Psychoanalysis at its best- by Lucy Sant’Anna Takagi, Psy.D

When I read this poignant account of the author’s experiences with her psychoanalyst, I knew I wanted to post it as a guest post on my blog! I’m grateful to the author for allowing me to do so and hope you will enjoy this as much as I did…

To Dr. Fred:  The experience of a Brazilian female patient with a white male psychoanalyst
By Lucy Santanna-takagi lucytakagi@YAHOO.COM

The experience of a Brazilian female patient with a white male psychoanalyst

This article is based on my memory, as a psychotherapy patient, of the interactions between my psychologist, Dr. Fred and I. It is one-sided. My memories have been affected by life experience, time, and all that love does to memories. This not a professional article. This is my story with a caring and honorable psychoanalyst in New York City, who from hereon will be referred to as Dr. Fred. Why am I sharing my story with you? Because not many immigrants in psychotherapy with white psychologists, write their stories and publicly acknowledge the benefits and the positive impact of psychoanalytic/ psychodynamic treatment. Additionally, by writing this, I honor Dr. Fred’s knowledge, talent, wisdom, and professional life.

The Therapeutic Alliance

The year was 1987. I was 23 years old. A Brazilian struggling in Rio de Janeiro. I had finally decided to not decline, again, an invitation to visit New York City from the man who would later become my husband. This man was born in Japan, but lived in the USA for over a decade. We met in 1983, as he was ending his first trip to Rio de Janeiro. The bus scheduled to take him back to the airport had broken down. I was on my last day of work at the lobby of the hotel. We started chatting. This is how we met. Fate. I had never planned to move away from my Brazil, but I felt disillusioned.

The normalcy of trauma in the background: Twenty years of military dictatorship had ended in 1985, but Brazilian citizens would only be allowed to directly vote for Presidents in 1989. The presidential candidate, who held the hopes of the Brazilian liberals, elected in March 1985, died abruptly in April,1985, before taking the post. During those years, social class differences were significant; and all kinds of discriminations were mostly attributed to those differences. Poor Brazilians lived in debt, paycheck to paycheck, got often unemployed, faced long lines for basic food items that would only be delivered in small amounts, etc. Inflation was rampant. With the growth of the dictatorship opposition and underground movement, oppression became more visible. For one hour each day of the week, all radio stations played long messages of how the country was successful and how obedience and order was important.

These and other experiences were “normal”. Eventually in the late 70s and early 80s, crime soared. With that, came a sense of one never being safe. I remember occasionally riding buses and seeing people dead, shot on the sidewalks. Robberies, kidnappings, car hijackings, all became “normal”. With all of that “normality” came a huge amount of anxiety, sadness, terror and anger. Families needed to protect their children from the harm that could come if one did not obey without question. Physical punishment was also “normal”. Questioning anything was dangerous. Compliance was expected. Systemically, the social environment became significantly more divided. This social fragmentation, in my opinion, benefited the status quo. Only a few powerful people had control of the masses, who were too busy struggling to bring bread to the table and limited in realizing their debts would likely never be offset.

Concomitantly, Brazilians thrived in nurturing relationships. Community, interpersonal and religious support, faith, and hope helped people survive. At that time, I felt detached from everything. I was a college graduate, had moved out of my parents’ house at 19 years old (a rare feat for most Brazilians!), but my profession was not allowing me to pay my rent. Coming to the USA, why not?

The Crossing Privilege:

I came to the US, fell in love with my husband, got married, and returned to Brazil to get rid of the little bit I had there. I said goodbyes but did not allow myself to fully feel it.  I believed I could always go back. I was again, detached. I returned to the US with two boxes and much hope for happiness. I was also terrified.

I had no idea of my privileges then. I came to the US by airplane, not by the La Bestia train in Central America. I had a visa. I did not leave debt in my country. I did not have to hire a coyote and have my loved ones be threatened if I did not pay. I had not been trafficked. I did not have to spend months hiding from town to town, hidden in cars, homes, or woods through Mexico. My trip lasted approximately 13 hours and not 3 months. Once on US soil, I did not become an “illegal alien,” or a “criminal,” but became a “legal” one. I could get a driver’s license and a social security card. Every job I had, gave me the option of having health insurance or retirement contribution. Although my spoken English was problematic, I could read and write in English. These were only some of my significant privileges.

In 1988, I began to struggle. Living in a new country, being married to a Japanese citizen, being young, and fighting the ghosts of my past suddenly seemed impossible. Again, I was privileged. My husband had a high position in a prestigious New York City firm and was willing to do anything to help me adjust to life in the USA. My request? Psychotherapy!

I had tried psychotherapy in Brazil. At that time, psychoanalytic treatment was valued and prevalent in Rio de Janeiro. One of my first analysts was too quiet, too removed, albeit caring. She probably was trained in what is known as ‘Ego Psychology’, an approach that focuses on defenses and interpretations. I somehow could not adapt to the “cold” hand-shake at the end of sessions, living in a country where hugs were given. The other analyst in Brazil was Lacanian. She informed me that session times were flexible. She explained that she would end sessions when she believed it was important to end. I knew nothing then, so I agreed. After a few months, I realized sessions never lasted more than 15-20 minutes. I was bothered to be paying full price, when I struggled financially, for a 15-20 minutes session. In Brazil then, health insurance companies did not cover psychological treatment. I had no health insurance, so I worked to pay all my medical and psychological bills. Unfortunately, I did not bring my feelings up. I feared that the Lacanian psychologist would state, “this is the model I use. I explained it to you in our first session.”  In short, I did not expect that my needs would be understood. So, I prematurely ended analytic treatment with both analysts.

Being always on the outside: In 1988, the Japanese companies and businesses in New York City were peaking. Ronald Reagan was President. My perception was that 42nd Street was still a street shamed and feared by middle and by high class New Yorkers. I worked full-time as a salesperson at a department store. My job was colored by a few co-workers who mocked and humiliated my “incorrect English” skills. I had been laughed at, had induced annoyance and exasperation in others, and had handled telephone calls by sobbing afterwards. Bullying and discrimination were not widely addressed at that time. To me, as an immigrant, those co-workers had reason and were justified in their comments towards me. I was an immigrant and my English was indeed problematic. The shame somehow felt deserved. Phone calls were the worst. I could not see the person’s mouth and had a very difficult time figuring out what was being said. My husband, who was also an immigrant, understood my struggles, and supported me. However, I felt completely lost in the beginning of 1988. I feared my feelings would push my husband away. I could not lose him as he was/is the most important healer/partner of my life.

At that time, the human resources department of my husband’s firm, offered medical and psychological treatment to any employee’s or employee’s family member in need. The firm had hired a clinical psychologist to screen cases and to provide appropriate referrals across New York City. Again, a privilege rarely experienced by any immigrant living in the USA! Even though I lived in New Jersey, I was extremely grateful to the resource available to me. All psychological treatment was covered by the company’s health insurance on a 80/20 percent split.  I met with the consultant in New York City.  The session was superficial, but pleasant and promising.

About a week later, I was given the referral to seek Dr. Fred at Central Park West. I was informed by the consultant that Dr. Fred had experience working with patients who had a traumatic background, had two Post-Doctoral degrees, and the consultant believed it would be a good match for me. I was also informed that a second appointment would be scheduled with him, for me to report whether or not I wanted another referral. I cancelled that second appointment with the consultant, after my first therapy session with Dr. Fred and have never regretted it.

In other to get to my sessions with Dr. Fred, I needed to drive to a bus stop, take the interstate bus and take a New York City subway. None of that, at that time, seemed onerous, in view of what and how much healing I received from Dr. Fred. I called him “Doctor” until after I became a psychologist myself, and he asked me to call him Fred. His office was on the first floor of a big building in front of Central Park. The waiting room was small, but his office was quite large. There was a desk, a comfortable chair that allowed him to sit in front of the couch, many photos of New York City hanging on the wall, a picture of Freud above his desk, and a long and cozy red couch. It was a very nice office. I loved the couch that held my body and soul so many times.

Language:

My first meeting was colored by much anxiety and much crying. Dr. Fred looked at me intensely, asked questions when I wasn’t clear. He also appeased me, when I repeated what I had said. I remember feeling shocked when I realized that I was being understood!!  My therapy was in English. There are pros and cons about having psychotherapy in or out of one’s mother tongue. I was Brazilian by birth, but American by choice. Using English in my therapy helped me maintain a level of distance to the loss of my country, family and friends, that I had left behind. Dr. Fred could understand what I was going through. At the very end of that first session, Dr. Fred asked me how I felt talking to him. I answered very positively. I asked him how he felt listening to me. He said he believed we could work together because he understood what I was going through. I was grateful.  He asked if I had any questions for him, and I remember with some embarrassment, asking him how old he was. I was 24 years old and he said he was 53 years old. On my way out, he smiled a warm and caring smile. I thanked him for being willing to continue to see me. He explained there was no need for me to thank him for that. He said although he appreciated the intent and the gratitude, his job was to understand people and he felt he could understand me very well.

Often times in therapy, my words or expressions would only come in Portuguese. Further, some words and expressions had no translation. I remember feeling frustrated when attempting to translate the Brazilian word “saudade” (a mixture of missing, longing, yearning for someone or something). I learned that literal translations did not work all the time. Dr. Fred had two expressions to communicate this to me. One was an uncensored smile or laughter with excitement, as if he had just made a discovery himself. This happened when I created a neologism or when I communicated something in a unique manner that he had never heard before. His other expression was one of being confused or trying to seek understanding on his own, before asking me. Being in direct eye contact with him, helped us navigate and gauge our communication patterns and be attuned to the communication that goes beyond words.

Slowly but surely, I began to think and dream in English. I would dream with my extended family in Portuguese – the translations in therapy could be frustrating because they were rarely accurate – but began to dream with my husband in English. I also had dreams of having therapy sessions with Dr. Fred in English. Psychotherapy co-occurred and was very much a part of my bi-culturalism process in the USA. During that first session with Dr. Fred, while at the door knob, I joked with him. I said that since analysis would require me to fall in love with him, we could simply proceed as if that was already in place. He laughed and I left.  No hugs, no hand-shake, but a significant sense of peace took over.

Idealization of American knowledge and practice:  Thirty-one years later, I still remember my inner experience of being recognized and understood by a white, American doctor. I am grateful for Dr. Fred’s attention to how as a woman, I tended to frequently apologize for things that I did not have to. I tended to absorb responsibility for other’s limitations, and to idealize and seek the approval of white males. Unfortunately, this latter realization came after our treatment ended, but he laid the foundation for the insight.  Dr. Fred also facilitated my awareness as to how I, as an immigrant woman, could be treated unfairly. I regret not having had more time to process the gender dynamics embedded in our relationship. Dr. Fred, a white male and I, a woman of color while seemingly white, working collaboratively. I pass as white until I speak, then I am an outsider.

Gaining Insights: One of the psychodynamic and/ or psychoanalytic treatment goals, is for the patient to gain awareness and understanding of how present behaviors may be linked to past experiences. After a few months in treatment, I begin to feel I could trust Dr. Fred. I had incidents in my past that had been traumatic, but I had not dared working them through with anyone. Despite my positive feelings about therapy with Dr. Fred, I remained unsure if I could really trust him for quite a few months. Having been the recipient of abusive and emotional assaults, I had internalized that I was at fault, that there was something wrong in me that brought those behaviors to take place.

At some point in the beginning of treatment, I tentatively disclosed to Dr. Fred an event that had just happened. I was devastated because I had made a mistake. At that time, a mistake would overwhelm me. It carried all the weight of me being flawed. It was not something I did. It was who I was. I felt I was a mistake.  Dr. Fred understood me being overwhelmed, but slowly expressed curiosity about whether my reaction could be possibly related to past interpersonal events. By then, he knew that other’s rage would shatter the child, who still lived within me.  Gaining understanding and insight, helped me slowly gain confidence in myself, in my experience, and in how others can use reaction formation, gaslighting, denial, to displace their difficulty with accountability onto others. I slowly moved from victim to survivor.

For the next five to seven years, Dr. Fred became my life-line. Initially, the process was overwhelming and terrifying, but also exciting. I learned through the therapy, that I could have multiple feelings at once, and often paradoxical ones! A world of new possibilities was opening up. I felt opened and exposed, but also cared for, respected and understood. My detachment gave away to a flood of buried and hidden feelings that often both terrified and helped me. The more I cried the more I felt like crying. And crying brought the fear that I would not be able to pick myself up and go on. Dr. Fred instilled in me the confidence that I could and would. The more I grieved, the more I gained.

Transparency, respect and acknowledging the privilege of receiving someone’s history:  My first memory was an event that occurred after the first month in treatment. Dr. Fred showed me his billing statement to be sent to my insurance company. He explained the diagnosis he had given me. I still remember asking him what Dysthymia meant. He explained and to my shock, asked me if I agreed with it!

At that time, Dr. Fred’s and my racial status, gender, citizenship status, etc. were not a focus of our therapy. Now however, I cannot help but to be surprised by a white male doctor asking an immigrant female client in the late 1980s, if she agrees with the label she is being given!  We are in 2019, and I still get shocked and grateful, when I think about it. I will never forget his consideration of me as a person.  A person capable of telling him if whatever diagnosis he had given, made sense to me or reflected my lived experience. That sense that my experience was being respected, induced in me, an immeasurable regard towards Dr. Fred and towards the practice of psychology in the USA.

The second memory happened a few months into the treatment, when after sharing with him something I had never shared with anyone, Dr. Fred thanked me for giving him the privilege of my trust. Again, his attention to details and to experiences that may be unimportant to others, but that within a psychoanalytic frame, help repair gaps left by real or by symbolic losses, was nothing short of healing.

Recently, I had a patient of color during an intake session disclose multiple deeply traumatic instances in his background. No affect. He simply reported deeply painful events as if reading an outline. When I expressed gratitude for his trust and acknowledged the difficulty the child in him must have endured, the tears rolled. He said, no one had ever recognized how difficult it was for him to report and relive those incidents. In that instance, I felt Dr. Fred was in the room.

Dr. Fred, as a psychoanalyst, demonstrated in action, that his patients were worthy of his respect, regard and consideration. He was consistently interested in my understanding of what things meant to me. He also invited me to consider the “trees in the forest” and not just gloss through them. At some point later in our treatment, he jokingly asked me if in Brazil they put something different in the water. I told him I did not understand. He explained that he became interested in treating other Brazilian clients after working with me, and he was surprised by their sensitivity and by their “emotional knowledge.”  I told him I was not sure how I felt about him expanding his practice in that manner. We both laughed at my jealousy.

Faith:

I was raised Catholic but was not a practicing Catholic in the USA or in Brazil. I did not know Dr. Fred’s religion and it didn’t matter to me. However, during one of our sessions, when I was protesting the pain that psychotherapy was causing, he asked me if I had ever read the Bible. I declined and he said. “It says that the truth shall set you free.” And freedom was a concept of great importance to me. I gained faith in myself and in my future.

Valuing symbols:

Meaning making and symbols, are important aspects of psychoanalytic and psychodynamic therapy. When I asked Dr. Fred what led him to become a psychologist, he warmly looked at me and said he enjoyed gardening. I was confused. He explained that working with patients was like being a gardener. A gardener who could nurture a seed with just about enough water, sun light, and care, that someday a beautiful flower could blossom. He attentively added something like, “It is like carving a diamond in the rough. Once the diamond is carved, everyone can see it. However, only the carver or the gardener and the seed or the stone, can value the experience of growth in every step of the way.”  Dr. Fred shared he had purchased a home in upstate New York, where he enjoyed gardening and working the land.

New York City & the symbol of freedom:

Dr. Fred very much enjoyed New York City. He had a friend, who had come to see him prior to one of our sessions, who was a photographer. He purchased New York City’s pictures from this friend, who needed the money, and hung them around the waiting room and his office. They were beautiful colored and black and white pictures of the NY bridges, skyline, and of Central Park. To me, they symbolized possibilities, paths opened, roads to be crossed. They were psychotherapy symbols of possibilities, growth and discoveries.

In my second session with Dr. Fred, before I began sharing my secrets, I gave him a rough stone that my dad had given me back in Brazil. My dad was a wonderful, caring and supportive figure in my life. My mother was the doer in the family, a driven fighter, someone who was and is always taking care of others. I was still little when my dad gave me the stone. I had probably complained about something I wanted that he could not afford. My family was poor. My dad came home one day and said he had received a rough stone from a colleague, who had told him it was valuable. My father gave the stone to me and said, “I want you to know that even though I cannot purchase things to give you, you are important to me.”

I still have that stone and grew up to love rough stones. To me, its value is what it symbolizes: my father’s love. I knew I was going to share many aspects of my family that would probably lead Dr. Fred to judge the people I loved. I needed Dr. Fred to help me protect the love I had received. I needed him to protect it from the pain I had also endured. Dr. Fred held the stone and agreed to keep it. He said I could ask him to give it back at any time. Now, as I write about this session and describe his analogy of therapy being like carving a diamond in the rough, I wonder if he could have had the intent of using the stone I had given him, as a symbol of hope.

The Couch Invitation:

Dr. Fred and I sat face to face; he on his chair and I, on the red couch. At some point after the first few months in therapy, Dr. Fred had asked me how I felt about laying on the couch and having a more formal analytic treatment. I had no knowledge of psychology then. I did not know what a compliment that invitation was. I felt that I needed to keep eye contact and notice his and my body language, as I shared my story. He accepted my choice and explanation without question. So, our therapy was not formally psychoanalytic, but more psychodynamic in nature.

Seeking Direction:

Different models of psychotherapy differ in defining the role of the psychologist and the form the treatment will take. There are many therapeutic models used to address and understand human suffering. Each has its merits and its deficits. The existence of many models, support the understanding that humans are different, have different problems, and need different models of intervention. There is no one size fits all when dealing with the psyche. But there are turf wars.

Psychoanalytic practice has lost its prestige. In the era of “evidence-based” and of Randomized Control Trials (RCTs) as being the only “evidence” that counts, this therapeutic modality is often misunderstood and devalued.  Psychoanalytic and psychodynamic practice values the specificity of each client, his/her emotional experience, it explores issues of power, oppression, and trauma, and how one’s history could influence current problems. It values interpersonal and therapeutic relationships, the importance of childhood experiences, and the unconscious. Unfortunately, these crucially important factors are often perceived as unrelated or irrelevant to outcome measures. As a result, psychodynamic therapy – as many immigrants in the USA! – is often excluded and dismissed. I find this to be a profound injustice to a treatment modality that started our field, that has evidence to support its effectiveness, and that continues to provide healing to so, so many.

In my experience both as a psychologist and as a patient, positive and long-lasting outcomes are unlikely to occur if the important areas mentioned above, are not dealt with.  My treatment involved addressing every crevice and nook of my daily life. My “symptoms” were being addressed. My problems were getting resolved. My confidence was increasing. My tolerance and understanding of my role and contribution to the hardships I endured, also increased. It felt that I, as a whole person, was being seen and understood, not simply parts of me or parts of the problems I had.

When I began therapy with Dr. Fred, I was professionally lost. I had dropped out of medical school in Brazil, as my family could not afford it. I had studied Theater Arts. I had become an actress but could not pay the rent. I did not know what I was meant to do in the USA. In 1988, although I continued to work with sales, the need to have a career was creeping stronger. My husband is a businessman and suggested I looked into possibly applying for an MBA and getting a degree in Marketing.

One day, after many sessions discussing my doubts with Dr. Fred, I asked him what he thought I should do. We discussed my needs to receive his advice. Finally, he looked at me and said, “Have you considered psychology?” I explained how profoundly touched I felt, that he believed I could “grow up” to do what he did.  He smiled warmly and explained that there was still rigorous training ahead, but that he believed the mixture of a medical doctor with an actress had to result in a psychologist! We both laughed. I have recently found out that Dr. Fred, too, had been an actor. Hearing Dr. Fred believing that I could become a psychologist was the jumping board to my career. …Or it could also have been the worst case of transference never worked through. … Or both.

I started taking undergraduate courses. Then, I got pregnant with my first child; had to stop the courses for a year. Then resumed the courses while pregnant with my second child. Then, as the children were little, I applied for my Master’s degree in Psychology. All of it, with the steady and unwavering support of my husband, who worked so I could go to school and who co-parented our children along the way. I applied for my Doctoral degree in Clinical Psychology. After about fifteen years of schooling, here I am: a licensed psychologist.

Boundaries:

At one point in psychotherapy, I expressed my fantasy that someday, Dr. Fred and I could meet for coffee or lunch somewhere else. I noticed a tinge of worry in his face. I asked if I had said something wrong or if that was not allowed. He gently explained we could not do that. He explained his role, psychologist’s regulations, ethics, and why it would not be appropriate for us to meet elsewhere. I told him I accepted it. However, I asked if I could still fantasize about something that would never happen, but that I had hoped it could. He smiled, nodding affirmatively. The worry I had seen before in his face, had disappeared. It might have been during that session while we were talking about boundaries, that I remember Dr. Fred stating something like, “When I am gone, I want to be remembered as a honorable man, as a man who respected others, who did not exploit or abuse anyone. That is how I would like people to remember me, as being honorable.”

During the same period, I also asked Dr. Fred about his family. I knew he lived in the building. I had seen his wife, as she had an office next to his. We processed my curiosity. I had no shame in telling him that not having an extended family in the USA, left me vulnerable to seek families that could “adopt” me. I was not curious about his marriage per se, but about his children. From my experience of him in therapy, I believed Dr. Fred was an outstanding father. I remember us joking about me volunteering to clean his home, iron his family’s clothes (yes, in those years I ironed clothes… even towels!), just to be invited in, to be able to be one of his children. During those days, I also asked if he could show me a picture of his two children, who were then, I believe, teenagers. He did not answer. Our very next session, Dr. Fred surprised me stating that he had heard my request and had considered it. Again, my utter shock. I must say that as a psychologist in 2019, I would probably never show a picture of my children to any patient! However then, as a patient, I did not seem to have found any problem with my request.

Dr. Fred had creatively selected a picture of his daughter, Julie, as a baby to show me. He informed me of his children’s first names, Julie and Christopher, when I asked. I would have never recognized them if I saw them anywhere. The pictures of his daughter as a baby preserved and protected her. At the same time, it also fulfilled my need to see her and to confirm the great father that I believed Dr. Fred was. I still remember praising his daughter’s picture. It was a fair-skinned, bald and smiling baby. Dr. Fred responded by rubbing his hand on his bald head, stating that people said that he looked a lot like his daughter. We both laughed loudly.

The Unconscious:

Psychoanalytic and psychodynamic therapy presumes that we get motivated by things that we are aware of, but also by things we are unaware. The unconscious pushes us to act in ways that we may not have consciously intended. The more one gains awareness and understanding (insight), the more one is capable of improving relationships and of feeling empowered. In 1992, I delivered my second child, a baby girl. The session regarding Dr. Fred’s family had taken place probably around 1988. It was nowhere in my immediate memory. My husband and I had discussed names and we gravitated towards one name for our girl. When my baby was born and I looked at her, I suddenly felt the urge to name her Julie. When my husband asked about the change, I explained that there was something about our baby’s face that did not match with the name we had tentatively selected, but I could not explain what it was. It was only during therapy sessions later on, that I realized that Julie was also the name of Dr. Fred’s daughter! Additionally, unlike our first son, my Julie was a bald baby. Looking at her beautiful face and bald head, allowed my unconscious to manifest itself.

Julie and my son, Brian, were a testament to my psychic survival and emotional growth. I understand many who will read this, will believe that I had some kind of erotic transference towards Dr. Fred and that unconsciously I was wishing to give birth to his child. I did work through that also. However, what mattered to me then and now, was that Julie symbolized that a child could be well parented. She meant hope. She meant that I too, could be a good mother, even if I made mistakes. By then, I had realized that I was no longer a mistake myself, but that I could and would make them, many of them. And that was OK, because I could also repair them.

Therapeutic ruptures:

Although my treatment with Dr. Fred was overall very positive, I was not as aware then, of the influence of racial, cultural, immigration, gender and power dynamics in psychotherapy. I wished I had had the chance and the wisdom to have addressed these issues more in depth during the time we spent together. As an immigrant woman in psychotherapy with a white American male, there were some instances where ruptures occurred and were repaired, but only from an individual basis. The influence of social, political, and historical contributors were unfortunately left out of both of our understanding. Below are a few examples:

Immigrants as Invaders:

In 2019, there are multiple misperceptions of immigrants in the United States. These misperceptions have an impact on everyone. Undocumented immigrants are particularly vulnerable because they need to be invisible. References such as “criminals,” “aliens,” or “illegals” carry the weight of possible detention, criminal persecution and social exclusion. Children of immigrants, who are born in the USA, as well as naturalized citizens, are also vulnerable to bullying and to being told they do not belong. This sometimes, explicit message of not belonging is psychologically traumatizing.

Psychodynamic psychotherapy values the recognition and exploration of all parts of oneself. Although there is a power differential between patient and psychologist, which may mirror other power differential relationships the patient might have endured, the focus on mutuality and collaboration often allows for insights and for a corrective experience. However, it is important to recognize how gender, ethnic, cultural, racial, and other identities and experiences, can influence mutual understanding and healing.

There was one instance where Dr. Fred’s statements were hurtful to me as a female immigrant. I remember complaining to him about having had a frustrating discussion with my husband. Dr. Fred was challenging my difficulty asserting myself. Seemingly frustrated and probably absorbing the anger I was disavowing at my husband, Dr. Fred (I believe in a counter-transferential impulsive reaction), said that he believed the Japanese citizens were “bowing away” their appropriation of New York City. He explained that the Japanese tendency to seem agreeable, probably masked their inner aggression.

It is interesting to reflect on the belief of immigrants “invading” one’s geography. At that time, in the early 1990s, Japanese businesses were booming in New York City. There were many white Americans who were angry at this “Japanese invasion.” However, unlike now with Latino immigrants, Japanese immigrants then, brought significant investments into the US economy and arrived legally in the USA. They often came on a work Visa, worked in Japanese companies, but were not always aware of this undercurrent of resentment from mainstream America. In the 1990s, cases of Japanese citizens being overtly or covertly rejected and aggressed upon, were not unheard of. These experiences often brought to the surface, the history of internment camps, and fear would ensue. When I heard what Dr. Fred stated, I suddenly realized that he had rejected my husband based on the stereotype he had developed. I was conflicted because I needed to retain Dr. Fred as an ally, but I could not pretend that what he said had not hurt me. He apologized in subsequent sessions for his statements and explained that he was addressing my difficulty asserting myself. He had not meant to be offensive. In hindsight, that was a missed opportunity to explore how the social, historical and oppressive reactions towards the “other” could have influenced our interaction. I was unable to wrestle with him over it. However, that was one moment where his whiteness and mine and my husband’s color, seemed shockingly clear in the room.

Family Relationships:

Many immigrants in the USA, experience the survivor’s guilt. They feel indebted to the welfare of their families of origin. Different ethnicities have different family patterns. Latino families tend to be perceived as “enmeshed” by non-Latino professionals, as a result of the collectivistic and interdependent relations of its members. Conversely, the American emphasis on assertiveness, independence and individualism, is often perceived as being “cold,” detached, and even rude. In the 1990s, feeling that I had the privilege of living in a country that respected human rights, that valued freedom and liberty, and whose flag included its 50 States united by a color that symbolized vigilance, perseverance and justice, led me to feel responsible for caring for my family in Brazil.

I feel deeply sad, discussing here, the bond that holds families together even when they are apart. I feel sad knowing that families are being separated in our southern borders. My family members did not have the same privilege that life had granted me. Dr. Fred had a difficult time understanding that debt. It seemed incomprehensible to him, at times. Again, I wish I had had the understanding I have now, to address how his and my cultural values, influenced how we both defined “problems.”

Therapy Termination:

I remained with Dr. Fred until the early years of my second child. I dreaded knowing that I would need to end treatment. As going to New York City was often difficult for me, Dr. Fred and I started having telephone sessions. I still felt I needed to talk to him weekly, but I also could see how difficult and challenging that was becoming for me. We talked and spent more than a few months discussing ending, but not doing so. I do not remember much of our last session. I remember already having been accepted into my Masters program and already taking graduate classes. So, this happened around 1997-1998 or so. However, one memory is clear. During our last session, Dr. Fred had placed on his table, the stone I had asked him to hold for me years before in the beginning of our treatment. I cried when I saw it, because I had forgotten about it. He remembered. We talked how it felt to be ending and how his door would be always open.

Post- Termination:

One of the beautiful things about psychodynamic treatment, is that it continues even after the therapy has ended.  After my therapy ended, I would occasionally check Dr. Fred’s name on the internet to make sure he had not moved or retired.  Somewhere around 2006-2007 or so, after I had graduated from my doctoral program, I contacted Dr. Fred and invited him to have lunch in the city. To my surprise, he accepted and asked me to refer to him as Fred, stating “as we are now colleagues.”  He suggested we meet at a Brazilian restaurant in midtown Manhattan. It was during the Fall and I was nervous. He had not aged from the last time we had met. Before we started, I informed Fred that since I had invited him and that his acceptance had been very important to me, I would pick the lunch tab. He somewhat reluctantly agreed. I introduced him to the Brazilian Caipirinha drink, which he very much enjoyed. We talked about my degree and all the many hurdles for licensure in New Jersey (e.g. I had to do the oral exam, although it was discontinued shortly after I took it).  We joked about my transferential feelings and professional choice.

Unlike in a therapy session, Fred also let me know that he had recently lost his brother to depression. Not surprisingly, he seemed really impacted by that loss. Fred was originally from Seattle. He was very proud of both of his children, who according to him, had chosen professions to help others and had a social justice commitment. He said he was still working and still going to his home in upstate New York, where he very much enjoyed the scenery.  I told Fred I was in analytic treatment and would be discussing our meeting in my treatment.  He smiled and said he expected no less. He mentioned that he also had grown as an analyst since our treatment. He said he did more group work and was much more focused on relational dynamics with patients. He asked me how I knew I was ready to go back into the psychoanalytic matt and wrestle interpersonally. I found interesting his use of the word “wrestle” to describe the therapeutic interaction. I guess emotionally, we do wrestle. I told him that I just felt the need to gather more understanding. He nodded affirmatively.

I do not remember what else we talked about, but we talked a lot. On the way out, we shared a cab. Before I got out, Fred held and kissed my hand and told me to keep being strong. A few years afterwards, around 2013 or so, I again briefly saw Fred at a Relational Psychoanalytic Conference in New York City. We just greeted each other from afar. Coincidentally, as I was leaving the conference and grabbing a cab, I saw Fred also leaving, holding hands with while walking with his wife, a block ahead of where I was. Before getting in my cab, I took a minute to appreciate the love those two shared and the beautiful image of seeing them holding hands, walking together. It was the last time I saw Fred.

At the end of May, 2017, I left him a telephone message, asking him if I could have his consent to discuss our therapy in a presentation I was doing. His wife responded and informed me that Fred had been struggling with the beginning of Alzheimer’s disease. My stomach sank. She said she had spoken to Fred about my request and that he had still been able to remember me! I teared up. That was such a gift. She said he gave his full consent for me to discuss our treatment and to name him. His wife added that I needed to write about what it was like to have had therapy as an immigrant living in the USA. I told her it had saved my life. She asked me to write about it, stating that more than ever, people needed to hear what it was like to be an immigrant in the USA. I told her I would try. Then life happened and only now, I felt I could start telling my story with Fred.

The Diamond:

As I searched again the internet in July, 2019, to communicate with Fred and with his wife that I was going to finally write about our treatment, I had devastating news. Fred passed away on June 28, 2019. The funeral home posted many beautiful pictures of him and of his family. The ones where he smiled were particularly precious to me. A few of those pictures are how I remember Fred. Warm, sensitive, caring, witty, and honorable. He and his wife were happily married for over 50 years. His children and grandchildren all seem healthy and happy in the pictures. I was correct. He was a great man, a wonderful father and a gifted psychologist.

I hope, wherever his spirit is, that he feels and sees how many people he touched and how precious his life was. To me, he, the psychodynamic treatment he employed, and the therapeutic relationship we developed, were the diamond carved out of the rubble, after all! I can only say, thank you.

Luciene (Lucy) Sant’Anna Takagi, PsyD, LLC

Brazilian Clinical Psychologist practicing in Newark, New Jersey

Bio:

Dr. Takagi earned her Master’s in Educational Psychology with a concentration on Child and Adolescent Clinical Psychology from Montclair State University in 1999. She received her doctorate in Clinical Psychology from the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University in 2006.

She has worked clinically with inner-city, ethnically, financially and culturally diverse populations and with adult and child victims of sexual abuse. Dr. Takagi is a trained forensic evaluator and has done assessments and treatments of victims impacted by abuse and neglect. She has testified as an expert and fact witness in New Jersey’s civil courts. Dr. Takagi has also worked forensically, evaluating undocumented immigrants applying for documentation. Currently, she paused her forensic work, and is only doing clinical work because of her other work commitments.

Dr. Takagi is a licensed psychologist in NJ and in NYS. She is also a member of the American Psychological Association (APA); a member of the APA Division 39 (Psychoanalysis); a member of the APA Division 35 (Society for the Psychology of Women); a member of the New Jersey Psychological Association (NJPA); a member of the American Professional Society on the Abuse of Children (APSAC) and a member of the Latino Mental Health Association of NJ (LMHANJ).

Dr. Takagi is the 2020 President of the New Jersey Psychological Association (NJPA); 2019-2021 elected Member at Large (MAL) of the American Psychological Association (APA) Committee of State Leaders (CSL); 2019 Past-President of the Essex County Association of Psychologists (EUCAP), and a Past-President of the GSAPP Alumni Association at Rutgers University.

In NJPA, Dr. Takagi co-chaired a Task Force in 2017 on the needs of Early Career Psychologists (ECP) and Permit Holders in NJ. This Task Force eventually led to the formation of the NJPA ECP Committee which advocated for changes in the NJ Licensing Law, now under revision in the NJ legislature. NJPA was recognized through a plaque from the American Psychological Association (APA) for “Efforts to Count Practicum Hours for Licensure” in 2018.

In 2019, Dr. Takagi testified in the NJ Regulated Professions Committee In Trenton for Bill # 5307, revising psychologists training requirement for licensure. The Bill was unanimously passed.  Additionally, in December 2017, Dr. Takagi and five other psychologists from NJPA, crafted a letter protesting the exclusion of psychodynamic and other psychological treatments from the list of effective treatments in the APA Clinical Practice Guidelines for PTSD. Her letter, co-authored by a group affectionately known as the “NJ6”, eventually led to the development of the Alliance for the Inclusive Integration of Science and Practice in Psychology, a group that authored and supported the PTSD Petition ((https://www.thepetitionsite.com/takeaction/480/492/776/?cid=headerClick)). The petition has gathered over 57,000 signatures.

Dr. Takagi has been teaching at MSU Center for Child Advocacy and Policy in the Department of Social Work and Child Advocacy since 2011.