Self-Psychology Case Conceptualization - Jennifer

Identifying Information

She was a 25-30 year old self-identified Caucasian female. She had been married to her husband Dan for three years. She recently had her first child, a daughter. Several years ago Jennifer and Dan moved to Los Angeles from their previous residence in Philadelphia. Part of the impetus for this was Jennifer’s desire to become a film actress. She previously was self-employed as a model and wanted to diversify her repertoire of experiences. Dan was self-employed as a software engineer and his employment opportunities were more-or-less portable to any other geographic location.

An important point to note about both of their professions is that they were economically perilous and uncertain. In order to support themselves they had to appeal to a wide variety of potential employers. To do so they had developed adaptive, almost chameleon-like presentation skills. To some extent this flexibility skirted the edge of plausibility. One acquires a modicum of occupational skill, then quickly extrapolates it into an entire set of background knowledge and experiences over the domain of possible jobs. I did not view this as a cause for concern because most persons who are self-employed tend to engage in this form of resume enhancement without giving it much thought. The critical issue remains if one can perform the task, given the assignment.

If one’s standard of beauty is tall, white, long legs, straight brown hair, attractive figure, then Jennifer was physically gorgeous. Her picture had been on numerous book and magazine covers and in numerous advertisements and commercials in magazines and on TV. One would recognize her picture if one saw it on a magazine rack in the check-out line at a grocery store, or, at least, regard it as someone familiar, even if it wasn’t quite possible to put one’s finger on who it was. On arrival at the Clinic, she had to wait in a separate room, at the risk of being recognized or even importuned by other Clinic clients. Her acting career was somewhat more checkered. Like countless others who have been enthralled by an imaginal Hollywood film industry, her ambition far outstripped the reality of the movie business, where casting decisions are seemingly arbitrary and capricious, made without rhyme nor reason. The best source to understand this dynamic is the Hollywood novel: wondrous tales by Nathaniel West, Raymond Chandler, F. Scott Fitzgerald, Aldous Huxley, Joan Didion and others. Their protagonists teeter perilously on an edge between hope and despair; is hope anything more than the absence of despair; if one’s world is bilaterally bounded (i.e. either succeed or fail), then there are no shades of gray.

Since her movie career didn’t seem to be going anywhere, Jennifer became an actress in pornographic films, on-line videos and also started appearing in compromising positions in magazines such as Playboy, Penthouse and Hustler. She also became a prostitute–not one working on the street, but rather what she euphemistically referred to as an “escort,” an updated term for what formerly was known as “call girl.” It involves little in the way of escorting in the sense of say, accompanying somebody to a social function (though in principle it might). She told me the economic structure of the pornography industry was such that the actresses make very little. Rather, they are expected to use the exposure (so to speak) to leverage other business opportunities, primarily, dancing at clubs and prostitution (Jennifer was no dancer).

Pornographic video companies are subject to the same vicissitudes as major studios. Their work frequently is duplicated and posted on free internet sites, as a result of which the economic value of the work is severely depreciated. Furthermore all pornography actresses maintain an extensive web presence and if somebody wants to view them having sex, it’s just as easy (perhaps more easy) to do so on the actresses’ own private site, as it is using a video aggregator or a video company site. Another market trend is a strong viewer preference for “amateur porn” made by exhibitionist couples, as opposed to professionally shot pornographic movies.

Jennifer was at the high end of her occupation and made approximately $250,000 per year. She did not use the services of an agency, pimp or procurer. Her only advertising was by word of mouth among a select coterie of clientele, and a professionally designed website (most likely by her husband). Since her business was all cash, she didn’t feel a need to declare any of it as income, so her earnings were tax free. “I make a lot more money than friends of mine who are doctors or lawyers,” she said.

She apprised me that the basic rule is that 100% of pornography actresses also are prostitutes (though a much lower percentage the other way around, since they don’t have the requisite looks). 100% of feature dancers at nightclubs are prostitutes (though again not the other way around). A large percentage of models are prostitutes (though again not the other way around) and they command high compensation. According to Jennifer, there also was a not-inconsequential subset of “media personalities” (she named Paris Hilton as an example) who also are not unwilling to prostitute themselves, given the right amount of money; she reported one could spend a night with Paris Hilton, for example, for $50,000 or thereabouts. “There is a term for it in the industry,” she said, “which is WHAMs – an acronym standing for waitresses, hookers, actresses, models. At some point they all end up doing the same thing.”  I interpreted her to mean it’s the underbelly of today’s celebrity culture, enhanced by the interaction between personality and the media; both depend upon and are in vital need of the other. 

Jennifer advised that, although there are rare exceptions to the rule, most often, after one starts acting in pornographic films, one pretty much truncates one’s demand to act in non-pornographic movies and on television. So it’s an important and consequential career decision. Although far from naïve, I have never been to a strip club, read a men’s magazine or had sex with a prostitute, so Jennifer’s ruminations on the economics of her business were informative.

She had an interesting idea for a reality TV show, which was to take ordinary 20-somethings and put them in a compromising situation, where they would have to make a decision about having sex. This either could be a street corner or a high-end hotel bar. I thought the former too violent and the latter not atypical. I interpreted her concept as illustrating the uncertainty and indeterminacy of her life, never really knowing what was real, genuine and for certain. In a profound way, she was adrift, even homeless, bombarded by 21st century culture in ways even she didn’t understand.

Developmental History

Jennifer’s childhood was contributory. She was an only child. Mother was a full-time housewife. Father was employed full-time as an analyst for a secret governmental intelligence agency, most likely the CIA. Jennifer spent much of her childhood on military bases in isolated locations, e.g. Scandanavia. Initially as a result of his occupation, but then characterologically, Jennifer’s father was highly secretive. She never knew exactly what he did, and suspects her mother didn’t, either. Functionally, Jennifer grew up without an internalized, minimally adequate father figure. Her mother was quite, weak and completely deferential to her father. Most likely as a result, Jennifer became close to her mother. Both, in a way, were survivors of significant psychological abuse. Jennifer’s mother recently demised, which impaired her psychologically. She still is in grief recovery.

Jennifer was sexually precocious at an early age. She began having sex when she was 12 years old. After several of our sessions together she was able to confide to me that her uncle (father’s brother) had molested her as a child, which I did not find surprising. She had sex pretty much indiscriminately with a variety of partners throughout high school and college, and also was voyeuristically exhibitionistic. For example, once she took off all over clothes in broad daylight in front of a public fountain at a square in Philadelphia for an impromptu photo shoot by her then boyfriend. Her first serious relationship post-college was with a married man. She reported she was in love with him and they were together for several years, however, he was unable to leave his wife and family for her. This understandably caused her to feel rejected.

Jennifer is highly intelligent. She graduated near the top of her class from Penn State University. She applied to and was accepted for admission to several prestigious business schools, however, she chose not to pursue this career option. From a spiritual standpoint, Jennifer is a practitioner of reiki, which is an Eastern spiritual tradition. She is not a member of any organized religious denomination. I am skeptical of Western society’s adoption of Eastern metaphysics, which smacks of what Edward Said aptly characterized as orientalism. But if it worked, who am I to criticize? 

While she had friends, most of them (both male and female) were sexual partners and crew from pornographic movies. She apprised me it was difficult to make friends outside of the pornography business because one had to lie about one’s occupation, and do so consistently, at the risk of incurring social opprobrium. She is a moderate social drinker and does not use/overuse any substances. Her only medication was 1 mg. klonopin PRN, which she uses infrequently. She had no STDs or other medical problems. She apprised me she had breast augmentation several years earlier, but “not a lot” and she showed no evidence of the kind of gross anatomical deformity many women in her profession (and otherwise) succumb to. She showed no evidence of suicidality, homicidality or spousal abuse. She disclaimed any previous psychotherapy. While I was dubious about this, there was no way to verify or disconfirm her assertion, so I took it at face value. She reported she never had been involved in a dispute or altercation with any of her clients that might have had the possibility of leading to violence.

Presenting Problem

Jennifer self-referred for therapy complaining of vague symptoms of existential malaise, ennui and dysphoria. She had come to accept that, because of her career as an actress in pornographic films, it would be impossible for her to transition to non-pornographic movies or television roles. Although physically beautiful, she now was out of the age range for first-call models and pornographic actresses. Even desirable prostitutes now were trending younger. While she had made a considerable amount of money, most of it was stored in her house and various safe deposit boxes in the form of cash. The few investments she had made were unsuccessful, e.g. several rental homes in Riverside, which she had purchased at the top of the market right before the real estate cash, which now were underwater and cash flow negative. Furthermore, she led an expensive life-style; for example, she wore designer clothes and her car was a late-model Rolls Royce.

After she told me she had been molested as a child, a missing piece of the puzzle fell into place for me, which was that she also may have had some form of dissociative identity disorder. This facilitated her development of a carefree, sexy, outgoing alter ego, which may have corresponded in various degrees with her “true” personality, but which also was out of consonance in various important dimensions. It hid the baby part of her personality under a facade of self-accomplishment, self-reliance and independence.

The Treatment

I saw Jennifer for 12 sessions, the maximum permissible by the Clinic. Her attitude towards treatment was positive. She always was on time for scheduled appointments and never missed an appointment. She understood the time limitations of each session. While I was not involved with the economics of the Clinic, I was told she paid in cash, which didn’t surprise me. She knew how attractive she was and did not hesitate to deploy this resource in an engaging, flirtatious style. For example, if one were seated next to her, she would reach out and touch one’s arm or knee when making a point (this caused me to move my chair across the room, which was not large). She cultivated an easy, conversational intimacy. Even though she may have been bored to death, she had a remarkable facility to stay, or at least pretend to stay, engaged (this perhaps is her greatest accomplishment as an actress). Her slate-gray eyes seemingly took in everything she saw, and she maintained absolute, even uncanny eye contact. She would talk softly if she wished for you to move closer to her, in order to understand what she was saying – a clever conversational strategy that had not previously occurred to me. Her manner was easy going, deferential, with a lot of je na sais quoi. She projected an aura of self-confidence, in full command of all of her considerable resources, which she unhesitatingly and skillfully deployed; but at the same time, discreet and confidential.

We discussed several themes over the course of therapy. First, the ethos of many GenX women is completely different from baby-boomers, GenYs or millennials. “For many GenX women,” said Jennifer, “having sex for money is no big deal.”  Jennifer described for me how she even was able to talk women who were casual acquaintances into having occasional sex for money, even if they were married. She described one case where her friend’s husband found out about it, which (understandably) caused no end of turmoil. I have seen the same phenomenon before; GenYs and millennials are more “moral” in a conventional sense than GenXs.

Second, Jennifer liked to have sex. She had numerous male as well as female partners. She claimed she typically did not distance herself and her client while having sex, but rather actually enjoyed it as much as possible. She had no problem with kissing her clients, performing oral sex and achieving orgasm–both (or so she told me) typically outside the scope of most escorts’ employment. As I observed earlier, much of this might be due to her latent acting skills.

Third, she claimed (and I believed her) that there are over 10,000 pictures of her in various states of undress and coitus readily available on the www. I told her I did not understand the need for this profusion of images, particularly given that, after a point, they were functionally indistinguishable. How many different pictures of one having sex did one need?  She was unable to answer this question but for some reason it hit a nerve for her so she pondered it carefully and brought it up on several separate occasions.

Finally, I never understood how her husband fit into the scheme of things. Jennifer told me her husband started off as one of her clients, then his role evolved over time. I asked her about the dynamics of their relationship; in particular, how her husband was able to tolerate her occupation as a prostitute. Even if he believed she was faking enjoyment of sex with a client, how would he know for sure; what would qualitatively differentiate his having sex with her, from her having sex with just about anybody else?  I never was able to get a satisfactory answer to this question; whenever we discussed it, Jennifer just would smile enigmatically. I still find this aspect of her case to be puzzling.

There actually are several analogies between psychoanalysts and prostitutes. Both perform a professional service. Both require a special expertise. Both typically are paid by the hour. Both must empathetically attune themselves to their clients; they must convince their client they are doing something more than just making a living. Much of what a prostitute does is listening to her client’s various problems, complaints, issues, etc. and in a sense performs a therapeutic function. In a successful transference, the psychoanalyst in effect sells love to the client, just like the prostitute sells love to hers. The difference between certain theoretical orientations and prostitution – for example, sex surrogacy – is unclear.

Psychodynamic Conceptualization

Jennifer’s case best is conceptualized in terms of self-psychology. At its core, self psychology is a theory of the self. The self is more than a collection of primitive drives, ego conflict, or relationships with objects. It is not some kind of an undifferentiated mass. Rather it consists of separately identifiable components. Babies are born with a “nuclear self,” which has certain innate capacities and limitations. Baby’s parents present to baby a “virtual self,” which is parents’ concept of who baby is. Putting these two together, baby arrives at a “cohesive self,” which becomes a kind of organizing principle for baby’s experience of the world. Baby uses “selfobjects,” which lie on a fine line between real-world objects and objects which baby has incorporated into its mental life. Baby does not experience selfobjects as existing independently from self. Rather baby integrates them into its understanding of the world; they comprise an essential element of baby’s normal functioning. Selfobjects may be “transitional objects” as that term is understood in other schools of psychotherapy, such as a blanket, a toy, or a sled (famously depicted as “Rosebud” in Citizen Kane). The important point is not so much what the object is, rather, the nature, scope and extent of how baby uses it and the way it contributes to baby’s coping skills. If there is no selfobject, or baby’s relationship with parents is impaired, then baby will become frustrated. On the other hand, provided it is handled properly, some frustration is critical for baby’s development (what Kohut called “optimal frustration”), because baby must learn to lead a life separate from that of parents.

In doing so baby passes through a phase where baby experiences self as the organizer of all experience–an omnipotent, “grandiose” self. In a way this phase of baby’s internal world might be described as narcissistic. The selfobject is idealized. Understandably it is difficult for baby to transition between the grandiose self and the cohesive self because the illusion of omnipotence is powerful and attractive. It is a kind of “phantasie,” which baby develops as a result of its interactions with parents and the world. Baby in effect must reconcile itself, or become disillusioned with, its magical powers to alter reality. It must differentiate itself from parents. At each stage the self dynamically adapts to its experience of objects and others. Most psychological problems result in a failure of empathy between parent and baby at some point during this process. Parents must develop what Kohut called “twinship” with baby–a state where baby’s needs are clear to parents, parents are reliably available, and parents in turn mirror baby experiences back to baby, enabling baby to feel intimately connected to them. Baby must feel affirmed and validated. It must experience parents’ confidence in confronting the contingencies and exigencies of an uncertain world. It must solve the problem of other minds–how it’s alike to, and different from, others with whom it interacts. Baby will soak up its experience of parents like a sponge, and they are critical not only to baby’s early development but also baby’s sense of self.

One of the goals of therapy is to recreate, or reinstall, this empathetic relationship, with therapist as surrogate for parent. The therapist must “empathize, not analyze.”  The therapist must offer interventions that correspond with the client’s own experience and concept of what it is to be a human. If the client resists an interpretation it’s not necessarily because the therapist has activated a defense mechanism. Rather, the therapist simply has not yet fully entered the client’s world view (Kohut called this mode of observation “experience-near”). The therapist must discern the nuances and idiosyncrasies of the client’s private world, venture forth into it and respond to it in a way that makes sense and resonates for the client; that feels authentic and genuine. In particular the therapist must trace the evolution of baby’s selfobjects and discern their permutations and transmutations into an adult form of life; for example, educational background, occupation and choice of romantic partner. The client must understand how a relationship with an outmoded selfobject may cause personal distress or maladaptive social functioning. Key to these transitions is that patient’s baby-part must feel understood. Therapist must supply missing experiences of mirroring and twinship–transmuting internalizations–resulting in reparative selfobject experiences. Only with this connectedness between the therapist and client will therapeutic change be possible. The client will confidently go forth to confront reality with a sense of inner tranquility, but also inner strength and confidence. The client will not just be a victim of circumstance, but an active agent in transforming reality to as to conform itself to the client’s expectations, not the other way around.

Here, there was no question but that Jennifer had developed an adequate self-sustaining structure. She was bold and confident in her work. She showed no sense of shame or embarrassment. Unlike many other prostitutes she used her real name as her professional identity. Her ambition at that point in her life was unclear. Her ideals and values did not correspond to those that might be characterized as socially conventional. But now, in the early 21st century, why should she bother to conform herself to them?  Who cares?  Even though there was a sense in which she lived outside the law, her own value system was consistent and honest.

Having said this, there is no question but that Jennifer yearned for a selfobject in the form of a father who never was there to provide a mirroring selfobject experience. Her only concept of masculinity was that of a sexual partner whose primordial need for gratification was foremost. All she had was pictures of herself at prior stages of her life, not real, genuine experiences. She had no concept of a father who was understanding, tolerant, nurturing and ambitious for his only child. This created a deficient understanding of, and capacity to relate to, men. Men literally were objects, to have sex with then forget about. In a backwards kind of process, they were the ones who turned her into a selfobject, rather than the other way around. They were disposable, fungible, rather than creatures with whom one might be able to construct an enduring relationship. Since many of Jennifer’s sexual partners also were women, she also tended to view them in the same way. They were not so much competitors for scarce male resources, as Jennifer would win such a competition hands down. Rather, they were impediments or annoyances–people who could not help her, who most likely would annoy her, and who had to be brushed aside in order for her to maintain a state of poise and equilibrium in her life and go about her day-to-day activities. Put simply, she didn’t give it much thought.

At the end of treatment, my goals for Jennifer were to consider the power dynamic, which her role as sexual partner played in her development. She had walled off her early baby experience as having been molested by her uncle; I invited her to reconsider it carefully and understand the role it played in her subsequent development. I advocated much the same strategy in reconceptualizing her relationship with her father. While it is impossible for one to alter and relive one’s past, at the least one can restructure it imaginally and discern the pivot points, the intersections and vectors where things might have been different, had they not been the way they are.

I suggested she examine her mother’s role as a passive creature with little will of her own, who needed tending and nurturing, much of which fell Jennifer to provide. Even though Jennifer seemingly was strong, self-reliant and self-sufficient, there was a baby part of her that needed love and nurturing, as well–not the fake, artificial love of a client who may develop a crush on her as a sex object, but rather a genuine, stable romantic partner with whom she could develop, or attempt to develop, an enduring romantic relationship.

Given the unstable nature of her work, Jennifer needed to develop better tolerance of ambiguity, inconsistency and indeterminacy. She had to learn to live with uncertainty, yet not be caught in hesitation. As she got older, and became less viable as a model and prostitute, she needed to develop other interests; perhaps she should consider going back to school (though not law school, the prospect of which she now detested). Jennifer showed remarkable capacity for self-insight, and at the conclusion of therapy I felt confident she would be able to accomplish these objectives.

I have not heard from her since, and have experienced no curiosity to find out how she’s doing.