Jeremy Sharp (00:00.568)
Hello everyone and welcome to the testing psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.
Jeremy Sharp (00:13.356)
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Hello, welcome back to the testing psychologist. We’ve got a clinical episode for you today and it is really, really good. So 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. And he’s currently working on a book called Farewell Diagnosis, Defracting Psychoanalysis Assessment
and autism, 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. 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 and what quote unquote modern analysis looks like these days. We talk about the Rorschach as sort of 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 I think dovetails really well with my recent conversation with Dr. Stephanie Nelson and some of the other conversations on this podcast around
Jeremy Sharp (02:26.766)
doing a depth-based assessment that goes beyond diagnosis. So 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. So I hope that you find this conversation as stimulating and compelling as I did with Dr. Ben Morse.
Jeremy Sharp (03:19.074)
Ben, hey, welcome to the podcast. Thanks, Jeremy.
Great to be here. a long time listener and eager to get into our conversation.
Hey, yeah, yeah, me too. Me too. I’m sure, you know, 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 and I’m excited to have this conversation and see where we go. So yeah, thanks again. So 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 like how you spend your life and your energy, why I choose to focus on this?
topic.
Yeah, great question. So my undergrad, first half of it, I was at a school that was very STEM intensive. And so I did math, lot of engineering, some pretty crunchy science. And there was a part of me that always really loved and enjoyed that. The second half of my undergrad experience was much more social science, humanities, philosophy. So I went in a very different direction, but
Ben Morsa (04:28.128)
ended up really loving both. And that all came back around when I went to graduate school and my intention was to study psychoanalysis, to learn how to practice. And 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 clinical psychology training programs. And so I showed up to my interview and the person interviewing me was kind of like, well, you know, 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
But just did nothing about assessment. huh. And, you know, I think I linked back to this experience of math and science and curious about quantitative stuff and I must not have, spoiled it too badly. Cause of course I just thought that obtaining my doctorate there, but you know, it was something about my graduate training that I think really taught me about the, the possibility of having these two seemingly very different,
types of work in conversation with each other. Something about seeing that modeled and present and also learning about some of the history of folks who kind of carried those identities, know, folks like Roy Schaeffer, more recently Phil Erdberg of the RPAS world. He was what’s called a research analyst. So he was an analyst, but that was back when institutes kept things in a kind of tiered system and
You have to be an MD to be recognized as sort of a true analyst. So, I think through a lot of rooting and digging around, I’ve found both other people who practice boats, and a kind of training and an early developmental community of my own where I got to play with. So that’s really, what got me into here. Once I got a taste of that, I hear I am.
Jeremy Sharp (06:44.622)
Yeah, yeah, yeah, that’s fair. That’s fair. So I’m just curious, I guess about the state of analysis these days. mean, I’m assuming, I don’t know, you look young and cool. People can’t see you have a mullet. It’s a fabulous mullet. And that tells me that, you know, you maybe went to grad school sometime in the last 10 years, I don’t know, 10 to 15 years. And 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 like a long way divorced from the time when analysis was popular. So what was that like and how is it showing up in graduate programs now?
Yeah, that’s such a great question. And I’m really 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 kind of understandably put off by.
But analysis is much more than that narrow slice of experience. And I think particularly in the contemporary moment. So I imagine a number of your listeners, maybe you are familiar with Nancy McWilliams. She’s a psychoanalyst out of Rutgers and she’s written now a quantrivium of essential texts. think psychoanalytic diagnosis, psychoanalytic psychotherapy, psychoanalytic case formulation, and she released one on supervision during COVID.
And 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 I think represents something new in analysis. We’re much more flexible in how we think about it. But when you listen to McWilliams talk about it, it’s everyday language. It’s like talking to that really great supervisor you have.
Jeremy Sharp (08:48.526)
and you
your finger on why it was just the gash- 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 would credit Nancy McWilliams and her work really creating a translating bridge to psychoanalysis with any of us in kind of millennial generation or younger finding an interest in it as a form of practice.
But analysis is also really active in some of our most pressing human and political questions at this time. So there’s a book called The People’s History of Psychoanalysis by Dr. Daniel Gastán-Vilde that I think is a good representative text of what some of the younger folks, I guess we could say, are doing in analysis. Another really important effort that has come out in recent years, headed by Dr. Dorothy Holmes, the
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 for a lot of analytic training happens and trying to understand, the lack of representation and how to make formal analytics spaces more inclusive. Yeah, quite a summary. So I could really go in a ton of different directions. Like these are my
My peers and my folks, and they’re doing exciting things, but for the listeners here, I would say, if you haven’t given the analytic world a love recently, consider dipping your toe in. You won’t have to read Freud if you don’t want to.
Jeremy Sharp (10:30.51)
I think that’s all people want to hear probably is, is it really just Freud? No, there’s plenty more. Plenty more to look into. Yeah.
That sounds good.
Okay, and yeah, we’ll put all those books and links in the show notes, you know, as usual, so folks can go check those things out if they would like to. So I wonder if we start to bridge a little bit. I mean, to me, the perhaps obvious overlap of analysis and assessment is in something like the Rorschach. don’t, you tell me if that’s maybe a good place to start. And if not, we can go a different direction, but I’ll leave it to you.
I think the Rorschach is a great place to start, 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. So Rorschach himself, there’s a really excellent translation of his original book,
that was just released, I think published by APA. Dr. Phil Urberg, a colleague here in the area, headed that project. It’s really excellent because you see a person struggling with a tool like the Rorschach, which can be so ambiguous and expansive, struggling to bring some kind of structure, struggling to bring some kind of common language way of interpreting, way of testing our hypotheses to this endeavor.
Ben Morsa (12:10.668)
Then of course Rorschach, the instrument comes to the United States in the 20th century and 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 of course 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 I think listeners are likely familiar with would be the RPAS, which has really gone a long way towards testing and verifying these variables. So the Rorschach has this quantitative element, and that’s essential because it’s just the reality of how we communicate and look at each other’s work in the Guild of Psychology. But there’s still wiggle room for some of the close, ideographic
very personal, very aesthetic, and I think very alive dimensions that something like the Rorschach offers.
Yeah, yeah, I like the way that you put that and it’s cool to have the history. I like that we’re peppering in some history already. I just love having context and understanding where things come from. So I appreciate that. So 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?
Sure, sure. it regards the Rorschach, I think a first way we could start to think about that would be, you as a child or maybe now with children ever play the game where you look up at clouds and you say, that looks like, and you fill in the blank?
Jeremy Sharp (14:03.674)
sure, sure,
Yeah, can I ask what’s enjoyable about that game?
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 or 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.
Yeah, it’s this way to get to know people that leaves room for a surprise. Right. And I would think, or one way that I think about psychoanalytic work is a way of approaching our work that leaves room for the patient to surprise us. Clouds of course, you 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 see that. So it’s not a anything goes kind of structure.
Mm.
Jeremy Sharp (14:51.863)
Mm-hmm.
Ben Morsa (15:04.914)
But it is ambiguous enough that we can try to make some meaning. And that is how Worshok designed the original tent, Ingblots. His father was a draughtsman and 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. So…
I often think of the Rorschach or 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. And 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 a meta way, the Rorschach,
Children are a bit like inkblots and we as assessors are looking at these different features of the blood and we’re kind of 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
I like that. Yeah. I didn’t know where you were going with this cloud example, but that totally fits. That totally fits. Yeah. I mean, we are in many ways, going through a similar process as we assess kids, try to, try to see what’s going on with them. Kids are pretty ambiguous sometimes.
Ben Morsa (16:55.662)
And so is our life and our life to children who were 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 just physical movement happening in a lot of different directions.
lot of that is ambiguous, but it’s not random, There’s of in there. And so when we’re thinking about a child who’s becoming overwhelmed in unstructured class time, we’re engaging in some of this Rorschach-like exploration, I think, of trying to get a sense of how they are navigating something that’s ambiguous, but not random.
Like this?
Ben Morsa (17:51.424)
And that’s really part of why the Rorschach has the second phase where our job is to understand not only what they saw, but why they saw it that way. Part of what we look at is their process of explaining, well, this is why the cloud looks like a duck. This is why the block looks this way. This is what I thought was going on in class when I got overwhelmed and started counting.
Right.
Jeremy Sharp (18:19.17)
Right, right. Yeah, 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 I think of it as, you know, they’re pretty, it’s like a rigid box, but then whatever happens within that box is pretty open, you know, and it is like these classroom materials that are just laid out and the kids get to choose whatever they’d like and work.
in whatever way they’d like for however long they’d like. that’s, you know, that’s really cool. And yeah, now I’m seeing, I’m seeing the Rorschach everywhere. I’m seeing projectives everywhere.
Okay, good. Then this is, this is what I’m going for here. Do get things that’s difficult about talking about psychoanalysis is there are a couple of schools of thought. You know, there’s analysis that is about knowing, which is like, this is how the unconscious works. I’m going to make these interpretations. The analyst reveals to the patient some truths that they were fighting not to know. There’s also analysis that is about being.
Because when-
Ben Morsa (19:27.95)
Like how do we, how do we support their capacity to be in every 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, like jargon speak, we might call that the container. And the containers literal things like, yeah, 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, now there’s a whole lot of room to see what comes up and to see what a person makes of that experience. Right. Right.
So 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’s shrinking? If you’ve seen
Whoa. Can you jog my memory about it? Because it’s ringing a bell, but I’m not sure I have.
Okay, okay, okay. So the general premise, it kind of revolves around this group of, think, three psychologists who are in practice together. And one of them is very prone to, well, going wildly off script. You know, the container is a little diffuse, where he’s meeting clients in public. He’s, you know, one of his clients ends up living with him. So yeah, if you haven’t, that’s okay. We don’t have to go down this path, but I’m just, you know, it’s gonna
Jeremy Sharp (20:56.206)
talk a little bit about the interplay there of the container and if it’s a little bit wobbly and what happens there.
Sure, sure. you know, folks will often ask me, have I seen this? Right. And there’s the literal question, have I seen it? There’s a dimension of kindness, like, 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. And I think I hear you noticing something about container boundaries.
how that gets diffused and that that’s something that’s represented in this show. Yes. Yeah. This gets us to a really important question about ethics. Because analysis in some ways has been, side load might be a good way to describe it.
Now.
And so there’s not necessarily a whole lot of broad familiarity with how it works.
Jeremy Sharp (22:04.494)
Hmm.
And so these media examples of how analysts, how therapists who might work from that orientation work, I think 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 rule this out. I don’t know. That one’s, that one’s for voting for me. It’s, it’s not my world.
Yes.
Jeremy Sharp (22:33.61)
No, that’s fair. That’s fair. think you make a good point that analysis has in either enjoyed or not enjoyed a lot of media attention. And I think of all the approaches that we that we do, it’s probably the most depicted in media for better or worse.
I think a better example might be have you caught couples therapy on showtime?
No, I haven’t. I know what you’re talking about. just haven’t seen it, which is ridiculous. My wife and I are both, my wife is a master’s level therapist who does a lot more depth based spiritual kind of work with folks. And so it’s a wonder that we haven’t seen every single therapy show out there.
I feel you sometimes we got to not watch the thing that is that is so on the nose, but Orna Guralnik is excellent in it. And I think a good example of like the modern practice of analysis, which includes like you see the analyst, you know, analyst is no longer just the white man behind the cow. And so some of these media presentations, I’m a bit more fond of.
Okay.
Ben Morsa (23:43.692)
My favorite would be Dr. Malfi and the Superman.
I was going to bring that up and then yeah, didn’t want to totally, but yeah, you’re right. I, yeah, that’s, that’s one of the best. That’s one of the best that’s, that’s going to stick in my memory for a long time. So I think we’re going down a good path here where we can start to talk about the, the actual application of some of these, you know, some of the, and these analytical tools to assessment, but I want to, I would love to.
you know, dig a little bit deeper into these actual tools to kind of 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, you know, concepts, tools again, to, provide some context for our discussion here.
certainly. So one of them I think about and I imagine folks with therapy experience, whether present during their training might be familiar with the phrase, the slower you go, the faster you get there. And that is in my mind, a tenant of analytic work, meaning that we have to toggle the pace down a bit. We have to get a little more Montessori about it.
Hmm, yes.
Ben Morsa (25:07.72)
We try to remove some of the ways we typically structure things so that we can learn something new. Right. And 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. Your experience too.
Some of that is I don’t assess in like the three to six range as much as I did in my training and early careers. So, you yeah, you’re seeing teens like they’ve been assessed before we refresh the data that that’s pretty typical. Reassessment sometimes looks like hopping between lots of different diagnoses. Like I went this place for the ADHD assessment and then I followed on over here for the autism assessment. But I wasn’t really so sure.
You know, what about this other thing? And so as an assessor, I might be looking at three, four or five different reports. can all great reports. can give depth full database. Insights into 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 sort of layering them on.
Hmm
Ben Morsa (26:55.926)
And in some cases, that can be a bit more concerning than others, 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. 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 in this family. Does any of that help me understand the history and the journey of assessment that they’ve had?
Yeah, that’s fair. So you’re talking about asking kind of 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 kind of putting the current assessment in context with all those factors. Is that fair?
Absolutely. I might add to that, you know, Stephanie Elson uses this phrase, the secret question. And I’m very fond of that idea for two reasons. One, it’s a question and questions are so helpful in our process, but two, it’s a secret. And I think 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, us 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 onto. But you couldn’t put it into a question to an assessor because
Ben Morsa (29:00.606)
It’s just that deep or it just hasn’t had that process to come into words yet. And 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 into that space.
Yeah, yeah, I like that. You know, I like to get concrete with things. So what does this look like in the, the assessment process? Are you literally asking, like I was, it was running through my mind. What if I just ask parents their deepest fear as they come into the, said, maybe that’s a little too intense, but you know that I tend to live in, in extremes. So I’d love to hear how you tackle that.
Yeah. So, you, you have figured me out that I, 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 to 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, kind of 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 wrapped.
Jeremy Sharp (30:53.238)
and
place that this comes up for me that’s more concrete is 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, right? We’re usually not reaching for that as our first interpretation of the data in front of us.
Mm.
Ben Morsa (31:23.17)
There are lot of other higher base rate things we want to evaluate first. And yet most folks going for an assessment don’t understand what psychotic process is. wouldn’t imagine to think, to look at how that might be showing up in a child’s development and wouldn’t necessarily have a place to go to, to get that assessment question answered. I think when this question comes up, it’s often.
sit on deep fear a parent had. And it might be like, who is my kid? How do I understand them? How will other people understand them? And will they understand them in a way that’s gonna support them having a good enough life? So my long-winded way, Jeremy, is like, I kind of 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.
Hmm. Sure. Yeah. Yeah. 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. And, know, typically it comes toward the end after I’ve built a lot of rapport, hopefully with the, with the family and, can dive in and just say, yeah, some version of, yeah, what I, this is a scary process. I wonder if you’re, you know, worried about.
X, Y, or Z. Sometimes I’ll name what I think might be a fear of theirs, which is, you know, and I’ll generalize it and just say, Hey, most people, parents almost always come in thinking that I’m going to tell them they’re the worst parent in the world, you know? So if that’s running through your mind, that’s totally okay. Or that it’s somehow your fault. so, you know, 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 that is part of the picture for them and then we’re kind of aligned and it’s out in the open.
Ben Morsa (33:30.026)
Yeah. Yeah. And I hear that that’s a process for you, that it’s not the first thing you’re going to ask. perhaps because that gives you and them a chance to build alliance that gives you as an assessor, a chance to understand how to engage with them on this question, their readiness for it. And I don’t mean readiness, like, are they strong enough or good enough as parents? I just mean.
In some stages in life, we might have so much happening and it’s so overwhelming that getting to that sort of level three question to use a TCA term might not be a first session endeavor. And another thing I think I hear you doing that I build some analytic bridge to is a diffusing the punitive super ego.
Ooh, what’s that?
You speak to a parent’s unconscious fantasy that you were there to punish them. They were going to identify with the super ego they kind of 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 information. So I hear you kind of naming the possibility of that projection and just defusing it, know, turning the heat down on that. And that, guess, or I would imagine in many cases gives you more room and emotional safety to get to those deep fears.
Jeremy Sharp (35:19.694)
That’s the hope. That’s the hope.
Yeah, that’s what we got is hope and reflection, right?
Yeah, it’s true. Okay, nice, nice. So I like that. So we’re slowing the process down. What other tools are out there that we might pull from the analytic world?
Sure. So another that I would think about is attending to negative space. And by negative space, I mean I’m using this in the artistic sense. So because we all took the EPPP, and I feel pretty certain this was in a study guide somewhere. You remember these Gestalt images? Like is it two people kissing or is it a bath? Of course.
Of course. course.
Ben Morsa (36:08.366)
Yeah, 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. my gosh, like this school year is really rough. The teacher is not a good fit with my kid and like…
Friendships have blown out and you know, it’s one of those types of things that might bring a person to assessment. We of course want to listen to all of that and take it very seriously because it’s, it’s, it’s top of mind. It’s why someone’s coming in. There’s more that we can add to that. There’s more in this space in between and to try to make it practical. This connects with slowing down.
there’s the early assessment process before someone has even signed an agreement and formally engaged the assessment. Right? 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 sham 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 watts for the ink watts to really appear for them to be rather.
I like this, I like this. And so how does that show up again, just kind of bringing it to life? Can you give me examples of what that looks like figuratively when we’re paying attention to the negative space in our, even in the phone call or even in the interview or during the assessment?
Ben Morsa (38:10.926)
process.
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Ben Morsa (39:56.622)
Thanks.
Ben Morsa (40:01.774)
Sure, sure. So this is one I think about because it’s one I’m vulnerable to falling into. I call it the three minute voicemail or the multiple voicemail. You 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?
Yeah, what can I already begin to get curious about? And I might pull for some other information too, like how am I feeling when I listen to this? Because for me, I’ve noticed that a counter-transferential process I really need to pay attention to as if I listen to a voicemail and I have the immediate urge to call the person back, even in some totally unrealistic way, like I’ve got a session in 10 minutes, that’s not gonna happen.
Huh? Uh-huh.
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 asked the parent, what’s your greatest fear about your child?
and
Ben Morsa (41:22.796)
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, right? Like, it’s a new call. What’s the question? What’s our availability? When do they need it? You know, we’re kind of doing this intake and triage process.
But I guess what I’m trying to emphasize is there’s already clinical material in those initial moments. And we shouldn’t 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.
Okay. I like where we’re headed with this. Yes. Yeah. Okay. So what’s next? We’ve got the negative space. Do we have more tools that we can work with?
Or so another is, gosh, I’ll ask you because you mentioned this when we had our first conversation, which you’re to sharing your experience about beyond.
yeah, yeah, I will. I will. don’t know that it’s going to live up to the hype here, but I will share my experience there. Thank you. Yes. So to provide some context, let’s see, I think I told you in our initial call that my wife and I, who I’ve mentioned already as a therapist and she’s a group therapist, you know, specifically she specializes in group work. And I’m sure you know, this guy, Beyond is a, is a,
Jeremy Sharp (43:14.062)
a pretty powerful figure in the group space. And so I don’t actually know much about him. I’ve only, you know, 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 I get, we get into this group or this workshop.
Okay, so just disclaimer for anyone out there who wants to go to the AGPA conference. Any workshop will turn into a therapy group. There’s no, the boundaries are diffuse, okay? The container is pretty diffuse at this conference. So we didn’t know this, this was our first time. We’re young, we’ve just graduated, I think. And so, you know, 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, and halfway through the group, somehow we disclosed that we were engaged and together. And the group at that point, and it was based on Beyond’s principles or approach to group work. That’s how he comes into this story. And 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 went nuts. We were just sort of deer in the headlights, like what the?
hell is happening right now and why is this, why aren’t we learning about the thing we wanted to learn about? are you know? So anyway, that’s the story. And it ended up pretty poorly. we basically ran out of that conference and we’ve never gone back. So that’s, that’s my experience and my brush with beyond and his group. Yeah.
Ben Morsa (45:23.854)
Well, thanks for being open to share that because I’m guessing you haven’t picked up any Beyond since.
I think when we got back home, I think I did dig into it a little bit and read through some of the, you know, the theory and the work, but it’s been a long time.
Okay, okay. You know, I think like, I wonder how many of these types of experiences listeners have had in some kind of relationship with psychoanalyst. And the experiences, because I’m familiar with his work, I imagine where they’re going is you and your then fiance, you were a kind of primal scene. You were like the parents in the Oedipal scenario.
Thanks, y’all.
Ben Morsa (46:08.534)
you represent some kind of knowledge or alliance that they’re necessarily excluded from and then manner of primary process breaks.
That’s great. Yeah, that’s probably what.
It makes me curious about the container in this experience of yours because, yeah, your face says it all. Because if there’s a container, we can go into that. can kind of fall apart. can see just how, charged and powerful feelings can be in groups. And then it’s the other part of beyond as he uses this word metabolize. 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 at us and kind of like digest it a bit and sort of give it back to them and that they can take in.
That makes sense. like that word. And I think we do that quite a bit. Yes.
Ben Morsa (47:16.502)
Yeah, I think a lot of it is naming stuff that is like probably already part of people’s practice. There just isn’t a like an analytic jargon attached to it and there need not be. So I brought in that piece about the on because he has this phrase where he says every session should begin without memory or desire.
And of course he’s talking about the analytic or therapy sessions. And on the one hand, that sounds. Plus might be a reaction would have, because it’s like, what do you mean without memory and desire? Like 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? Um, but he’s offering yet.
not in such a literal way, but as a kind of meditation to say, can you start to notice the frameworks that you bring into a space? That the heuristics that you use to understand what is happening in front of you, and 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?
I think, a kind of on the ground example would be like a classroom observation. So do you use a structured form for your classroom observation or do you go in there and observe? The ladder might sound kind of foolhardy, like, well, you know, no structure, but of course, I think there are appropriate ways to approach that kind of encounter.
Yeah.
Ben Morsa (49:11.852)
The fact that there isn’t such a clear structure makes it harder, 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 sort sithereens 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, for drovel 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. 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. Don’t get them because base rates have a certain truth to them, but just sort of add or notice ways that
in the busyness of life, we might be filtering important information.
Got to with this also apply to confirmation bias at all and how that comes into our work. well, I’m making this leap of, you know, 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 this is they’re coming for an ADHD assessment. Well, it’s really hard to not.
Ben Morsa (50:29.846)
Yeah? Tell me about the link you’re making.
Jeremy Sharp (50:53.09)
go into the testing thinking I’m ruling out everything but ADHD or you know I’m ruling in ADHD or whatever you know like we’re kind of confirming that initial initial theory whereas if we come in with a little bit more of a blank slate so to speak then it helps combat.
Yes. Yeah. think the, idea of confirmation bias and, I know cognitive biases is a returning topic on this podcast. It’s a sets of episodes. always drop in. I do think you’re making an important and accurate link there. So this phrase that could sound kind of foolhardy, arrogant analyst actually has a close relationship with a scientific process of, of observation.
take that. I’ll take that. Yeah. Now you bring up, I’m not sure if, you know, there’s, it’s exactly what we’re talking about here, but you bring this, bring up the topic of autism and how this may fit in with some of these ideas. And I definitely want to talk about that because I feel like that’s so, it’s a frat topic right now in an area that a lot of us struggle with. So what are you, what are you thinking in that regard?
now
Ben Morsa (52:11.978)
Yeah. 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. And it’s under contract with Bloomsbury. Yeah. So what happens when I say the title? What comes up?
gosh, you know, I was like 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. live in extremes. just, I’m, am who I am, but yeah, that’s what happened. I was, but I was mainly excited about, about this time. I love the topic or I love the title.
Okay, okay. So looking at negative space, looking at the quieter sound, looking at the smaller proportion, could you tell me about the 25 %?
Yeah. Yeah. So this comes up, I think this is hot on the heels too, cause I just released or recorded an episode with Stephanie Nelson about, we call it kind of like evaluations 2.0, where we’re looking beyond, you know, diagnosis, strengths, challenges, recommendations, and, you know, bigger, kind of, you know, deeper topics. And I feel, joked with 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,
you know, she kind of blows the doors off of, you know, 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? And, you know, is, are we going to stop diagnosing? And if so, what does that mean? And can I learn something new? Is it too late? Can I do it well? So it triggers, you know, this cascade of questions and feelings around, you know, the foundation, it sort of shakes the foundation of the work that we’re doing.
Ben Morsa (54:12.632)
Yeah, absolutely. I can relate to those feelings. I imagine many listeners can. And 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 in flux. So, and I think for a couple of reasons because we
Yes.
Ben Morsa (54:57.87)
I’m going to talk about two points of history. One’s related to identity. One’s related to assessment. So I’m a queer man and I’ve worked with queer folks and trans folks all my training and career, et cetera. And so I’m very familiar with the history of how our identities became diagnosed. Right? So homosexuality was removed from the DSM and it’s no coincidence that it was replaced with gender identity disorder.
Yes.
Ben Morsa (55:27.18)
The thought being, that was a way to keep conversion therapy approved by insurance companies, feminine boy project, all this sort of thing. So that makes me, I think, 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 like we used to hold that symbol. Like 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. Right. and so there’s a way that our identity is kind of 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, right? So something that another piece of history that I keep in mind when I’m having feelings like the 25 % you mentioned. Oh my gosh, will I will 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 Services, now the CIA. It’s kind of looking at like, how do we create a battery to see who’s going to be a good spot?
Nettet Sanford, was the founder of the Wright Institute, a place probably many listeners now work alumni based there, was one such psychologist. You know, 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 cause 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, you know, almost a hundred years ago,
Ben Morsa (57:39.1)
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-mathetic reasoning, some kind of structure and organization to what we’re doing. So, you know, those things I think are all very alive. and we have a pretty deep.
emotional connection to that beyond just like what is the research saying what’s the truth sure
There’s a lot to unpack here.
You know, the point that you make, I just want to go back to that. The point that you make about, it’s really, the diagnosis becoming the identity and then that, you know, taking some quote unquote power out of clinicians hands and that being threatening, really resonates. don’t know exactly where to go with that, but I, I’m just recognizing the, know, that kind of stirs something. And I think that’s, that’s, important. And I’m, would imagine a lot of folks.
feel similarly, a lot of clinicians and I’m just imagining too, you may know more than I do or thought about this in a deeper way, but the, you know, folks, let’s just take the, self-diagnostic movement or, you know, the autistic folks who are self-diagnosing, are kind of, are probably like, well, it’s about time, you know, it’s about time we, you know, the power balance shifts a little bit. And I’m just, I think I’m just.
Ben Morsa (59:12.333)
Yeah
Jeremy Sharp (59:20.27)
sort of thinking out loud and sort of processing through. But that’s a big shift and a real process for folks.
Yeah. And I think that it’s about time thing reminds me calls to mind the decades of history and activism around this, right? So Judy Singer writes her master’s thesis that features the word neurodiversity in the early nineties. course, there was a movement around that that she also acknowledges at that
point. And I think when we’re doctors or 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 Lorry center. So very much in like the attachment and child psychodynamic and headstart movement side of things. was really great training. it gives you this impression of, 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. Right? 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.
I was working in this setting where I was trying to place where and thinking about that specificity, I think helps us to appreciate both what folks in the self diagnostic movement, I think 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,
Ben Morsa (01:01:29.154)
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, the vulnerability or some of the ways that I get kind of doctor feels, I guess I’ll call them. my shoulders come up and I’m kind of irritated and I’m sort of agitated about the issue.
This tends to happen when something else is 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 significant trauma, a major medical event, a terminal illness and a primary attachment figure, an affair or infidelity between partners that does not
seem to have been reckoned with or processed. When those things are in the picture, 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 in the extreme,
I’ll join you in some extremes. In the extreme, could sound like saying, it can’t be, you know, 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. And that’s not at all what I’m saying. I hope, cause I don’t believe in formal practice. And yet we are faced with this dilemma of how do we engage folks? It’s the dilemma we’ve always had.
Check.
Ben Morsa (01:03:25.08)
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?
Mm-hmm.
Cause I think that’s the risk is we come in with jargon and our power and these sorts of things. we sort of like. Flam it down there and people are like, I don’t know what any of this means and you don’t understand me. So I’m out. You know, so think that’s a big part of the dilemma that we’re negotiating. But part of the way I gave the book this title farewell diagnosis is I’m wanting to explore what happens when we exceed diagnosis, like when we add to it.
When we get curious about not just whether I have certain sensory differences, executive functioning differences, social communication differences, you know, that McBoss 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 patience? 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. I don’t want it to pop. And so I’m trying to play with, think about, engage in dialogues like this to see, we bring more of this negative space around the diagnosis in?
Ben Morsa (01:05:09.986)
Will that help us to work through what could easily be a standoff between profession and paper?
Well, Yep.
I would love to hear more about this. And it sounds like you’re writing a book about it. So that’s good. us, know this, our, 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, long time about this, but I didn’t want to hear how this dovetails with the writing that you’re doing and what’s going on with this book.
Sure, sure. So the book came out of,
Ben Morsa (01:05:59.438)
I wrote a chapter in an edited volume. I think it’s called, Picarities of 21st Century Childhood. So 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. And my chapter was called, Fractional Distillation on Psychoanalysis, Misunderstanding or Misformulation of Autism. Because some of the older analytic
Literature really approaches autism as like the most base kind of pre-edible condition that needs to be cured. You know, they talk about children being cured of their autism. You know, there some really intense problematic ways they engage us. But what I was trying to do is say there’s, still something that we can learn. Tractional distillation comes from the idea of a fracking column.
And, you know, roughly speaking, the fracking 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 happen to be the more valuable ones, rocket fuel and diesel and the ones that come out the bottom, like that’s the stuff we’re going to use for asphalt. And so was trying to use this metaphor as a way to explore the risk, the danger of making therapy something that
makes an autistic person or attempts to make an autistic person not autistic. 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.
mmm
Ben Morsa (01:07:52.386)
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 I’m doing. And the way I’m trying to approach it is, are you familiar with the double slit experiment?
It’s like back in chemistry someday, it was probably exposed to us. At least that’s where I heard it. But it’s this theory and 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 like depending on the type of battery or the meaning making system of the assessor.
You may or may not be.
And so I use that as a metaphor to look at this relationship between self-diagnosis and clinical diagnosis. You know, how they’re kind of entangled with each other. And my hope is that the book fosters a kind of non-binary dialogue because I think the thing that feels most unfortunate about this conversation nowadays is when it just becomes a split fight. Yeah, 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.
Jeremy Sharp (01:09:21.321)
Hmm, I love that. What’s the timeline? When can we, when can we get our hands on this book?
gosh. My first draft will be submitted for peer review in August. So I’m guessing sometime in 2020. But that’s the nature of, you know, I run a group practice. not an academic. So writing is what happens in my evening and weekends.
Okay
Jeremy Sharp (01:09:45.675)
Right. Yeah, I know that. 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. Cause I don’t know if I can wait that long. This has been a really compelling thought provoking discussion. I have a lot of admiration for how you’re approaching this topic and you know, clearly thinking pretty deeply about it. So yeah, I would love to have some further discussion if you’re up for it at some point.
I absolutely would be Jeremy. And I just want to express my appreciation for your openness to this. a 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, you know, both rewarding in its own right and its own kind of corrective experience.
I appreciate that. love a good corrective experience. That’s for sure. and I will say this maybe to tie it up a little bit that and I hope this I don’t mean this in any sort of minimizing kind of way, but the the concepts that you’re talking about feel familiar. You know the language and the terminology may be different as it is. I think in many of our theoretical orientations, we’re kind of 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. 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.
Ben Morsa (01:11:52.118)
Yeah, yeah. Well, I’m glad we could do some work to closing that distance because I’ll link back to Mick Williams. It’s one of the things I really look up to in her capacity to write about really rigorous theory and these ways that people read and go, I kind of already had that in the back of my mind. I just, I needed to be in a good conversation to really appreciate.
Mm-hmm. I like that. like that. Well, thank you again. And yeah, hopefully our paths will cross again before too long.
That sounds good, Jeremy.
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. If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts. And if you’re a practice owner or aspiring practice owner,
I’d invite you to check out the Testing Psychologist Mastermind groups. 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 slash consulting.
Jeremy Sharp (01:13:24.578)
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.
Jeremy Sharp (01:13:49.794)
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