1977). Nonverbal and Verbal Systems of Communication — A Study in Complementarity. Psychoanal. Study of the Child, 32: 307-25.
Bion, W. (2005). The Tavistock Seminars. London: Karnac
Boyer, L. B. (1989) Countertransference and Technique in Working with the Regressed Patient: Further Remarks. Int. J. Psychoanal., 70: 701-14.
Dalai Lama and Ekman, P. (2008). Emotional Awareness: Overcoming obstacles to Emotional Balance and Compassion. Henry Holt.
Darwin, C. (1998) The Expression of the Emotions in Man and Animals. Oxford.
Deutsch, H. (1942). Some Forms of Emotinal Disturbance and their Relationshiop to Schizophrenia. Psychoanal. Q., 11: 301-21.
Ekman P and Freisen, W. V. (1969). Nonverbal leakage and clues to deception. Psychiatry, 32, 88-105.
Ekman, P. (1985). Telling Lies: Clues to Deceit in the Marketplace, Politics and Marriage. NY: Norton.
Ekman, P. (1996) Why don’t we catch liars? Social Research, 63, 801-817.
Ekman, P. (1997) Expressive Behavior and the Recovery of a Traumatic Memory: Comments on the Videotapes of Jane Doe. Child Maltreatment 2:2 113-116.
Ekman, P. and Rosenberg, E. (1997). What the Face Reveals. Oxford.
Ekman, P. (2003) Emotions Revealed. NY: Holt.
Fonagy, P. (2001) Attachment Theory and Psychoanaysis. Guilford.
Ferro, A. (2009) Transformations in Dreaming and Characters in the Psychoanalytic Field. IJP. 90: 2; 209-30.
Freud, S. (1926). Inhibitions, Symptoms and Anxiety. SE. XX. p. 77-178
Giovacchini, P. (2000). Impact of Narcissism: The Errant Therapist on a Chaotic Quest. NJ: Aronson.
Goffman, E. (1990). The Presentation of Self in Everyday Life. Penguin
Green, A. (1999) The Fabric of Affect in the Psychoanalytic Discourse. Routledge.
Hoffer, W. (1950). Development of the Body Ego. Psychoanal. Study of the Child, 5: 18-23.
Laplanche and Pontallis (1973). The Language of Psychoanalysis.
Lasch, C. (1979) The Culture of Narcissism: American Life in an Age of Diminishing Expectations. Warner.
Leutzinger-Bohleber, M., Stuhrast, U. Ruger, B. Beutel, M. (2003). How to study the quality of psychoanalytic treatments and their long-term effects on patients’ well -being: A representative, multi-perspective follow-up study. Int. J. Psycho- anal. 84: 263-90.
Levenson, R. W., Ekman, P., & Friesen, W. V (1990) Voluntary facial action generates emotion-specific autonomic nervous system activity. Psychophysiology., 27, 363-384.
Lutz, A. Greischar, L. Rawlings, N Ricard,M and Davidson, R (2004) Long-term meditators self-induce high-amplitude gamma synchrony during mental practice PNAS Nov. 16, 2004 vol. 101 no. 46.
Ogden, T. (2005). This Art of Psychoanalysis: Dreaming Undreamt Dreams and Interrupted Cries. New Library of Psychoanalysis.
Piaget, J. and Inhelder, B. (1969) The Psychology of the Child. NY; Basic.
Pinsky, R. (2008). Memory and Modernism. J. Amer. Psychoanal. Assn., 56: 1081-7.
Rostovtzeff, M. (1963). Greece. Oxford.
Rusakow, L., Gershan, W., Bulto, M., and Szajnberg, N. (1993). Munchausen’s Syndrome Presenting as Cystic Fibrosis with Hemoptysis. Pediatric Pulmonology, Vol. 16:326-329.
Szajnberg, N. and Crittenden, C. (1997). The Transference Refracted Through the Lens of Attachment. J. Am Acad. of Psa. 25: 3, 409-438.
Tuckett, D. (2004) Does Anything go?: Toward a framework for the more transparent assessment of psychoanalytic competence. IJP 86: 31-49.
Wallerstein, R. (1990). Psychoanalysis: The Common Ground. Int. J. Psycho- Anal. 71: 3-20.
Wallerstein, R. Dewitt, K. Hartley, D. , Rosenberg, S. Zilberg, N. Scales of Psychological Capacities. Unpublished MS.
Winnicott, D.W. (1977). Maturational Processes and the Facilitating Environment. Karnac.

1 These emotions have specific behaviours (e.g. gaze aversion and eyelid lowering for shame) and physiologies without having universal facial expressions.
2 The latter two are mostly obsolete, but these are useful to understand the historical roots and tendency of the word. For instance, under the sixth definition is “To put on a pretense of … assume a false appearance of; to counterfeit or pretend.” We use this to describe someone with an affected air, let us say, of an aristocrat. This definition has more in common with “persona,” the mask Greek actors use to “display” a “personality” — one’s social presentation (an aspect of false self) — as opposed to “character,” something “engraved” in one’s self, which may be closer to the “true self” (Winnicott, 1974).
3 The concept of a “transference from one place to another” echoes Freud’s earlier idea of affect emanating from impulses, a concept developed by contemporary French psychoanalysts (Freud, 1926; Green, 1999).
4 Here, I will not discuss anxiety, both its position relative to affect and emotion and its position in our inner lives. In fact, anxiety has a priviileged position both in Ekman’s work and in psychoanalysis, a position not entirely within the category of affect, but not entirely outside “feelings,” as by definition, it is felt, and by extension, it has some relationship to emotions (Freud, 1926). For Ekman, anxiety has components of fear (facially and physiologically), but is not the same; unlike fear, Ekman, following both psychoanalytic and pre-psychoanalytic thinking, anxiety has no (obvious) external object; fear clearly does. However, this would take us beyond the confines of this paper’s exploration of emotion and psychoanalysis.
5 This tribe was also being studied by Gajdusek for their neurodegenerative Kuru, which he demonstrated was due to their cannibalism of their relatives who had died of this slow-virus.
6 When Mead wrote a review of Paul’s first book, she emblazened the review with the title, “THE APPALLING STATE OF THE HUMAN SCIENCES.” One doesn’t have to be a psychoanalyst to hear the “Paul” in Appalling.
7 For instance, he identifies “awe” as an infrequent, but powerful emotional experience.
8 Gesture and emblems are more culture-specific body movements. For instance, folding the arms across the chest may mean holding back information in certain cultures in certain situations (and may mean other things also). That is, these do not have the universal and rapid presentation that facial expression has in displaying emotions. On the other hand, deceit may be uncovered by catching such behaviors, among others. But, this takes us beyond this paper.
9 In an early study, a professor stressed students in individual interviews. For instance, a female student maintained outward equanimity, but unwittingly “gave the finger” to the professor. Intriguingly, when Ekman described this to them, both denied that it had happened; only when they watched the film, did they see it.
10 In this author’s experience, for instance, an attorney for a wealthy alleged child molester challenged the author in Court to assess whether the attorney was lying. He asked, “Is my middle name Roderick?” The author responded, that he could test the attorney’s truthfullness, but the question needed to be more important to the attorney, such as “Your client has molested this child, Yes or No?” The attorney refused to continue.
11 This is a computerized series of actors showing specific facial expression of emotions at various speeds. The program first tests the observers reliability reading emotions. Then, after a training period, retests.
12 These are: Hope; Zest; Attribution of responsibility; Flexibility; Persistence; Standards and Values; Relationship commitment; Empathy; Affect regulation ; Impulse regulation; Sex regulation; Self Assertion; Reciprocity; Trust; Empathy; Self assertion; Rely on self/others; Self esteem; Self coherence.
13 I use the term “character” rather than “personality,” which is more commonly used in the psychiatric terminology. Both words have ancient Greek origins. “Character” refers to something that is etched or engraved in us; Personality, from “persona” refers to the mask used by actors to portray someone. Heraclitus insisted that character was destiny (even as he also said that one could not dip one’s foot in the same river twice): that is, he suggests that character is ingrained and determines one’s fate. Psychoanalysis being psychoanalysis would be more interested in one’s character than in persona. One dilemma: while we may have consensus about assessing character, we may have greater challenges across cultures assessing what is optimal or healthy character. For instance, Lasch in his stunning assessment and critique of American society in 1974, found that there was a new prevalence of narcissism as a valued character trait (not just a psychopathology); he connected this with changes in American capitalism and bureaucratization of government and industry, associated with a weakening of the family, loss of presence of fathers and rise of valuing appearance and “getting along, over previous values associated with a meritocracy. That is, if Lasch is correct, the sudden interest and rise of Narcissistic Personality Disorder in the 1960’s may have more to do with cultural drift in American society and its values, than with a “discovery” of a previously “hidden” phenomenon. If we pursue Lasch’s challenging ideas, different cultures may value different character traits. Then, we might expect possibly different goals in psychoanalysis in different cultures. But, this takes us beyond the bounds of this paper.
14 An emblem is “a gesture that has precise meaning known to all members of a cultural group such as the A-OK emblem in the U.S” This same emblem in Sicily refers to a perverse sexual act. (Ekman, personal communication).
15 In an intriguing study, Levenson, Ekman and Friesen (1990) found that holding one’s facial muscles in the pattern of specific emotions (a sad face; a happy face, resulted after some minutes in the evocation of the emotions The researchers discovered this first on themselves, much as Harvey first explored blood flow in his own arm — or, Freud on his own dreams.

Leave a Reply

Your email address will not be published.