TBIPS' TRAUMA WORKSHOP SERIES, Part I: Dissociation

Dissociation: Dis-order of Subjectivity.

Dis-aggregation; and Dis-connection
De-personalization; De-realization; and De-contextualization

The most provocative part of any presentation is, for me, the clinical, which, in addition to who says (left-brain) what to whom, includes relationship, the implicit, and, a lot of right-brain knowing, and not-knowing. For ethical reasons, I can only marginally report on who says what to whom. Still, discussing ideas, not a particular case, excitedly lights up the curious brain.

On October 25, 2008 Richard A. Chefetz, MD, from New Directions in Psychoanalysis at the Washington Psychoanalytic Foundation, and the Advanced Psychoanalytic Training of the Washington School of Psychiatry opened the Trauma Series Workshop of the Tampa Bay Institute for Psychoanalytic Studies, Inc with a paper on Dissociation. Chefetz used Bucci's definition of dissociation: the unlinking of normally associated elements of experience that nonetheless remain unconsciously, implicitly, bound and related. This unlinking is facilitated by failure of the brain to formulate referential connections between different elements of experience, the failure to provide the context necessary to [more]accurately interpret experience.

While dissociation is part of normal mental function, e.g. highway hypnosis, or the fact that the brain selectively allows little, at any one time, into conscious awareness, when the right (amygdala) brain is overwhelmed with emotion, the left brain (Broca's area) is hypoperfused such that the experience cannot be linked to potentially helpful narrative. In fact, during intense emotion, e.g. intense fright, one can be rendered literally speechless (a fact that can be used didactically-cognitively to vitiate the guilt of a survivor who could not protest at the time of the abuse and victimization). Right brain hyperactivity can intensify vulnerability and aggravate trauma by denying it symbolization through narrative. (Likewise, when the left brain is busy, we tend to notice less our painful feelings and bodily sensations.)


Trauma is an experience that changes one's world view, one's self view, one's subjectivity (a person's interpretation of thoughts, feelings, and sensations). The dissociative process protects the self from trauma, from, e.g. the disparate elements of both loving and fearing the unpredictable caretaker. But its fallout includes severely limiting one's affective capacity and it creates incoherence, coherence being necessary for self regulation.

Isolated affect, an attempt at regulation, is dissociation that maintains attachment. A child accommodates to prevent the needed caretaker's withdrawal. Security, i.e. sameness -what is predictable, coherent, familiar- is sought, even if it is painful, creates deadness, or requires the disappearance of the self. Chefetz notes that a therapist, by being helpful, can cause a shift in a patient's self state, from child to adult, but then, the adult, believing only children need (and get) help, paradoxically, goes into a panic.

Dissociative Identity ("multiple personality") Disorder challenges the therapist's idea of a unified, cohesive self. We are likewise challenged to tolerate our own varying self states, and our capacity, as well as the patient's, for anger, rage, sadism, collusion. Can we, for example, explore with the patient her/his request for physical closeness and sexual contact, its meaning, its potential betrayal if acted upon, and can we be trusted to set and maintain appropriate boundaries? Will we deny this capacity in ourselves and insist on being the 'rescuer,' or withdraw, or lose all awareness of the ways we are sadistic?

Chefetz reminds us to be be curious and open about what we are feeling in a given moment, and to remain 'experience near.' I will, on January 10, 2009 in Part II of the Trauma Workshop Series, talk more about dissociation, both in the therapist and patient, how to navigate and how to use it, as well as about how to recognize, after the fact, enactments and their usefulness, when working with adults who have survived severe physical and childhood sexual abuse.

Lew Aron, PhD in Tampa

Lew Aron visits Orlando-Tampa and shares with us his talk on

"Rethinking Psychotherapy and Psychoanalysis: What Does Feminism Have to Do With It?"

Lew Aron, PhD, a great, modern, psychoanalytic thinker and orator, visited Tampa on Saturday October 18, 2008 to share his critique on the historical evolution of psychoanalytic thinking, and on the contribution made to it by postmodern, deconstructive feminism. As we know from our clinical work, some beliefs have to be 'broken' to allow putting them back together in a new configuration. Never had I seen attendees at a Tampa Bay Psychoanalytic Society Scientific Meeting so abuzz with excitement as they embraced the iconoclastic thoughts put forth by Dr. Aron. Some of his points are as follows:

Aron urges that to understand the concept one must understand its context. When an author, Freud, for example, writes: whom is to be convinced by the paper, with whom is it in dialogue, with what is the author struggling?

After discussing how psychoanalysis today is in trouble (the aging out of analysts of the American Psychoanalytic Association, the paucity of candidates in training, the ever declining number of analytic patients), Dr. Aron notes how analysts can not even agree on the definition of what analysis is, nor on whom might benefit from it. There is an argument about the number of sessions per week, about sitting up or recumbency, about how much supportive work means it is no longer an analysis. Aron sees some of the arguments in history to be about economics and prestige.

Freud never differentiated between psychoanalysis and psychotherapy, but he did eschew hypnosis and suggestion, the latter having brought down his illustrious contemporary Charcot. Psychoanalysis has been so doctrinaire as to try to fit the patient to the theory/technique, instead of vice versa. Franz Alexander advocated for this flexibility and was summarily extricated from mainstream American psychoanalysis, accused of blurring the distinction between psychoanalysis and psychotherapy, and of ignoring psychoanalytic parameters (Eissler).

European emigrant analysts coming to the U.S. before WWII could afford more flexibility. But those who fled the Nazis, losing home, livelihood, family, may have recreated in the U.S. what had been lost, and so may have clung tenaciously to doctrine. Gill defined psychoanalysis as a therapy that when conducted by a neutral [as if exists] analyst leads to the unfolding (i.e. intrapsychic) regressive transference neurosis to be resolved by interpretation alone, or mostly.

Interpretation has been privileged as an active masculine penetration of the passive female unconscious (an idea which backs imperialism, colonialism, racism, homophobia, misogyny; and allows for conquering the inner world and beating down resistance, as one attendee noted). Likewise, autonomy has trumped dependency. Hartman and Rapaport argued for ego autonomy, i.e. analysis led to structural change; if take this parameter away, then one would rob patients of the ability to do for themselves. After all, successful outcome is measured by a patient's ability to continue in self-analysis, having internalized the analytic process and the analyst. Yet Wallerstein's 1954 study at Menniger "54 Lives in Treatment" showed the relationship to be mutative. (Kernberg, who ran the study, has noted that the main contribution of psychoanalysis to the world is psychoanalytic psychotherapy. [One attendee modified this to: it is psychoanalytic thinking that is its greatest contribution].) The implication: if psychoanalysis deals with the inner world and autonomy, then psychotherapy deals with behavioral change and transference cure.

Apparently, analysts have privileged autonomy, in part, because analysts like to be left alone! (Smith's study on the ideal patient). Autonomy is valued (but then how have a healthy dependent relationship, such as marriage?), and dependency feminized.

Freud's theories arose contemporaneously with the rise of antisemitism in Vienna. Freud feared people would say his ideas applied only to Jews. Rabbinical Jews idealized the studious, passive man, but, in a culture which conflated circumcision with castration, Germanic men did not want to be seen as passive and effeminate. Aron purports that when Freud said that the bedrock of psychoanalysis is the repudiation of femininity, Freud had to repudiate his culture's belief that Jewish men were feminine, passive, castrated. Using Greek mythology to bulwark his position, Freud advocated the opposite: a kind of 'I, like all men, am not passive, castrated or feminine (or homo erotically attracted to Fliess, nor willing to be so with Ferenczi) but, instead, I am Oedipus, aggressive, willing to murder (even my own father), attracted sexually only to women (even my own mother).' (Freud, if he believed it, he believed it to be universal.)

An important insertion: Freud never denied that sexual abuse occurred prevalently. He only denied that it was the etiology of hysterical neurosis. (Himself hysterical, he would be indicting his father.)

Freud had to defend this binary opposition between active/passive; male/female; (Goy/Jew) to save his science (psychoanalysis) and save himself. Historical acceptance of falling to one side of the polarity, this binary configuring, leaves no room for a third and the tension held between two polarities. Aron encourages us to refrain from investing in binaries, and encourages, instead, their deconstruction.

Accordingly, Aron cautions against the erroneous conflation of intensity of training with the intensity of treatment. Different from most of his contemporaries, Aron finds it a mistake to separate psychoanalytic and psychotherapy training. Instead, he recommends that candidates receive didactics and supervision, but that candidates learn for themselves the difference frequency (really the meaning of a particular frequency--loved, enslaved, dependent, special--to a particular patient) and intensity make for their patients, some seen on the couch, some in a chair. Most radically, he recommends that candidates choose their own therapy.

There seem to be only two things analysts agree upon: that there is an Unconscious (though not on what it is or how it works) and it is important to scrutinize the therapeutic relationship (though not on how or when). Aron quotes (L. Friedman) "monstrous" [like a gryphon or chimera?] to describe psychoanalysis. It does not fit one category well, not solely science, art, medicine, psychology, literature, cinema, quixotic, or cost-benefit soundness). Our fore thinkers were rebels, misfits, radicals, and reformists, living in a particular relationship to authority. Psychoanalysis has moved from the Golden Age of consensus, to pluralism.

[It's been a long, and temporally short, road.]

Healing Haunted Lives: Trauma Workshop Series

Recognizing and Treating

Dissociative Adaptations

to Trauma in Adults

Richard A. Chefetz, M.D

Saturday, October 25, 2008

9:00am - 4:30 pm

Crisis Center of Tampa Bay

One Crisis Center Plaza, Tampa, Florida

(Exit Bearss Avenue WEST, off I-275)

This is an introductory program geared to provide clinicians with a theoretical framework that uses common sense language to describe dissociative processes and their vicissitudes.

Using selected videotapes from the clinical setting, Dr. Chefetz brings the participant into the consultation room to educate about the intensity of the affective disarray and the profound nature of shifts in subjectivity that regularly intrude upon the consciousness of persons with complex dissociative disorders. Dissociative processes are part and parcel of mental life, not just a production of severe trauma. This seminar will help participants learn to identify dissociative processes in both patient and therapist as a routine, but usually un-noticed, part of subjective experience.

Healing Haunted Lives: Trauma Workshop Series

4-part Trauma Series Workshop begins on October 25, 2008, starting off with Dr. Richard Chefetz who will elaborate on dissociation. The series will end on March 7, 2009 with Dr. Ghislaine Boulanger discussing herlongstanding work with Vietnam Veterans as well as more recent work with those intimately affected by the events of 9/11. Discounted registration will be available for attendance of the complete series.

Early Registration Discounts through 10/19!

Contact tampabaypsa@aol.com to register or call (813) 908 - 5080

Program

Recognizing and Treating Dissociative Adaptations to Trauma in Adults

• What really happens in dissociation? (Video)
  
• Attachment, Dissociative Process, and Psychotherapy
  
• Transference/Countertransference
• Enactment and Dissociation (Case presentation and discussion)
  
• Working with Intense Shame (Brief Case and Video)
  
• Affect and Dissociation: The Golden Thread

Richard Chefetz, M.D.

Faculty, Institute of Contemporary Psychotherapy & Psychoanalysis, Washington School of Psychiatry, Modern Perspective inPsychoanalysis and New Directions in Psychoanalysis/Washington Center for Psychoanalysis; Distinguished Visiting Lecturer at theWilliam Alanson White Institute, NYC; past-president International Society for the Study of Trauma and Dissociation