Monday, October 27, 2014

Group Process 2

Additional important lessons for individual therapists to be taken from participation (procedural learning; 'the medium is the message') and understanding of group process as demonstrated by Roth on Oct 25, 2014 include:

1. The assignment (or acquisition) of authority (power).
The group facilitator often asked permission of the group and individuals to make comments on certain behaviors, e.g. pairing, before actually making said comments. He also, on occasion, made it clear that these were his point of view and open to review by the group with the possibility of a different outcome.

2. The use of data that was present and available for all to make use of.
The facilitator skillfully used exact words and phrases from group participants to call events of individuals to the entire group's attention, always reminding the group that one member may have been designated by the whole group to hold or contain something for the entire group (e.g. loss, trauma, sadness, aggression). Unfortunately, for some, this method was too exposing, felt to be too personal, and, therefore, narcissistically injurious, something the individual therapist strives to avoid but inevitably finds her/himself inflicting. Since injury is inevitable, what is valuable is the reparation. Reparation cannot occur if admitting injury is further humiliation. Likewise, the disappearance of the consultant, like the end of a session, feels, to some, being 'kicked to the curb' and we have no next session with the facilitator. The group will have to make use of the consultant through object constancy.

Sunday, October 26, 2014

Group Process

Many psychoanalysts eschew group therapy, but yesterday the Tampa Bay Psychoanalytic Society, Inc had an experiential look at group processes provided by its guest 'speaker' Jeffrey Roth, MD. Based on Wilfred Bion’s basic assumptions about groups, as taught in the U.S. by the A.K. Rice Institute for the Study of Social Systems, we had firsthand experience with the impact about how our behavior and unconscious processes organize experience intrapsychically, interpersonally and en masse.

Bion posited three basic assumptions for group behavior:
1)      Fight/flight, where the group hostilely engages authority
2)      Dependency, where the group does nothing but expect that the all powerful authority will provide for everything, and
3)      Pairing, where the group deems authority as incapable of providing what is needed and so two in the group are ‘elected’ as the pair who will now make provision of group needs.
A fourth group, the work group which functions to accomplish tasks, is often thwarted by these three basic assumptions, while paradoxically illuminating (through consultation) what the work group needs to address.

How did our use of group process help us in our work as individual therapists? We procedurally learned that everything that emerges (data) is useful and has meaning, contributing to the richness of the dyadic interaction, if the therapist welcomes it in, and can make use of it, instead of being bored as if nothing ‘deep’ is being related. All data signals what would like to be taken in or pushed away. Groups function around ‘BART’,  boundaries, authority, roles, and tasks. How these four entities are negotiated by the group are experienced, studied, elucidated, and may be transformative. While the group experience is transformative, and may continue to be so, old roles and skill sets (leader, scapegoat, etc) remain available. We are made up of multiple selves, after all.  

Sunday, October 19, 2014

Horror Film: The Orphanage, viewed and discussed 10-19-14

The Orphanage (2007), directed by Juan Antonio Bayona,  is about the unconscious, inadvertent, intergenerational transmission of trauma and it was deftly discussed today by Adriana Novoa, PhD at the Return of the Repressed Film Series.  She notes that most horror films place what is horrifying ‘outside’ or into the ‘Other’, but that this film places the horror inside the characters, and inside the audience through its emotionally resonating themes.

Laura (Belen Rueda), her husband Carlos and their adopted, seven year-old son Simon (Roger Princep) move to Laura’s childhood orphanage which she hopes to restore and reopen to care for five more children. Simon does not understand his mother’s need to take in more children. He has been told neither that he is adopted nor that he is HIV positive, but is understandably angry when he overhears this. When Laura and Carlos host a festive garden party for potential wards,  Simon disappears. Laura begins to suspect that the orphanage is haunted. Consulting a medium (Geraldine Chaplin), she learns that a number of orphans had been poisoned there. Perhaps Laura repressed any knowledge of Tomas who had drowned, a few days after Laura is adopted, as the result of a cruel prank played on him by the other orphans. These culpable children disappeared soon after.  

The audience can speculate that Laura’s dissociation of her early traumas (loss of childhood playmates, for example) made it difficult for her to recognize the losses Simon experiences. Her refusal (out of terror) to recognize her own son behind the mask, as well as his anger at her ‘lies’, lead to his unfortunate demise. His final attempts to communicate himself to her (through banging from the cellar where he is trapped) fail just as his previous communications about his discoveries of Tomas’ anguished world fail to get Laura’s understanding. Her misrecognition of Simon’s world is fatal. Laura’s unconscious wish to restore the lost (murdered) five children by caring for an additional five differently-abled children is thwarted. Likewise her unconscious knowledge of the accidental death of Tomas is recreated, poignantly, in Simon’s accidental death. Only in Neverland, in death, can the lost children be reunited with Wendy, now grown. Nowhere is the return of the repressed more dangerous.

Wednesday, October 15, 2014

The Developing Self and Origins of Shame

 Knox gives us a neurobiological explanation for the origins of shame. Should the mother register disgust for her infant or her infant’s agency, the infant’s sense of self and of agency is linked –through the insula (where mirror neurons may activate disgust) and the midline structures (where the sense of self is thought to be encoded) –with shame. A mother who cannot tolerate her infant’s distress may cause the infant to procedurally learn to hide pain in order to protect the attachment. This may result in a fear of love or Fairbairn’s schizoid personality, where shame has been linked to relationship.

A sensitively attuned mother is less likely to be disgusted by her infant and his needs. Winnicott speaks of the primary maternal preoccupation as a necessary requisite to allow for development of sufficient attunement of mother for baby. In doing so, we can infer that, he advocates for safeguarding the necessary space for the pregnant woman and new mother to acquire the necessary sensitivity to the needs of her infant. Should there be a failure to attune to the infant’s needs, the infant is in danger of a disruption of going on being, and of annihilation anxiety. Winnicott notes that in the early days of life, it is the mother who must identify with the baby, and not vive versa.

Lycia Alexander-Guerra
Tampa, FL

“…the need for the therapist to facilitate a process of disruption and repair (Beebe & Lachman 2002) in which the patient has an opportunity to correct the therapist's misattunements (Benjamin 2009)”  
I give an example from today’s session.
The client, in 8th year of therapy with me, tried to correct my misattunement saying that I had to listen [to]her need more, that is, she did not need my mirroring, but rather my opinion different [from] hers. While explaining that to me I asked her what she was experiencing my mind focused on. She replied, “I know you listen to me [with] so [much] concentration that I get love and affection.” Then gradually she started crying. After a little [while], I asked, ‘What was the correlation with your tears?’ She told me, “I asked for your opinion different [from] mine [and] you give me a different focus on me, compared to the not being focused [on by] my parents. How can I be so arrogant?”

 I think that was an example of disruption and repair where a part of herself was correcting me, paying attention to a self state I was ignoring, while another self state of hers was being repaired but was partially ignored by her!

 “What the mother does well is not in any way apprehended by the infant at this stage. This is a fact according to my thesis. Her failures are not felt as maternal failures, but they act as threats to personal self-existence”
I am not sure I agree with such a thesis. Although there is limited consciousness or self to perceive the mother as good enough, or bad enough, I think there is sufficient attachment-based relational need that is encoded preverbally via the body. If the mother attunes well or not well with the baby’s attachment needs, regulation/dysregulation is experienced via the body.
Stavros Charlambides
Athens, Greece

Knox, J. (2011). Dissociation and shame: shadow aspects of multiplicity. J. Anal. Psychol., 56:341-347.

Winnicott, D. (1956). Primary maternal preoccupation. In: Collected Papers, Through Pediatrics to Psychoanalysis. NY:Basic Books.

Thursday, October 2, 2014

More on Winnicott’s The capacity to be alone

I like, as always, the poetic rhythm Winnicott offers to the reader! As I was reading Winnicott’s The capacity to be alone, I questioned whether the author was trying to make explicit a narcissistic developmental issue or a schizoid developmental trauma? In my view, the latter was more likely.

The capacity to be alone is presented as a prerequisite of the capacity to be alone with your self. While he goes very deep in helping us understanding the issue I think the paper misses addressing the other side of the coin, that is, the capacity not only to be with your self but also the capacity to be without the other. This is in my view different from the former one. I did not see something written in the paper regarding dissociative phenomena, especially about those clients who are caught in between, partially being able to stay alone, and, simultaneously, stay without the other.

These clients can stay in silent moments in treatment for a while and give a glance to the analyst. They can stay partially alone in the presence of the analyst but cannot stay equally alone without his presence (that is evident via the glance). Many times as well these clients are alone psychically in the presence of the analyst: they are involved with the discussion but you sense their body is frozen (not in excitement attachment). This is an indication, I think, that they can be partially alone in the presence of the analyst, and with themselves, but not alone without him .

Winnicott, D. (1958). The capacity to be alone. Int.J.Psa., 39:416-420.

Stavros Charalambides
Athens, Greece

Wednesday, October 1, 2014

On Play and the Capacity to be Alone

[Winnicott writes]
·       The capacity to be alone is a highly sophisticated phenomenon and has many contributory factors. It is closely related to emotional maturity
·       Ego-relatedness refers to the relationship between two people, one of whom at any rate is alone; perhaps both are alone, yet the presence of each is important to the other
·       Gradually, the ego-supportive environment is introjected and built into the individual's personality, so that there comes about a capacity actually to be alone.
·       If the patient cannot play, then something needs to be done to enable the patient to become able to play, after which psychotherapy may begin. The reason why playing is essential is that it is in playing that the patient is being creative.
·       There is no need for the therapist to organize chaos all the time. Sometimes that behaviour covers and substitutes a real need for rest and empathic listening.

For example I have a patient deeply emotionally detached [who] tries to understand how to handle relationships. For that reason I proposed [to] him to join a group and indeed he accepted. He is in the group for 3 months and now he feels angry with other members because they talk and they do not allow time and space for him and others. When I asked him (in individual session) what do you want from others when they see that you are not talking? He replied "to give space to my silence. I do not want [them] to tell me anything but I need [them] to respect my silence and accompany me in that. I want to stay all in silence for some minutes in order to feel what I feel, to touch the depth of my sorrow that I cannot otherwise demonstrate."

At the previous session I "played", as Winnicot says, with him. I showed him a video from the web. In that video a man was seeing a woman from a distance and then tried to reach her by walking [across] a street. A car hit him, some glass from a window broke [and reached the woman]. However, they did not reach each other. The message was that all of that was only in the man’s fantasy. While my client was watching the video he cried and I did not ask him anything except one comment, "It seems that you at least reached out to something." So I was company, a silent company to his noisy loneliness.

Winnicott, D. (1958). The capacity to be alone. Int.J.Psa., 39:416-420.
Winnicott, D.W. (1956). D.W. Winnicott, Playing and Reality, London: Tavistock, Chap. 4  Playing: creative activity and the search for the self. 

Dimitrios Tsiakos, 
Athens, Greece