Author: By Dawn M. Skorczewski
Publisher: New York: Routledge, 233 pp., 34.20, 2012.
Reviewer: Judith Harris

In 1956, Anne Sexton (1928–1974), one of America's best-known poets of the confessional school of poetry, was admitted to Westwood Psychiatric Hospital after being diagnosed with postpartum depression. Among other causes, it seems that Sexton's emotional and physiological vulnerabilities were made worse by the dynamics of being cast swiftly into motherhood.

Sexton's own childhood had been an unhappy one. Her father, an affluent businessman, was an alcoholic and highly critical of his daughters. Her mother, sociable and vivacious, apportioned love parsimoniously. Sexton always described her mother as taking “top billing” in the household. In contrast, Sexton's live-in Aunt Nana was soothing and uncomplicated, lavishing infantilizing attention on her niece when the young Sexton might have pursued accomplishments more appropriate for her age.

As a student, Sexton did not particularly excel. She eloped with Alfred Muller Sexton II (Kayo), from a prosperous local family, just after high school. The couple moved back and forth between their parents' houses until Kayo went into the military service. Kayo then went to work for Anne's father in the garnetting business as a traveling salesman. During one of his absences, at her mother's insistence, Sexton began seeing a psychiatrist, Dr. Brunner-Orne (the mother of Dr. Martin T. Orne, who would later become Sexton's analyst), who had treated Sexton's father for his alcoholism. In 1952, Sexton became pregnant with her first child, Linda Gray. Sexton's beloved Aunt Nana died in 1954. A second child, Joyce Ladd Sexton, was born a year later.

Admitted to Westwood Psychiatric Hospital after her second child was born, Sexton was referred to Dr. Martin T. Orne, who took over Sexton's case from his mother and treated her from 1956 to 1964. Sexton was seriously, even psychotically, disturbed and suffered from agitation, suicidal depression, and fits of feeling “unreal.” However, unlike most of the patients at Westwood, Sexton was not diagnosed as schizophrenic, and Orne sought her release from the hospital so that she could start seeing him as an outpatient from two to four times a week.

The relationship between Anne Sexton and her therapist, Dr. Orne, is one of the most intriguing in psychiatric literature and is the topic of Dr. Dawn Skorczewski's excellent book, An Accident of Hope: The Therapy Tapes of Anne Sexton. Skorczewski analyzes the efficacy of the Sexton-Orne treatment as it related to her poetry, and many of the cultural myths surrounding psychoanalysis. The significance of the audiotapes of Sexton's private therapy sessions is the focus of Skorczewski's study, including how they became public in the first place and Dr. Orne's stunning role in bringing them forward.

Sexton's story as a psychiatric patient contradicts artistic fears about the anticreative power of psychotherapy. Sexton found her calling as a poet as a direct consequence of her treatment and—arguably—as a result of Orne's “innovative” treatment to help Sexton compensate for memory fugues that afflicted her whenever there was talk about close relationships that elicited internal rage, aggression, or anger. Skorcewski brings into relief the cultural implications of women being treated for mental illness in America in the mid-1960s. In such a climate, women were expected to behave and speak modestly and deferentially, often subjugating their own desires for independence and power to the men they married or consulted as authorities. Women's roles as sexual objects, magnified by film stars, went uncontested in most social circles. Although the diagnosis of “hysteria” was struck from diagnostic manuals, women were often met with the same stereotypes by male psychiatrists. Some never altered their view of female patients as unmanageable, views that were the focus of intense criticism by feminists in the decades that followed Sexton's treatment with Orne.

Skorczewski's work with the transcripts of Sexton's private therapy sessions refuses any prurient interest the reader may have in Sexton's flamboyant character—or the melodramatic features of her suicide. With her extensive knowledge of psychoanalytic theory, Skorczewski is able to make lucid comparisons between Orne's clinical approach, which relied heavily on Freudian theory and its later expression as ego psychology, and contemporary theories of analysis that she argues provide superior modalities for treating mental illness and depression. Thus, she sums up the intended argument of her book in her interview with Helen Epstein:

I tried to show how the therapy influenced the poems, and how the poems, less obviously, pointed to new directions that psychotherapy and psychoanalysis would take in the decades to follow. (8).

Therapy Transcripts

The current book is not the first to gain direct access to the transcripts of Sexton's psychiatric sessions. Diane Middlebrook's seminal biography in 1991 had already infringed on the confidentiality of Sexton's therapy (with Orne's apparent encouragement) to a lesser extent, which incited a heated debate over the ethics of making a psychiatric patient's sessions public. That issue now exhausted, Skorczewski's research goes beyond alluding to the tapes, instead offering the reader the actual transcripts as the basis of her commentary.

Readers are thus invited to “listen in” on large segments of the final tapes, recorded in the months from November 1963 to April 1964. Through these months, Sexton converses with Orne on politics, sex, violence, mental illness, motherhood, poetry, and even suicide. Unlike the earlier tapes, which depict a very sick woman trying to cope with psychotic breaks and self-loathing, yet arduously studying the craft of poetry, the later tapes show an already-accomplished poet who is struggling to maintain confidence and overcome the demonic forces that potentially could self-destruct. The later tapes also reveal the devastating consequences of having to terminate treatment with Orne, who Sexton considered irreplaceable as her interlocutor and protector.

As Skorczewski notes, one can hear the long silences of Sexton's trances due to dissociated states of mind. One can also hear Orne trying to coax her back to consciousness. And given the interest Orne and Sexton shared in the theoretical basis of clinical work, Skorczewski considers each of their therapy sessions in terms of a clinical concept that has been contested and redefined in the decades following Sexton's treatment. Throughout, the subjects of poetry and therapy are intertwined both in Sexton's mind and in the cultural climate in which she was writing “confessional” verse.

The chapters analyze various recurrent themes that arise in the sessions, such as Sexton's insistence that Orne cocreated her poetic identity, a claim that the Freudian-trained Orne sharply denied, inviting readers to consider the different perspectives of contemporary theories versus classical theory of the analyst's personal involvement in the treatment. Sexton's search for the painful roots of her unhappiness reveals traumatic childhood events and memories, which she would later transpose into poetry.

Skorczewski's interest in Sexton was spurred by the research she was doing in Victorian literature and father/daughter incest. She had noted a pattern of daughters running away from their paternal households, had read Sexton's poetry, and wanted to explore more of Sexton's confessional revelations about her childhood abuse. Skorczewski admitted she was “surprised and frustrated” when the authoritative biography of Sexton came out and the biographer concluded with certainty that Sexton had never been sexually abused. She wanted to hear Sexton discussing early events involving her father and aunt in order to make her own decision: that Sexton had been a victim of childhood sexual abuse.

Skorczewski then examines trauma theory from 1960 to the present in order to hypothesize that Sexton's marriage—haunted by domestic violence—had been a perpetuation of her earlier traumatic experiences. While Orne's classicism led him to dilute the potency of childhood sexual abuse in a more general mix of current conflicts and regressive tendencies, Scorczewski makes the point that contemporary theorists now see such trauma as that which must be acknowledged and worked through in itself.

In another chapter, the author explores a poem of Sexton's that arose from a therapeutic impasse and demonstrates how Sexton used the poem to repair the disruption, and to work both sides of the coin: both as a patient and as her projection of Orne behaving as the therapist she wished he would be.

As Skorczewski introduces the content of her chapters it is clear that she gains real insight into the analytic couple, especially in the final chapter where she reveals Orne's projection (countertransference) onto Sexton in accusing her of needing to feel special, “as if this tendency were a disease” (p. xxv) or something she should feel ashamed about, an accusation that Sexton questioned in a poem and in a session. Skorczewski's discussion illuminates the conflict by seeing Orne suppressing his own wish to be special and projecting it back onto Sexton in a more hostile manner: “By his suppression of his own narcissism and his pejorative analysis of Sexton's, Orne pathologized what might be identified as the creative drive for recognition shared by both patient and doctor” (p. xxv).

In fact, as early as chapter 1, “You, I , We Created the Poet,” the transcript makes evident the impasse between Sexton and Orne when it came to Sexton's desire to be seen as “special” by him and his clinical decision to withold that gratification. Self-approval seems impossible without his approbation, so significantly have they merged in Sexton's own mind as a “we.” Here is a condensed example of that discussion, which Skorczewski cites during a conversation in which the idea of bringing in a consultant to assess the progress Orne and Sexton were making in helping her get well:

Sexton : I feel like I want to continue treatment with you. Not just because I am transferred to you . . . I think that our relationship, even though it is stormy is really pretty good . . . You can use a lot of words.

Orne : Mmhmmm.

Sexton : I think the tapes are very . . . I listen to them and it's a different thing. In the first place I really hear you. Much more than I hear you here. Then again I hear me too, as much as I can bear to. Oh, I keep looking for some magical thing. If there was just some . . .

Orne : Some? What?

Sexton : Well, I'd like to say to you do you think I will ever get well, and you'd say what do you mean by well.

Orne : Mmhmmm.

(There is more talk about which doctor might be consulted.)

Sexton : I'd like to say, why, this one's impressed with my writing, why aren't you? You know? I did it all for you.

Orne : I am impressed with your writing.

Sexton : What does that mean?

Orne : My interest is you, and I am impressed with your accomplishment.

Sexton : Would you be just as impressed if I'd never been anthologized and never awarded? No, because you know you are not a judge.

Orne : Probably not because I am not a judge.

Sexton: And neither would probably someone else.

Orne : No, that's not true. I think in an area where I was competent to judge I would not need anyone else's statement . . .

Sexton : Of course you know my history so well and you know me so well that what I write in a poem you already knew.

Orne : That's not the issue. You don't understand it. You see, if you say am I impressed with your work, yes, it's very impressive. But you keep wanting me to be more interested in your poems than in you.

Sexton : Well, they are my accomplishment.

Orne: No, you are your accomplishment.

Sexton : Well, I haven't done very well, let's face it. (pp. 6–7)

Both Sexton and Orne's competencies are in play here, each one simultaneously judging herself or himself and the other in terms of success. If Sexton has not accomplished much in the area of improving her life with her husband and children (which she goes on to address), then in her view of Orne's criteria for accomplishment, she has failed, despite her extraordinary success as a nationally known poet. While Orne is responding with care, and interest, he continues to draw a division between Sexton's poetry and Sexton herself, as if the poetry is something she does—like needlework—and she is much broader than that, and it is her “self,” the “you” separate from him, that interests him, not her accomplishments. What he fails to see is that Sexton herself cannot make that differentiation. Skorczewski will argue that such a differentiation is fictive in itself, Orne's projection onto Sexton about what constitutes the bounded self in the therapeutic relationship.

Skorczewski's most salient theme is that contemporary relational theory has moved beyond the classical model of analysis. No longer the absent/silent analyst and the reclining patient, associating from infancy and childhood, psychoanalytic treatment is conceived of as a cocreated space in which analyst and patient work with parity, with both partners interweaving their subjectivities in order to achieve progress. Orne, however, a product of his time and education, utilized a conflict theory of analysis. The psychoanalytic dyad is divided between the doctor's rational authority and the patient's irrational subjugation to that authority. The therapist's task is to help the patient correct false views of reality and to live more consistently in the reality that the therapist makes more understandable to the patient. However, Skorczewski argues that had Orne been more sensitized to Sexton's efforts to reach him on her genuine level, as disclosed in the tapes, and focused less on her problems in dealing with “reality,” he might have focused on Sexton's attempts to forge a new kind of relationship with him.

New approaches to psychoanalytic treatment suggest that practice has evolved in the direction that Sexton had anticipated. In the years since Sexton's treatment, new ideas such as relational theory and feminist psychodynamic theory, as well as the work of Winnicott, Balint, Klein, and Kohut, among others, allow for more vital connection between analyst and patient.

Sexton's almost fairy tale–like transformation from a psychiatric patient into a celebrated poet was due to Orne encouraging her to write poetry, early on, in order to find something of interest in her life outside of the consulting room. However, as successful as she was to become, winning literary awards and acceptance by the academic community, she could not survive her own obsession with death and suicide. As Orne observed, “Anne had a remarkable fascination with death, and it seemed likely that she used her trances or memory fugues to play the role of dying, which perhaps helped her not to commit suicide.” She told Orne, in 1961, as he recalled in an interview,“I've taken care of the ‘live' part by writing my poem.s” (Middlebrook, 1992, p. 149).

Sexton made a career out of the kind of self-exposure that many patients fear. Her creativity overcame her inhibitions; she was writing to find out about herself and her relationship to the world. Poetry provided some order to the overwhelming chaos. But Sexton did not write such autobiographic verse in a vacuum. Robert Lowell's autobiography in verse entitled Life Studies made a decisive break with the formal verse patterns and lavish rhetoric that marked the early period of high modernism. Lowell rejected Eliot's modernist ideal of authorial im personality in favor of what seemed at the time (1959) to be more private and self-revelatory, and both Plath and Sexton (students of Lowell's) employed that “personal style” to explode cultural myths about women's place in American society.

Moreover, the term “confessional,” used by M. L. Rosenthal, somewhat ambivalently, as a description of the character of idiosyncratic, personal writing such as Sexton's, implied an analogy between poetry “confession” and religious “confession,” an analogy that Sexton absorbed and explored throughout her career.

Not unlike classical psychotherapy, confessional poetry drew from spontaneous associations, seeking to unleash the powers of the raw, repressed emotions (often recalled from childhood) associated with early trauma, a labor of unburying the buried. As I have elsewhere quoted Judith Herman in her book Trauma and Recovery , “Ghosts will come back to haunt. Murder will out. Remembering and telling the truth about painful events are prerequisites for the social order and the healing of individual victims” (Harris, 2006, p. 1). Remarkably, Sexton described her own process of creating poetry: “The art, whether it be murder or suicide, chooses you . . . it is a no-matter-of-choice-project” (Furst, 2000, p. 6). The same is true of associative talk, as the patient probes deep within for the truth, without conscious regard for how that truth will be judged by analyst or others to be moral or immoral. Truth, self-examination, self-knowledge—these were Sexton's pursuits in poetry and therapy, the core of “confessional” writing that seeks resolve and redemption in the end.

Doubtful Termination

Throughout the years that Orne and Sexton worked together, Orne was set on the goal of achieving (if not rushing) a “cure” for Sexton's mental disturbances. After eight years of treating Sexton, Orne left Harvard in order to take a position at the Philadelphia Institute of Experimental Psychiatry, planning to return once a month to see her and his other patients. He felt ambivalent about Sexton's readiness for termination and recalled that: “Although many therapeutic gains had been made from 1956 to 1964, [I] felt that Anne's emotional health still depended on the support she received from her husband and other people who cared for her” (Orne, pp. xviii).

When Orne left Boston, he made arrangements to see his former patient intermittently for follow-up, but felt that Sexton needed another therapist on an ongoing basis. At first she did extremely well with the new therapist, Dr. Fredrick Duhl, but as Orne recalled in his Introduction to the Middlebrook biography, “the therapeutic contract became untenable due to a change in the relationship (xxii).” Sexton had entered into a sexual affair with her psychiatrist, prompting her husband to seek a divorce.

She did then employ a new therapist, a woman, who would not allow Sexton to see Orne even intermittently, because in the therapist's view Sexton's “transference relationship with him would undermine the new therapist's treatment, (xvii)” and so he was forbidden to see her. Thus, in Orne's view, this was a period in which her relationships with significant others (particularly her husband) were severely diminished and she was more vulnerable to her trances, in which she “role-played” dying and gave fuel to suicidal impulses. Sadly, Orne wrote, if in therapy Sexton had been encouraged to hold on to the vital supports (including himself) that had helped her build the innovative career that meant so much to her and others, it was his conviction that “Anne Sexton would be alive today (xviii).”

It is true that Orne's departure deeply distressed Sexton, although she seemed to be functioning, at least superficially. She was teaching in a college, writing prolifically, and had stabilized to the extent that she could maintain her professional façade. After her affair with Duhl, Sexton's alcohol and drug addictions escalated, along with rages, depression, and suicidal urges. In December 1972, Sexton's current psychiatrist informed her that she could no longer continue as her doctor. At that point, Sexton was stressed to the breaking point and confided: “This is no termination of any sort but an amputation, and I feel pretty damned desperate (Middlebrook, 381).” Only her art kept her from taking her own life, as she typed out in this statement:

I am afraid to die. Yet I think it might do a few favors. If I COULD just die inside, let the heart-soul shrink like a prune, and only to this typewriter let out the truth . . . Can I save myself? I can try . . . I keep right on trying. Granny, you electric Smith Corona heart, you buzz back at me, and I pray you do not break . . . (Middlebrook, 1992, p. 381)


Another Breakdown

Tragically, it was not her beloved Smith Corona that would break, but Sexton herself, resulting in both being forever silenced. Sexton's last therapist, Barbara Schwartz, was not a psychiatrist but a social worker with a warm manner who ultimately became one of Sexton's friends. She accepted Sexton as a patient temporarily while a “real” psychiatrist was to be found for her. Sexton was particularly in search of a psychoanalytically trained doctor (as Orne had been) who could also prescribe medication. During that period, she conducted many interviews, taught workshops at Boston University, and traveled to give readings. In the last six months of her life, she received religious instruction from a seminarian at the Episcopal Divinity School in search of a “doubtful, but ever possible, joyous God.” Yet, when Sexton imagined the end, it was not a turning to God but a re turning to the arms of a “consecrating mother Middlebrook, 394).” In one of her last poems she imagines death as a walk into the sea: “I wish to enter her like a dream, and sink into the great mother arms, I never had (394).”

Anne Sexton ended her life on Friday, October 4, 1974. She saw Barbara Schwartz in the morning, for whom she had just dedicated an unpublished poem, had lunch with her best friend, the poet Maxine Kumin, stripped her rings from her fingers, put on her mother's old fur coat, and went into the garage with a glass of vodka, where she closed the doors behind her. She sat in the driver's seat of her old red Cougar and turned on the ignition and the radio.

One can only imagine how Sexton's suicide impacted Orne, back in Philadelphia. Given his long-term relationship with Sexton, it is not surprising that he agreed to be interviewed by Diane Middlebrook for the biography that was to be published in 1991. In addition, and most remarkably, Orne offered Middlebrook 300 audiotapes of Sexton's therapy sessions, as well as his personal files. He then wrote the forward to the Middlebrook biography, explaining why he breached the ethics of confidentiality between doctor and patient by releasing the tapes:

When Professor Middlebrook requested an interview to discuss my work with Anne for the biography, I thought about how important it had been to Anne always to try and help others, especially in their writing . . . After much soul-searching, and after being assured that Anne's family had given their approval, I allowed Professor Middlebrook to have access to the audiotapes and my therapy file (xvii).

After listening to the tapes, Middlebrook writes that she felt compelled to revise her entire manuscript, relying on the first-hand material of Sexton's therapy sessions with Orne. By disclosing Orne's assistance along with the existence of the tapes, Middlebrook set off a storm of controversy in the medical and literary communities. Alessandra Stanley wrote in the New York Times , in 1991:

[Orne's] action has caused far more consternation in literary and more particularly psychiatric circles than any other revelation in the biography which chronicles in sometimes harrowing detail Sexton's madness, alcoholism and sexual abuse of her daughter, along with her many extramarital affairs, including one with a woman and another with the second of her many therapists.

Recording and transcribing psychotherapy sessions was a radical idea in 1960 and makes some professionals uneasy today. Sexton, as was already mentioned, had trouble remembering what occurred in each session due to her memory fugues, or what she referred to as her “trances.” As Orne commented in his introduction to the Middlebrook biography, elaborating on Sexton's aphasias, or memory lapses, he reflected: “It seemed likely that she used the trance episodes to play the role of dying, which perhaps helped her not to suicide (xvii).” She became unresponsive in her trances, and these self-induced “absences” could last for minutes, hours, even days. The tapes were an important innovation in the therapy and changed the dynamics between Sexton and Orne. By listening to and being able to tolerate her own pain and anger on the audiotapes, Orne states that Sexton “began to recall emotional events that mattered to her and was gradually able to deal with her emotions in poetry (xvii).”

By listening to herself on tape, and transcribing what she heard, Sexton was then able to recall why she was angry, and this helped her to make unprecedented progress in therapy, although Orne admits that the procedure itself led “to some embarrassing moments for [him] as the therapist as he conceded in his Introduction:

Since Anne was able to point to errors in my memory of prior sessions—it was a unique experience for Anne to know more about what transpired in her treatment than her therapist did. In many regards, it made the relationship between us far more equal than in the past— a true collaboration , in which Anne could discover important insights and share them with me. (p. xviii )

Orne's release of the audiotapes also put himself unwittingly on display—inviting precisely the kind of critique Skorczewski undertakes in her book, exposing the impasses in the therapy, and what mistakes were made that impeded Sexton's progress. Nevertheless, he apparently preferred to put himself under scrutiny than to withhold the tapes that he felt certain Anne Sexton would have wanted released and accessible to the public, “in the spirit of helping others”:

Although I had many misgivings about discussing any aspects of therapy, I also realized that Anne herself would have wanted to share this process—much as she did in her poetry—so that other patients and therapists might learn from it. (p. xvii, Middlebrook, 1991)

Orne also added that when he offered Sexton the tapes (he had already moved to Philadelphia), she told him to keep them in the hope that he would find a way to use them to help others in similar circumstances.

Skorczewski's study is particularly effective in utilizing the material of the tapes to investigate not only the biographical details of Sexton's life and therapy, but also to link them to her art. From the last six months of the treatment, the author skillfully teases out central recurring themes in the therapy and the art, such as Sexton's fears of abandonment, her wish to stay secure in her relationship with Orne, and her susceptibility to sexual and domestic abuse. One of the motifs that runs throughout Sexton's therapy tapes reveals the vulnerability she felt as a patient enmeshed in a therapeutic relationship that often, paradoxically, confused and alienated her—as she vacillated between loving and hating her analyst. In “You, Doctor Martin” she expresses that ambivalence: “Of course, I love you; / you lean above the plastic sky, / god of our block, prince of all the foxes” (quoted in Skorczewski, 2012, p. 10). And, in a very early little sonnet to Orne, found among his files, Sexton appears torn between wanting to love and wanting to tear down this idealized figure of the analyst upon whom she has projected her own power as well as her defeat:

Well doctor—all my loving poems write themselves to you. If I could channel love, by gum, it's what I'd do. And never pen another foolish Freudian line that bleeds across the page in half-assed metered rhyme . . . if all this bother and devotion is not, in truth, for you—(Since you're the expert in emotion) tell me Doctor—who? (Middlebrook, 1992, p. 54)

Sexton seems to be in the throes of early frustration with gaining the kind of affective responses she instinctually wishes to receive and has channeled her anger into a sardonic love poem, deferring to the doctor as the one who can interpret the meaning of the transference. Like many patients, Sexton seems mystified that an ordinary mortal has evoked in her such desperate emotions, this psychoanalyst who is an expert in interpreting emotions, and yet her visceral need for love's gratification goes unanswered. As Skorczewski reflects:

When I listened to the sessions in which Sexton sought connection with Orne, I was struck again and again by how Orne missed her efforts to reach him and instead focused on her problems with “reality.” (Epstein, 2012, p. 4)

The psychoanalyst is the “expert” on emotions, at least in Sexton's reality.Orne He had trained to be an objective observer who helped patients correct defensive or regressive distortions of reality. Mental health came from being able to, he once told Sexton, “keep reality straight (Skorczewski, 3).” In such a context, Sexton, as a poet who is building on a “reality” of the imagination, must be separate from the reality of the real world. In order to get better, the “true” Anne Sexton, distinguishable (at least by Orne) from the poet-personae Anne Sexton, can only improve her condition by doing away with her defensive masks and emotional states that obscure. No doubt Sexton's desire to talk about her poetry in therapy and evince a response from Orne was a way for her to balance both worlds—one that only she occupied in poetry, and the world seen through therapy. As in the poem, “You, Doctor Martin,” he walks from breakfast to madness, somnambulant, unfazed. The classical analyst is trained as the “voice of reality” to help his or her patient clarify truth and dispense with obscurant fantasies and distortions.

Freud conceptualized the analytic situation in terms of an abstinence by the analyst in which he or she does not gratify the expressed wishes of the patient. For Freud, the psychoanalytic process demands of the patient a laborious process of renunciation, bringing to light infantile wishes, so that healthier and more mature forms of libidinal organization become possible through the transference.

Reflections on Transference
By 1957, Anne Sexton had read enough Freudian theory to be familiar with the idea of transference. Her early sonnet to Orne, staged in prose lines, reveals the irony of transference love projected onto the doctor who becomes a love object, and seems, at least in this poem, and at times in the poem, “You, Doctor Martin,” unfazed by the incendiary intensity of Sexton's emotions. The analyst is endowed with the insight to interpret the meaning of a patient's emotional attachment. While Sexton may be sardonic in her depiction of the cyclical aspect of the transference that never yields a true identity beyond the doctor's appeal to the patient, turning it into a kind of game of hide and seek, we can also read the early sonnet as an expression of Sexton's attachment to the real Dr. Orne. She will declare throughout her treatment that she was not “in love” with Orne and did not feel that she had transferred her conflicted sexual feelings about her father onto him. Instead, she felt, as Skorczewski suggests, more of a relation to him that was bound up inextricably with her poetry and her life.

For Freud, transference was a mésalliance, or a false connection, something that the analyst should consider as “unreal” that must be traced back to its unconscious origins. One can hear a tone of frustration as she tries, both in the poem sonnet and in the session, to make sense of this “need” to be attached, even if she denies a transference that is rooted in her past and projected onto the analyst. This attachment is an unheard demand on the analyst, and Freud insisted that the analyst never regard it as personal, but as some mechanism that leads the patient to reassume her position as a child in pursuit of some love that went unanswered in her early life, which can be corrected now through the analyst's interpretation, not the analyst's reenactment of the experience.

This paradoxical tension is even more heightened when the patient is a creative person like Sexton, who was introspective by nature. She understood how they overlapped and, like many patients, she understood the role of the psychoanalyst almost as well as her role as the patient, although she remained diffident when challenging Orne to reconsider his own principles. In her world, it was language that united both discourses, and how that language erupted from deep within the hidden silences of the unconscious.

For Sexton, art, like therapy, was created from an inner necessity, and with no ulterior purpose and without prethought about communication and significance, which is later attributed to them. Every artistic activity on her part was an act that created meaning as a way of countering the existence-threatening erosion of meaning that is at the core of mental illness, as she writes:

For praise or damnation, the poem must be itself. At best, one hopes to make the poem something new, a kind of original product. Otherwise why bother to hope, to make? And my newest poems . . . they come from a part of me I don't know, haven't met and won't understand for a couple of years. They know things I don't know myself. (Furst, 2000, p. 6)

This comprehensive statement made near the end of her life makes clear that Sexton understood the creative process to be as mysterious as the associative process of classical psychoanalysis. Yet before anything else, she was preoccupied with finding the truth, exploring her early experiences and current conflicts and trying to remember despite the fugues what she had discovered in order to make “a clean breast of it,” something that both therapy and confessional poetry strive to do in the process.

From the beginning, Freud believed artists were investigating the same psychic terrain psychoanalysts were and that they were in some ways more forward-reaching in their grasp of human behavior. For writers, particularly poets, Freud suggested that the excitements of fantasy, which can be actually distressing, might become a source of pleasure for the readers of a writer's work. In Freud's judgment, the artist is responsible for creating the art object, but lacks the rationality to properly understand it.

In “Said the Poet to the Analyst” in Sexton's first volume of poetry along with “To You, Doctor Martin” (like “You, Doctor Martin,” this poem is addressed to Orne and included in Sexton's first volume of poetry, To Bedlam and Part Way Back ), she points out the differences between the poet and therapist, modulating a bit on Freud's presumptions as she writes:

My business is words. Words are like labels,

Or coins, or better, like swarming bees . . . 
business is watching my words. But I

Admit nothing. I work with my best,

When I can write my praise for a nickel machine,

That one night in Nevada: telling how the magic jackpot

Came clacking three bells out, over the lucky screen.

But if you should say this is something it is not,

Then I grow weak, remembering how my hands felt funny

And ridiculous and crowded with all

The believing money. (quoted in Skorczewski, 2012, p. 17)

In Skorczewski's view, Orne's reluctance to gratify Sexton's wish that he claim his place as cocreator of her poetry was counterproductive. Although it was he who first encouraged Sexton to write poetry due to diagnostic tests that demonstrated her creativity, urging Sexton to write poems that he proclaimed “wonderful,” he tended to withdraw from protracted conversations about them and her publishing success in the outside world. Instead, he insisted on considering her writing as only one facet of her whole self, something she did, but not everything that she was as a human being.

The poem reveals Sexton's insecurity about believing her good fortune is credible, since it can't be deserved—it is a matter of luck, rather than skill (with Orne representing skill)—if Orne is not in congruence with her own self-appraisal. More important, these lines articulate a patient's special vulnerability when it comes to the analyst's interpretation of truth and reality—since he must correct the patient's erroneous view of reality, through interpretation and resounding meaning. Whatever her presumption, the analyst can annul her “words” by saying they are not what they seem to be—or they are defensively guarding a deeper truth about the self, too painful for the conscious self to confront. The poem reveals how heavily the speaker relies on the presence of the analyst to witness her creative efforts . . . the speaker needing the doctor if she is to find meaning, even if the meaning she seeks goes beyond his understanding of what it could be.

The psychoanalytic hour is not made of absolutes but of beliefs, not delegated by will but by accident, and hope—as well as a belief in the analyst's ability to truly understand the patient better than the patient does herself. The patient must believe that whatever he delegates as real or true is always a correction of what she has disguised or misconstrued—even if she has proof of the “money” right there in her hands.

In fact, Sexton viewed her relationship with Orne as a kind of merging of two people into one—articulating her attachment in phrases such as “can't let you go” or “You, I, we created the poet.” Her attachment to him, especially at the time he was considering the move to Philadelphia, demonstrates the bond shared by the patient and analyst and how difficult termination is, both for the patient and the analyst. As Skorczewski quotes Sexton saying to Orne after six years of therapy:

I'm only sorry how much of my life is tied up with yours—you are attached to me too—it's an odd kind of transference. I'm not in love with you; you are not a father figure. What is this attachment that I can't let you go? No one else will do with you what we did; we have seven years of past and it would not be normal.” (p. 13)

Skorczewski shows that Orne had ample room to acknowledge what this “attachment” was—and to concede that his relationship to Sexton was more than a clinical relationship between patient and doctor. Sexton had blurred boundaries between herself and Orne and expressed both in transcripts and poetry a desire to merge with him, a desire that Skorczewski views as unavoidable in the analytic dyad, contrasting Freud's view with later challenges by more contemporary analysts. Elisabeth Young Bruehl has argued in her book Cherishment: A Psychology of the Heart, perhaps more effectively than any other analyst/intellectual that a merging state, undifferentiated and boundless, should be acknowledged and explored rather than discouraged in the analytic dyad in favor of autonomy (in Arthur Furst, p.4).

Whereas Freud and Orne viewed the patient's wish to merge with the analyst as regressive, and believed that a division between “socially emergent” role as a poet and her “real” self could be drawn, Sexton saw the two as continuous and insisted that Orne share with her the pleasure and gratification of creating within herself the “poet.” But Orne rebuffed Sexton's overtures to consider her poetry, which was their metaphorical “offspring,” the progeny of their union as the analytic couple. When Sexton said, “[My poems] are my accomplishments,” Orne replied, “No, you are your accomplishments.” Thus, he does seem to thwart his own goal to help by rejecting her hope to be accepted for this one role: “poet.”

In contemporary theory, Skorczewski argues there would have been more room for Sexton to explore her wish to see Orne as the cocreator of the “poet.” Yet, I think there is real meaning in Sexton's transferring onto Orne a fathering role, the making of this mutual progeny, the poet-personae , “Anne Sexton.” This is a direction that Skorczewski does not take in her discussion, though I think it would glean insights, even if it borrows directly from Freudian theories about infantile sexual desires—here, the desire to be Orne's “wife” and having his baby (with the poetry as metaphor). Yet, Sexton's desire for Orne's participation in her success, her merging of the writing of her poems with his incentive for her to explore poetry, seems to me to be proof of a different dynamic occurring between them, one that reveals Sexton's primal affection for Orne and her attraction to him as a protector and guardian not only of her, as a patient, but of the poems themselves, which she identified with her body, as she wrote elsewhere (“poetry is my love, my postmark, my hands, my kitchen, my face” (Furst, p 6). Indeed, strict Freudians might even interpret Sexton's desire to have Orne “parent” the poetry as a part of an Electra complex in which the female patient compensates for her “lack” of a phallus by presenting the father-analyst with a baby in its stead. The “baby” is metonymical, made of words that are always partial, never “whole,” always in flux, and fragmented, the baby prior to self-consciousness. If such an interpretation seems antiquely Freudian, it shows at least how intense the transference to Orne was, making more onerous the task of Orne's fostering autonomy in his famous patient.

It might be argued that this demand perpetuated a long-standing wish for a parental union that was never gratified, given Sexton's own parents' detachment from her, and her being a victim of sexual abuse. Without Orne's direct acknowledgement of their mutual creation, the “poet,” Sexton would have to bear her achievement as her own and be a “spinster,” which would mean also accepting a boundary between Orne and herself, something that the transcripts show was difficult, if not impossible, for Sexton to do, perhaps also seen in her early symbiosis with Aunt Nana and then as allegedly exhibited by Sexton's predilection toward inappropriate sexual advances toward own daughters.

However, this difficult thing that Orne was asking her to do may be what was really helping her. She asked for his acknowledgement of his contribution and their rapport. His training would have instructed him to turn it back to her so that she could reflect upon her need to depend upon him for the success that allowed her to travel far from the refuge of the consulting room.

Skorczewski is nevertheless correct in stating that Orne's refusal to see his own role in helping Sexton find her voice as a poet is simply inaccurate, since it was he who first encouraged her to write and he who remained the principle witness to her immediate success. His obviating the topic seemed to Sexton to be a denial of her deserving such public admiration. Skorczewski's view is that regardless of Orne's classical training, he should have been flexible enough to see that not assuring Sexton of her profound gift created an impasse in the therapy.

She argues that if he had been sensitized to the feminist and relational theories that Skorczewski discusses in her book, Orne might have focused on Sexton's attempts to develop a new kind of relationship with him. On the other hand, one can see Orne continuing to turn the issue back to the analysand to reflect upon and maintan the analyst's presence to a minimum—a matter of technique.

He might have understood the idea of intersubjectivity as the hypothesis that human consciousnesses are constitutionally interdependent, and that, as unique human personalities, we form and reform ourselves, not in isolation, but rather in relation to and under the influence of other human subjects. Thus, there would have been ample opportunity for Sexton to explore this new metamorphosis of self, which was not static but evolving as a consequence of the therapy and the poems. He might have focused also on her contributions to him , as she never faltered from the idea that she might have influenced his way of seeing the world. She said, “You know I've changed you, too (qutd. by Skorczewski, p. 193),” and he might have given Sexton credit for urging him to be more authentic, less theory-driven, and more spontaneous and honest with himself and his patients.



Epstein, Helen. (2012, April 19). “Fuse author interview: ‘An Accident of Hope'—Analyzing the psychotherapy of Anne Sexton.” The Arts Fuse ,

Furst, Arthur. (2000). Anne Sexton: The last summer . New York, NY: St. Martin's Press.

Harris, Judith. (2006). Signifying pain: Constructing and healing the self through writing . Albany, NY: State University of New York Press.

Middlebrook, Diane. (1992). Anne Sexton: A biography . New York, NY: Vintage Books.

Sexton, Anne. (1960). To bedlam and part way back . New York, NY: Houghton.

Skorczewski, Dawn M. (2012). An accident of hope: The therapy tapes of Anne Sexton . New York, NY: Routledge.

Young Bruehl, Elizabeth. (2000). Cherishment: A psychology of the Heart. New York, NY: The Free Press.