Aron's Third and developing mentalization

The Gergely and Watson (1-17-13 post) paper on affect-mirroring leading to infant brain development, as well as a sense of self and intersubjectivity and mentalization, brought to mind Lew Aron’s paper  (2006) Analytic Impasse and the Third: Clinical implications of intersubjectivity theory. Int. J. Psycho-Anal., 87:349-368,  in which Aron demonstrates that three people are not necessary to create a triangle, that is, triangulation can take place within a dyad. He expands the idea of a child’s use, even before the oedipal period, of a third vertex of a triangle when a caregiver, capable of self reflection, advances intersubjectivity. It is the dialogue within her that creates the third vertex.  Utilizing Benjamin’s ideas of the third-in-the-one and the one-in-the-third, Aron elaborates how the third can be used for differentiation as well as for connectedness, respectively.  When mirroring their infants’ affect, mothers never match perfectly, and thereby signal to the infant that her mirroring is “her version of his response.”  The infant utilizes this signal which helps both to differentiate her from him, and also to anchor his own sense of self/self state.

Likewise, the therapist can, being of two minds, by her disclosure of her dilemma (e.g. the wish to rescue and the wish not to impinge or infantilize), open a transitional, triangular space in which patient and therapist might collaborate. Aron finds this particularly useful when an impasse has arisen. The analyst grapples with a dilemma in a way that opens up a third, transitional space where increased negotiation can occur. [One can imagine a myriad of vertices of ever enlarging geometric shapes.] The therapist finds ways to facilitate thirdness,  “a process of identification of the patient’s position without losing her own perspective…”  The possibility of collaboration, as well as the disclosure of the workings of the analyst’s mind, facilitate mentalization in a patient.  Aron notes that others, too, see the third as “an emergent property of dyadic interaction” as well as “a dyadic achievement that creates the psychic space necessary for reflexive awareness and mentalization (Gerson, 2004)…” Keeping two ideas in mind create a third point of view. Even interpretation, then, becomes a mutual endeavor.

Affect Mirroring Builds Baby's Brain

At TBIPS, we are blessed with a community of clinicians whose families are ever growing. Yesterday, one of our candidate’s first born (left) turned one year old. Additionally, one of our instructors, Ray Roitman, pictured  with his new grandson (below), recently became a grandfather.

Also yesterday, the second year class, in its Developmental Issues: Narcissism and Development of Shame Throughout the Life Cycle course, discussed a paper that I thought fortuitously coincident with our expanding village: Gergely and Watson’s (1996) The Social biofeedback theory of parental affect-mirroring: the development of self-awareness and self-control in infancy. IJPsa., 77:1181-1212.

In it, Gergely and Watson speak to the developing brain-mind of the infant, including sense of self and intersubjectivity aided by mentalizing, and to the caregiver’s role in facilitating this development. When an infant, for example, imitates facial expression and/or the tone and prosody of the caregiver’s voice, the parts of the infant’s brain commensurate with the affect associated with this facial musculature and voice are stimulated. The caregiver’s affect then, signaled by face and voice, stimulate the infant’s commensurate feeling. The caregiver’s brain is building the networks of the baby’s brain! Perceptions (sound, sight, proprioception, etc) build representations in the brain; behavior is mapped as representations in the brain.

This imitation by the infant becomes the first building blocks of sense of self, as well as of empathy and mentalization (knowing the contents of one’s mind and of another’s). When the caregiver feels happiness/joy/pleasure upon holding in her/his arms a responsive infant, the happiness of the caretaker is evident in facial expression and voice. The imitation of these by the infant stimulates a similar area for registering emotion in the infant’s brain.  The infant, too, feels this happiness/joy, such that the infant and caregiver are now on the same wave link, a meeting of minds, sharing a like experience where each ‘knows’ what the other feels.  This procedurally stimulated joy lays the ground work for, first, the felt worthwhile self and, later, the symbolized thoughts such as ‘I am worthwhile and loveable.’  Repeated experience encodes the brain to ‘know’ self and self with others. Likewise, the caregiver’s disdain, contempt, anxiety, and depression can be transmitted intergenerationally.

Matching and mirroring from the caregiver of the infant’s emotional state is always imperfect, ideally introducing an otherness sufficiently familiar for the infant to feel understood and of like minds, but sufficiently different to allow the inchoate thirdness of intersubjectivity as well as to, when necessary, function to soothe, contain, mitigate and modify the infant’s disorganizing emotional states so that regulation occurs. (The experience of regulation first supplied by the caregiver eventually is encoded sufficiently in the brain to provide for self regulation.) Meanwhile, mutual regulation is taking place when infant and caregiver respond rhythmically riffing off each others’ emotional states. The pleasure in this toddler’s face and the hope of this grandfather is constitutive of the experience of mutual regulation.

Book Review: Emotional Orphans by Cate Shepherd

The holidays always mean for me a few extra moments to read for pleasure. One book which I considered a treat is Cate Shepherd’s Emotional Orphans, Healing Our ThrowAway Children. Though Emotional Orphans reads like fiction—it is a fictionalized account of Shepherd’s journey as a contemporary psychoanalytic therapist, and of the stories of treatment with some of her most courageous, loveable, sometimes infuriating, adolescent patients-- its truth is evident to therapists who dedicate themselves to their patients. The reader will come to admire and even love, as Shepherd did, these obstreperous adolescents. Like a beloved character in a novel or television series, I missed at each chapter’s end the kids she describes. I would even wait a day in order to savor what I had just read before beginning the next chapter, believing each time that the one I had just finished was my favorite.

Just as her child patients are fictionalized, so are her mentors, some of whom are given to speak the words found in the writings of Winnicott, Bacal, Beebee, Bowlby, Bromberg, Kohut, Shane, Lachmann, Bion, Brandchaft, Ogden,  Shengold, Solorow, Teicholtz and others. Everywhere are allusions to her breadth of her and her reading, without Shepherd ever devolving into jargon or an academic treatise.  Pearls of contemporary psychoanalysis abound, tucked in between compelling accounts of children struggling to be seen.  [She quotes Winnicott: “It is a joy to be hidden, a disaster to not be found.”(p.59)] Shepherd so seamlessly describes complex ideas that young psychotherapists will not have to struggle to grasp them.  In describing her patients:

Reverie              

Mario saw his true reflection in the eyes of people who cared about him (p.69)

Pathological accommodation

It’s a crazy-making role-reversal in which a child is used to serve the needs of the parent while sacrificing her own developmental needs. (p.72)

I was caught in the same dilemma as Angel, compromising my own truth to maintain necessary ties (p.177)

Attachment  

If they can attach to you, they can make use of you (p. 115)

Everything you’ve invested in these kids is theirs to keep (p.71)

Therapists are not interchangeable for the same reasons that mothers are not. (p.205)

 As a young child, Jesse never had a chance to form the kind of secure attachment that fosters the development of empathy and self-regulation. As a result, she could not regulate her emotions, and she felt little empathy for her caregivers. (p.22)

Dissociation (p.38):

“…because no one validates his experience.”  “…Dissociation shields him from unbearable pain, but it is also a way he accommodates to an environment in which there is no space for his pain to exist.” (p.176)

And when adolescents push our buttons, perhaps the hardest to hold onto:

Patients act aggressive because they feel vulnerable. (p99)

…outrageous behaviors as messages to be decoded rather than crimes to be punished. (p147)

As long as there is aggression, there is hope (p.81)

Pearls even in Sanford Shapiro’s Foreword:  “a teenager’s anger comes from an instinct of self-protection”

Trauma and dissociation:

Kids could survive horrible injuries, losses, and despair if they didn’t feel alone. (p.132)

needed outrageous behavior to preserve his soul. His father was a soul killer. (p.79) [Shengold; Miller]

“He experienced a disruption in his connection with you,” …”This left him feeling isolated and dysregulated.” …”The vandalism was a part of his attempt to right himself..” (p.170) …vandalism as organizing activity (p.175) The vandalism is not the symptom. The dissociation is the symptom. (p.176)

Note the unobtrusive symmetry of the two paragraphs [the therapist’s need for validation, the child’s need for validation. Lovely.]:

 When I saw similar pain in Jesse, I felt validated. If Jesse’s suffering was real, mine could also be real. If her circumstances could elicit empathy, maybe mine could too. ... (p.31) [Intersubjectivity (seeing the subjectivity of the analyst)]

Parents who scapegoat their children can induce a special kind of desperation. While other children find comfort and support, the scapegoated child is deprived of a clear mirror for her emotional experience. The absence of validation can produce more trauma than the injury itself.

On procedural learning:

Children learn what they live (p.113)

Self-disclosure:

I was honest with Angel. I answered his questions when I could, and guarded my privacy when I needed to. (p.182)

       

Procedural Learning

…when he pushed against my boundaries and watched me enforce them, he learned to construct boundaries of his own (p.182)         

Winnicott’s survival

… a therapist who does not abandon or retaliate, but remains available and responsive in all circumstances… (p187)

Our indestructibility is their only security. (p.39)

The importance of keeping out of the way of the patient’s agenda of healing; [though no mention of negotiating competing agendas]

…try to stay out of the way, and find out how he needs to use you (p.168)

Some I just plain liked:

Staying calm is half the battle. The other half is staying connected. (p.220)

Or a saying on needlepoint:

We are not here to see through one another, but to see one another through. (p.121)

While many of the similes did not excite me or were too well worn, the two times she described kids’  like “popcorn” made me smile with its familiarity. Sometimes her angry at the absurdity of agency workings sounded understandably embittered and Shepherd is honest about the stress and time-limited ability to withstand agency work. She advocates for the therapist’s own therapy, as well as avocations [hers in this tale is martial arts] that provide “a strong counterbalance to the stress of our work.” (p. 78). Emotional Orphans is a very readable and moving account of relationship with patients, and I recommend whole heartedly.

Spring 2013 Courses Offered at TBIPS

REGISTRATION FORM TBIPS COURSES

Spring Semester 2013                                      (Second and Fourth Year Courses)

TBIPS Second Year Courses        Spring Semester 2013 begins January 30, 2012

Relational Concepts and Implications for Treatment Part II

This course will explore the relational co-creation of the treatment situation, reviewing influences on relational ideas and technique from Object Relations, Interpersonal, Relational Intersubjectivity, Inter- subjectivity systems theory, and Self Psychology. We will discuss: mutuality, intersubjectivity, dissociation, disclosure, and other topics from a contemporary point of view as well as look at clinician contribution to the therapeutic matrix. (16 weeks) Meets Weds 330-445pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

Clinical Case Conference

This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material. (16weeks) Meets Weds 500-615pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

Developmental Issues in the Analytic Setting:  Attachment

This course will examine the ways in which development informs our clinical work with adult patients. Life events and developmental transformations throughout the lifespan will be explored in terms of their relevance for adult treatment, with an emphasis on attachment styles’ effects on the clinical situation. (16 weeks) Meets Weds 630pm-745 (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

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TBIPS Registration Form  Second Year Courses                      Registration deadline Jan 12, 2013

Name______________________________________    

Discipline _____________________    Degree_____  State ____ License # _________

Address_____________________________________________

City__________________________________________ State____   Zip___

Phone____________________________        E-Mail_____________________________

Request Long Distance Learning (check one, if applicable):  ___phone     or     ___Skype 

                                                  Spring Semester 2013   Second Year Courses

___  Relational Concepts and Implications for Treatment Part 2  where is traum

        Meets 16 Wednesdays 330-445pm

         (Jan 26; Feb 2, 9, 16, 23; Mar 2, 9, 16, 23, 30; Apr 6, 20, 27, May 4, 11, 18, 2011)

         Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

         Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom A

        Registration deadline Jan 12, 2013

___ Clinical Case Conference

         500-615pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

         Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

         Registration deadline Jan 12, 2013

         Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom A

___   Developmental Issues in the Analytic Setting

          630-745pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

          Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

          Registration deadline Jan 12, 2013

          Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom A

  _____ Number courses taking Spring Semester 2013 x $250 (x $200 if 3 or more)

 $_____ Total amount Enclosed

Please Make Check Payable to: TBIPS, Inc.  Please mail completed registration forms and check to:

TBIPS, Inc.

13919 Carrollwood Village Run

Tampa, FL 33618

Refund Policy: 85% refunds available for cancellations received at least seven days prior to start of course.

TBIPS Fourth Year Courses                                    Spring Semester 2013 

Psychosoma II  

This course will continue to explore the interconnectedness between mind-body expression of psychological life from a contemporary perspective. Reading body communications as salient material for analysis and negotiating ways to bring these communications into the relational and narrative realm will be discussed. (16 weeks) Meets Weds 200-315pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

Clinical Case Conference

This course is designed to support the clinician’s work and offers opportunity to integrate clinical material with psychoanalytic concepts, including ethics, and ways to deepen the psychoanalytic process, with a focus on the therapist’s self reflection, the clinical relationship, and ways to facilitate what is mutative for the patient. Attendees are encouraged to present case material. (16weeks) Meets Weds 330-445pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

Electives:

Participants design their own 4-8 week syllabus to explore any topic of their choosing and, along with picking the readings, will teach this topic to peers.  Topics in the past have included Lacanian thought; neurobiology; the feminist voice; child’s play; and others. (16 weeks) Meets Weds 500pm-615pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

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TBIPS Registration Form  Fourth Year Courses  Registration deadline Jan 12, 2013

Name______________________________________    

Discipline _____________________    Degree_____  State ____ License # _________

Address_____________________________________________

City__________________________________________ State____   Zip___

Phone____________________________        E-Mail_____________________________

Request Long Distance Learning (check one, if applicable):  ___phone     or     ___Skype 

                                                  Spring Semester 2013   Fourth Year Courses

___  Psychosoma II  

         200-315pm (Jan 26; Feb 2, 9, 16, 23; Mar 2, 9, 16, 23, 30; Apr 6, 20, 27, May 4, 11, 18, 2011)

         Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

         Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom B

        Registration deadline Jan 12, 2013

___ Clinical Case Conference

         330-445pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

         Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

         Registration deadline Jan 12, 2013

         Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom B

___   Electives:

          630-745pm (Jan 30; Feb 6, 13, 20, 27; Mar 6, 13, 20, 27; Apr 3, 10, 17, 24; May 1, 8, 15, 2013)

          Fee: $250 for a single course; $200 if enrolled in full semester of 3 or more courses.

          Registration deadline Jan 12, 2013

          Venue: 13919 Carrollwood Village Run, Tampa, FL 33618, Classroom B

  _____ Number courses taking Spring Semester 2013 x $250 (x $200 if 3 or more)

 $_____ Total amount Enclosed

Please Make Check Payable to: TBIPS, Inc.  Please mail completed registration forms and check to:

TBIPS, Inc.

13919 Carrollwood Village Run

Tampa, FL 33618

Refund Policy: 85% refunds available for cancellations received at least seven days prior to start of course.

Keeping a New Year's Resolution?

Need help keeping your New Year’s resolutions? An increased understanding of the plasticity of the brain may help. As you may know, dendritic branching (connections conveying signals between neurons) come into being or are pruned in an ongoing fashion. Important for resolvers to consider are the following: environment through experience is encoded in the brain, changing brain chemistry and anatomy; and procedural (such as behavior/habits) change is better effected in the context of a safe and supportive relationship. What this means for those who have vowed to lose weight, quit smoking, be kinder, etc is that your goals may be more easily met if you seek to change your behavior with a buddy, friends, a personal trainer or life coach, or a group, something many an attendee at AA may know better than we.  Likewise, if you want to be a better therapist, participate in a training program or Study Group. (TBIPS offers both…see next post for Spring courses which begin Jan 30, 2012).

goodbye to 2012 and to …

Andy Williams Whitney Houston Etta James actor Jack Klugman William Windom Andy Griffith Ernest Borgnine writer Ray Bradbury Maurice Sendak Nora Ephron Gore Vidal publisher Helen Gurley Brown astronaut Neil Armstrong Sally Ride Representative Sam Gibbons Senator Daniel Inouye Arlen Specter  George McGovern jazz musician Dave Brubeck  Earl Scruggs Doc Watson Mike Wallace Dick Clark psychoanalyst Daniel Stern Richard Isay and Ethel Person General Norman Schwarzkopf comedienne Phyllis Diller Trayvon Martin and 20 first graders and six adults at Sandy Hook Elementary