psychotherapy

Issues related to psychotherapy

GlamoramaBrideAndGroomThe art of coupling and staying together for a long period of time in a world where each partner is often self-reliant; where relationships can split and re-form is seriously challenged. Children often find themselves shuttled between the newly formed partnerships, and life gets complicated.

Self-reliance takes away one of the fundamental glues that kept relationships together over a long period in the past, but conversely we could say that self-reliance is really about individuation, the capacity to realize one’s true potential in life, without relying so heavily on someone else. Our ancestors, living perhaps in a more limited, sometimes brutal world, didn’t focus so much on this individuation thing. Today, however, we can achieve that capacity for individuation and self-reliance, and that gives us options in relationship, including living alone outside of relationship.

Generally we still do, however, want to form partnership, to feel the physical and emotional attraction of the other, to form a team to accomplish life goals together, each pulling on their own strengths. The goals may be raising children to their full potential, forming partnerships in education, business or the arts, or other pursuits, where it is exciting to be a team with each other.

Relationships don’t often form this way however! That is, they don’t form after one has achieved a degree of self-reliance and individuation, because that is a process that can take well into middle age, and even then there is still plenty of work to be done!

Therapists working with couples and individuals on the issues of relationship see the same thing over and over again. In the 1970’s it was called co-dependency (the opposite of self-reliant), and this term still works fairly well.  The partners are dependent on each other to fill some void or piece of something in life that they could not achieve on their own. Maybe one is very logical, orderly, confident and bold, but not very empathic or intuitive. Their partner is sensitive, empathic and intuitively attuned, but not always logical and their confidence is undermined because they feel everything around them so intensely, including negative vibes from other people. In heterosexual couples the logical one is often enough the man and the more empathic one the woman. Hence John Gray’s idea that “Men are from Mars and Women are from Venus” (Gray, 2005). This dynamic is prevalent in Gay and Lesbian relationships as well.

When working with these couples or individuals, I like to consider a couple of things. First, what is their individuation path, if we can find it? What were they supposed to develop into, to bring to this world? The concept of individuation comes from the psychology of Carl Jung (Sharp, 1998). It is also an idea that comes up in Family Systems theory where it is called differentiation (Nichols, 2012). The idea is that you have a potential for something in life that gets arrested in the process of forming codependent relationships, and/or self-destructive behaviors (e.g. addiction). These compensating behaviors get in the way of your potential.

Let’s say you are a real foodie, you love food, and are fascinated and intrigued with all facets of food including preparations, nutritional aspects, food from different cultures and so on. You are a great cook, cooking satisfying meals for your family, but they rarely appreciate it, and it means so much to you to be appreciated for his gift. Your husband is dismissive. He is absorbed in some important work, and takes you for granted, especially in this area. The kids may have picked up on some of that also. You have that sensitivity and empathic attunement, coupled with the lack of confidence and boldness described above. Your husband has the confidence and boldness but takes your nurturing contribution with the food and other things for granted. With you taking care of those things, he is freed up for his business focus for example. You are frustrated.

Before I go into the resolution of this scenario, I want to describe the second thing I look for when working with couples and individuals in relationship. What is there attachment style? If they are in therapy it is likely that they suffer from one of the three kinds of insecure attachment (Main, 1995). These are (1) Dismissive – always in control – in my first years of life, I couldn’t depend of caregivers so much, there was some neglect of my needs, so I have developed this – “My way or the highway, I’m in charge, in control, you’re lucky I’m around taking care of things!” attitude towards life. (2) Preoccupied – always wondering whether I am measuring up to my primary attachment figure because in my first years of life, sometimes they were with me, and sometimes I couldn’t be so sure! – I’m preoccupied with this, and lack confidence, but I’m very sensitive to everyone’s needs, and always trying to serve them. (3) Disoriented-Disorganized – I was terrorized by my caregivers, they neglected me, abused me, let me be abused by others – I can’t really trust people – I don’t know who I am really – I first go towards people, then run away – I have no boundaries. Some believe that this last type, is inclined towards Personality disorder (see my last Post).

The woman in the scenario could have a Preoccupied style and her husband a Dismissive style. I often see this in therapy. They were attracted to each other to fill a void in their lives. He found a receptive emotionality indirectly from her, and she found strength and confidence in him instead of herself. In the beginning they were intensely attracted to each other, had an amazing sex life, but now their sex life and intimacy in general are zero. Why? He has a low opinion of her lack of confidence; she is disgusted with his lack of empathic attunement. It comes out in how they parent the children. It is really a mess!

Jung’s concept of individuation is an anecdote because it recognizes that with strength and confidence, and a sense of order, the woman could parlay her love of “all things about food”, perhaps into a career in catering or by becoming a restaurateur, or nutrition expert; something beyond the role of codependent servant.  Jung called this idea of integrating the weak functions (those she projects onto her husband) the transcendent function; that is, she can realize her true potential (transcend) by taking on those characteristics she has projected onto her husband (confidence, orderliness) and coupling them with those qualities (sensitivity, empathic attunement) that she naturally has as a result of her psychological wound.

The work in therapy focuses on this potential, but also working through scenarios where the woman enacts her preoccupied attachment style to her detriment, working on how it feels to step out of that; feel more self-serving, confident (at first it feels unnerving, anxiety producing, coupled with some depression about the box that she has put herself into).  If I am working with the couple, then the man, with his whole host of issues related to integrating sensitivity and empathic attunement has to be worked through.

Couples counseling often works better on relationship than individual counseling if both are committed to change, achieve the same realization about what has happened and is happening in their relationship, and both are willing to hang in there. The dynamic has to change between the two, in front of you the therapist, rather than just helping the individual achieve the insight. But an individual may have a partner that is not willing to commit to this process. In this case, more often than not, it will be about assisting this person to find a new relationship!

(2005) Gray, John  “Men are from Mars, women from Venus”, Harper Perennial, NY.

(1995) Main, Mary “Recent studies in attachment: Overview, with selected implications for clinical      work.” In: Goldberg, Susan (Ed); Muir, Roy (Ed); Kerr, John (Ed), (1995). Attachment theory: Social,        developmental, and clinical perspectives. , (pp. 407-474). Hillsdale, NJ, US: Analytic Press, Inc,    xiii, 515 pp

(2012) NIchols, Michael P. “Family systems”, Pearson, NW.

(1998) Sharp, Daryl “Jungian psychology unplugged: My life as an elephant”, Inner City Books, NY

Cannon Beach Nov 2013 - Crescent BeachThis idea of the ‘personality disorder’ gets a lot of traffic in the game of accusations, criticism, judgement, blaming and shaming that goes on in the toxic breakdown of relationships. It’s easy to blame the other of a ‘personality disorder’ based on a superficial understanding, gleaned from online information, or perhaps a psychotherapist. “It’s always about you, you have no concept of what others are feeling so you must have narcissistic personality disorder”, or “first you love me, then you hate me…I’m always walking on eggshells around you so you must have borderline personality disorder”, or “you have no conscience, you lie, and deceive…you don’t care about people, so you must be a ‘sociopath’ (a common term for ‘antisocial personality disorder’).”

There may be a grain of truth to some of these quick and easy street diagnoses, but I think it is important to know what we are talking about when we talk about personality disorder.

Having a ‘personality’ or having character traits that distinguish us from others, implies that we are separate from others, of course, and that we developed those traits when we separated from the maternal field, in the first 18 months, through the 3rd year of life. In that process we developed a sense of ‘other’ that allowed us to be empathically attuned to others, how they see things the same or differently, based on their experiences.

This seems like common sense to an adult, but an infant is primarily narcissistic and can only develop this sense of other, and empathy for the other, by going through a trusting and secure attachment to the primary caregiver. This is the mother in most cases – they break, get disappointed that they can’t remain narcissistic, then there is loving repair, with a sense that I can trust other people, starting with my Mother, or other caregivers.

If the infant and developing toddler had what we call an ‘adverse childhood experience (ACE)’ such as a feeling of neglect, terror, ambiguity and confusion about caregivers, the developing child will most likely internalize the terror and ambiguity of the external environment and, throughout life, project out the expectation that this will happen again and again with anyone they are relating to, which results in a feeling that they can’t trust anyone from moment to moment. Fear and/or anxiety that ‘something bad is going to happen’ can be released at the slightest provocation, causing an eruption of affect or emotion from the lower part of the brain, the part that promotes fight, flight or freeze. Emotions become dysregulated (out of control). If the person being related to is in a position of authority, such as a supervisor in a work environment, the problem can be exacerbated. Intimate relationships are also difficult because they work on trust, and on the unconscious assumption that the primary secure attachment is being re-established, though with an adult sense of separation and boundaries.

An individual whom has had this Adverse Childhood Experience (ACE), leading down the path described above, is said to have ‘insecure attachment issues’, or in a sense we could say ‘unresolved attachment issues’, which results in fear of the other, or excessively clinging to the other or a moving back and forth between the two, with no real sense of the boundary. They would not have that sense of separation, and empathic attunement with the other that someone would have that experienced secure attachment with the primary caregiver.

They give the impression, without boundary, and projecting both negative (and sometimes excessively positive) characteristics onto the other, that they have ‘no core sense of their own selves’. We say that they seem to have no specific character or personality. Hence the terms ‘personality disorder’ or sometimes ‘characteriological disorder’. They seem to have the narcissism of the infant, and they also seem to have an altered sense of reality, because they are projecting and lack that attunement with the other. The term ‘borderline’ was an indication that the individual is ‘on the border between reality and psychosis’, but this is increasingly being seen as an inadequate way to perceive this behavioral phenomenon. The person with personality disorder does project their sense of reality onto the other, but, unlike the schizophrenic, they do understand reality, and often what they have done, in the aftermath, and this can lead to a painful sense of shame, and despair as they are cut off from loving attachments and relationships. In the worse case scenarios, they can become so cut off from the ability to form relationship or to take supervision at work, that they find it difficult to survive, to take on social responsibilities required in the process of making a living as an adult. This can lead to despair, and not uncommonly, suicidal despair.

The therapist helps to heal this issue, by staying with the client, holding all of the swings from positive to negative projection, understanding what is going on, not taking it personally, and often tolerant of the constant breaking and repair in the therapeutic relationship that is painfully necessary and difficult over time. As the person with personality disorder starts to heal, and their old projective defenses start to fall away, they get anxious and depressed. “Can they really replace that old defense with trusting, loving attachment with boundaries?” This is where the therapist stays with the client, often building up that first relationship.

The approach I am describing is largely psychodynamic, emphasizing the healing power in the ‘relationship between the therapist and client – the attachment dynamics’, but other techniques such as Dialectical Behavior Therapy (DBT) are also useful for developing skills in distress tolerance, coping, emotional regulation, and group and interpersonal interaction. The client does really need to develop social skills, and it often takes a group and other processes besides individual psychotherapy to accomplish this.

The good news is that neuroscientists are telling us that the neural and memory circuits in the brain change as we adapt to new ways of relating in the therapeutic setting, and this really can promote healing!