Monday, February 15, 2010

Frank Lachmann: Principles of Salience; Empathy and Affect; Expectations: met, surpassed, violated.

Three Principles of Salience
In his early morning presentation on Saturday, February 13, 2010 to the Tampa Bay Psychoanalytic Society, Inc, Dr. Lachmann encouraged attendees to include an awareness of the leading edge of a patient’s strivings, and not to overemphasize the trailing edge. For example, a patient’s competitiveness with the therapist may be an advance for the patient, a moving beyond what he/she could previously achieve [previously may have been unable to assert her/himself]. This new striving needs to be recognized as growth, and not merely be interpreted as a wish to usurp (Oedipal) or steal from the analyst the interpretations. Lachmann also distinguished between the Self Psychological approach:‘I learned from the patient…’; and other approaches: ‘I pointed out to the patient… [which, I think, speaks to co-creation and a collaborative effort, as distinguished from the one who knows, the omniscient analyst].

To provide the underpinnings for what we may find useful clinically/ how transformation comes about,Lachmann (and B.Beebee) in their book "Infant Research and Adult Treatment" elaborated three principles of salience, developed from infant research: 1) an infant builds its psychic structure (representations; organizing principles, RIGs) through its ongoing experiences of regulation, both self regulations and interactive regulations. For the latter, day to day activities between infant and mother build up what to expect from the particular dyad. The accrual of these built up experiences, which are mutually influenced by each partner in the dyad, is a dialectic of ever changing, moment by moment, influence on the self and other. [You can never stand in the same river twice.] In the clinical setting, session to session activities, such as greetings and parting rituals [or how either approach or withdraw from certain topics], also build up representations of interactions which become generalized (Dan Stern’s RIGs). Important, in addition to interpretation, are these built up expectations. 2) disruptions inevitably occur, when , e.g., mother is over or under responsive to the infant, and repairs must then follow to reestablish regulation. In the clinical situation, ruptures (e.g. the end of the session) do not require apology but, instead, ruptures in dialogue are to be investigated. 3) Heightened affective moments (from Fred Pine), whether due to joy or trauma, have a more powerful organizing effect than the mere passage of the time they take to occur would warrant. [similar to “attractor states” in systems theory, per one attendee]. The three principles of salience are clinically useful to think about in session: e.g. what produced the disruption? How might it be explored? What was a heightened affective moment? A clinical example was used to illustrate this.
Empathy and Affect

In his later morning presentation, Lachmann talked about empathy and affect. Empathy, “vicarious introspection" [Kohut] or ‘feeling oneself into the subjective experience of another,’ is advocated from the very beginning of treatment. (Later, citing Robert McKee, lecturer on structure of film narrative, McKee says that -- a “like me” experience from the viewer, a resonance with the character who must have a shred of humanity, a moment of recognition, is required to maintain the audience’s emotional involvement).

Lachmann countered critics who erroneously characterize Self psychology as using empathy as the only way that an analyst conveys information or effects transformation. Empathy, Lachmann says, is necessary but not sufficient. Differing from Kohut, Lachmann stated that it is not the transformation of archaic narcissism (which needs mirroring and idealizing transferences) into mature narcissism (empathy, humor, creativity, recognition of transience, wisdom), but, rather, it is affect and only affect which is transformed in therapy, and done so only as a result of affective engagement. It is not defenses, self states, or ego organization, but affect, which is transformed.

Kohut did not spell out how transformation is brought about. Using the three principles of salience, Lachmann says transformation is bi-directional, impacting both therapist and patient, and co-created (the analyst may have empathy, but the patient must be ready to be empathized with), and embedded in the therapeutic process, ongoing throughout the therapy. It is through ongoing regulation, rupture and repair, and heightened affective moments that transformation takes place. [of Lachmann’s 2007, Transforming Narcissism: Reflections on Empathy, Humor, and Expectations the following is written: “He asserts that empathy, humor, and creativity are not the goals or end products of transformations, but are an intrinsic part of the ongoing therapist-patient dialogue throughout treatment. The transformative process is bidirectional, impacting both patient and therapist, and their affect undergoes transformation - for example from detached to intimate - and narcissism or self-states are transformed secondarily as a consequence of the affective interactions. Meeting or violating expectations of emotional responsivity provides a major pathway for transformation of affect.”]

Precursors to empathy are procedural and non-conscious, but none the less lead to an understanding of the patient’s subjective experience. They indicate the capacity for later empathy and accessibility to our inner states, and include: cross modal transfer (e.g. where one hears the words, but imagines/sees the scene) . This precursor is present from birth, as illustrated in neonates who imitate sticking out the tongue (what has been seen is transfer to body movement), or in infant’s ability to attend to a ball (smooth or nubbed) previously felt, but not seen; state sharing (different from projective identification, as state sharing is bi-directional and co-created, and as it is a natural occurrence and not necessarily defensive); and entering in to the behavioral stream of another (one may change posture or vocal tone to be commensurate with the other’s). Resonance does not have to be exact to be effective. [In fact, the analyst, being close enough to be reminiscent of an old object—transference, but also different enough to be new object and to allow for the possibility of a new experience—new relational paradigm or new organizing principle, is therapeutic.]

In ongoing regulation, patient and therapist negotiate closeness/distance, intimacy, and attachment via their posture, body movements, vocal tones, and rhythms, all which lead to transient shifts in the affective states of both partners. Each self transforms, each changes, leading to something unique and new. Tronick’s “still face”(of previously responsive and engaged mother) paradigm was used for illustration, in which violation of expectations leads to distress, disengagement, and withdrawal in infants.

Expectations: met, surpassed, violated
In the afternoon, Lachmann discussed infant research further, and later dissected the reports on the school shooter Kip Kinkel, who first murdered his parents before killing classmates. Lachmann, noting Edward Tronick’s and Dan Stern’s works on the violations of expectations of affective responsivity (and Andre Green’s paper on the ‘dead mother’), reminded us that infants meet/imitate affective states of the mother to be in connection with her and not merely as a defense against loss.

Violations, when repeated, can become strain trauma, and early trauma of chaos, unpredictability, abuse, and other indiscriminate behavior, may leave a person vulnerable to feeling unsafe with others or when alone, and handicap the capacity for reciprocity in relationships. Such a person may lack resources to right self esteem when narcissistically injured and therefore erupt with rage, and may have learned, early on, to violate (invading privacy—as in obscene phone calls; assault; rape) the expectations of others. But joyful violations (irony, humor, creativity, and well-timed surprise-- about three seconds for infants)may be welcome. On the other hand, expectations too closely met, as when mother echoes infant’s distress without some irony or modification, may increase the infant’s terror or anxiety. One may have expectation of welcome or rejection, invasion or intimacy.

Therapeutic action may confirm (meet) or contradict (violate) expectations. Lachmann asks: What is the nature of the different experience that the analyst effects with the patient?, and, What specifically is the effect of this differing experience on the patient?, for a different experience in itself is not sufficient to promote change.

Lycia Alexander-Guerra, MD
photos by John Lambert, LCSW


Richard Nikla said...

What concerns me about the criminology, among other situations, is Lachmann’s discussion of Kip Kinkel. The concept of vagotonia as a measure of excessive parasympathetic arousal may be evident in criminal behavior. Porges discusses behavior from a neurological and polyvagal response, and Lachmann was discussing it from psychological and social response. Although it is the purpose of mental health counselors, social workers, psychologists, teachers, and others to preserve peace and enhance positive behavior, we do not always recognize the signs until after the fact. Hind sight is usually 20-20. Although we seldom have a chance to measure our responses after the fact, what is important is recognizing these actions to help the individual, and in the Kinkel situation, saving lives. Kagan talks about studies where children with higher vagal tones, heightened parasympathetic arousal, were less inhibited, happier, and smiling. This could also lead to better success and easier socialization in school. Some of this is genetic, but after we are born it becomes more environmentally controlled. As we all work from a different base, we also all work from a different social sphere. Knowing how the body works in different situations, I think, is key to working with people. People may confuse thought processes and habits when it comes to behavior. It is not entirely true that we can change our thoughts and create a new atmosphere. Some habits become neurologic reactions that are more hardwired in the brain and nervous system than is evident. There is also a feeling of safety and lack of safety that drives these systems to respond and creates stressful reactions. Some of the conversations in the group reflected thought process changes, but Lachmann showed the neurological interactions as measurements.

Kate Braithwaite said...

I found this fascinating and hopeful