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Folks, hello. Welcome back to The Testing [00:01:00] Psychologist. We’ve got a clinical episode for you today, and it is really good. I’m talking with Dr. Ben Morsa. He’s a psychologist in private practice in Oakland, where he provides psychological assessment, psychoanalytic psychotherapy, and consultation. He founded the group psychology practice, Tide Pools, in 2022. He’s currently working on a book called Farewell Diagnosis: Diffracting Psychoanalysis, Assessment, and Autism, which is under contract with Bloomsbury.
This is a fascinating conversation as you can tell from the title. We talk about marrying psychoanalysis and assessment, which on the surface might seem like a tough marriage, but after this conversation, I hope that you might arrive in a different place. I think that Ben and I get into a number of topics that are both fascinating and useful.
So we talk about some background in psychoanalysis [00:02:00] and what “modern” analysis looks like these days, we talk about the Rorschach as a natural bridge between analysis and assessment, and we talk about a number of analytical concepts or tools that we can employ in the assessment process that dovetails really well with my recent conversation with Dr. Stephanie Nelson and some of the other conversations on this podcast around doing a depth based assessment that goes beyond diagnosis.
I want to make sure and mention, because we don’t mention it during the episode, that Ben and a colleague are doing a day-long workshop at the SPA Conference in late March. If you are headed to the conference or maybe want to head to the conference for this workshop, I would highly recommend it. You can go to the SPA website and register for that workshop, and check it out. I hope that you find this conversation as [00:03:00] stimulating and compelling as I did with Dr. Ben Morsa.
Ben, hey, welcome to the podcast.
Dr. Ben: Thanks, Jeremy. Great to be here. I have been a long-time listener and eager to get it into our conversation today.
Dr. Sharp: Hey, yeah. Me too. I’m sure people see the title of this episode and wonder how we are going to marry psychoanalysis and assessment. And if I’m being honest, I’m wondering the same thing. I’m excited to have this conversation and see where we go. So thanks again.
I’ll start with a question that I always start with, and that question is, why this? When we’re talking about a podcast episode or even how you spend your life and your energy, why choose to focus on this particular topic?
Dr. Ben: Great [00:04:00] question. My undergraduate; first half of it, I was at a school that was very STEM intensive and so I did math, a lot of engineering, some pretty crunchy science. There was a part of me that always really loved and enjoyed that. The second half of my undergraduate experience was much more social science, humanities, philosophy. So I went in a very different direction, but ended up really loving both.
And that all came back around when I went to graduate school. My intention was to study psychoanalysis, to learn how to practice. I did that by way of becoming a psychologist. So I chose a clinical psychology program that was psychoanalytic in orientation, which was definitely still present, but not as common as it was maybe 40, 50 years ago in [00:05:00] clinical psychology training programs.
And so I showed up to my interview and the person interviewing me was like, clearly you’re interested in psychoanalytic and psychodynamic work, but you are aware that this program has a significant emphasis on assessment, yes? And truth be told, I was aware, but I was really hoping we wouldn’t get to that topic because I did not know nothing about assessment. I think I linked back to this experience of math and science, and curious about quantitative stuff. I must not have spoiled it too badly because I kept obtaining my doctorate there.
But it was something about my graduate training that really taught me about the possibility of having these two seemingly very different types of work in conversation with each other. Something about seeing that [00:06:00] modeled and present, and also learning about some of the history of folks who carry those identities; folks like Roy Schafer, more recently Phil Erdberg of the R-PAS world. He was what’s called a research analyst. So he was an analyst, but that was back when institutes kept things in a tiered system and you had to be an MD to be recognized as a true analyst.
Through a lot of rooting and digging around, I’ve found both other people who practice both, and a kind of training in early developmental community where I got to play with both. So that’s really what got me into once I got a taste of that, here I am.
Dr. Sharp: That’s fair. I’m curious about the state of analysis these days. I’m assuming, you look young and cool. People can’t see you have a mullet. It’s a fabulous mullet. And that tells [00:07:00] me that you maybe went to graduate school sometime in the last 10 to 15 years. I’m curious about the state of analysis these days and how it is being presented in graduate programs being that in my mind, we’re a long way divorced from the time when analysis was popular. So what was that like and how’s it showing up in graduate programs now?
Dr. Ben: That’s such a great question. I’m glad we’re getting into this topic because like a lot of systems of thought and practice that enjoy their moment in the spotlight, there’s a rather arrogant history to psychoanalysis that I think many people respond to and many folks are understandably put off by. Analysis is much more than that narrow slice of experience, and I think particularly in the contemporary moment.
I imagine a [00:08:00] number of your listeners, maybe you are familiar with Nancy McWilliams. She’s a psychoanalyst out of Rutgers. She’s written now a quantity amount of essential text, psychoanalytic diagnosis, psychoanalytic psychotherapy, psychoanalytic case formulation. She released one on supervision during COVID.
She’s someone you can look at on YouTube and you can listen to her talk about, she’s talking about analysis, but she doesn’t draw a hard line between analysis and therapy, which already represents something new in analysis where we’re much more flexible in how we think about it. When you listen to McWilliams talk about it, it’s everyday language. It’s like talking to that really great supervisor you have, and you couldn’t quite put your finger on why it was just the gestalt. You learned a lot. You were well held. You took developmental risks. I’m idealizing a bit here, but I think it’s appropriate.
So I [00:09:00] would credit Nancy McWilliams and her work creating a translating bridge to psychoanalysis with any of us in millennial generation or younger finding an interest in it as a form of practice. Analysis is also active in some of our most pressing human and political questions at this time. There’s a book called The People’s History of Psychoanalysis, by Dr. Daniel Gastón-Vildó that is a good representative text of what some of the younger folks we could say are doing in analysis.
Another important effort that has come out in recent years headed by Dr. Dorothy Holmes, the former director of my graduate program, she’s directed for many years there, also an analyst. She’s been leading a commission, which has been looking into psychoanalytic institutes where a lot of analytic training happens [00:10:00] and trying to understand the lack of representation and how to make formal analytics spaces more inclusive will be a great way to summarize it.
I could go in a ton of different directions. These are my peers and my folks. They’re doing exciting things. For the listeners here, I would say, if you haven’t given the analytic world a look recently, consider dipping your toe in. You won’t have to read Freud if you don’t want to.
Dr. Sharp: I think that’s all people want to hear probably is, is it really just Freud? No, there’s plenty more to look into.
Dr. Ben: A lot of good too.
Dr. Sharp: We’ll put all those books and links in the show notes as usual so folks can go check those things out if they would like to. I wonder if we start to bridge a little bit. To me, the perhaps obvious overlap of analysis and assessment [00:11:00] is in something like the Rorschach. You tell me if that’s maybe a good place to start and if not, we can go a different direction. I’ll leave it to you.
Dr. Ben: I think the Rorschach is a great place to start with both because it’s analytic in spirit and because it has had to negotiate some of the same changes, challenges, opportunities in a shifting profession of clinical psychology. Rorschach himself, there’s a really excellent translation of his original book that was just released, published by APA. Dr. Phil Erdberg, probably here in the area, headed that project.
It’s excellent because you see a person struggling with a tool like the Rorschach, which can be so ambiguous and expansive [00:12:00] struggling to bring some kind of structure, struggling to bring some kind of common language way of testing our hypotheses to this endeavor.
Then Rorschach, the instrument, comes to the United States in the 20th century. We’ve got all kinds of different ways of coding it and interpreting it, and this is where the Rorschach gets some of its reputation of being a bit too loose when it comes to psychometric armature. That changes when we get to Exner. He did a bunch of research, he brought some of the variables into the 20th century but the most significant shift that listeners are likely familiar with would be the R-PAS, which has gone a long way towards testing and verifying these variables.
So the Rorschach has this quantitative element. And that’s essential because it’s the reality of how we communicate and look at each other’s work in the Guild of Psychology, [00:13:00] but there’s still wiggle room for some of the close ideographic, very personal, very aesthetic, and very alive dimensions that something like the Rorschach offers.
Dr. Sharp: I like the way that you put that. It’s cool to have the history. I like that we’re peppering in some history already. I love having context and understanding where things come from. So I appreciate that. You mentioned that there’s maybe an example that we could talk about that would bring this to life a little bit, would you be willing to share that?
Dr. Ben: Sure. As it regards the Rorschach, a first way we could start to think about that would be, did you as a child or maybe now with children ever play the game where you look up at clouds, you [00:14:00] say how that looks like, and you fill in the blank?
Dr. Sharp: Oh, sure.
Dr. Ben: Can I ask what’s enjoyable about that game?
Dr. Sharp: I think that it’s so variable that you get to see where everyone’s imagination goes. You get to have some sense of how they interpret ambiguous shapes and stimuli, and maybe give some insight into mood, hopes or what they’re excited about, something like that. And it’s totally wide open. It can be whatever you want it to be.
Dr. Ben: It’s this way to get to know people that leaves room for a surprise. One way that I think about psychoanalytic work is a way of approaching our work that leaves room for the patient to surprise us. You could point at a cloud and you could say that looks like this, and a group of people might look at it and say, well, I really don’t [00:15:00] see that.
So it’s not that anything goes kind of structure, but it is ambiguous enough that we can try to make some meaning. And that is how Rorschach designed the original 10 inkblots. His father was a draftsman. He wanted to create forms; human, organic, animal, these types of things that were suggestive, but not so explicit that there was a so-called right answer.
I often use this example of watching clouds because it’s a familiar enough example to most that it usually gets us into a conversation. It’s a way of helping, for example, parents think about not only this tool that I’m saying, hey, I’d like to include in part of my work assessing your child, but also the process of assessment itself.
So in this meta way that [00:16:00] Rorschach, children are a bit like inkblots, and we as assessors are looking at these different features of the blot, we’re trying to integrate them. And there are certainly some answers that are much less supported and maybe much more concerning, but there are also many different types of answers that can be useful and helpful that can activate the types of things you’re talking about. Like I’m getting to know this person. I see what their imagination is like. I might even get a flavor of how they’re feeling today or how they organize people in their life.
Dr. Sharp: I like that. I didn’t know where you were going with this cloud example, but that totally fits. We are in many ways going through a similar process as we assess kids and try to see what’s going on with them. Kids are pretty ambiguous sometimes.
Dr. Ben: Yeah. And so is our life and our life to children who [00:17:00] are in the process of development of systems and structures that they’ll use to organize their experience. A loud classroom with lots of moving pieces, with different types of social dynamics, with physical movement happening in a lot of different directions; a lot of that is ambiguous, but it’s not random. There’s some structure in there.
And so when we’re thinking about a child who’s becoming overwhelmed and unstructured class time, we’re engaging in some of this Rorschach-like exploration of trying to get a sense of how they are navigating something that’s ambiguous but not random. And that’s part of why the Rorschach has the second phase where our job is to understand not only what they saw, [00:18:00] but why they saw it that way. Part of what we look at is their process of explaining, well, this is why the blot looks like a dot, this is why the blot looks this way, or this is what I thought was going on in class when I got overwhelmed and started shouting.
Dr. Sharp: Right. As you describe it, I see a lot of parallels between this and the Montessori model in particular, where, I don’t know how much you know about Montessori, but it’s like a rigid box, but then whatever happens within that box is pretty open. It is these classroom materials that are laid out and the kids get to choose whatever they like and work in whatever way they like for however long they like, and that’s really cool. Now I’m seeing the Rorschach everywhere, I’m seeing projectives everywhere.
Dr. Ben: Okay, good. Then this is [00:19:00] what I’m going for here, because one of the things that’s difficult about talking about psychoanalysis is there are two schools of thought. There’s analysis that is about knowing, which is like, this is how the unconscious works. I’m going to make these interpretations. So the analyst reveals to the patient some truths that they were fighting not to know.
There’s also analysis that is about being; how do we support their capacity to be in everyday life? And being, when we start to see that as our goal, we’re getting closer to what I think you’re saying when you talk about the box. In jargon speak, we might call that the container. The container’s literal things like, I’m going to meet you for 50 minutes. There’s a fee for my session. There are certain boundaries in our relationship that we do not cross. That being established, there’s a [00:20:00] whole lot of room to see what comes up and to see what a person makes of that experience.
Dr. Sharp: Right. I’m going to go completely off script and maybe ask an irrelevant question, but I do that sometimes and we’ll see where it goes.
What are your thoughts on the show Shrinking, if you’ve seen it?
Dr. Ben: Can you jog my memory about it because it’s ringing a bell, but I’m not sure I have?
Dr. Sharp: Okay. So the general premise, it revolves around this group of three psychologists who are in practice together. One of them is very prone to going wildly off script. The container is a little diffuse where he’s meeting clients in public. One of his clients ends up living with him. If you haven’t, that’s okay. We don’t have to go down this path. It’s going to talk a little bit about the interplay there of the [00:21:00] container, if it’s a little bit wobbly and what happens there.
Dr. Ben: Sure. Folks will often ask me, have I seen this? There’s the literal question; have I seen it? There’s a dimension of kindness, I want you to understand enough context so that we can look at the cloud, the inkblot together, but there’s also something people are noticing when they’re bringing it in. I hear you noticing something about container boundaries, how that gets diffused, and that that’s something that’s represented in this show.
Dr. Sharp: Yes, absolutely.
Dr. Ben: This gets us to a really important question about ethics because analysis in some ways has been, siloed might be a good way to describe it. And so there’s not [00:22:00] necessarily a whole lot of broad familiarity with how it works. And so these media examples of how analysts, how therapists who might work from that orientation work are a lot of people’s point of entry and then get us thinking about what would it be like to see that person and how odd or concerning it might be to work with a therapist who might invite me to room or so. I don’t know. That one’s verboten for me. It’s not my rule.
Dr. Sharp: No, that’s fair. I think you make a good point that analysis has in either enjoyed or not enjoyed a lot of media attention. I think of all the approaches that we do, it’s probably the most depicted in media for better or for worse.
Dr. Ben: A better example might be, have you caught Couples Therapy on Showtime?
Dr. Sharp: No, I haven’t. I know what you’re talking [00:23:00] about. I just haven’t seen it, which is ridiculous. My wife is a Master’s-Level Therapist who does a lot more depth-based spiritual work with folks. And so it’s a wonder that we haven’t seen every single therapy show out there.
Dr. Ben: I feel you, sometimes we got to not watch the thing that is so on the knowns. Orna Guralnik is excellent in it. I think a good example of the modern practice of analysis, which includes you see the analyst. The analyst is no longer just the white man behind the house. And so some of these media presentations I’m a bit more fond of, my favorite would be Dr. Melfi and his fans.
Dr. Sharp: I was going to bring that up and then I didn’t want to totally, but you’re right, that’s one of the best. That’s going to stick in my memory for a long time.
[00:24:00] We’re going down a good path here where we can start to talk about the actual application of some of these analytical tools to assessment, but I would love to dig a little bit deeper into these actual tools to set the stage before we totally make that leap into the assessment world. You mentioned the container, but I know there are many others that could be relevant in our work, and I would love to just hear about some of these concepts, tools, to provide some context for our discussion here.Dr. Ben: Oh, certainly. So one of them I think about, and I imagine folks with therapy experience, whether present or in their training, might be familiar with the phrase, the slower you go, the faster you get there.
Dr. Sharp: Yes.
Dr. Ben: And that is, in my mind, a tenant of analytic work, meaning that [00:25:00] we have to toggle the pace down a bit. We have to get a little more Montessori about it. We have to try to remove some of the ways we typically structure things so that we can learn something new.
A place that I think this comes up very directly in assessment and in assessment practice is nowadays, I would say most kids I assess have already been assessed probably multiple times, and I think your experience too. Some of that is I don’t assess in the three to six range as much as I did in my training and early careers.
So you’re seeing teens, they’ve been assessed before. We refresh the data, that’s pretty typical, but reassessment sometimes looks like hopping between lots of different diagnoses like I went this place [00:26:00] for the ADHD assessment and then I followed on over here for the autism assessment, and I wasn’t really so sure. What about this other thing?
And so as an assessor, I might be looking at 3, 4, 5 different reports. They can all create reports, they can give depthful data-based insights into a part of this child, but when we scale back to look at the whole system, we might be noticing something like a process of intensification, positive feedback, where on the surface we’re talking about assessments and figuring things out, but underneath there’s some kind of fear, some kind of reactivity, some kind of acceleration that is also part of this process of getting multiple assessments and layering them on.
In some cases, that can be a bit more concerning than others [00:27:00] because sometimes when you’re looking at lots of different parts of the elephant, you might be missing a rather important elephant. I know I’m getting a little wordy with my symbols, but so the first piece I would think about is this sense of slowing down, particularly when we’re looking at multiple assessments.
It doesn’t mean disregarding them at all. It means adding to them by wondering what else is happening in the context and the ecology of this child and this family. Does any of that help me understand the history and the journey of assessment that they’ve had so far?
Dr. Sharp: Yeah, that’s fair. So you’re talking about asking big picture questions or even just observing and taking in the environment, the context, family dynamics, everything that’s gone into this kid’s history up to that point and putting the current assessment in context with all those factors. Is that fair?
[00:28:00] Dr. Ben: Absolutely. I might add to that, Stephanie Nelson uses this phrase that the secret question, and I’m very fond of that idea for two reasons:1. It’s a question and questions are so helpful in our process.
2. It’s a secret. And that implies it might even be a secret to the family themselves.
So part of what we’re trying to do is we’re trying to create a space where we can support people to put into words what the analyst Christopher Bullis calls the unthought no. So, as feeling this fear that you might carry around as a parent about your child that is partially explained by diagnosis, but there’s more residue there. There’s more depth, there’s more feeling that you’re holding on to, but you couldn’t put it into a question to an assessor because [00:29:00] it’s just that deep, or it just hasn’t had that process to come into worth yet.
I think that’s a very important space and opportunity for us as assessors, and one that you need not be an analyst to have skills to go into, though I think analysis does offer some interesting thought frameworks and keywords like the container to help us bring some language examples.
Dr. Sharp: I like that. I like to get concrete with things. So what does this look like in the assessment process? I was running through my mind, what if I just ask parents their deepest fear as they come into the evaluation, maybe that’s a little too intense, but I tend to live in extremes. So I’d love to hear how you tackle that.
[00:30:00] Dr. Ben: You have figured me out that I pull a lot of history into how I think about things. I think what you’re getting at here, how do I go about this? Could I, for example, just ask a parent, what’s your biggest fear? What kind of question does that feel like? Is that too close, too intimate, too much? Am I going to overwhelm them?Without going into the whole history; one of the biggest fights in psychoanalysis was between Anna Freud, Sigmund Freud’s daughter and Melanie Klein, for who was going to inherit the field. Melanie Klein, who I’m probably more aligned with, was of the opinion that if someone is really anxious and frightened, naming that or inviting that into words can be profoundly rounding.
I think a place that this comes up for me, that’s more concrete is [00:31:00] those cases where I start to wonder, are we looking at some prodromal functioning? Are we looking at the possibility of some incipient psychosis in an adolescent? Because that’s a very low base rate thing. We’re usually not reaching for that as our first interpretation of the data in front of us. There are a lot of other higher base rate things we want to evaluate first.
And yeah, most folks going for an assessment don’t understand what psychotic process is, wouldn’t imagine to think to look in how that might be showing up in a child’s development, and wouldn’t necessarily have a place to go to get that assessment question answered. I think when this question comes up, it’s often some deep fear a parent had, and it might be like, who is my kid? How do I understand them? How will other [00:32:00] people understand them, and will they understand them in a way that’s going to support them having a good enough life?
So, my long-winded way, Jeremy, is I trust that you could contain the response if you ask the question. I’m curious how it goes in a case, if you find yourself asking.
Dr. Sharp: Sure. I’m trying to think if I’ve ever actually asked that question. I would say that I do ask a version of that question in most intakes or interviews. Typically, it comes toward the end after I’ve built a lot of rapport, hopefully, with the family and can dive in and just say some version of, this is a scary process. I wonder if you’re worried about X, Y, or Z.
Sometimes I’ll name what I think might be a fear of theirs, and I’ll generalize it and just say, hey, most [00:33:00] parents almost always come in thinking that I’m going to tell them they’re the worst parent in the world, so if that’s running through your mind, that’s totally okay, or that it’s somehow your fault. I’ll get at it in some kind of different way. And then typically, I would say, way more often than not, parents will breathe a little bit and acknowledge that that’s part of the picture for them. And then we’re aligned and it’s out in the open.
Dr. Ben: I hear that that’s a process for you. That it’s not the first thing you’re going to ask, and perhaps because that gives you and them a chance to build an alliance, that gives you as an assessor a chance to understand how to engage with them on this question, their readiness for it. I don’t mean readiness like are they strong enough or good enough as parents, I mean in some stages in life, we might have so much [00:34:00] happening and it’s so overwhelming that getting to that level 3 question, to use a TCA term, might not be a first session endeavor. Another thing I hear you doing that I could build some analytic bridge to is diffusing the punitive superego.
Dr. Sharp: Ooh, what’s that? Let me guess.
Dr. Ben: You speak to a parent’s unconscious fantasy that you were there to punish them. That we’re going to identify with the superego, they project. Projection’s not so bad in modern psychoanalysis. It’s how we communicate, but you’re sensitive to that being a parental experience, maybe it’s something you can identify with, maybe you’ve just worked with so many parents, you know like I know that that’s one of the hard parts of being a parent is you’re so in it, you want to know that you’re doing it well, and it’s very vulnerable to go to an assessment, for example, and get some [00:35:00] information.
So I hear you naming the possibility of that projection and just diffusing it, turning the heat down on that. And that, I guess or I would imagine in many cases gives you more room and emotional safety to get to those deep fears.
Dr. Sharp: That’s the hope. Great.
Dr. Ben: That’s what we got is hope and reflection, right?
Dr. Sharp: Yeah, it’s true. Okay. Nice. I like this. We’re slowing the process down, what other tools are out there that we might pull from the analytic world?
Dr. Ben: Sure. So another that I would think about is attending to negative space. By negative space, I’m using this in the artistic sense because we all took the EPPP and I feel pretty certain this [00:36:00] was in a study guide somewhere. You remember those gestalt images, is it two people kissing or is it a vase?
Dr. Sharp: Of course.
Dr. Ben: Of course, that’s playing on this idea of positive and negative space, foreground and background. And in psychoanalysis or a psychoanalytic approach, we’re doing work to make sure that we’re thinking about the negative space because it’s so easy to get caught up in the foreground. Oh my gosh, this school year is really rough. The teacher is not a good fit with my kid. Friendships have blown out. It’s one of those types of things that might bring a person to assessment.
We want to listen to all of that and take it very seriously because it’s top of mind. It’s why someone’s coming in. So there’s more that we can add to that. There’s more in this space in between. And to try to make it [00:37:00] practical, this connects with slowing down. There’s the early assessment process before someone has even signed an agreement and formally engaged the assessment.
And so in my practice, we think a lot about what is happening in that initial phone call. What is happening in that initial message? We’re not just listening for scope of practice and potential questions, we’re trying to better understand the context of a parent, of a child, of a family because something about that context will help us to create a fuller texture in the same way that you need the white space on the Rorschach blots for the inkblots to appear for them to be right there.
Dr. Sharp: I like this. And so how does that show up? Again, just bringing it to life, [00:38:00] can you give me examples of what that looks like figuratively when we’re paying attention to the negative space even in the phone call or even in the interview or during the assessment process?
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All right, let’s get back to the podcast.
[00:40:00] Dr. Ben: Sure. This is what I think about because it’s one I’m vulnerable to falling into. I call it the 3-minute voicemail or the multiple voicemail, where you get a voicemail and it runs out the time on your voicemail, and then you get another voicemail after that. This raises a lot of questions for, okay, what is happening here? What can I already begin to get curious about?I might pull for some other information too, like how am I feeling when I listened to this? Because, for me, I’ve noticed that a countertransferential process I really need to pay attention to is if I listen to a voicemail and I have the immediate urge to call the person mad, even in some totally unrealistic way, like I’ve got a session in 10 minutes. That’s not going to occur, [00:41:00] but if I feel that urge, if I start to imagine like I’m coming to the rescue, but I have no idea what that would be or what it looks like, this helps me to think about this case in a different way.
For example, this might not be the kind of case where I ask the parent, what’s your greatest fear about their child because they may be in a state of too much happening in the system, too much flux and flow for that question to be helpful, it might just be overwhelming and disorganizing. So we have our checklist of things we go through in these business processes, like, oh, it’s a new call. What’s the question? What’s our availability? When do they need it?
We’re doing this intake in triage process, but I guess what I’m trying to emphasize is there’s already clinical material in those initial moment, and we shouldn’t [00:42:00] jump to conclusions really heavy handed interpretations, but if we listen to that information, if we start to get curious about it, it opens up a whole other channel of observations.
Dr. Sharp: Okay. I like where we’re headed with this. Yes. Okay. So what’s next? We’ve got the negative space; do we have more tools that we can work with?
Dr. Ben: Sure. So another is, oh gosh, I’ll ask you because you mentioned this when we had our first conversation. Would you be willing to share your experience about Beyond?
Dr. Sharp: Oh, yeah, I will. I don’t know that it’s going to live up to the hype here, but I will share my experience there. Yes. So to provide some context, I think I told you in our initial call that [00:43:00] my wife and I, who I mentioned already is a therapist and she’s a group therapist specifically, she specializes in group work.
I’m sure this guy beyond is a pretty powerful figure in the group space. I don’t know much about him. I’ve only had this ancillary contact. And so we went to the American Group Psychotherapy Association conference. This was 15 or 17 years ago. We were not married yet, but we were engaged.
And so we get into this workshop. Just a disclaimer for anyone out there who wants to go to the AGPA conference, any workshop will turn into a therapy group. The boundaries are diffuse. The container is pretty diffuse at this conference. So [00:44:00] we didn’t know this. This was our first time. We’re young. We’ve just graduated.
And so we go to this conference and we end up in this workshop together, and it turns into a therapy group. And so we are in this group with maybe 15 or 17 other people. Halfway through the group, somehow we disclose that we’re engaged and together. And the group at that point, and it was based on Beyond’s approach to group work. That’s how he comes into this story. Our group leader referenced his approach several times.
So we disclosed that we’re together, we’re engaged. Somehow that comes up and immediately the group turns on us and we become the scapegoats for the group because we’ve snuck into the workshop and we are an energy system that is more aligned with one another than to the group and people [00:45:00] went nuts. We were deer in the headlights, what the hell is happening right now, and why aren’t we learning about the thing we wanted to learn about?
Anyway, that’s the story and it ended up pretty poorly. We ran out of that conference and we’ve never gone back. That’s my experience and my brush with Beyond and his group.
Dr. Ben: Thanks for being open to share that because I’m guessing you haven’t picked up any Beyond sense.
Dr. Sharp: When we got back home, I did dig into it a little bit and read through some of the theory and the work, but it’s been a long time.
Dr. Ben: Okay. I wonder how many of these types of experiences listeners have had in some kind of relationship with psychoanalysis, and the experiences, because I’m familiar with his work, I imagine where they’re going is, [00:46:00] you and your then fiancé, you were a primal scene. You were like the parents in the Oedipal scenario. You represent some kind of knowledge or alliance that they’re necessarily excluded from, and then the manner of primary process breaks.
Dr. Sharp: That’s great. That’s probably why.
Dr. Ben: It makes me curious about the container in this experience of yours. Your face says it all. Because if there’s a container, we can go into that. We can fall apart. We can see just how charged and powerful feelings can be in groups. The other part of Beyond is he uses this word metabolites. The analyst, the parent, the assessor, part of what we have to do is take in what the patient or the group or the child, whoever we’re working with is throwing [00:47:00] at us and digest it a bit and give it back to them, and that they can take it.
Dr. Ben: That makes sense. I like that word. I think we do that quite a bit. Yes.
Dr. Ben: Yeah. I think a lot of it is naming stuff that is probably already part of people’s practice. There just isn’t an analytic jargon attached to it and there need not be. I brought in that piece about Beyond because he has this phrase where he says every session should begin without memory or design.
Of course he’s talking about analytic or therapy sessions and on the one hand, that sounds less might be a reaction it would have because it’s like, what do you mean without memory and desire? [00:48:00] I’m supposed to be tracking the course of treatment and if I don’t desire to help this person in some way, well, then why am I here?
But he’s offering it not in such a literal way, but as a meditation to say, can you start to notice the frameworks that you bring into a space? The heuristics that you use to understand what is happening in front of you. Is there a way to set them aside a bit so that this person can reveal themselves to you, so that they can show themselves to you?
An on-the-ground example would be a classroom observation. So do you use a structured form for your classroom observation or do you go in there and observe? The latter might sound [00:49:00] foolhardy like, well, it’s no structure but I think there are appropriate ways to approach that kind of encounter.
The fact that there isn’t such a clear structure gives you more of an ethical imperative, gives you a certain kind of responsibility you have to enter it with, but it might reveal something that might fall through the cracks or sit there in these between spaces on a more formal observation measure.
So another way we can look at this is when we’re wondering about lower base rate presentation. Like I mentioned, from trouble concerns, because that’s something that comes into my practice once or twice a year. If we go in and we’re using our high base rate conditions and explanations as our default, we’re more likely to miss those lower base rate possibilities.
[00:50:00] And so a more concrete application of this in the assessment world would be something like, hey, also keep the low base rate things in mind because base rates have a certain truth to them, but just add or notice ways that in the busyness of life, we might be filtering important information now.Dr. Sharp: Got you. Would this also apply to confirmation bias at all, and how that comes into our work?
Dr. Ben: Yeah. Tell me about the leap you’re making.
Dr. Sharp: I’m making this leap of faith, we suspend these initial expectations and we try to come in, like you said, without memory or desire. And to me, that just seems like a natural antidote to confirmation bias where we’re entering an assessment just based on, let’s say, the parent says that they’re coming for an ADHD assessment. It’s hard to not go into the testing thinking I’m ruling out everything but ADHD, I’m ruling in [00:51:00] ADHD or whatever, we’re confirming that initial theory, whereas if we come in with a little bit more of a blank slate, so to speak, then it helps combat.
Dr. Ben: Yes. I think the idea of confirmation bias and I know cognitive biases is a returning topic on this podcast. It’s a set of episodes I always drop into. I do think you’re making an important and accurate leap there. So this phrase that could sound foolhardy, arrogant to analyst actually has a close relationship with a scientific process of observation.
Dr. Sharp: Great. I’ll take that. I’m not sure if it’s exactly what we’re talking about here, but you bring up the topic of autism and how this may fit in with some of [00:52:00] these ideas. I definitely want to talk about that because I feel like it’s a fraught topic right now, an area that a lot of us struggle with. So what are you thinking in that regard?
Dr. Ben: I can go in so many directions here, so I’ll rely on you to help keep our conversation tethered because this is the focus of the book that I’m working on, which will be titled, Farewell Diagnosis. It’s under contract with Bloomsbury. So what happens when I say the title? What comes up for you?
Dr. Sharp: Oh, gosh, I was 75% thrilled at this idea and 25% what’s going to happen to my life without diagnosis. Like I said, Ben, I live in extremes. I am who I am, but that’s what happened. I was mainly excited about this. I love the [00:53:00] title.
Dr. Ben: Okay. So looking at negative space, looking at the quieter sound, looking at the smaller proportion, could you tell me about the 25%?
Dr. Sharp: Yeah. So this comes up, I think this is hot on the heels too, because I just recorded an episode with Stephanie Nelson about, we call it evaluations 2.0, where we’re looking beyond diagnosis, strengths, challenges, recommendations, and bigger, deeper topics. I joked to Stephanie, this always comes up when I talk to her, and it’s this question of what am I going to do with my life?
Because every time I talk to her, I feel like she blows the doors off of the traditional assessment model in some form or fashion. And then I have to recalibrate and think, okay, how’s this going to affect my practice? Are we going to stop diagnosing? And if so, what does that mean? And can I learn something new? Is it too [00:54:00] late? Can I do it well? It triggers this cascade of questions and feelings around the foundation. It shakes the foundation of the work that we’re doing.
Dr. Ben: Absolutely. I can relate to those feelings. I imagine many listeners can. I think something that comes out of the self-diagnostic movement is an awareness of diagnosis, especially with something like autism. I don’t want to imply that there is no objectivity to it, certainly, but that objectivity, the idea that it represents something very true and we can know what that is seems very much in flux.
Dr. Sharp: Yes.
Dr. Ben: I think for two reasons, because we want to talk about two points of history, [00:55:00] one’s related to identity, one’s related to assessment. I’m a queer man and I’ve worked with queer folks and trans folks all of my training and career, et cetera. And so I’m very familiar with the history of how our identities became diagnosed.
Dr. Sharp: Yes.
Dr. Ben: Homosexuality was removed from the DSM and it’s no coincidence that it was replaced with gender identity disorder. The thought being, oh, that was a way to keep conversion therapy approved by insurance companies, feminine boy project, all this sort of thing.
So that makes me sensitive to some of what’s happening almost in a mirrored way, where it isn’t the identity becomes a diagnosis per se, it’s that the diagnosis is now becoming more of an identity. And then this leaves us in a really interesting place as assessors because we used to hold that [00:56:00] symbol. That was our symbol, it was our job, it was our license, it was our responsibility.
I’m saying was like it’s past tense. It’s not, this is still very present and real. And so there’s a way that our identity is wrapped up in it too. And so when we’re meeting with someone who might be self-diagnosing or in a process of self-exploration, it seems like everyone at the table has some deep personal investment in it beyond just doing their job.
Another piece of history that I keep in mind when I’m having feelings like the 25% you mentioned, oh my gosh, will I have a job is there’s a book called the Assessment of Men and documentation of this team of psychologists that was gathered to create the assessment process for the then office of special [00:57:00] services, now the CIA. It’s looking at how do we create a battery to see who’s going to be a good spy?
Nevitt Sanford, who is the founder of the Wright Institute, a place probably many listeners know, large alumni base there was one such psychologist. So he’s listed in the name of people. If you look at the names, it’s a lot of really big names in psychology, you might’ve known from your licensing exam or because they’re part of your tradition.
I used to assign the first chapter of this when I would teach assessment, because even though it’s written almost 100 years ago, they’re dealing with the same questions, problems, dilemmas, how do we respect the individuality of the person and the diversity of human experience while also trying to bring some kind of non-methodic reasoning, some kind of structure and organization to what we’re doing.
[00:58:00] Those things are all very alive, and we have a pretty deep emotional connection to that beyond just what is the research saying? What’s the truth?Dr. Sharp: Sure. There’s a lot to unpack here. I just want to go back to that. The point that you make about the diagnosis becoming the identity and then that taking some “power” out of clinicians’ hands and that being threatening resonates. I don’t know exactly where to go with that, but I’m just recognizing that stirs something. I think that’s important. I would imagine a lot of clinicians feel similarly.
I’m just imagining too, you may know more than I do or thought about this in a deeper way, but [00:59:00] folks, let’s just take the self-diagnostic movement or the autistic folks who are self-diagnosing are probably like, yeah, it’s about time the power balance shifts a little bit. I’m just thinking out loud and processing through that that’s a big shift and a real process for folks.
Dr. Ben: Yeah. It’s about time thing calls to mind the decades of history and activism around this. Judy Singer writes her master’s thesis that features the word neurodiversity in the early 90s. Of course, there is a movement around that that she also acknowledges at [01:00:00] that point.
I think when we’re doctors or in my experience, when you’re going through training, if you’re in a place that’s fairly well supported, part of my training was at the Reginald Lourie Center. So very much in like the attachment in child psychodynamic and Head Start moving inside of things. It was really great training.
It gives you this impression of what’s possible when the system is working well, but this system often doesn’t work very well. And some of that is dynamics of historical oppression. Some of that is something like COVID. The question I like to ask assessors is, how did COVID change assessment? And the reason I like asking that is because everyone’s got thoughts and ideas, not only general, but also very specific.
[01:01:00] I was working in this setting where I was trying to place where, and thinking about that specificity helps us to appreciate both what folks in the self-diagnostic movement are calling the field to think about, but also some of our own response. What do I mean by that?If you can appreciate how hard it is to obtain a comprehensive assessment in this country, then I think you can appreciate how valuable a process of self and community exploration for a person struggling to access assessment might be. I’ll flip it a little bit, and I’ll join you in some of the vulnerability or some of the ways that the doctor feels, I guess I’ll call them.
My shoulders come up, I’m irritated and I’m agitated about the issue. This tends to happen when something else is [01:02:00] also happening. What do I mean by that? An assessment comes in and the question is, well, is it autism, or we think it’s autism, and I might be noticing, um, significant trauma, a major medical event, a terminal illness, and a primary attachment figure, um, an affair or infidelity between partners that does not seem to have been reckoned with or processed.
When those things are in the texture. I sometimes worry that diagnosis gets so loaded with hopes, fears, and desires that we’ll miss these other things that I, as an assessor, see as important. And it took me a long time to get to this position because I think it can sound like saying, I’ll join you in some extremes, in the extreme, it could sound like saying [01:03:00] you can’t be autistic because you had trauma or you can’t be autistic because there’s emotional over involvement in the family system.
That’s not at all what I’m saying, I hope because I don’t believe that form of practice. And yet we are faced with this dilemma of how do we engage folks? It’s the dilemma we’ve always had. How do we talk to them in a way that recognizes the reality of their experience while introducing something of our own, and have it end in a way that’s better than the group conference experience you mentioned?
Because that’s the risk is we come in with jargon and our power and these sorts of things. We flame it down there and people are like, I don’t know what any of this means. And you don’t understand me. I think that’s a big part of the dilemma that we’re negotiating. Part of why I gave the book this title, Farewell [01:04:00] Diagnosis is I’m wanting to explore what happens when we exceed diagnosis. What do we add to it? When we get curious about not just whether I have certain sensory differences, executive functioning differences, social communication differences, that big DOS triangle, but what would it mean for me to be autistic? What would it mean to this parent if the child is autistic? What do they hope will happen if that diagnosis is verified? Is it understanding? Is it patients? Is it higher self-esteem?
And whatever those hopes are, how will the diagnosis get us there? Because I think there’s a way that right now the diagnosis feels a bit almost like a bubble, and I don’t want it to pop. And so I’m trying to play with, see, [01:05:00] think about, engage in dialogues like this to see, can we bring more of this negative space around the diagnosis and will that help us to work through what could easily be a standoff between profession and pay?
Dr. Sharp: Well said. I would love to hear more about this, and it sounds like you’re writing a book about it, so that’s good. Tell us, I know the time flew during this conversation and I know there’s so much that we didn’t even get to, and we could talk for a long time about this, but I do want to hear how this dovetails with the writing that you’re doing and what’s going on with this book?
Dr. Ben: Sure. So the book came out of, I wrote a [01:06:00] chapter in an edited volume. It’s called Precarities of 21st Century Childhood, looking at childhood in a psychoanalytic lens, and some of the things that are missed and left out and how we commonly talk about it. My chapter was called Fractional Distillation: On Psychoanalysis’s (Mis)Formulation of Autism. Because some of the older analytic literature approaches autism as the most base preedible condition that needs to be cured. They talk about children being cured of their autism. There’s some really intense problematic ways they engage this.
What I was trying to do is say there’s still something that we can learn. Fractional distillation comes from the idea of a fracking column. Roughly speaking, the fracking [01:07:00] column is we’re heating a bunch of crude and we’re putting it under pressure and the molecules that come out at the top happened to be the more valuable ones, rocket fuel and diesel and the ones that come out the bottom, that’s the stuff we’re going to use for asphalt.
And so I was trying to use this metaphor as a way to explore the danger of making therapy something that makes an autistic person or attempts to make an autistic person not autistic. And so in the advocacy community, we might call that masking. So I was trying to open this conversation about how forced masking to get someone to a higher level, to make them more productive or spur along development in some way potentially carries a cost.
The chapter was warmly received by some folks. An editor approached me and said, “Hey, would you make this a book?” So that’s what [01:08:00] I’m doing. And the way I’m trying to approach it is, are you familiar with The Double Slit Experiment?
Dr. Sharp: No.
Dr. Ben: Back in chemistry, someday was probably exposed to us, at least that’s where I heard it. It’s this quantum theory or the series of experiments that revealed to us that light behaves both as a particle and a wave. Depending on how you arrange the measuring apparatus, you’re going to see something different. And so in our world, that could be depending on the type of battery, or the meaning making system of the assessor, you may or may not see autism.
And so I use that as a metaphor to look at this relationship between self-diagnosis and clinical diagnosis, and how they’re entangled with each other. My hope is that the book fosters a [01:09:00] non-binary dialogue. Because I think the thing that feels most unfortunate about this conversation nowadays is when it just becomes a split; there’s no engagement or exchange in between. So the book, the shortest way I can put it as an attempt to try to do some of that exchange.
Dr. Sharp: I love that. What’s the timeline? When can we get our hands on this book?
Dr. Ben: Oh gosh. My first draft will be submitted for peer review in August, so I’m guessing sometime at 2026. I run a group practice. I’m not an academic. So writing is what happens in my evening and weekends.
Dr. Sharp: I know that very well. So what I take that to mean that we’ll just have to commit to having another conversation on the podcast at some point in the meantime to dig deeper because I don’t know if I can wait that long. This has been a [01:10:00] really compelling, thought-provoking discussion. I have a lot of admiration for how you’re approaching this topic and clearly thinking pretty deeply about it. So I would love to have some further discussion if you’re up for it at some point.
Dr. Ben: I absolutely would be, Jeremy. I want to express my appreciation for your openness to this. Being someone who works psychoanalytically and someone who’s also an assessor can feel like a very split experience, because assessment space doesn’t often encounter psychoanalysis, and psychoanalytic space doesn’t often encounter assessment. So being able to engage in this kind of dialogue about it with a colleague is both rewarding in its own right and its own corrective experience.
Dr. Sharp: I appreciate that. [01:11:00] I love a good and corrective experience. That’s for sure. Oh, and I will say this maybe to tie it up a little bit that, I don’t mean this in any minimizing way, but the concepts that you’re talking about feel familiar. The language and the terminology may be different as it is, in many of our theoretical orientations, we’re talking about similar concepts and just calling them different things.
So the terminology is not quite as familiar, but the ideas do feel familiar. And that is comforting that it’s not as scary or as foreign as I might have thought when we started this conversation that many of these concepts and ideas, we can easily bring these things into assessment and there’s not as much distance as it seems on the surface.
Dr. Ben: I’m glad we could do some work to close that distance because I’ll link back to McWilliams. It’s [01:12:00] one of the things I look up to and her capacity to write about rigorous theory, and these ways that people read and go, oh, I already had that in the back of my mind. I needed to be in a good conversation to really appreciate it.
Dr. Sharp: I like that. Well, thank you again. Hopefully, our paths will cross again before too long.
Dr. Ben: That sounds good, Jeremy.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
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And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. [01:13:00] I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
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