The Neuroscience of Language Explains How and Why Psychotherapy Cures

Drawing much inspiration from a lecture given by Sapolsky (2011), an expert in the neuro- and biological field, I would like to discuss the use of language, or — more accurately put– communication, as a cure for psychological pain.

The profession of Psychotherapy, at its formation, was termed the “talking cure” (Freud & Breuer, 1895).  This literally means talk as a means of relieving one of symptoms or psychical and often also somatic nature. What the term “talking” does not describe is the “listening” from the other person. In psychotherapy it is the talking to someone who is actively listening that cures. Read also: The Psychotherapeutic Alliance.

Language is in verbal and non-verbal communication

Talking and listening is communication. When we think of communication, we think of dialogue, and language. Language, according to Sapolsky is more than speaking or writing verbally. Neuroscience has indicated, especially through studying the neurobiology of sign language learning of completely deaf individuals, that whether it is verbal or non-verbal, the communication process is the same. This means that language is not merely a motoric process (i.e. about moving lips and tongue), but rather a cognitive process.

Language is unique to humans

Human communication has universal qualities. All forms of human languages have semanticity, embedded clauses, all human language can “talk about things”, can talk strategy. There is arbitrariness of language, in which words are not tied to meaning. People are able to tell lies, and say one thing and mean/feel another. Language is also invented and re-invented. Human children have innate ability to coin phrases and say things they have never heard before (N. Chompsky).

Unlike animals that have specific vocals for specific emotions, human language is not tied to specific emotions. This explains why in therapy we notice a quality of communication in which there is a “content-affect split”.

Non-verbal aspect of language

We do not communicate with words alone, there is also verbal tone, sounds, body movement, hand gestures, facial expression. Gestalt therapists look out for these during therapy as well, since the non-verbal language reveal often much of the emotional content of the communication. Certainly emailing does not allow for non-verbal communication. Perhaps that is why many of us feel more secure communication over messenger apps to even talking on the phone.

Neuro-centers of the brain that affect language

Ninety percent of humans process verbal language in the left hemisphere of the brain. The other (right) hemisphere, process the non-verbal and emotional content of the communication. The Broca’s area is connected to the motoric nature of language production. The Wernicke’s center is responsible for language comprehensibility. The connection between these two centers connect the two functions.

Through studies of biological brain disfunction due to disease, degeneration or injury, scientists have managed to identify which part of the brain is utilized for which function. Through neuro-imaging, we know that in tourettes syndrome, for example, where the sufferer curses uncontrollably, the limbic system is hyperactive. The limbic system is not known to be responsible for emotions and not language production, but language is connected to the formation of emotions.

Many have also proven that singing is a way for people who suffer damage to the Broca’s area (and hence have problems talking). Singing activates the right hemisphere and emotional centers of the brain.

Hence the phenomenon of the talking cure; an emotional weight off the shoulders when on talks emotionally to someone who is willing to listen.  One can also see how verbal language is only a part of communication. Clients who have problems with speech (in particular in Alzheimers patients) respond to communication with music.

 

 

References:

Freud, S., & Breuer, J. (1895). Studies on Hysteria. SE 2.

When to Engage the Services of a Psychotherapist

When is it a good time to decide to get psychotherapy? What has to happen before someone actually needs psychotherapy? Does seeing a therapist mean that I am sick / crazy?

Nobody has to ask these questions when one is physically ill. One goes directly to the general practitioner, because it is clear to one that his/her body is not feeling as good as it normally does. Psychological health is slightly different, the degree of suffering is not so clear, and often we feel “it is not necessary” or “I can get through this” and/or “it is to much of a luxury” to get psychotherapy. Oftentimes ignored emotional challenges (which can be unpacked in psychotherapy) lead to debilitating mental suffering in later life.

 

Certainly this article come from within a psychotherapist’s blog. It is however the intention of the author to shed light on the “hows”, “whys” and “what for” in seeking psychotherapeutic treatment. As a psychotherapist having worked also in psychiatric wards in hospitals, I’m also a witness to how mental health of an individual today is vulnerable to life-changing situations.

Individuals who attend therapy when they can still work and function in their daily lives have better prognosis than those who are at already a point where their psychological state does not allow them to live independently of others or medication.

When is appropriate time to seek psychotherapy?

Imagine these rather normal scenarios:

Scenario 1: Your child is not sleeping well, and has frequent nightmares. In the day he is agitated and has problem paying attention. This is stressful for you, because you are at a loss in managing his fits of anxiety, crying at night, etc. You are thinking of seeing the pediatrician/child psychiatrist but he/she is a doctor, and you are aware of the side effects of prescription drugs on children.

Scenario 2: You lost a parent 2 years ago and most of your family members and yourself have mourned your loss and have moved on. Your youngest sister, 15, is lately very depressed and has stopped going to work or socializing. You believe that she has not got over the loss of the parent.

Scenario 3: You are aware that you are using the computer / smartphone / tablet constantly. It is difficult for you to get yourself away from the LCD screen. When you’re in social events and have to turn off your phone, you feel annoyed and want to leave the place. You have feelings of guilt/shame about this.

Scenario 4: You are a successful career person. Lately you have not slept for more than 4 hours on average per night. You’re mentally exhausted, but every night you lay in bed, and your mind is racing with thoughts. You are considering taking sleeping medication.

Scenario 5: You are a college student and have recently moved out of your family home. Lately you have been feeling panic attacks in the night.

Scenario 6: Your child has been diagnosed with an illness that requires complicated medical treatment. You are worried sick. You have other children.

Scenario 7: You witnessed something traumatic (real or fiction or imagined). 6 months later, you still get nightmares and/or flashbacks.

Scenario 8: Your teenager is withdrawing from the family and his/her grades, which used to be good, are falling.  You notice him/her losing excessive weight. You need someone to talk to.

Scenario 9: You are suffering pain in part(s) of your body, and the many doctors you have consulted confirm that they could find no physical clues to the causes. Doctors tell you it could be psychosomatic.

Scenario 10: Your marriage is breaking up, and you are worried that the children will be affected by the split. You want to get a divorce and you want the process to be done cordially, so that the children are spared the emotional turmoil involved in the conflict.

In all these scenarios, the services of a qualified psychotherapist can be a life-saver. These problems are not uncommon, and they happen to anyone living in this internet age we are in today. It is not to say that the internet per se has anything to do with it, but these are the kinds of problems familiar to people around the world.

What Happens in Psychotherapy?

A psychotherapist is a professional trained to be a person-in-contact with you and/or your child. As human beings we get embroiled in our daily life, unawares of the underlying emotions that drive us. These un-felt, emotions are what some of us would describe as the unconscious.

The therapist’s work is to study this aspect of your character.  He/she does this by asking you questions about yourself, and checks with you at each step how you feel about certain things. The therapists also gives you feedback on your blind spots about your mannerisms, incongruences in your dialogue with him/her (for example if you contradict yourself or if your words  contradict your body language, etc). The therapists holds a dialogue with you in this way and in so doing, you discover things about yourself you were not previously aware of. You also gain insights into the the situations you found yourself “stuck” in.

Above all, psychotherapists work under the rule of strict confidentiality.

Difference between psychotherapists and counselors

Psychotherapists, more so than counselors, work with your unconscious.  We are interested in what drives and motivates you, and what is causing the stress responses in your lives. Psychotherapists that work with couples and families treat the individuals as part of a system. It is the unconscious forces in each member of the family that create the family dynamics. Psychotherapists believe that it is only by going deep into the emotions can we really uproot the inner conflicts behind the stress, sleeplessness, psychosomatic pain and problems that we face in our daily lives.

Most psychotherapists, unlike counselors, do not give advise (at least they try not to). Rather, the therapist will sit with you during these hours and provide you just enough support and as much support as you need to find your own resources. This way, we do not heal you, we help you make your own reparations.

Difference between psychotherapists and psychiatrists

Most Psychotherapists, unlike psychiatrists, spend more time being with you and we do not provide psycho-pharmaceutical drugs. If you are depressed, we provide do not encourage you to reach for an antidepressant (sometimes we send clients to the psychiatrist, when the client’s symptoms are severe). If you are on medication, we would ask you how it is working for you. Some clients come to us because they want to wean themselves off the drugs. This is because many psycho-pharmaceuticals are dangerous if you suddenly stop taking them.

Gestalt therapists, for example, works as your person in contact, who would guide you through your inner conflicts (which we know can feel desperate), and walk you through the experiences till you see the light again. Usually we expect to go through with you some painful experiences, thoughts and memories. We believe that it is through understanding these anxiety-causing experiences that you can find long-term peace to live again. Taking medicine alone robs you of this chance to overcome your depression in this way.

Difference between psychotherapists and psychologists

Unlike clinical psychologists, psychotherapists view the client as an individual person, builds a transpersonal relationship with you, and do not commonly see diagnosis as a main part of their work. This means that we do not see you as “a depressed patient”. We regard you as a person in relation to us who is in a mental / spiritual / emotional / social / relational situation that needs to be understood. Psychotherapists delve into the unconscious inner conflicts, looking at childhood experience and past traumatic events /illnesses that may be the cause of present afflictions. He/she sees the client as an individual with a special challenging life situation, with a unique family background, with a unique vulnerability. Most psychotherapists are trained to contain your vulnerability.

How do Psychotherapists do this?

Most licensed psychotherapists from Austria & Germany ( I can only speak for this part of the world since I am trained there) are rigorously trained for the profession. The training takes more than 6 years to complete. We are trained academically in psychology, psychopharmacology, sociology, gerontology, child and youth psychiatry, psychotherapy research, cultural anthropology, philosophy, neuroscience, ethics, sexuality and diagnostics. Over and above the academic studies we complete hundreds of hours of individual psychotherapy and group psychotherapy ourselves. We also work at least a thousand hours in psychosocial and hospital institution as interns.

How do you shop for a psychotherapist?

Use the internet and check their credentials. Psychotherapists who do not have credentials little accountability. Since you are engaging someone who is going to work with your mental suffering, it is only advisable to engage someone who is trained in a reputable institute.

Call the therapist and ask for a first interview. During this interview ask questions and you’ll have a feel if this person can help you. After a few sessions, check again.

Recommendations from friends/and other professionals do help. The best is to try the therapist out.

Characteristics of therapist to look out for:

  • does he/she answer your questions transparently?
  • do you get the impression that your concerns are being addressed?
  • do you get the impression that he/she is authentic in what he/she says?
  • do you get the impression that he/she is curious about you?

Most important thing to remember is that the therapist is a professional to serve you. In your first interview with him/her you should get impression that the therapist is more interested in knowing about you than about him/her telling you about him/herself.

 

 

 

Psychotherapy is about Uncovering Truths of the Self

It is said that the truth will set you free. In psychotherapy patients liberate from the psychological stressors in their lives through uncovering the truths about themselves.

This might sound counterintuitive if we believe that we know everything about ourselves or that we are in total control of the decisions we make. The field of psychology has proven empirically that this is not the case, and psychoanalysis has provided theories about how this is so.

Put briefly, the human person is an integral part of his/her society and culture through which our  psychological processes are influenced.

Knowing the truth is coming to terms with this realization. That we become depressed, anxious, angry… etc because we have lost the sense of our of needs. In so doing we turn them into symptoms, so that we do not have to face these needs.

An example would be that of a woman who is depressed and no longer able to enjoy simple things in life. Through therapy she uncovers the truth that her going into depression is a means for her to not face up to an inner rage, for it was safer to lock oneself into a state of depression than to attack another person, especially an abusive childhood caregiver.  Realizing the truth of her rage, she is able to talk about it and understand it. In Gestalt therapy, the client is encouraged to express this rage through art, speaking, acting out, writing… etc. When the underlying issue is set free, the depressive symptoms lose their foundation as well.

Therapy in this way is done with the patient being in control of his/her progress. Therapists in general do not advice, coerce or make analysis to tell the clients what the truth is. Clients find this out through dialogue with the therapist. The client has the agency to his/her own truths and healing.

When patients are asked retrospectively what they gained from a period of psychotherapy, their answers frequently feature an increase in their sense of agency: “I learned to trust my feelings and live my life with less guilt,” or “I got better at setting limits on people who were taking advantage of my tendency to comply,” or “I learned to say what I feel and let others know what I want,” or “I resolved the ambivalence that had been paralyzing me,” or “I overcame my addiction” are typical comments (McWilliams 1990 p. 16).

Bibliography

McWilliams, N. (1999). Psychoanalytic case formulation. Guilford Press.

Symptom Relief in Psychotherapy

It is a given that a person comes to therapy to seek relief in symptoms  psychological stress, relationship tensions and/or physical pain/discomfort not treatable by medicine alone. Usually a patient comes to a therapist to present a problem or a chief complaint after having suffered it for a considerable amount of time, while trying alternative/self-treatments.

It is not unusual that the decision to come for psychotherapy and the meeting of the therapist alone can diminish the symptoms. This is due to the relief the client usually feels after having let go of the need to control his/her own symptoms.

Despite this, psychotherapeutic treatment usually lasts months and often years. This is because as the therapy progresses the client and therapist uncover areas underlying the symptoms that need to be addressed, along the way setting new therapeutic goals. The work of therapy goes beyond the swift removal of  disturbances.

Uncovering root causes of symptoms are often painful processes. The client needs to feel safe and trust the therapist enough to go deep into the work. For example a young woman with anorexia comes to terms with her feelings of betrayal and entrapment within a perfectionistic family only after 6 month in treatment. She needed another year to come to terms with inner rage against her care givers in order to overcome feelings of disgust for having food in her stomach.

 Other examples include the man who comes for short- term couple therapy to “improve his communication” with his wife turns out to have a secret lover who is rearing his unacknowledged child; or the little boy referred for “acting up” with authorities has a private habit of torturing small animals (McWilliams 1999).

Clients usually need a lot of time in order to have the courage to open up their most painful emotional experiences– first to themselves, than to the therapist. Through the trust built within the therapeutic alliance, can revelations of negative emotions like fears and shame be grasped. Through coming to terms with these feelings of vulnerability can the client learn to master his/her feelings and behavior with understanding, knowing that he/she has choices and has the capacity to reach for resources.

 

The man who is compulsively unfaithful to his partner wants not just to stop having affairs but to be relieved of his constant preoccupation with fantasies about them. The woman with an eating disorder wants not just to stop vomiting but to get to the point where food is merely food to her, not a repository of desperate temptation and wretched self-loathing. A man or woman who was sexually abused in childhood wants to change internally, subjectively, from feeling like a sexual abuse victim who happens to be a person to a person who happens to have been a sexual abuse victim (Frawley-O’Dea, 1996).

Psychological symptoms (and psychosomatic symptoms as well) are the result of an individual’s survival strategy, otherwise known as creative adjustment to unpleasant experiences usually encountered in childhood. Hence the problems clients come to the therapists with,( e.g eating disorders, panic attacks, depression, relationship problems, addictions… ) are superficial signs (or tip of the iceberg). Looking at the experiences and emotions that lie within to keep these symptoms going is what the therapy is about. It is through uncovering these that the client gets to fully understand the root of his/her symptoms, and gradually find their own resources to relieve themselves of the effects of these symptoms and live better.

Bibliography

McWilliams, N. (1999). Psychoanalytic case formulation. Guilford Press.

What can Psychotherapy do for you?

The questions “what is psychotherapy for?”, “what is the benefit of psychotherapy to the client?” “what should I expect from seeing a psychotherapist?” can be summarized as questions to seek out the goals of psychotherapy.

Setting Goals are Necessary in Therapy

Psychotherapy research has shown that goal setting on the onset of psychotherapy treatment is instrumental in the outcome of the therapy. This may seem the obvious course of action and “something all therapists and clients do”. However, if we think setting therapy goals is straight-forward, it could be that we are not setting the goals conscientiously enough.

Difference between Psychotherapeutic Diagnosis and Medical Diagnosis

Somewhat like a patient going to a doctor’s office, the client goes to a psychotherapist because he/she is facing discomfort and/or is suffering from symptoms. Unlike the doctor’s patient, the psychotherapeutic client’s symptoms are of a psychological nature. This is where we have to be more conscientious than the doctor.

Each Client is Unique

Psychological pain is multifaceted and is not realistically diagnosed on the spot. Therapists use questionnaires and their own observations as instruments for diagnosis, but we are also aware that what we see in the client is unique to the client.  This is largely due to the understanding that psychological suffering has much to do with the client’s environmental situation (social, economic, historical, etc.) as well as the client physical state. Most of these factors cannot be tested using test kits. These get uncovered through therapist-client dialogues in the therapy session.

Goals in Psychotherapy that Benefit Clients

Goals made between client and therapists that go beyond merely “fixing symptoms” do more justice to, and offer more benefits to the client. This is especially important for client who have dependency or non-functioning behavioral issues.

McWIlliams (1999) writes quite clearly that the goals of psychotherapy extends beyond the disappearance or mitigation of symptoms of psychopathology. It extends also to

  • * the development of in- sight, an increase in one’s sense of agency,
  • * the securing or solidifying of a sense of identity,
  • * an increase in realistically based self-esteem, an
  • * improvement in the ability to recognize and handle feelings,
  • * the enhancement of ego strength and self-cohesion,
  • * an expansion of the capacity to love, to work, and to depend appropriately on others, and
  • * an increase in the one’s experience of pleasure and serenity.

There is empirical evidence to prove that when these goals are worked on, positive changes happen, including better physical health and greater resistance to stress (p.12).

Bibliography

McWilliams, N. (1999). Psychoanalytic case formulation. Guilford Press.

Former patients’ conceptions of successful psychotherapy

This article features a study by Binder et. al 2009,  Why did I change when I went to therapy? A qualitative analysis of former patients’ conceptions of successful psychotherapy. 

The findings of this study provides us with some answers to what patients or clients of psychotherapy regard as change in psychotherapy, and how they perceive their experience in therapy which is considered successful for them.

The client’s point of view is very important. Mental states cannot be fully measured, as opposed to physical states. There is no machine, or test kit to measure the mental state of health. A person’s mental wellness is witnessed through his/her ability to function in daily life, and also his/her own perception of how things are.

What is successful psychotherapy or counseling? If a client claims to feel better, we’d ask what they meant. It could mean they feel more relaxed, less stress, less anxiety.  They could say that they are able to sleep better, have less physical pain. Or they could feel more energetic– whichever is important to the client at the time.

Methodology of this Study

The qualitative research was conducted using semi-structured, qualitative, in-depth interviews with 10 former psychotherapy patients, recruited through an advertisement in a local newspaper. A descriptive and hermeneutically modified phenomenological approach– i.e. using expert interviewing and not just questionnaires in order to grasp full meaning of what is transpired in conversation –was used to analyze interview transcripts.

Findings

What was most important explicitly for the clients in the therapy?

1  Having a relationship to a wise, warm and competent professional.

  • the client’s feeling of safety within the therapeutic relationship was mention.
  • the therapist having the right doses of contact with the client, and
  • the therapist having flexibility in approach to working with the client.

2  Having a relationship with continuity, safety and hope when feeling inner discontinuity.

  • the continuity, consistency of the therapy.
  • therapist being with them through difficult emotional experiences.

3  Having beliefs about oneself and one’s relational world corrected.

  • the patient is able through therapy to reconnect with his/her meaning making, having a look at misconceptions or introjects of which the client was not aware of.
  • therapists guides the client through his change of the worldview.

4  Creating new meaning and see new connections in life patterns.

  • the idea of having been helped by having one’s beliefs and belief systems corrected,
  • help in making new choices, or change in habitual patterns
  • helps the client see how the his/her present experiences and behavior in reaction to the experiences are rooted in the past experiences, i.e getting clarity and insight.

Comments

Psychotherapy is quite unlike medicine. The clients’ or patients’ needs for treatment are very diverse and individual. Even though there is such a thing as diagnostics in psychiatry, we have to understand that these diagnostics are constructs for professionals to communicate the symptom of the client with each other. With psychological issues, the same symptom displayed may does not mean same source or cause of problem. It also does not mean that the clients with same symptoms will benefit from similar treatment.

Why this?

Put simply, it is because the mental state of the individual is the product of the individual’s relationships, culture, physical health, age, economic situation… etc. The psychotherapist sees the client as a whole person, whose experiences and meaning making are important in therapy.

The result of the findings reflect this.

Bibiliography

Binder, P. E., Holgersen, H., & Nielsen, G. H. (2009). Why did I change when I went to therapy? A qualitative analysis of former patients’ conceptions of successful psychotherapy. Counselling and Psychotherapy Research9(4), 250-256.

Psychotherapy expertise in Singapore: A qualitative investigation

These are summarized findings obtained from this 2008 study by Jennings et. al. entitled Psychotherapy expertise in Singapore: A qualitative investigation. The researcher cited Singapore as a good place for studying psychotherapy due to it cultural diversity relative to its geographical size.

In this study, a group of 9 therapists and/or counselors were selected from a pool based on being seconded by colleagues as “master therapists”. The interviews were conducted with structured questions, and video-taped. These were later analyzed using grounded theory.

Results of the Study

Here are the viewpoints of the master therapists.

Needed personal characteristics that therapists should have:

  • Empathic : Master therapists spoke of possessing a great empathy for their clients. As one master therapist explained, once the client felt genuinely understood and accepted in whatever circumstances, true change and healing began.
  • Non-judgmental:  This trait can produce a sense of safety for clients.
  • Respectful: The master therapists were mindful of their impact on clients and the importance of working with clients in a respectful manner. Respect for clients, whoever they are and whatever their issues may be, was a pervasive theme among these master therapists.

Needed developmental influences that therapists should have are:

  • Experience: The interviewees described a journey, explaining the many elements that created and influenced their path to expertise. When exploring elements of expertise, experience was mentioned frequently as an important factor. One master therapist made the point that there were no quick developmental influences and no guarantee that experience alone leads to expertise.
  • Self-awareness: The master therapists spoke of how their self-awareness has served them well when conducting therapy. One master described it as recognizing your internal processes when working with clients and being able to be a participant/ observer of interactions with clients.
  • Humility. The master therapists recognized humility as another important component in the development of expertise. Recognizing one’s limits may serve as a source of motivation and growth. One master therapist described the importance of the humbling process of recognizing and learning from one’s mistakes.
  • Self-doubt: Despite their experience and reputation, some of the master therapists addressed another issue related to the development of expertise* periodic self-doubt*and how this feeling motivated them to keep growing their clinical skills.

Therapists’ approach to practice:

  • Balance between support and challenge: Many of the master therapists spoke of the importance of maintaining a balance between support and challenge when working with clients.
  • Flexible therapeutic stance. The master therapists described a flexible approach in their work with Psychotherapy clients. If client variables required them to adapt their style, they did. One theory does not fit all.
  • Empowerment/strength-based approach: A number of master therapists spoke about their clients’ internal resources and how the therapist’s task was to reinforce these strengths and bring them to bear in dealing with the problem at hand.
  • Primacy of the therapeutic alliance: Many of the master therapists acknowledged the importance of the therapeutic relationship. The impact of the relationship varied from a necessary condition in the therapeutic process to the relationship being the actual source of healing.
  • Comfortable addressing spirituality: Beyond observance of any particular religion, many master therapists spoke of a broad personal spiritual mind-set, which primarily functioned as a backdrop when working with clients but also included some therapists privately praying for clients.
  • Embraces working within a multicultural context: A number of master therapists spoke of the importance of cultural awareness in their work and the challenges of adapting Western therapeutic approaches to Eastern values and systems.

On on-going professional growth:

  • Professional development practices: Professional development, a key factor in developing and maintaining expertise, was not limited to conferences, literature, or textbooks. One master therapist believed that therapists should extend beyond their areas of practice to broaden development.
  • Benefits of teaching/training others: Now highly regarded and seasoned, the master therapists have much to offer other therapists. Many of the master therapists viewed teaching and training as an opportunity to hone their own skills and to reflect upon their practice.
  • Challenges to professional development in Singapore. During the interviews, master therapists identified several ‘‘professional growth edges’’ in the Singapore psychotherapy profession. For instance, a training need recognized by several therapists was that of basic counseling skills. One master therapist explained that basic counseling skills are not natural for many Singaporean trainees.

 

Comments on the Study and it’s Results

As a Singaporean therapist with training in Austria, it appears that what the master therapists highlight regarding personal characteristics, development and education of therapists are not so different in Singapore than in Europe.

There is one difference that stands out for me, and that is of the need of the Singapore-based therapist to address spirituality. Although it is also important in Europe, the emphasis in this article gives me the impression that is more important and challenging in Singapore.

What is somewhat disappointing about the results is that (and it was articulate also in the article) is that the Master therapists shared very little of their own emotional experiences. The researchers attributed it to the cultural background of the therapist. As someone doing qualitative research myself, I am of the opinion the it is the job of the researchers to lead the subjects to provide this information.

It could be that the shortfall in this study is the interviewers own discomfort in checking with the interviewees on more personal levels.

As a whole, I do agree that Singapore is good ground for psychotherapy research.

Bibliography

Jennings, L., D’Rozario, V., Goh, M., Sovereign, A., Brogger, M., & Skovholt, T. (2008). Psychotherapy expertise in Singapore: A qualitative investigation. Psychotherapy research18(5), 508-522.

Projective Identification

Otto Kernberg explains what Projective Identification is:

Projective Identification is one of the primitive defensive operations that goes together with splitting and primitive idealization and omnipotent control.

It is a primitive form of projection of attributing to others what one cannot tolerate in oneself. It is characterized by combination of attributing to somebody else what the person is experiencing but cannot tolerate. While they are still capable of maintaining empathy of what they experience but cannot tolerate. There is also a tendency to induce behavior in the other in effort to control the other person to absolve themselves.

Basically it is an insidious method of inciting emotions, which one cannot come to terms with in oneself, in another person. This as a means to control the other person. 

A possible example of such an occurrence is someone who is insecure and envious of another. This person creates situations whereby he/she incites envy and/or competition in the other person.

It could also someone controlling a group. A manager may have a paranoid ideas of the team being disloyal to him, begins to behave in ways to incite feelings of mistrust between the members of the company.

 

Extra Notes (see Video attached) on Child abuse and projective identification:

Identification of the aggressor : being a ghost to chase the ghost away, stockholm syndrom (Anna Freud’s).  Ferenczi’s idea of identification with the aggressor: The abused child behaves in the way the abuser wants to protect himself from the abuser, by appeasing and complying.

The child introjects the abuser’s feelings: he feels both innocent and guilty. There is a clash of feelings. The abuser, to make himself feel less guilty induces the guilt on the child victim. The parent / abuser projects the impart feelings (also known as projective identification, a term Melanie Klein coined later on) on the child. He induces guilt on the child. The child introjects the shame and feels guilty.

The client should be allowed to express their criticism on the therapist, or they will turn on themselves. These negative feelings are not just negative transference. When the clients can voice their critic in therapy, it is a breakthrough. It is a break from the childhood pattern.

 

Moments of Uncertainty in Therapeutic Practice: Interpreting Within the Matrix of Projective Identification, Countertransference, and Enactment

Projective and Introjective Identification and the Use of the Therapist’s Self (The Library of Object Relations)

Projective Identification: The Fate of a Concept (The New Library of Psychoanalysis)

Projective Identification and Psychotherapeutic Technique

Alexithymia Quiz: How to Tell if You are in a Relationship with Someone with No Feelings

You may wonder what is the significance of knowing this: is my spouse / boss / colleague / friend / sibling someone who happens to be alexithymic? Someone who has literally no feelings?

We are not all the same. In fact we are often blind to the people we live with, to their personality and character traits, because we live within our own personality biases. Without psychotherapeutic work, we are often not aware of the fact that we see and feel the world differently from the people around us. That we also have a tendency to assume that the other person understands us and vice versa.

Alexithymia is not uncommon. It is assumed that about 10% of the population is alexithymic. With awareness through psychotherapy, one may get to realize that one is or had been living with persons who are unable to identify and describe emotions in the self.  This condition is seen as dysfunctional because it leaves the person un-empathic, and the  people around the sufferers often get hurt.

Alexithyma proves to be prominent in a number of clinical disorders (e.g., somatoform disorders, panic disorders, depression with dominance of vital and somatic symptoms, posttraumatic stress disorder [PTSD], and eating disorders).  Extent of Alexithymia is also significant to outcome in the treatment of these disorders.

Psychological questionnaires used to measure Alexithymia include: Observer Alexithymia Scale (Haviland et.al, 2001) and the the Bermond-Vorst Alexithymia Questionnaire (Vorst et.al, 2001).

Reference

Haviland, M. G., Warren, W. L., Riggs, M. L., & Gallacher, M. (2001). Psychometric properties of the Observer Alexithymia Scale in a clinical sample. Journal of Personality Assessment, 77(1), 176-186.

Helmes, E., McNeill, P. D., Holden, R. R., & Jackson, C. (2008). The construct of alexithymia: Associations with defense mechanisms. Journal of clinical psychology, 64(3), 318-331.

Vorst, H. C., & Bermond, B. (2001). Validity and reliability of the Bermond–Vorst alexithymia questionnaire. Personality and individual differences, 30(3), 413-434.

Quiz: How to Identify Alexithymia in a Person

Note: this is a basic quiz and not to be used as diagnosis of yourself or the other person. If you suspect that the condition affects your psycho-social functioning, please consult a mental health professional.

Does he/she:

Gestalt Therapy Case-Study: From procrastination to recalling a story in a novel

Written by: Nicole Chew-Helbig on 15 June 2017 in Vienna, Austria.

Cite this article as: Chew-Helbig, N. (06/2017), Gestalt Therapy Case-Study: From procrastination to recalling a story in a novel, in The Psychotherapist . Date accessed 11/2019, https://nikhelbig.at/gestalt-therapy-case-study-from-procrastination-to-recalling-a-story-in-a-novel/.

Abstract

This case study is an abstract from a therapeutic work. It is a demonstration how a recall of the client’s favorite novel as a teenager develops into a psychotherapeutic session that is meaningful to the clients identification of himself. This is a technique usually used for working with dreams in Gestalt therapy, in which the client plays the parts (makes projections) of his dream.  In this case it is not the dream, but the novel.

Case study: CL’s Novel

CL works in a publishing company. He reports having problems with procrastination. Although quite successful at his job, he struggles making datelines. He finds himself delaying getting things done till the last minute, which sees himself sitting up till early hours of the morning smoking cigarettes. This is an excerpt of a Gestalt Therapy Session. Throughout this article, the principles of Gestalt Therapy adopted in this session are also explained in this color.

NC: Now can you bring to mind a moment in which the word “procrastination” feels familiar?
CL: (Contemplates…) Yes. I had to write a short article for the company’s blog. It was in morning, I took out the PC, but then I did instead some online shopping.
NC: Stay with the feeling of the moment before you switch to online shopping.

“Staying with the feeling” is an approach in GT where the narrative (which is usually an intellectual process) is embodied into experience.  
CL: I feel anxious.
NC: This familiar to you?… stay with it. Can you remember a time in your childhood when you felt something like this?
CL: In school. It was Math, and I had homework. The teacher wasn’t pleased, I made mistakes I did not understand…

This narrative goes on, and we talked about anxiety about what he considered “small criticism”. This recall of the past is a “free association”. The experienced client knows how to take memories or images that pop up in the moment and vocalize them. Sometimes these associations do not seem to make sense at the moment, but these usually do. 

NC: Stay with this anxiety again… much earlier… maybe at home…
CL: Nothing special, really, I am just having a picture of a dirty bicycle. I was 8 or 9, it is my bicycle. I was supposed to clean it, but I didn’t want to do it.
NC: You had to do it, but you do not want to do it now?

CL had used the present tense, and I felt it is a good thing, so I followed with the present tense. This is a good opportunity to work with past experiences as if it were in the present. Actually this is how we live, with occurrences of our past popping up in the present.

CL: Yes.
NC: What would you rather have done?
CL: Read a book.
NC: Have you a book in mind?
CL: Yes. (mentioned a title of a book).
NC: Where would you go to read this book?
CL: In my bedroom.
NC: How does it feel to be in your bedroom reading this book?
CL: Relaxed, comfortable… safe.

Notice that he said “safe”. It seems to correlate with the “anxiety” behind the procrastination. This is an indication that sitting in the room, and reading that book is a way out of anxiety. At this point I could have gone back to the anxiety, and tried to work on it. My interest of the moment, however, took me to the curiosity about the book (which I will explain later why). This is working in the here-and-now. The therapist is following her own feelings of curiosity, and being present.  This means that we may, at this juncture abandon trying to sort the problem of procrastination. In Gestalt, we work on what is present. The present is always changing. We do not try to force goals into the present or force the client to concentrate or dwell on issues that are not there at the moment.

NC: The title of this book got my interest, I have not heard of it before.
CL: (laughs). It is a very old novel. German novel about German brothers coming back from the 2nd World War, and the Russians came.
NC: You mentioned this book was comforting to you, a 9 year old.
CL: for some reason, yes.

The backstory here is, like many of his generation, CL’s estranged father was a soldier in the German NS. CL himself is a liberal (kind of left-wing writer). This information in background, now got my interest to this book preference CL as a child. The background is very important to the Gestalt therapist because we are interested in the foreground. The foreground is made clearer only when the background is complete. 

NC: Tell me about the book…
CL: (laughs, a little more shakily. He goes to his phone, and searches this book on an online site. Makes some association:)
NC: What comes to mind…
CL: Two scenes. This guy talks to his buddy in prison about the time he was taken from his home by the Russians. He was in the garden of his parent’s home, and his mother had baked a cake. Then they came to take him away. (laughs) He tells his buddy that he wished now that he had taken the cake along with him. The other scene is that he tells his buddy, “now I hope the Americans come, and gets rid of the Russians, so that they can free us”).

CL, has made associations again. This I found to be interesting. The scenes have irony and are a bit funny. Freud in his writings, “Der Witz und seine Beziehung zum Unbewußten” or “Jokes and Their Relation to the Unconscious” , tell us that there is significant repressed unconscious material in jokes. We’ll see how this plays out… 

NC: Could you play out the scene? Try. You are this guy talking to your buddy in prison. Say “I am in the garden of my parents, and my mother had baked a cake…”

Unlike psychoanalysis, where the therapist takes on the task of analyzing the joke for the client, in Gestalt Therapy, the client tells us his/her version of the story. This method is usually used in Dream analysis (or dream work) in Gestalt therapy. The client is invited to take a role in his dream (or in this case, story). His task is to talk in the first person.  By this time, there was actually resistance on the part of the client. There were points in the session when CL started to intellectualizing, either by stepping out of the scene, or to make judgment of the scene, even though he was quite agreeable to doing this experiment of playing the part of the characters in his associations. Playing part in associations and dreams is usually uncomfortable for many people because they feel awkward, or they do not trust what they say or feel in this kind of work. My experience is that the client is seldom ever wrong in this sense.

CL: I am in the garden of my home. My parents are there. Mother has baked a cake.
NC: Tell me about the cake.
CL: Delicious. She baked it often.
NC: then what happened.
CL: Soldiers came to the gate, and took me away. Then I am in the prison talking…
NC: Slow down. What happened as they took you away…
CL: That is not in the book.
NC: They are at the gate, they ask you to come with them.
CL: Yes.
NC: What’s going on.
CL: I feel scared, I suppose.
NC: I can imagine.
CL: In I am not sure if I would ever come back.
NC: Yes. Now, come back here with me. Have you an understanding what is going on with this character in prison as told his buddy that he should have taken the cake along?
CL: He is scared, he wished his mother was there, he’s afraid he would never see her again.
NC: Would you like to work on the next scene?
CL: Sure.
NC: I am in prison and I hope…?
CL: I am in prison, I tell my buddy, I hope that the Americans come soon and drop bombs on the Russians.
NC: What is the purpose of that?
CL: to save us.
NC: From?
CL: We are trapped in prison.
NC: What does it mean to be in prison?

This part took a bit of time. We stayed with it together… Staying with the client’s pause is good point of contact. Contact is a very essential part of Gestalt therapy. It usually comes when the client touches something emotionally significant, and when the therapist is able to give support. 
CL: No freedom… I am in danger… I am guilty… I feel hopeless… I feel helpless…
NC: in prison, no freedom, in danger, guilty…
CL: yes.

The client, in his association, has come to contact with some deep feelings. These are unconscious until now. We can ask “what are you feeling guilty about…?”, but this might lead the client to intellectualizing. The cleaner path is to bring the client back to the present situation, the here-and-now.

NC: Tell me about what’s happening now. You being here with me now, we are talking now…
NC: are you in danger?
CL: no. I am safe.
NC: Guilty?
CL: No… not hopeless nor helpless. (Takes a deep breath.)

Note that this is a condensed version of the dialogue. CL had a bit of difficulty with the associations at first, and this is normal. Why we worked these scenes is because they were freely associated, and my guess was that they had significance. The other clue that this was significant was the resistance of the client along the way of this experiment.

At the end of the dialogue, CL took a really deep breath reflexively. He looked calm, and said “I feel good”. “Fine,” I said, and we ended there.

This short session demonstrated a closing of a gestalt. The client had anxiety-related procrastination issues, and that led to a memory. This memory led to a group of unconscious feelings, which took solace is a kind of joke or wit, or an entitled way of thinking “I hope the Americans bombs the Russians..” These were also not fully owned by the client, since he attributes it to a story book. However, the client was really interested in the experiment, because he realized, too, that there was some kind of association between this story and his relationship to his father. The beauty of Gestalt therapy is that we help the client come to his own meanings and understanding through his experiencing and embodiment of the experience. The therapist’s work here was that of supporting, and not of prying. 

In the following sessions we discussed this dialogue again in relation to CL’s relationship to his parents. There was even clearer understanding to the cultural significance of “jokes” or “making light” in tough situations. Also, there was a discussion about how we deal with anxiety and fear.

The rest of the associations with regards to this dialogue, I’ll leave it to you, the reader.