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Envy… and Gratitude

This is an excerpt to this video entitled, “Introduction to Kleinian Theory”.

I. Rejection of Death Instinct

  • Klein rejects Freud’s Death Instinct theory (20-25)
    • Reasons for rejecting the theory (25)
      • Klein argues sufficient ego exists at birth to experience anxiety (20)
      • She emphasizes the role of primitive defense mechanisms and object relations (20)

II. Splitting and the Paranoid-Schizoid Position

  • Splitting is necessary for the developing mind (40)
    • Ideal breast vs. persecutory breast (41)
    • Super ego identified with the bad breast (42)
    • Conscience identified with the good breast (42)
  • Two ways to protect the good from the bad (43)
    • Projection (paranoia) (43)
    • Idealization (depletion of self) (43)
  • The paranoid-schizoid position (44)
    • Term “schizoid” refers to splitting, not schizoid personality (44)
    • Splitting of both object and ego (44)
  • Persecutory object can be internal or external (45)

III. Passion and the Paranoid-Schizoid Position

  • Passion belongs to the paranoid-schizoid position (46)
  • Love, commitment, and ideals are formed here (46)
  • The sacred resides in the paranoid-schizoid position (46-47)
    • Examples: religious reverence, secular sacred (life of a child, democracy) (46-47)

IV. Dialectical Thinking

  • Mental health as an oscillation between paranoid-schizoid and depressive positions (48)
  • Fairbairn’s concept of mental health (48)
  • Author’s concept of a transitional area (48)

V. Envy

  • Envy is a two-body phenomenon (distinguished from jealousy) (49)
  • Envy can lead to destructive behavior (spoiling) (50)
  • Envy in patients can lead to backlash against progress (50-51)
  • Envy of the analyst (52)
    • Can be experienced as a defense against unconscious destructive wishes (Kernberg) (52)
    • Can be an attempt to resume a development process (Kohut) (52)
  • The envious super ego (53)
  • Projection of Envy (53)
  • Defenses against Envy (53-54)
    • Spoiling
    • Devaluing
    • Rigid idealization
    • Projection of Envy

VI. Idealization

  • Kernberg vs. Kohut on Idealization (54-55)
    • Kernberg: defense against destructive impulses (54)
    • Kohut: attempt to resume a development process (54)

VII. Countertransference

  • Winnicott on hate in the countertransference (55)
    • Some patients distrust analyst’s goodness and need to experience their hate (55)

VIII. Analyst’s Bias

  • Analysts may have a bias towards linking or separating (56)
  • Importance of analyst’s development of a “bisexual orientation” (56)

IX. Attacks on Linking

  • Beon describes attacks on linking in schizophrenia (56)

X. Use of Analyst as Container

  • Patients may use the analyst as a container for bad objects (56-57)
  • Three possible responses of the analyst (57)
    • Unaffected (blocks process) (57)
    • Rejects the bad object (patient sees analyst as persecutory) (57)
    • Contains the bad object (leads to relief and Envy) (57)
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Freud and Fiction: The Psychological Thinking about Literature

Thought and speech are constituted by language. The medium of our consciousness, also known as our psyche, can be understood from verbal thought, as Lacan says, “the unconscious is structured like a language.”

In this blog, I re-post an interesting lecture “Introduction to Theory of Literature ” by Fry (2009). Fry talks about the essay of Peter Brook, “Freud’s Masterplot: a Model for Narrative”, a chapter in his book, “Reading for Plot, Design and Intention in Narrative“. From this essay the psychological meaning of discourse is developed and discussed.

Brooks on Jakobson and de Man

Plot vs. the Story: The Plot, which Brooks calls, syuzhet  in Russian. The story, fabula, it is the subject matter out of which the plot is made.

Metaphor and Metonymy: 

Metaphor unifies, brings together different ideas, situations.

Metonymy brings things together “by a recognizable gesture toward contiguity but which nevertheless does not make any claim or pretension to unify or establish identity” — without unifying. Metonymy is a figure of speech which a thing or concept is called not by its own name but rather the name of something associated in meaning with that thing or concept.

Reading Jakobson and de Man, Brooks helps us understand the terms described to us above.  In Brooks’ essay, “Freud’s Masterplot,” the that the framework for argument is psychoanalytic and that the author is draws primarily from the text of Freud’s Beyond the Pleasure Principle.

On Freud

In this essay Brooks takes from Freud is the idea of structure. The idea that the unconscious is structured like a language. Hence in psychoanalysis is considered a “talking cure”, in which the unconscious is revealed via narrating and free association. “Talking cure” was first coined in the case of Anna O.

In terms of creating fictional plots, in terms of the nature of fiction, which is what interests Brooks–well, what does this mean?

Aristotle tells us that a plot has a beginning, a middle and an end. It seems almost logical, but we should consider this … A beginning, of course–well, it has to have a beginning and it has to have an end… but why does it have a middle? What is the function of the middle with respect to a beginning and an end? Why does Aristotle say, that a plot should have a certain magnitude? Why shouldn’t it be shorter? Why shouldn’t it be longer?

What does the middle have to do with the necessary connection with the beginning and the end, in such a way that resolves a kind of logic that makes the story worth being?  How does all this work? Brooks believes that he can understand it in psychoanalytic terms.

From Freud’s  The Interpretation of Dreams, Brook finds the methodological idea that text can be “mechanized”.

The central two mechanisms of the dream work are simultaneously:

  1. Condensation : takes essential symbols of the dream and distills them into a kind of over-determined unit, so that one can see the underlying desires and wishes expressed in a dream, manifest in a particular symbolic unity.
  2. Displacement: essential symbols of the dream, the way a dream attempts to manifest that which it desires, are not  expressed in themselves but are displaced into obscurely related ideas or images or symbols.

Displacement is a detour of understanding. Condensation is a distillation of understanding. SIMULTANEOUSLY.

Jacques Lacan probably noticed that the work in every day discourse, and also in our dreams, and our narratives, can be understood as operating through these two mechanisms, condensation and displacement.

Condensation is metaphorical in nature, and displacement metonymic in nature. Metonymy is delaying, and a “différance of signification”– or deferring to a later time. Metaphor is in trying to bring together meaning “in a statement of identity of the discourse that’s attempting to articulate itself”, bringing together identity, “affirmation of resemblance”.

So we can see how Brooks combines Freud’s structure in the interpretation of dreams, showing its correlation with Jakobson and de Man’s structure of literature.  Brooks is not interested in the psychogenesis of the author, nor the characters.

The text is not there to tell us about the author or the character. The text is alive, to express desire, put in motion. The structure of the text is there to manifest desire. Freud has a particular desire to fulfill a desire for reduced excitation. can be associate the death wish as the reduction of excitation.

Brooks’ Departure from Freudian Criticism

Brook is taking a different angle with his essay by not getting involved in freudian criticism nor does he talk about how freudian ideas are used in literature.  

“I would remind you in passing that although we don’t pause over traditional Freudian criticism in this course, it can indeed be extremely interesting: just for example, Freud’s disciple, Ernest Jones, wrote an influential study of Shakespeare’s Hamlet in which he showed famously that Hamlet has an Oedipus complex. Think about the play. You’ll see that there’s a good deal in what Jones is saying; and in fact, famously in the history of the staging and filming of Shakespeare–as you probably know, Sir Laurence Olivier took the role of Hamlet under the influence of Ernest Jones. In the Olivier production of Hamlet, let’s just say made it painfully clear in his relations with Gertrude that he had an Oedipus complex. Again, there were actual sort of literary texts written directly under the influence of Freud. One thinks of D. H. Lawrence’s Sons and Lovers, for example, in which the central character, Paul Morel, is crippled by an Oedipus complex that he can’t master and the difficulties and complications of the plot are of this kind.”

“Moving closer to the present, an important figure in literary theory, Harold Bloom, can be understood to be developing in his theories of theoretical text, beginning with The Anxiety of Influence, a theory of the author–that is to say, a theory that is based on the relationship between belated poets and their precursors, which is to say a relationship between sons and fathers. So there is a certain pattern in–and of course, I invoke this pattern in arguing that Levi-Strauss‘ version of the Oedipus myth betrays his Oedipus complex in relation to Freud. Plainly, Freudian criticism with these sorts of preoccupations is widespread, continues sometimes to appear, and cannot simply be discounted or ignored as an influence in the development of thinking about literature or of the possibilities of thinking about literature.”

The text is there to express desire, to put in motion, and to make manifest desire or a desire. Brooks says that he has a particular desire in mind.

The structure of the text, or the way in which the text functions is to fulfill a desire for reduced excitation.  This means that the desire which can be associated with the pleasure principle in sexual terms and can be associated with the idea of the death wish that Freud develops in Beyond the Pleasure Principle.

In these ways Brooks understands the structure, the delay, the arabesque, or postponement of the end.

Within the text there involves a kind of coexistence between the possibility through “desire of reducing excitation, being excited, and reducing excitation.”

Dreams and stories don’t just express this desire; they also delay it.

Many of the dreams we have are neither exciting, and are tedious. Fiction, as art, has structure, and is thus precisely designed to create delay to a desired degree but not unduly beyond that degree.

Middle of fiction involve this process of delay, they seem also to revisit un-pleasurable things.  The experiences that constitute the middles have a tendency to un-pleasurable. The middles are not un-interesting, but they are page turners because they reflect un-pleasant episodes… which we seem to be fascinated with.

Why, in other words, return to what isn’t fun, to where it isn’t pleasure, and what can this possibly have to do with the pleasure principle?

Beyond the Pleasure Principle

In Beyond the Pleasure Principle,  Freud considers the phenomena experienced with trauma victims. Written at the end of the First World War,  many of the contemporary books written in that time dealt with the subject of war experiences: Virginia’s Woolf’s Mrs. Dalloway, that her treatment of Septimus Smith in Mrs. Dalloway is a treatment of a traumatized war victim and Rebecca West, wrote one in particular called The Return of the Soldier, the protagonist of which is also a traumatized war victim. It seemed to be the theme of the period and Freud’s Beyond the Pleasure Principle contributes to this theme.

Brooks himself likes to refer to the text of Beyond the Pleasure Principle as itself a master plot–in other words as having a certain fictive character, like The Return of the Soldier or Mrs. Dalloway.

Freud begins by saying, “The weird thing about these trauma victims whom I have had in my office is that in describing their dreams and even in their various forms of neurotic repetitive behavior, they seem compulsively to repeat the traumatic experience that has put them in the very predicament that brought them to me. In other words, they don’t shy away from it. They don’t in any strict sense repress it. They keep compulsively going back to it. Why is that? How can that possibly be a manifestation of the only kind of drives I had ever thought existed up until the year 1919, namely drives that we can associate in one way or another with pleasure–with the pleasure principle, obviously; with a sort of implicit sociobiological understanding that the protraction of life is all about sexual reproduction and that the displacement or inhibition of the direct drives associated with that take the form of the desire to succeed, the desire to improve oneself, and the desire to become more complex emotionally and all the rest of it? All of this we can associate with the pleasure principle. How does this compulsion to return to the traumatic event in any way correspond to or submit itself to explanation in terms of the pleasure principle?”

“The Aim of All Life is Death”

The compulsion to repeat, manifests itself in adults in various forms of neurotic behavior.  We can think of it in terms of effort at mastery of something, like a rehearsal of the inevitability of death. The trauma of death which awaits and which has been heralded by traumatic events in one’s life, a near escape: for example, in a train accident or whatever the case may be. So Freud in developing his argument eventually comes to think that the compulsion to repeat has something to do with a kind of repeating forward of an event which is in itself unnarratable: the event of death, which is of course that which ultimately looms.

Freud’s argument is that there is somehow in us a compulsion or a desire, a drive, to return–like going home again or going back to the womb to return to that inanimate state. “The aim of all life,” he then says, “is death.”

Brooks says:

We need at present to follow Freud into his closer inquiry concerning the relation between the compulsion to repeat and the instinctual. The answer lies in “a universal attribute of instinct and perhaps of organic life in general,” that “an instinct is an urge inherent in organic life to restore an earlier state of things.“…

This function [of the drives] is concerned “with the most universal endeavor of all living substance–namely to return to the quiescence of the inorganic world.”

But there’s a reason as to why novels are long: “not too long, not too short, but of a certain length–of a certain magnitude, as Aristotle puts it.”

The organism doesn’t just want to die. The organism is not suicidal. That’s a crucial mistake that we make when we first try to come to terms with what Freud means by “the death wish.” The organism wants to die on its own terms, which is why it has an elaborate mechanism of defenses–“the outer cortex,” as Freud is always calling it–attempting to withstand, to process, and to keep at arm’s length the possibility of trauma. You blame yourself as a victim of trauma for not having the sufficient vigilance in your outer cortex to ward it off. Part of the compulsion to repeat is, in a certain sense–part of the hope of mastery in the compulsion to repeat is to keep up the kind of vigilance which you failed to have in the past and therefore fail to ward it off.

According to Freud, the organism wants to evolve toward its dissolution.

So there is this tension in the organism between evolving to its end and being modified prematurely toward an end, a modification which in terms of fiction would mean you wouldn’t have a plot, right? You might have a beginning, but you would have a sudden cutting off that prevented the arabesque of the plot from developing and arising.

Now what Brooks argues following Freud is that to this end, the creating of an atmosphere in which with dignity and integrity… this is where the pleasure principle and the death wish cooperate.

Hence Freud is able to proffer, with a certain bravado, the formulation: “the aim of all life is death.” We are given an evolutionary image of the organism in which the tension created by external influences has forced living substance to “diverge ever more widely from its original course of life and to make ever more complicated détours before reaching its aim of death.” In this view, the self-preservative instincts function to assure that the organism shall follow its own path to death, to ward off any ways of returning to the inorganic which are not imminent to the organism itself. In other words, “the organism wishes to die only in its own fashion.” It must struggle against events (dangers) which would help to achieve its goal too rapidly–by a kind of short-circuit.

… [W]e could say that the repetition compulsion and the death instinct serve the pleasure principle; in a larger sense [though], the pleasure principle, keeping watch on the invasion of stimuli from without and especially from within, seeking their discharge, serves the death instinct, making sure that the organism is permitted to return to quiescence.

Two differing drives coexist in the developing and enriching of the good plot.

The problem in Beyond the Pleasure Principle, is that it’s awfully hard to keep death and sex separate. The reduction of excitation is obviously something that the pleasure principle is all about. The purpose of sex is to reduce excitation, to annul desire. The purpose of death, Freud argues, is to do the same thing.

For example,  the compulsion to repeat nasty episodes, to revisit trauma, and to repeat the un-pleasurable.  It could be called something which is a kind of pleasure and which therefore could be subsumed under the pleasure principle and would obviate the need for a theory of the death drive as Freud develops it in Beyond the Pleasure Principle.

As with the plot: desire emerges or begins as the narratable.

What is the unnarratable? The unnarratable is that immersion in our lives such that there is no sense of form or order or structure. Anything is unnarratable if we don’t have a sense of a beginning, a middle, and an end to bring to bear on it. The narratable, in other words, must enter into a structure. So the beginning, which is meditated on by Sartre’s Roquentin in La Nausee and quoted to that effect by Brooks. The narratable begins in this moment of entry into that pattern of desire that launches a fiction. We have speculated on what that desire consists in, and so the narratable becomes a plot and the plot operates through metaphor, which unifies the plot, which shows the remarkable coherence of all of its parts.

In narrative theory there’s no such thing in fiction as irrelevant detail. Nothing is there by accident. The nature of the underlying desire that’s driving the plot forward; but on the other hand, metonymy functions as the principle of delay, the detour, the arabesque, the refusal of closure; the settling upon bad object choice and other unfortunate outcomes, the return of the unpleasurable–all the things that happen in the structure of “middles” in literary plots. The plot finally binds material together, and both metaphor and metonymy are arguably forms of binding. Brooks says:

To speak of “binding” in a literary text is thus to speak of any of the formalizations (which, like binding, may be painful, retarding) that force us to recognize sameness within difference, or the very emergence of a sjužetfrom the material of fabula.

Tony the Tow Truck Revisited

Tony the Tow Truck. I would suggest that in the context of Beyond the Pleasure Principle we could re-title Tony the Tow Truck as The Bumpy Road to Maturity. It certainly has the qualities of a picaresque fiction. It’s on the road, as it were, and the linearity of its plot–the way in which the plot is like beads on a string, which tends to be the case with picaresque fiction, and which by the way is also a metonymic aspect of the fiction–lends the feeling of picturesque to the narrative. Quickly to reread it–I know that you all have it glued to your wrists, but in case you don’t, I’ll reread it:

I am Tony the Tow Truck. I live in a little yellow garage. I help cars that are stuck. I tow them to my garage. I like my job. One day I am stuck. Who will help Tony the Tow Truck? “I cannot help you,” says Neato the Car. “I don’t want to get dirty.” “I cannot help you [see, these are bad object choices, right?],” says Speedy the Car. “I am too busy.” I am very sad. Then a little car pulls up. It is my friend, Bumpy. Bumpy gives me a push. He pushes and pushes [by the way, this text, I think, is very close to its surface a kind of anal-phase parable. In that parable, the hero is not Tony in fact but a character with whom you are familiar if you’re familiar with South Park, and that character is of course the one who says, “He pushes and pushes…”] and I am on my way.” [In any case that is part of the narrative, and then:] “Thank you, Bumpy,” I call back. “You’re welcome,” says Bumpy. Now that’s what I call a friend.

So that’s the text of Tony the Tow Truck. Now we’ve said that it’s picaresque. We can think in terms of repetition, obviously, as the delay that sets in between an origin and an end. We’ve spoken of this in this case as–well, it’s the triadic form of the folk tale that Brooks actually mentions in his essay; but it is, in its dilation of the relationship of beginning and end, a way of reminding us precisely of that relation. He comes from a little yellow garage. The question is, and a question which is perhaps part of the unnarratable, is he going back there? We know he’s on his way, but we don’t know, if we read it in terms of Beyond the Pleasure Principle, whether he’s on his way back to the little yellow garage or whether–and there’s a premonition of this in being stuck, in other words in having broken down–whether he’s on his way to the junkyard.

In either case, the only point is that he will go to either place because the little yellow garage is that from which he came; in either case–little yellow garage or junkyard–he’s going to get there on his own terms, but not as a narcissist and not as the person who begins every sentence in the first part of the story with the word “I,” because you can’t just be an autonomous hero. On your journey, and this is also true of the study of folklore, you need a helper. That’s part of fiction. You need another hero. You need a hero to help you, and having that hero, encountering the other mind as helper, is what obviates the tendency, even in a nice guy like Tony, toward narcissism which is manifest in the “I,” “I,” “I” at the beginning of the story. Notice that then the “I” disappears, not completely but wherever it reappears it’s embedded rather than initial. It is no longer, in other words, that which drives the line in the story. So the arabesque of the plot, as I say, is a matter of encountering bad object choices and overcoming them: neatness, busyness–choices which, by the way, are on the surface temptations. We all want to be neat and busy, don’t we? But somehow or another it’s not enough because the otherness, the mutuality of regard that this story wants to enforce as life–as life properly lived–is not entailed in and of itself in neatness and busyness. Resolution and closure, then, is mature object choice and in a certain sense there, too, it’s a push forward, but we don’t quite know toward what. We have to assume, though, in the context of a reading of this kind that it’s a push toward a state in which the little yellow garage and the unnarratable junkyard are manifest as one and the same thing.

Now as metonymy, the delays we have been talking about, the paratactic structure of the way in which the story is told–all of those, and the elements of repetition, are forms that we recognize as metonymic, but there’s something beyond that at the level of theme. This is a story about cars. This is a story about mechanical objects, some of which move–remember those smiling houses in the background–and some of which are stationary, but they’re all mechanical objects. They’re all structures. In other words, they’re not organic. This is a world understood from a metonymic point of view as that which lacks organicity, and yet at the same time the whole point of the story is thematically metaphoric. It is to assert the common humanity of us all: “That’s what I call a friend.” The whole point of so many children’s stories, animal stories, other stories like this, The Little Engine that Could, and so on is to humanize the world: to render friendly and warm and inviting to the child the entire world, so that Tony is not a tow truck–Tony’s a human being, and he realizes humanity in recognizing the existence of a friend. The unity of the story, in other words, as opposed to its metonymic displacements through the mechanistic, is the triumphant humanization of the mechanistic and the fact that as we read the story, we feel that we are, after all, not in mechanical company but in human company.

That’s the effect of the story and the way it works. In terms of the pleasure principle then, life is best in a human universe and in terms of–well, in terms of Beyond the Pleasure Principle, the whole point of returning to an earlier state, the little yellow garage or junkyard, is to avert the threat that one being stuck will return to that junkyard prematurely or along the wrong path.

What is interesting?

Narratives are interesting. We compulsively repeat the unpleasant, return to the un-pleasurable… why? In order to gain mastery of what might otherwise be a moment of helplessness in the face of traumatic experiences. I am not sure if it is a death-wish as much as a defying of death. It is as if repeating the event is a means of making “banal” that which has caused so much “excitement” in the form of anxiety. 

As in psychotherapy, patients with psychological issues talk away their suffering. How does the talk do this? Talking or narrating, is a form of repeating unpleasant events. It is not the mere talking about something, but talking to someone who is listening. If there are more people listening, the healing effect gets better.

There is also an effect of hearing another person’s narrative on the listener. The listener is touched by the unpleasant narrative of the other. There is a vicarious effect (something to do with our mirror neurons) and our sense for empathy. Hearing another’s narrative, has a spiritual effect on the listener. This is the reason why we are drawn to such stories and narratives, of plots in literature.  NIk

References:

Brooks, P. (1992). Reading for the plot: Design and intention in narrative. Harvard University Press. p. 90. 

Fry, P. (2009). Introduction to Theory of Literature. Lecture retrieved from: https://www.youtube.com/watch?v=GnnWbVvnYIs.

The Manic Need to Control : Kleinian Theory

These are excerpts on the subjects from notes taken from Carveth’s lecture “Introduction to Kleinian Theory 5”.

Manic defenses are manifested to protect the ego from despair. It is a means of being omnipotent, and is very much belongs to the paranoid-schizoid position as defined by Melanie Klein.

Inability to deal with loss, leads to symptoms, like depression, and behaviors, like rage. This is a sign of a regression into an existence of black-white thinking, in which there are projections made towards the outside world to ward off unbearable feeling. It is attack on psychic reality, in an effort to control the external objects.

Read also : Making Reparation and mourning as the road to mental healing.

Why the need to control, triumph?

These acts defend the self against realization of dependency. It defends against loss. Triumph is needed so that the person defeats the object, so that there is that “I do not have to care for the object”– which is an aggressive and dangerous condition.

This kind of thinking also serves to ward off envy. Hence it is better to come to terms with one’s feelings of envy, so that on can use it constructively, like for self improvement, than to avoid feelings of envy by trying to dominate and destroy the other.

Contempt is there to deny the object’s value …the object is rendered not worthy of guilt. Contempt justifies the abuse and annihilation of the other.

There is also “manic” in the culture we live in. Our culture as we know it, is one that seems to put taboo on tenderness.

Read also : Conformity and Obedience: Slippery Slope to Dehumanization of the Other and Privacy as Personal Control.

Quote from the 18th Century on Control of the Other

Jean Jacques Rousseau (1712–1778) in Social Contract 1762:

“Man is born free; and everywhere he is in chains. One thinks himself the master of others, and still remains a greater slave than they. How did this change come about? I do not know. What can make it legitimate? That question I think I can answer.”

Notable notes:

Interesting points (at the last 5 mins of the video) on guilt, control and being omnipotent.

Strategies for dealing with the object related

From Britton’s Sex Death Superego:

  1. The Schizoid withdraws from the object
  2. The borderline colonizes the object
  3. The Hysteric impersonates

From Carveth‘s The Still Small Voice :

  1. The psychotic denies the reality of the
  2. The pervert castrates the object#
  3. The psychopath destroy
  4. The neurotic acknowledge dependence and guilt towards and suffers from the conflicts
  5. The healthy person repairs loves depends on and sacrifices for good object but also prepared to hate the bad object

Bibliography

Carveth, D. (2016) Introduction to Kleinian Theory 5. YouTube Video. Retrieved from https://youtu.be/VxdWHU1wrBY on 12.2017.

Bion: The Function of Myths in Groups

A group is not an aggregate of individuals. It’s a body that has a mental state and creates a phantasy.

The group produces its own mythology. When the group work is focused on primary functioning, in problem solving, this causes the surfacing of anxiety. Myth has function. It acts as mediator from the mother – infant position to society.

From narcissism (living as only me) to socialism (living as part of society). Myth generates reaction and response because it connects the inner worlds of people. Myths can also be changed. Psychomythology.

Myths are used by the mother to explain “facts of life”.  It provides a illusion that answers the questions of the child and solves his/her developmental problems in understanding the self and world around him/her.

Parent-child transferences are re-played by individuals in groups. Family stories are re-told through unconscious acting out in groups.

Myths also occur in “work” & “non-work” transition.

External influences that change the group pose challenges to status quo of the group. This makes the group conscious of itself. Arrival of a new member, e.g., creates this kind of uncertainty and awareness.

This is a fright-flight response*, but with decorum. The new member is instructed then implicitly how to tow the line.

The task of making contact with the emotional life of the group is like the contact between mother and child. Breast mother family group. The chapter in this book describes an interesting case study of a group therapy, in whicha new member enters the group (Garland 2003).

 

 Note

Bion describes the situation that unfolds when the group is left without a leader. The leaderless group is displaced by one of the following: 

baD: Basic Assumption Dependency –> the need for an omnipotent omniscient leader (a kind of God).

baP: Basic Assumption Pairing –> Group members support tactically a  pairing, with a basic assumption that something good is going to come out of it (like a primal scene).

baF: Basic Assumption Fright Flight –> there is need for rational leadership. If the ability to reason fails, the group plunges into anxiety and hatred.There is regression, and a need to hold onto magical thinking. The group finds the man/woman that has marked paranoid tendencies (Carveth, 2017).

Bibliography:

Carveth, D. (2017). THE TRUMP EFFECT: Freud’s and Bion’s Group Psychologies. Youtube video: https://www.youtube.com/watch?v=SdWG8UiAtpE .

Garland, C. (2003). Group Therapy, Myth in the Service of Work. Mawson, C. (Ed.). Bion today. Routledge. p. 298-316.

Making Reparation & Mourning as the Road to Mental Healing

Reparation allows us to live out loud. When I can apologize, I have less inhibition. According to Melanie Klein, Reparation is a basis of creativity… to restore the loss. Capable of recovery.

We make reparation for our miss-doings. We are humans and we make mistakes. Sometimes it is our negligence that hurt others. Sometimes we are just too weak, too young, too old, too ill, too afraid to do the right thing at a particular time.

Mourning is involved in also other aspects of losses, which does not involve the death of another, but rather the death of one’s sense of self. An example of how this can happen is when one is being diagnosed with a debilitating illness or has become disabled in some way, or has a child/family that is diagnosed as such. Mourning is also “the reaction related to painful experiences that entail an experience of loss — such as loss of the quality of life, loss of health, loss of previous self-identity, loss of hope, or loss of the container function of the parents. (Barone 2005)”

Owning up to our mistakes/shortfall/incompetencies and taking responsibility for hurt caused is a means of making reparation.

In so doing we also mourn the losses (a broken relationship, a lost trust, a lost opportunity, a metaphorical or real death) as a result of our incapacity to do what was necessary to avoid the unfortunate situation.

Being able to face with the loss / to accept responsibility is the path towards inner-strength. We are able to move on from our human failing. We know that we have the resources in us to get on with life because we are able to overcome a mistake that caused us guilt.

Facing up to one’s role in such losses is not the same as blaming oneself. It is to acknowledge what actually happened, and how one was part of it. To blame oneself is to accuse oneself of something one doesn’t believe one has responsibility for. 

Gestalt Therapy Case Example of Making Reparations

Mr. K, a young man of 23, comes to therapy with impulsive anger issues. He has been incarcerated for assault and battery. Each time he regresses into violent behavior, he regrets it, and feels guilt. However, at the slightest provocation, he bursts into uncontrolled rage.

He has been to behavioral therapy to control his impulses. The treatment did not work and he was sorely frustrated. In jail, he was offered gestalt therapy counseling from an intern–  what looked like fighting fire with paper.

The therapist realized after 4 sessions a pattern in this client. Each session, he earnestly repeated the same story to her. Each time he did so, he revved himself into anger. It was a story of his childhood. His father had a violent nature and would beat his mother. As a child, from his early childhood, he remembers his mother in tears of fear and frustration as she served the family their meals. His older brothers were also later violent towards her and Mr. K.

The work for Mr. K turned out to be one of reparation. This was only possible because he was able to feel sadness and guilt (in the case of violent patients who do not feel this kind of remorse, it might not be possible).

Mr. K. was supported to revisit this childhood scene, and as he was retelling the story, the therapist asked him to hold back his anger and breathe by saying comforting words. She asked him what he experienced watching his mother’s sadness. He said he felt hopeless. He said he was too small and afraid to save her.

The therapist supported the client with helping him formulate these statements: “mother, I am 6 years old, and I am too small and too weak to save you.” and to himself “K, I am sorry, I am 6 years old and I am too small and too afraid to save your mother.”

Both K and the therapist were very touched by the phenomenon in the therapy room. This is the taking of responsibility. It is not self blame, but the recognition that one was simply not humanly able to save the mother.

The next steps came naturally. The therapist guided the client in a mourning process. The loss of a mother that could protect the son. Weeks of therapy was devoted to this process. It included creating art, writing poems.

Incapacity to make reparations and mental pain

There are individuals who have difficulty or have not capacity to accept responsibility. This is a mental state for some people and is part of their personality. In psychoanalytic term, it is a condition of being stuck in the paranoid-schizoid position and not being able to move forward to the more ambivalent depressive (nothing to do with depression) position.

When one is stuck in the paranoid-schizoid position, one suffers deep depression and paranoid anxiety. One’s state of mind is that on seeing the world in black and white and nothing in between. Everything is either very good or very bad. This was Mr. K’s life before his sessions with the therapist. He was had paranoid rage, and was very depressed.

Being so paranoid also leads one to have a need for omnipotence, which one displays through grandiosity or threatening (manic) behavior.

Taking responsibility for one’s own deeds is a lessening of omnipotence. Discovery of the resilience of the good object. Less fear of destroying it.


Manic reparation in the Paranoid-Schzoid position.

Say for example a man who strikes his wife then brings her flowers. Avoidance of acknowledging damage done, his aims to repair the hurt is in such a way that his own feelings of guilt and loss is never experienced. Not acknowledged. His wife is felt as inferior, dependent and contemptible. She is confused by his behavior. He then considers her ungrateful. He blames her for his anger towards her.

In this case his unconscious guilt is not reprieved. The good object, the wife, is “magically repaired”. Instant repair. It is like the instant cure of swallowing pills instead of going through therapy. Of going to sleep so that you do not see.

Emotional tantrum is used also as a quick way of handling problem

How do, for example, some people reveal their contempt? By raising emotionality. This is also see among people who do good deeds, like some social workers and activists?

Freud on Mourning and Melancholia

Freud (1922), in Mourning and Melancholia, writes about the ability to mourn as a means of overcoming loss. The inability to mourn or the absence of the mourning process leads to melancholia, which we understand today as major depression.

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Genuine Reparation and Creativity

Genuine reparation is slow, there is no quick fix. It takes consideration of the other person. It takes mourning the damage. It takes getting to experience the guilt, the fear of damaging the good object, the relationship. It also takes creativity.

Renunciation of magic and omnipotence. Allows the object to be free. To accept the separateness of the object. This is how we overcome guilt.

Un-recognized guilt, leads to aggression turned towards the self, which is a condition we know as major depression.

Hence the recognition of a loss and the process going through the mourning process, is essential to recovery and prevention of major depression. Much of the therapeutic process involves in one way or another accompanied mourning of loss.

Bibliography

Barone, K. C. (2005). On the processes of working through loss caused by severe illnesses in childhood: a psychoanalytic approach. Psychoanalytic Psychotherapy19(1), 17-34.

Klein, M. (2002). Love, guilt and reparation: and other works 1921-1945 (Vol. 1). Simon and Schuster.

Freud, S. (1922). Mourning and melancholia. The Journal of Nervous and Mental Disease56(5), 543-545.

The Function of Religion in Mental Health Today

Religion is in the modern “westernized” world today a topic of contention, that sparked off ever since the era of the Radical Enlightenment that began in the 18th Century in Europe. The situation is somewhat reversed in Asia because the religion of Asia was not Christianity till after this era. Since the theme of this website is not focussed on Religion or History, we cannot completely separate these aspects of cultural anthropology from modern life.

Religion founds the value system of the person. In Psychotherapy, we view the person’s wholeness. This includes the patient’s cultural background and religion. Religion is an important factor of life regardless of whether the person admits it to him/herself or not.

This is the focus of this article: to connect religion in mental health, and to mention the similarities and dis-similarities between the mindset of the two institutions– Religion (Christianity, in particular) and Psychotherapy.

Religion and Metaphors

Religion is transmitted by spoken and written word. Some are also depicted through art. There is hardly any religion in this world that is not transmitted through texts. Literature and art are language of metaphors. It is because of the use of metaphors that the meanings and wisdom of the texts can transcend through time.

Metaphors are poetic. These poetry contain truths about human nature and relationships, truth about our existence, our humanness as part of nature, and wisdom (Carveth, 2017). These are valuable messages that we learn through our culture and hand down to our children.

Much of this poetry is also transmitted through art. Visual art and music. This is how we attain the feelings and the essence of the religious influence.

As part of being human, we gain much from being able to absorb the images, poetry and music and make meaning out of them.

Some of these metaphors are considered myths. Myths are the strings that connect people in a group (Read also: Bion on Groups).

This is also known in Cultural anthropology as symbolism.

When we use symbols, we are able to grasp profound meanings through the symbols. We do not just look at the symbol as an object for what it is.

For example, a dove may symbolize peace. When taken literally a dove is just a white bird.

Religion against Pathological Narcissism

Narcissism is a word that very much belongs to the world of mental health. To the psychotherapist, narcissism is the root of mental and relationship issues. Religion, in its roots, and psychotherapy share, in a way a common goal of weaning man out of narcissism. There is a differentiation between healthy narcissism and unhealthy narcissism. Healthy narcissism is a self-preserving instinct that help us excel and survive in life. In this context, unhealthy narcissism is being referred to. Unhealthy narcissism is a borderline-operated personality structure as defined by Kernberg.

Read also: Kernberg’s Model of Narcissistic Personality Disorder

The intrinsic value system most religions is one of denouncing self grandiosity, entitlement and the exploitation of others. In the beatitudes recited by Jesus, it is written in Matthew 5:1-12:

“Blessed are the poor in spirit,
    for theirs is the kingdom of heaven.
Blessed are those who mourn,
    for they will be comforted.
Blessed are the meek,
    for they will inherit the earth.
Blessed are those who hunger and thirst for righteousness,
    for they will be filled.
Blessed are the merciful,
    for they will be shown mercy.
Blessed are the pure in heart,
    for they will see God.
Blessed are the peacemakers,
    for they will be called children of God.
10 Blessed are those who are persecuted because of righteousness,
    for theirs is the kingdom of heaven.”

In the beatitudes, Jesus lists out the qualities in a person’s character, and this aligns with Kleinian thought: that healing comes with the ability to mourn, accept one’s weakness, reconciliation (accepting others’ guilt and hence one’s own). Read also: The Manic Need to Control : Kleinian Theory

Religion against Idolatory

The grandiose self-image, and all the objects associate with this image (i.e. wealth, intelligence, looks…etc.) are the worshipped idols. The person is fixated on them, and has no time for anyone else. Idolatry is a projection of value on to external objects. It is a means of being a creator of something/someone greater than oneself. Underlying is the need to feel omnipotent, avoiding the shame of being small.

Religion against Self-Omnipotence, Pride and Oppression of Others

The narcissist lives in a state of constant need for omnipotence. No man is omnipotent, because we are vulnerable to the forces of nature. Eventually we get weak and die. The narcissist cannot deal with that and works against this dreadful thought by creating mental scenarios, idealization, demolishing others, envy, ambitions etc. Victimization of other persons by devaluing, discriminating against, bullying, alienating… is a means for the narcissist to deny his or her own vulnerabilities. He/she gets a taste of overcoming these vulnerabilities by annihilating the spirit of other people who he/she perceives to have these qualities.

Religious literature and art do teach us to overcome our self pride and grandiosity, and be kind and empathic to other beings.

Religion against Envy

Also a part of gaining omnipotence is the need to grab what is seen as good in other people. Read more about envy here. Religions tell us to “be thankful”. In many religions there is a kind of celebration of thanksgiving. Psychoanalysis mention too that gratefulness is an antidote for Envy.

Religion for Guilt and Reparation

Most religions have concepts of guilt and making reparations. Read about Guilt here. As human beings we often are tempted to do deeds that interfere with the wellbeing of others, and that our conscience tell us is not right. We feel guilt. Sometimes we feel guilt if we cannot fulfill our duties because we are human. Guilt is hence felt when we have humanity and compassion in us.

In pathological narcissism, guilt feelings cannot be felt by the individual. The pathologic narcissist has a mental issue that blocks out guilt feelings and empathy. When no guilt is felt, no reparation can be made.

Reparation is practiced in many religions. We are sorry and make up for it. According to psychoanalysis, reparation is the route to empowerment of the self. When we fall, we repair. We know then that we can overcome our failure and live stronger.

Read also: Making Reparation & Mourning as the Road to Mental Healing

The narcissist who cannot feel guilt and cannot repair becomes more paranoid.

Religion is our source for ethics, aesthetics, anthropology and should ideally be a cure for narcissism.

Religion and Magical Thinking

Religions also include what many may call “magical thinking”. Belief in “facts” we cannot rationalize. These are things that we will never be able to prove exist or doesn’t exists, and things that we leave to faith, because they are ungraspable.

While the wisdom and insights to human existence correlate overall in different religions, it is the content of this magical thinking that differ in different religions. This content that differs sometimes cause conflict between groups of people of different religions.

Julien Offray de la Mettrie
(1709-1751)

When Abuse of Religion cause Suffering

In today’s world, as it was in the days of the Enlightenment, people suffered because of abuse of religion by religious institutions. The ways people suffer because of religion:

  • Being oppressed by religion.
  • Being persecuted due to religion.
  • Being shamed by religion.
  • Being judged by religion.
  • Restriction of freedom /rights by religion. etc.

When this happens, we see the narcissistic side of religious institutions. The very act of omnipotence, grandiosity, pride and envy is enacted by religious institutions, and this causes immense suffering.

Psychoanalytic theory explains this as a phenomenon of the loss of ability of religions to separate the metaphors from the objects. The taking of metaphors literally. Seeing the white bird instead of peace in a dove.

In narcissist, this inability to symbolize is well documented. There is splitting of the psyche in the paranoid-schizoid position, and the person (in this case the institution) sees things in black and white. This split person is devoid of empathy and a sense of being one with humanity. Like a narcissistic person, a narcissistic institution idolizes and is concerned about its grandiose self image. It is against everything the religion it represents is about.

Put under the microscope, no religion is free from narcissism. Not even the so-called New Age or the Atheists!

Conclusion

Psychotherapists would often say that it is highly unlikely for a narcissist, especially a malignant narcissist or psychopath would ever show up for in their practice. It is usually the victims of these narcissists that seek help because of abuse. Pathological narcissism is a cause for suffering and environmental damage. It has been mentioned, that we live in a culture so terrified of tenderness, that we are drawn to pick up narcissistic traits ourselves. This too is the root of much of our mental pain.

Freud was quoted as saying that the cure for mental illness is the cure for narcissism, and in order for that to happen, one must learn to love. Melanie Klein says the antidote to envy is gratitude.

That said, I am not subscribing to adopting an attitude of accepting powerlessness, uselessness or total abandonment one’s rights. This kind of new-age mentality reflects also black-white thinking of the paranoid-schizoid position, and describes masochism, which harms more than it serves. There is, after all a concept of healthy narcissism and healthy use of envy, which serves to preserve the organism (self) and serve the environment (others).

Rather than deciding to be for or against religion, we could figure out for ourselves what works for us as individuals in the realm of spirituality and religion. We may also choose to look around us with unbiased eyes so that we can see what serves the world that we have and what destroys. This is probably our best guide.

Bibliography

Carveth, D. (2017). F&B 2017F Religion. Retrieved from https://www.youtube.com/watch?v=oeHOKh1NCqQ

Kernberg: Working with the Antisocial and Malignant Narcissistic Personality Disorder Spectrum

Kernberg (2008) writes that for the treatment of any case in which antisocial features of the personality disorder (PD) are suspect, the following should be evaluated by the therapist. Such evaluation makes it possible to access his/her ability to rely on the patient’s ability to sustain the therapeutic relationship and also to access the safety of the sessions:

  • The presence or absence of pathological narcissism.
  • The extent to which the superego pathology dominates (i.e. which part of the spectrum of the triad).
  • The intensity of egosytonic aggression and whether it is directed against the self in the form of suicidal/self mutilating behavior, or violent behavior against others / sadistic perversion.
  • Severity of paranoid tendency.
  • Stability of the person’s reality testing (ibid. p. 130).

The prognosis for Antisocial PD is not expected to be good in psychotherapy, in particular, if the client has severe aggressive pathologic behavior, and /or if the patient has no social support which the therapist can work with. According to Kernberg, therapists should begin work with client only after gathering the facts surrounding the clients’ coming for therapy, social support, ability to proceed with therapy in safety.

The treatment of malignant narcissistic PD (MNPD) has somewhat better prognosis than APD. A precondition for treatment is also strict control of antisocial behavior, and removal from social environment that facilitates his/her current behavior—e.g. exposure to the street gang.

General Psychotherapeutic Strategies

Kernberg’s suggestions are:

  • Establishment of solid, unbreakable treatment frame.
  • Systematic interpretation of psychopathic transference.
  • Guiding the patient to communicate honestly (if at all possible) about their behavioral problems outside the session.
  • Combining the above narrative with the developed regressive behaviors experienced during the sessions.
  • Gradually making it possible to connect the pathological behaviors interpretively into cognitive and affective experiences in the transference.

Highly deceptive clients make this work almost impossible. In such cases family members or other informants may be of help. The therapist should always make it prioritize urgency of intervention:  1. Danger to self/others, 2. Threats of treatment disruption, 3. Dishonesty in communication, 4. Acting outside and inside sessions, and 5. Trivialization of the communication.

Kernberg also states that it is essential to look for affects through verbal and nonverbal communication, nonverbal behavior, and the transference. The content of what the client says is usually a weaker source of affective information than what goes in these realms (ibid. p.140).

Treating Personality Disorders with Gestalt Therapy

Considering Kernberg’s suggestion, I notice the congruence of his method to Gestalt therapy practice:

Gestalt therapy is focussed on the process of the therapeutic dialogue, i.e. non-verbal interaction / body language. Therapist also encourages the client to enact situations that cannot be talked about. Poor functioning personality disorders prevents the individual from communicating with the therapist on a contactful level. As Kernberg notes, there is a tendency for such a client to deceive / idealize and devalue/ play victim or rescuer or persecutor with the therapist. The awareness of the therapist of this phenomena is essential. He /she is most effective when he/she can contain the clients behavior without getting roped into the game.

For this reason, in gestalt work, we focus of body language / tone of voice together with what is said, and we also focus on our (the therapists) own personal reactions. What the therapist tells the client is not analysis, but a descriptive reflection of what the therapists sees hears and senses.

The client benefits from this kind of honest interaction, because he/she too are not going to be caught up in games. In the beginning, there will of course be discomfort and frustration. If the client sticks to the work, there will be progress made.

Read also

Symptom Relief in Psychotherapy

Psychotherapy is about Uncovering the Truth of the Self

Former Patients’ Conception of Psychotherapy 

Bibiliography

Kernberg, O. (2008). Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders. Yale University Press.

Mourning and Making Reparation through Art

From a development standpoint, this ability to mourn a loss develops in the infant that has moved on from the paranoid-schizoid position onto the depressive position (remembering that the word depressive here has nothing to do with depression). It is a healthy development.

The more integrated infant who can remember and retain love for the good object even while hating it, will be exposed to new feelings little known in the paranoid-schizoid position : the mourning and pining for the good object felt as lost and destroyed, and guilt, a characteristic depressive experience which arises from the sense that he has lost the good object through his own destructiveness. (p.70)

Together with the ability to mourn is also the ability for feeling loss and guilt. This means also that there is a capacity for love that overcomes hate, and there is less projection of destructiveness on to another. In a infant this ability is a milestone in ego integration. He loses his hallucinations of being omnipotent, and can accept dependency.

Mourning and symbolization through the creation of art…

The pain of mourning is experienced, leading to drive toward reparation. These, Segal adds, are the basis of creativity and sublimation (turning negative experiences into creative objects). In other words, creating art in various forms is a means of symbolic reparation of loss.  These reparative activities are done because the individual is able to feel concern and guilt towards the other and the wish “to restore, preserve and give it eternal life”. This is in the interest of the self preservation, “to put together what has been torn asunder”, to reconstruct what has been destroyed, to recreate and to create.

Quote about Vincent Van Gogh. Photo taken from Van Gogh Museum, Amsterdam on Dec 2017.

“After his hospitalization in the asylum in Saint Remy Van Gogh felt like a “broken pitcher” that could never be mended. Even so, in between bouts of mental illness, he worked on steadily and courageously to become an even better artist. Painting and drawing, moreover, gave structure to his days and ensured that he did not fall prey to the loneliness plaguing the other patients.”

Sublimation helps the individual put his destructive impulses into creative work. At this point the genesis of symbol formation can be seen. The ability to symbolize is a very important development in human ego development. It is also a means for us to communicate metaphorically, thus allowing us to create and maintain contact with another person/or with society in an empathic way. Religions, for example, are founded on symbols. The healthy individual can also differentiate the symbol he/she has created from the reality from which the symbols are derived.

The depressive position is never fully worked through. The anxieties pertaining to ambivalence and guilt, as well as situations of loss, which reawaken depressive experiences, are always with us. Good external objects in adult life always symbolize and contain aspects of the primary good object, internal and external, so that any loss in later life re-awakens the anxiety of losing the good internal object and, with this anxiety, all the anxieties experienced originally in the depressive position. If the infant has been able to establish a good internal object relatively securely in the depressive position, situations of depressive anxiety will not lead to illness, but to a fruitful working through, leading to further enrichment and creativity. (p. 80)

The Neuroscience of Symbolization

Neuroscience explains brain activity difference between non-schizophrenic and schizophrenic patients in their ability to symbolize.

Tretter, F. (2017). NEUROSCIENCE AND PSYCHOTHERAPY. Private lecture at the Sigmund Freud University, Vienna Austria.

The above diagram shows a the gamma oscillation image from the brain of a non-schizophrenic person (left) and that of a schizophrenic person (right) when they are showed the black-white image of a face. The gamma oscillation on the right shows more brain activity, which is interpreted as the individual being able to derive a picture of a human face from the black-and-white shapes. The schizophrenic brain shows little activity, implying that the individual does not recognize the image as a face.

My Thoughts on Mourning and Gestalt Therapy

Reading this chapter by Segal on the depressive position has inspired me to thing about this subject in relation to gestalt therapy. Mourning brings with it lots of sadness and underlying guilt. In the text above, this guilt is attributed to the imagined destruction of the integrated love object.
If we observe people in mourning, there is always this element of regret. There is also a need to make reparation. This is often symbolic and aesthetic in nature. The whole process of the funeral services is in a way a symbolic way of bidding farewell to the dead. This helps the living to heal psychically.

Patients that have problems with the mourning process (e.g. those who cannot move on, those who could not feel sadness, but rage instead, or those who get chronically depressed) are usually stuck in a situation where they aren’t able to fully experience the loss. This could be because of their personality structure, from which the defence is against painful experiences. There is tremendous fear to go to those dark emotions.

The work of mourning in therapy is the work of reality testing. For the client to come to terms with the loss. This reawakens deeper feelings of loss experienced in infancy. It requires reworking of loss in the internal object. This process is needed to regain the ability of the patient to come back to reality, learn to love again and build up confidence again.

In therapy, these are worked through. For this to happen, there needs to be a lot of trust in the psychotherapeutic alliance. The therapist and client would spend hours together uncovering the defences that hold back the client from mourning. The technique of therapy is client centred, with a lot of focus on the phenomenology (non-verbal experiences) in the therapy session.

From this article, I also see the link between creativity and mourning. Using art in therapy (not synonymous with art therapy) is also common practice among Gestalt therapists. Creating art is a reparative measure, and together with therapeutic contact and communication, it facilitates openness to emotions and ultimately the freeing from depression and despair. This is a reinforcement of the technique.

Read also:

In  Sagentini’s Art  of the mother, the artist uses his art to sublimate the mourning of the loss of his “good mother”.

Bibliography

Segal, H. (2012). Introduction to the work of Melanie Klein. Karnac Books.

Other Sources

Carveth, D. (2016). Introduction to Kleinian Theory 5. Retrieved from: https://www.youtube.com/watch?v=VxdWHU1wrBY&t

CPTSD: Complex Posttraumatic Stress Disorder and Child Abuse

While PTSD is a typical response to a single stressor in adulthood, Complex posttraumatic Stress Disorder ( CPTSD ) is the result of childhood experience of abuse.

Complex Posttraumatic Stress Disorder CPTSD occurs in neither ICD nor DSM, but it has been proposed for over two decades (p.190). Adult victims of CPTSD suffer lifelong effects of emotional and physical instability of varying degrees of severity, making them also vulnerable in the face of stressful life situations.

Consequences of CPTSD:

Another name proposed for this disorder is “developmental trauma disorder.” CPTSD compromises an individual’s identity, self-worth, and personality; emotional regulation and self-regulation; and ability to relate to others and engage in intimacy.

Individuals can experience ongoing despair, lack of meaning, and a crisis of spirituality.

Children are Victims of CPTSD

While PTSD is an atypical response in traumatized adults, developmental trauma may be a very common (and thus the typical) response in traumatized children. Such trauma often goes unrecognized, is misunderstood or denied, or is misdiagnosed by many who assess and treat children.

Children are, due to their immaturity and helplessness, are more prone to being traumatized than adults.  They are also easy targets for narcissistic abuse.

Types of Abuse in CPTSD

CPTSD is generally associated with a history of chronic neglect, trauma, and abuse over the course of childhood. Neglect in early childhood compromises secure attachment and tends to result in avoidant or resistant/ambivalent attachment—or, most severely, toward the disorganized/disoriented attachment style that leads to significant dissociative pathology.

This neglect sets the stage for trauma in early childhood, which further interferes with normal affective maturation and the verbalization of feelings, leading to anhedonia, alexithymia, and intolerance of affective expression. Children and adolescents are more prone to dissociate than are adults.

Experience of Betrayal

Dissociation is especially linked to betrayal trauma—the neglect that allows for, or passively tolerate, more active trauma.

In the face of continued betrayal trauma, dissociation is the child’s best life-saving strategy.

The Bystander Parent

Repeated trauma in childhood involves a perpetrator and victim, but also a parent who permits the trauma to occur; is uninvolved, oblivious, and neglectful; or else is paralyzed by fear into inaction. Patient and therapist may find themselves playing any of these roles and their opposites.

Psychotherapeutic Treatment of CPTSD

When a client comes to therapy, it is often not apparent that he/she suffers CPTSD. Adult clients visit therapy for an array of symptoms that include (but not exclusively) depressive, anxiety, obsessive-compulsive, posttraumatic, dissociative, somatoform, eating, sleep-wake, sexual, gender, impulse-control, substance and non-substance dependency disorders and personality disorders.
There is a danger that therapists who are not aware of CPTSD overlook childhood experiences and spend too much focus on the diagnosed symptom.
If the therapist were to treat the trauma of CPTSD itself, this treatment if successful can ameliorate all the symptoms. This requires that the childhood abuse experiences be recounted and worked through.

The Therapeutic Process

It is common that the patient who has CPTSD will not be able to recollect the events of abuse. If he/she did, he/she may not be able to experience the feelings associated with the time. This is because of the dissociation of the child who was in the situation. Freud explains that what the client does not remember, he acts out. It is important for the therapist to be observant to the repeated behavior of the client in the interaction with the therapist.

The trauma and neglect of CPTSD are essentially relational, and so the therapeutic relationship itself becomes the principal vehicle of change. How the therapist feels, thinks, and acts depends on what aspect of the neglect/trauma drama is being played out with the patient (p.191).

Dealing with childhood trauma is a complicated process in therapy. There may a degree of enactment in the transference and this can be confusing. What is really necessary is a sound therapeutic alliance based on trust. Within the transference relationship, the client a therapist experience the client’s enactments and attitudes towards the abusing parent, the bystander parent and the client as victim and perpetrator. For this reason, the therapist has to be alert to the phenomenology and the here-and-now of what unfolds in the therapy sessions.

Bibliography

Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2. Guilford Publications.

Differentiating Symptoms of PTSD from Trauma-Associated Narcissistic Symptoms

Individuals suffering PTSD display symptoms that look like that of those suffering from trauma symptoms associated with the narcissistic personality (TANS).

This article by Simon (2002) sheds clear light on distinguishing between the 2 types of patients. The table below is an extract from the article:

If we were to extract the gist of the difference between PTSD and TANS, we may be able to summarize that unlike in PTSD, patients with TANS main “damage” is that of the grandiose image of the self. There is more shame and humiliation underlying. This is manifested by anxiety about damage to a kind of grandiose self image. In PTSD symptoms, the anxiety is mainly about survival.

Knowledge of these differences facilitate the psychotherapeutic treatment of the patients, since both types of patients experience the relationship with the therapist differently. This also reflects the difference between event onset trauma in the case of PTSD, and developmental attachment related trauma in the case of complex trauma.

Bibliography

Simon, R. I. (2002). Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: A diagnostic challenge. Harvard Review of Psychiatry10(1), 28-36.

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.

Personality vs Personality Disorders

There are the structural features of what we understand to be healthy functional normal personality in contrast to personality disorders.

The normal personality is characterized by:

1. An integrated concept of the self and an integrated concept of significant others.

“An integrated view of one’s self assures the capacity for a realization of one’s desires, capacities, and long-range commitments. An integrated view of significant others guarantees the capacity for an appropriate evaluation of others, empathy, and an emotional investment in others that implies a capacity for mature dependency while maintaining a consistent sense of autonomy (p. 8).”

2. The capacity for affect and impulse control, and capacity for sublimation in work and values.

“Consistency, persistence, and creativity in work as well as in interpersonal relations are also largely derived from normal ego identity, as are the capacity for trust, reciprocity, and commitment to others, also codetermined in significant ways by superego functions (p.8).”

3. Being able to internalize value systems that is stable, de-personified, abstract, individualized, and not excessively dependent on unconscious infantile prohibitions.

“Such a superego structure is reflected in a sense of personal responsibility, a capacity for realistic self-criticism, integrity as well as flexibility in dealing with the ethical aspects of decisionmaking, and a commitment to standards, values, and ideals, and it contributes to such aforementioned ego functions as reciprocity, trust, and investment in depth in relationships with others (p.8).”

4. Ability to manage appropriately libidinal (all of the instinctual energies and desires that are derived from the id) aggressive impulses. Having the capacity to fully express sensual and sexual desires with tenderness to the other, while being able to be emotional connected to the other in a relationship.

“(F)reedom of sexual expression is integrated with ego identity and the ego ideal. A normal personality structure includes the capacity for sublimation of aggressive impulses in the form of self-assertion, for withstanding attacks without excessive reaction, and for reacting protectively and without turning aggression against the self. Again, ego and superego functions contribute to such an equilibrium. (p.9)”

Bibliography

Kernberg, O. (2008). Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders. Yale University 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

This study reflects what I see in practice. Good outcomes in psychotherapy happens when the client is able to engage in the sessions with support of the therapist. The route to good outcome varies with individuals and the therapeutic alliance.

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.

Jane Tangney: the Difference between Shame and Guilt

Shame and guilt are uniquely human emotions. These are emotions that does not exist in infants up to a certain age. In other words, shame and guilt are emotions learnt, and this learning coincides with the infant’s discovery of the self, when the infant becomes self conscious.

In the lecture below, June Tangney explains the results of her research in this area.

What is the difference between shame and guilt?

According to Tangney, shame comes with the awareness of (or the judgement of) the self as having done (or being) something wrong or unacceptable. Guilt is related to the judgment of the deed (ones behavior) that one has committed.

Shame is also extremely painful relative to guilt. Shame is a feeling of being defective, a sense of being small, exposed, powerless. Shame can last for short or long periods of time. When one feels shame, one tends to want to isolate themselves.

Guilt is different. It comes with remorse, and people who feel guilt are typically drawn to taking reparative action, rather than isolating themselves.

Link between Guilt and Empathy

Empathy is a state of feeling the other’s feelings, and it brings us to altruism.

@ 24:00 Guilt and empathy are connected. Tangney’s team of researchers have found correlation between propensity for the feeling of guilt and people’s ability to step into somebody’s shoes (to be empathic). Meanwhile the other more self-absorbed, pseudo-empathic responses are related to shame.

When a person talks about a shame related feeling in a situation, there is less concern for the other and more focus on the self. When the feeling is that of guilt, the concern is for the other’s feelings.

Shame, Anger and Aggression

The research also found that proneness to shame also related to proneness to anger and aggression. People who are prone to shame, also tend to manage their aggression in a more un-constructive way.

Shame in Family Conflicts

There is therefore correlation with studies of shame in family conflicts and domestic violence.

People prone to guilt are more likely to live a more “moral” life.

Shame and Guilt are not Equally “Moral” Emotions

On the condition that we do not mis-interpret shame with guilt, the findings show that guilt feelings do not cost the person psychologically (as otherwise thought). This means that so long as we do not judge ourselves, but judge the deeds instead, we are in a better situation to cope with the psychological aspect of having done something deemed as inappropriate.

Proneness to shame, on the other hand has been linked to vulnerabilities to depression, anxiety, eating disorder etc.

This also brings to attention how society treats incarcerated people.

Adapting to a more Guilt-Prone style and less Shame-Prone style

Research showed no real inter-generational link in shame and guilt proneness.

Longitudinal studies show that teenagers that are in the guilt proneness fare overall better than  their shame-prone peers.

 

Fritz Perls: Working with Dreams in Gestalt Therapy

Dreams. What are they? For those of us who know already, dreams are the windows to our unconscious. To fall asleep and dream is to let go of our outer world. In doing so, the life of our inner world takes shape. Since our innermost consciousness is in sleep, separate from our senses that communicate with the outside world, the life of dreams seems to us mysterious: on the one hand, there seems to have meaning in the dreams, and on the other hand the context is an amalgamation of experiences and emotions mixed together and makes little sense. Most of our dreams are forgotten, and if we try to remember them, we cannot be sure if the memory of the dream is even accurate.

From the 9th Century didactic poem of Titus Lucretius Carus, De Rerum Natura (IV, v. 959),

The unconscious material in dreams is useful and important for psychotherapeutic work. This is especially so when the dream is a recurring one. According to Fritz Perls (1969):

“(T)he most important dreams– the recurrent dreams. (…) If something comes up again and again, it means that a gestalt is not closed. There is a problem which has not been completed and finished and therefore can’t recede into the background.”

Another proof that dreams are the stuff of the unconscious is proof that in people who suffer from sleep disorders, the problem is the result of the mind not being able to let go of the external world. This is a world of the senses and of spiralling thoughts.

Dreamwork in Gestalt Therapy

Sigmund Freud, in one of his most-read books, The Interpretation of Dreams, gives us an idea of how dreams are interpreted in psychoanalysis (Freud & Strachey, 1964) .

In this article, I focus on the dream work in Gestalt therapy. Gestalt therapy has a tradition of non-interpretation on the part of the therapist. So how does one work with dreams without interpretation? Much of the recorded dream work of Fritz Perls is found in this book, Gestalt Therapy Verbatim. Here are case studies of work conducted by Perls in front of a group. On reading this book alone, some colleagues find Perls’ style brash, and some even find it bullying. Before judging, we must ask ourselves if Perls’s work served the volunteer. Mostly it has. The members found greater self-awareness; many have experienced a closed gestalt or an integration of their split parts. Also it is useful to note that Perls’ clients are mostly students of therapy themselves and not “patients” in the true sense of the word.

Below is a video of Perls’ dream work. There is a lot of emotionality that arises from the client herself. Perls as a therapist merely supported her. He does not interpret (or at least that is the intention). What the meaning of the dream really was about is actually not verbalized. The patient derived her own sense of what it meant. She has also experienced the meaning and not only thought about it intellectually.

This non-interpretation is a different attitude from psychoanalysis.  In Gestalt Therapy, the client is asked to play component parts of the dream. They may even play the dream itself. For example, the client says “I am my dream, and I am vague, and I am not there for you to remember me…” or “I am my dream, but I am incomplete.”

In the example below, the lady plays the water, “I am the water…”

This is called projection. It helps the client to feel the part of him/herself that he/she has disowned and has projected onto objects of the dream. Disowned parts of the self are in the unconscious, and integration is the work of therapy.

“The dream is an excellent opportunity to find the holes in the personality. They come out as voids, as blank spaces, and when you get into the vicinity of these holes, you get confused or nervous. There is a dreadful experience, the expectation, “If I approach this, there will be catastrophe. I will be nothing.” I have already talked a bit about the philosophy of nothingness.” Perls, in Gestalt Therapy Verbatim (p. 90). 

“Every dream or every story contains all the material we need. The difficulty is to understand the idea of fragmentation. All the different parts are distributed all over the place. A person, for instance who has lost his eyes — who has a hole instead of exes will always find the exes in the environment. He will always feel the world is looking at him.”

Gestalt Therapy Dreamwork

This dreamwork is an excerpt from my article in EUJPC. The full article is found here.

Read also: Dreams and Dream Work in Psychotherapy 

References

Freud, S., & Strachey, J. E. (1964). The standard edition of the complete psychological works of Sigmund Freud.

Perls, F. S. (1969). Gestalt therapy verbatim.

Otto Kernberg: Transference Analysis in Psychotherapy

This is a summary of Otto Kernberg’s lecture on Transference Analysis.  Transference is an important term in psychodynamic therapies, and even dialogic therapies like Gestalt therapy.

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Transference is defined by Kernberg as: the unconscious repetition in the here-and-now of a dominant pathogenic conflict of the past.

In Psychopathology this pathogenic conflict plays out in the individuals’ present style of relating with others. Kernberg explains the origins of this mode of relating to be from the attachment of an individual to his mother at infancy. Early relationships, environment and the psychosocial world affect the neuro-biological make-up of the individual.

The experiences of the past, good and bad, thus get activated in the here-and-now, and affect how the individual perceives current situations and how he/she reacts to this situations. How he/she perceives his/her role is also affected by these early experiences.

Negative affects that do not reflect current reality is seen as pathological. These get reinforced through misunderstandings and reaction to and of the environment. These fixated negative reactions become the character and reflect the personality of the individual.

11:00 Kernberg explains that a combination of past experiences (and these are distorted and play out together in the present, not just one event at a time. Although we all transfer our experience of the past to our present, it becomes noteworthy as a personality disorder when this experience was overwhelming to the person, and becomes distorted.

What is done in psychodynamic treatment?

To resolve the pathological conflicts of the past as they get activated in the present.

14:25 By setting up a “normal” situation in the treatment situation. To sit with the patient face to face, and allowing him/her to say whatever comes to mind without feeling in danger of being judged, and to listen attentively to the patient.

Invite the patient to speak openly, support the patient to feel safe in this interaction.

Therapist exhibits technical neutrality. This interaction activates a transference relationship. The therapist can then help the patient interpret this transference reaction to past experience. This is called transference analysis. The adult mind of the patient can then be supported in integrating his/her past experiences with the present situation, leading to normalization of affect in the present.

Significance to psychotherapy…

Paying attention to transference situation, or what we can understand as the relational events that occur between therapist and client in the therapeutic setting in the here-and-now is very important to working with clients because it works directly with the personality of the patient. This is usually the armor that stands in the way of the psychotherapeutic work.  Kernberg’s lecture featured  here is detailed, and he explains how relationship experiences of an individual in infancy has a role in the wiring of the brain. He also explains how with psychotherapy that works with transference, his/her affect incongruence can be “mentalized”, and integrated within the patient.

Borderline Personality Disorder Case Illustration

46:00 Kernberg cites a case study of a patient with borderline personality disorder.

22 years old female, suicidal attempts, overdose of medications and street drugs, frequent hospitalization. 3 previous therapies, unsuccessful. sexual promiscuity,  antisocial and manipulative behavior, violent affect storms, attacking people emotionally.

Treatment started haltingly due to multiple suicidal attempts. Kernberg describes how he experienced her behavior towards him, which were violent and un-compromising. Kernberg explains how he reacted to her firmly, and in my opinion, authentically. He specified what he could tolerate and what he did not.  He however kept focussed on the transference without trying to fix or analyze or advice.

The behavior towards the therapist in this case is what Kernberg describes as the transference. It is how the patient has learnt to behave towards others in a relationship.

What we can take from this, is that patients who have had severe trauma as children do play out their pathological relationships with the therapist. It is up to the therapist to be aware of this patterns of relation of the patient. Sticking to the focus of the transference, and reacting authentically (if you are angry, say so, if you do not accept the abuse, say so, and set limits while being firm and sympathetic).

Kernberg also says that therapist have to look at the treatment in the long term, and although we may be impatient to see change in the patient, we have to be patient.

Important points to protect the frame of treatment

  • safety of the therapist.
  • * use common sense.
  • * be patient in the long run.  session takes months and years.
  • * analysis of what is going on is essential.
  • * tolerance of transference analysis is variable.

Significance of transference in Gestalt Therapy

Gestalt therapists do not use the term transference. This is because of the traditional link this word has to traditional psychoanalysis that Kernberg speaks about.  But the concept of using the interaction of the here-and-now is very much Gestalt therapy. Dialogical Gestalt therapist work with what we call the intersubjective or the in-between. This in-between is the transference. Gestalt Therapist who adopt the strict theory of the method, work with the following processes that is also present in transference analysis:

  • * working in here-and-now, 
  • * attention to the dialogue between therapist and client.
  • * non-judgmental (we call this phenomenological) listening to the client, allowing the client to his freedom of speech.
  • * active listening to the client.
  • * reflecting back to the client how his/her behavior or way of interaction affects the therapist.
  • * supporting the client to understand his current way of relating to his/her past (often pathologic) experiences.
  • * allowing the patient to integrate this phenomena of his/her past into the present.

The dawn of Gestalt therapy was initiated by psychoanalysts like Wilhelm Reich’s “Character Analysis and Sándor Ferenczi. The writings of these men, have already addressed the issue of working with transference as a means of working through character.

References

Kernberg, O. (2016). 29 Otto Kernberg. Youtube.com. Accessed on 05/2017. https://youtu.be/-H9qZBIfjHM

Further Reading:

Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (2007). Psychotherapy for borderline personality: Focusing on object relations. American Psychiatric Pub.

Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., … & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British Journal of Psychiatry, 196(5), 389-395.

Yeomans, F. E., Levy, K. N., & Caligor, E. (2013). Transference-focused psychotherapy. Psychotherapy, 50(3), 449.

Key Ideas in Daoist Philosophy that Coincides with Gestalt Therapy

The Dao De Jing (or Tao Te Ching 道德经) is a foundational text of Chinese philosophy and Taoism. 

The Dao De Jing, an essential text in both traditional Chinese culture and world philosophy, is believed to have originated around the fourth century BCE. It is ascribed to an anonymized thinker named Laozi, who was contemporary with Confucius (551–479 BCE). The text, written in aphoristic verse, is divided into two parts: one on Dao (道) and one on De (德), and it consists of approximately five thousand characters in its standard version. The Dao De Jing is still actively used in Daoist practice and is an inspirational guide worldwide (Kohn, 2019).

The Integration of Gestalt Therapy Principles with Daoist Philosophy

Gestalt therapy, a psychotherapeutic approach developed by Frederick “Fritz” Perls, focuses on the client’s present experience and their understanding of reality. It emphasizes awareness, freedom, and self-direction, aiming to enhance the individual’s sense of here-and-now (Yontef, 2011).

Common Philosophical Grounds

The Ever-Changing, ‘Acosmotic’ Cosmos

Daoists reject the traditional Greek concept of a single-ordered universe (cosmos) and instead see the world as an endlessly flowing series of interconnected events (“ten thousand things”). There is no ultimate, unchanging reality.

Ames & Hall (2003, p 29)

Time is not an empty framework but is created by the ongoing transformation of events. Things cannot be understood without their constant change over time. In Gestalt therapy, we are conscious of the temporality of the field in field theory

Events as Shapeshifting Processes

Daoists see “things” as porous, interconnected, and ever-changing events. These events gain their definition and function through their relationships with other events. Gestalt therapy theory of holism views the whole as more than the sum of its parts.

The Novelty Within Continuity

The world is ever-changing, yet there is a rhythm to life. In this context, persistence and the spontaneous emergence of genuine novelty exist side by side. This idea is synonymous with Gestalt therapy, which focuses on the here-and-now from which new figures of interesting phenomena emerge from the background.

Creativity as Co-creation

Daoists understand creativity as less about making things from nothing and more about the spontaneous emergence of novelty within the flux of interconnected events. This creativity is always multidimensional and transactional–it’s about the ‘self’ within the whole. In Gestalt therapy, we give space to the field the client and therapist bring into the therapeutic session as a co-created space, ready for the emergence of new experiences, which I would call enlightenment (to shed light on the experiencing). Creativity is self-creativity and co-creativity.

Perspectivism and Holographic Existence:

Mutuality does not negate individuality. Daoists reject a single, objective viewpoint. Each particular perspective, while unique, also contains and reflects the entirety of existence within it. Gestalt therapy reflects on the philosophy of phenomenology, an attitude of being in the world, attuning to what is, and being conscious of prejudice and bias. 

Creativity as Growth

Daoists view concepts like “sincerity” and “integrity” as outcomes of a creative growth process within relationships. It’s about co-creation, the dynamic of shaping and being shaped, that builds one’s unique identity. Gestalt therapy’s early adoption of the concept of the “fertile Void” and creative indifference marks the therapeutic attitude of the Gestalt practitioner.

Impact Through Personal Excellence

For Daoists, cultivating strong personal character (de) is the most potent way of positively shaping the world. A focused, well-developed person can become a force for positive change in their increasing spheres of influence (family, community, state, world). Gestalt therapy is especially focused on integration, which is, at the core, the true essence of integrity, which is the “de” of Daodejing. The forebearers of Gestalt therapy originated from a people who sought to achieve integration and suffered, instead, alienation.

Husbanding and Character

Daoists value “husbanding” – a balance of cultivation and conservation – for optimizing experience. Building strong character elevates one’s influence, creating a resource the world can draw on to solve problems. This correlates with Gestalt therapy’s focus on integration and acknowledging that we are all of the field. We face issues by connecting with the field without seeking to enforce change prematurely. This concept is presented in Gestalt’s paradoxical theory of change. The international community of Gestalt therapists also works outside the therapeutic office. Many of us are active in environmental and immigration issues.

Individuality Through Process

Uniqueness is not a starting point but a continuous achievement within the interconnectedness of existence. Freedom means expressing this achieved uniqueness for the benefit of the community. Gestalt therapy agrees with the importance of individual authenticity as part of the group. Gestalt therapy clients often address the core difficulty of belonging in teams and society and finding the freedom to be themselves. We speak of how we strive to belong by creatively adjusting to the point of losing our ability to make contact with the environment.

Transformation as Inherent Energy

The world transforms not because of an outside force but due to the constant interplay between events. Proper participation in this, what Daoists might call “the art of contextualizing” (ars contextualis), maximizes the creative possibilities in any situation. Gestalt therapy’s paradoxical theory of change explains this concept of transformation, an energetic process from within and not forced. The individual undergoing the therapeutic change experiences an organic shift in themselves at some point in their healing process.


On Polarities

The philosophical aspect of the Daodejing, particularly concerning the mutual entailing of opposites and the cyclical nature of experience, aligns closely with the principles of Gestalt therapy. This summary will explore how these concepts from Daoism resonate with Gestalt therapy, a psychotherapeutic approach that emphasizes awareness, freedom, and self-direction.

Mutual Entailing of Opposites

The Daodejing discusses the inherent duality in all aspects of life, where each state contains the seed of its opposite, and this constant interplay shapes existence. This notion is mirrored in Gestalt therapy’s focus on understanding and integrating the various polarities within the self. For example, Gestalt therapy often explores conflicting emotions or desires within a person, recognizing that acknowledging and balancing these can lead to greater self-awareness and psychological health.

Cyclical Movement of Qi

Daoism attributes the dynamic flow of life to the natural cyclical movement of qi (vital energy), emphasizing that this process does not rely on supernatural forces but on natural progression. Similarly, Gestalt therapy views human behavior and emotions as natural responses to one’s environment and experiences. It emphasizes the “here and now” and the fluid nature of our perceptions and understandings, encouraging individuals to engage actively with their current experiences without preconceived notions.

Emerging and Collapsing Cycles

The concept of life as a series of rising and falling cycles in Daoism encourages acceptance of change as a constant and inevitable element of life. This is akin to Gestalt therapy’s contact cycle. By focusing on the present, individuals are believed to better navigate their emotional and psychological landscapes, embracing change rather than resisting it.

Journey of Growth and Return

The Daodejing outlines life as a journey where initial potency gradually gives way to a ‘returning’ or weakening, where each phase of life brings about its transformation. This perspective resonates with Gestalt therapy’s theory of the five phases of neurosis (which I would acknowledge as the phases of therapeutic change).

Optimizing Possibilities

Both Daoism and Gestalt therapy stress making the most of one’s current circumstances through the full experiencing and acceptance of what is. In the Daodejing, this involves harmonizing with the cyclical nature of life to maximize potential at each moment. In Gestalt therapy, this process is facilitated by increasing awareness of one’s thoughts, feelings, and actions, and by integrating various aspects of the self to make healthier choices and respond more adaptively to life’s challenges. This is a process of creativity that arises out of the fertile void.

The philosophical teachings of the Daodejing, particularly regarding the entwining of opposites and the embracing of life’s cyclical and transformative nature, closely align with the principles of Gestalt therapy. Both advocate for a deeper understanding of life’s dynamics and suggest a holistic approach to living that embraces change, integrates opposites, and optimizes personal growth. This alignment underscores a shared philosophical foundation that values balance, awareness, and the fluidity of the human experience.

References

Ames, R., & Hall, D. (2003). Dao de jing: A philosophical translation. Ballantine Books.

Yontef, G. (2011). Gestalt Therapy.

Li Jian-ming. (2006). On the Implication of Dao in Dao De Jing.

Hendlin, S. J. (1978). T’ai chi chuan and gestalt therapy.

Henle, M. (1978). Gestalt psychology and Gestalt therapy.

Moore, L. E. (2004). GESTALT THERAPY: PAST, PRESENT, THEORY, AND RESEARCH.

Alienation: Philosophical Roots and Therapeutic Implications for the Gestalt Therapist

In today’s fast-paced and interconnected world, many of us find ourselves grappling with feelings of disconnection and fragmentation. From the pressures of work and social media to the demands of everyday life, it’s easy to lose sight of our true selves amidst the chaos of white noise. Gestalt Therapy offers frameworks and approaches that offer hope and guidance for reclaiming our sense of wholeness which is more relevant in our post-pandemic world than ever.

Alienation is a term that resonates deeply with many of us in today’s society. It’s that sense of feeling disconnected from ourselves, from others, and from the world around us.

Europe in the early 20th century, the world was undergoing profound social, political, and intellectual transformations. It was in this context that the philosophies of alienation and Gestalt psychology emerged, offering insights into the human condition and paths towards holistic understanding and healing. This essay delves into the intersection of these two paradigms, examining their philosophical underpinnings, mutual influences, and implications for Gestalt therapy.

The year 1923 marked the publication of Georg Lukács’s seminal work, “History and Class Consciousness,” a text that would deeply resonate with intellectuals of the time, including Fritz Perls. Lukács’s exploration of alienation and totality within the framework of Marxist thought laid the groundwork for understanding societal structures and individual experiences. Concurrently, Gestalt psychology, with its emphasis on holistic perception and meaningful wholes, was gaining prominence in the field of psychology. Perls, influenced by both Lukács and Gestalt psychology, would go on to develop Gestalt therapy, a groundbreaking approach to psychotherapy that integrated philosophical insights with therapeutic practice.

The Roots of Alienation: Lukács’s Dialectical Analysis and Heidegger’s Existential Analysis

At the heart of Lukács’s work lies the concept of alienation, a condition in which individuals become estranged from themselves, their labor, and their social context. Lukács’s dialectical approach to understanding reality emphasizes the interconnectedness of phenomena and the dynamic nature of totality. Drawing from Marxist theory, Lukács critiqued capitalism as a system that commodifies human relationships and reduces individuals to mere objects within a market-driven society. The concept of alienation, therefore, becomes central to the revolutionary critique of capitalism, offering insights into the fragmentation of human experience and the quest for wholeness.

Alienation is linked to concepts of fallenness and inauthenticity that are integral to Heidegger’s existential analysis, portraying how human beings often live without genuine engagement with their true selves or the realities of their existence, instead being led by societal norms and expectations– which are intensified today with the pace of technological development. These themes are essential for understanding Heidegger’s views on the potential for more authentic modes of being, which could be tied into therapeutic practices in Gestalt therapy by focusing on helping individuals recognize and overcome the influences of the ‘They’ to realize more authentic ways of being.

Gestalt Psychology: Perceiving Wholes in a Fragmented World

In parallel to Lukács’s exploration of alienation, Gestalt psychologists were investigating the nature of perception and consciousness. Rejecting the atomistic approach of structuralism, Gestalt psychologists argued that perception is inherently holistic, with individuals organizing sensory input into meaningful gestalts or wholes. The figure/background principle, central to Gestalt theory, highlights the dynamic interplay between elements and the contextual nature of perception. Gestalt psychology thus provides a framework for understanding how individuals perceive and experience the world as integrated wholes rather than fragmented parts.

Integration of Philosophies: Creative Indifference in Gestalt Therapy

By exploring the dynamic interactions between figure and ground, clients gain insight into their patterns of behaviour and the underlying causes of their distress. Through experiential therapeutic sessions, Gestalt therapy aims to facilitate the integration of fragmented aspects of the self, and the integration of the self in the environment, allowing for wholeness that reaches beyond the individual.


The potential of Gestalt therapy to reconcile the needs of individuals and society stems from its philosophical underpinnings, particularly the concept of creative indifference attributed to Salomo Friedlaender. This philosophy embraces the coexistence of polarities, allowing for a balanced approach that honors both the autonomy of the individual and the interconnectedness of society. Through creative indifference, Gestalt therapy offers a framework for navigating the tensions between personal growth and social responsibility, fostering a holistic understanding of human experience and facilitating healing on both individual and collective levels.

Therapeutic Implications: Navigating the Journey Towards Wholeness


Gestalt therapy stands out as a potent tool in resolving the tension between individual needs and societal expectations while maintaining ethical balance. At its core lies the philosophy of creative indifference, attributed to Salomo Friedlaender, which embraces the coexistence of polarities. This approach allows Gestalt therapy to navigate the complexities of human experience, addressing both the individual’s quest for autonomy and the interconnectedness of society.

In the therapeutic context, Gestalt therapy provides a safe and nurturing environment for individuals to explore their experiences of alienation and disconnection. Through guided exploration and experiential techniques, clients are encouraged to delve into their feelings of estrangement from themselves and others. By fostering heightened awareness and facilitating the integration of fragmented aspects of the self, Gestalt therapy guides clients towards a deeper sense of authenticity and wholeness.

Today, in a world increasingly characterized by social isolation and digital connectivity, the issue of alienation has taken on heightened significance. The pervasive influence of the internet and social media has paradoxically amplified feelings of isolation while fostering a culture of superficial connections. Moreover, the rapid advancement of technology raises concerns about the potential for further alienation as humans become increasingly reliant on digital interfaces for communication and interaction.

In this context, the principles of Gestalt therapy offer a timely and relevant framework for addressing the challenges of alienation in contemporary society. By providing individuals with the tools to reconnect with their authentic selves and fostering a sense of integration with society, Gestalt therapy offers a pathway towards healing and wholeness. Therapists equipped with the philosophy and techniques of Gestalt therapy are uniquely positioned to guide individuals through the process of confronting and transcending their experiences of alienation, ultimately facilitating a deeper sense of connection and belonging in the world.

References:

Bocian, B. (2015). Fritz Perls in Berlin 1893-1933: Expressionism Psychoanalysis Judaism. EHP-Verlag Andreas Kohlhage.

Chew-Helbig, N. (2022). Understanding Salomo Friedlaender’s Creative Indifference: A Psychotherapy Case-Study. Geštalt Zbornik9, 5-15.

Heidegger, M. (2010). Being and time. Suny Press.

Naranjo, C. (2004). Gestalt therapy. The Attitude and Practice of an Atheoretical Experientalism.

The Psychotherapeutic Journey Towards a Mature Psyche: Melanie Klein’s Psychoanalytic Theory

Melanie Klein emphasises the role of unconscious defence mechanisms in shaping our perceptions of the world and ourselves. This essay will delve into the core tenets of Klein’s theory, focusing on the two primary phases of psychoanalytic development: the paranoid-schizoid position and the depressive reparative position. We will explore the characteristics of each phase, the defense mechanisms employed, and how the analyst facilitates the transition towards a more mature psyche.

The Paranoid-Schizoid Position: A World in Black and White

The initial phase of psychoanalytic development according to Klein is the paranoid-schizoid position (PS). This stage, encompassing the first few months of life, is characterized by an immature ego struggling to make sense of overwhelming emotions and fragmented sensory experiences. The infant perceives the world in extremes, categorizing everything as either “good” or “bad.” The good experiences are associated with the gratifying breast, which provides sustenance and comfort. Conversely, frustrating experiences, such as hunger or discomfort, are perceived as emanating from a bad breast.

This splitting defense mechanism serves as a psychological safeguard for the infant. By dividing the world into good and bad objects, the infant can manage the intense anxiety associated with negative emotions. However, this splitting also hinders the development of a more nuanced understanding of reality. People who remain fixated in the paranoid-schizoid position may exhibit black and white thinking, struggling to see the complexities of human relationships and situations.

Another prominent defense mechanism employed during the PS position is projection. The infant projects its negative feelings, such as rage and frustration, onto external objects, often the primary caregiver. This can lead to a distorted perception of the caregiver as a malevolent force, fueling feelings of paranoia and mistrust.

The Depressive Reparative Position: Towards a More Realistic View

As the infant matures and develops more sophisticated cognitive abilities, it gradually transitions into the depressive reparative position (DR). This phase, typically emerging around the end of the first year, is marked by a shift towards a more realistic view of the world. The infant begins to recognize that the caregiver is not simply a good or bad object but a whole person capable of offering both love and frustration.

This newfound understanding brings with it a wave of depressive anxieties. The infant grapples with the fear of having damaged or destroyed the good object through its projected aggression. To alleviate this anxiety, the infant employs the defense mechanism of reparation. Through reparation, the infant attempts to undo the harm it imagines it has caused to the loved object. This might manifest in behaviors like clinging or increased attentiveness to the caregiver.

The DR position also paves the way for the development of empathy and compassion. The infant starts to recognize the caregiver’s own feelings and experiences, marking a significant step towards emotional maturity.

The Role of the Analyst in Facilitating Development

The psychoanalyst plays a crucial role in supporting the patient’s journey through these developmental phases. By providing a safe and non-judgmental space, the analyst allows the patient to explore their unconscious fantasies and anxieties. Through techniques like free association and dream analysis, the analyst helps the patient unearth the roots of their emotional conflicts, often stemming from early childhood experiences.

As the patient confronts these unconscious thoughts and feelings, the analyst acts as a containing object. The analyst’s consistent and supportive presence helps the patient manage the overwhelming emotions that may arise during this process. By fostering a therapeutic alliance, the analyst creates a secure space where the patient can experiment with new ways of relating to themselves and others.

The Importance of Klein’s Theory

Klein’s theory of psychoanalytic development offers valuable insights into the complexities of human behavior. Her emphasis on unconscious defense mechanisms provides a framework for understanding how our early experiences shape our perceptions and emotional responses. By recognizing the influence of the paranoid-schizoid and depressive reparative positions, we can gain a deeper appreciation for the challenges and triumphs encountered on the path towards emotional maturity, which is the process of long term psychotherapy.

Limitations and Further Considerations

While Klein’s theory has been influential in the field of psychoanalysis, it is important to acknowledge its limitations. Gestalt therapy expands on the concept of development and maturity as a therapeutic path by considering the environment and how the infant creatively adjusts to that environment. Gestalt therapy also provides where analysis leaves behind, which is the facilitation of the therapeutic process, by which the practitioner brings the client beyond analysis towards experiencing the state of being in the paranoid-schizoid and depressive reparative positions during the therapy hour.

Despite these limitations, Klein’s work remains a valuable contribution to our understanding of early development and the unconscious mind, providing the foundation for psychotherapy. Her theory continues to inspire contemporary psychoanalytic thought and practice, and is also a wonderful resources for the gestalt therapist.

Reference:

Wilhelm Reich’s Influence on Gestalt Therapy

Wilhelm Reich was a prominent figure in the early development of psychoanalytic techniques, particularly noted for his integration of body movements and psychological experiences, as well as his focus on sexual liberation and character analysis. Reich’s work was characterized by its active and engaging approach during analysis sessions, which contrasted with the more traditional, passive “abstinent” psychoanalytic methods. He was deeply interested in the link between physical posture and psychological states, a pioneering approach that heavily influenced Fritz Perls.

Reich’s methods, which included his “character analysis” and later the development of vegetotherapy, emphasized the bodily expressions of psychological resistances—a concept that deeply resonated with Perls. During his training analysis with Reich, Perls experienced a dynamic and contact-prone style of psychoanalysis that highlighted the importance of real-life experiences and emotional honesty in therapeutic settings.

“A human being has a right to be right, to have an opinion, without being criticized for it or having to struggle for recognition.”

— Spurgeon-English, recalling Reich’s approach.

Reich’s Influences from Body Movement Studies

Reich was not the first to consider the connection between body and psychological states, but he was among the most influential in the psychoanalytic community. His thoughts were preceded and inspired by the work of others like Otto Fenichel and Sandor Ferenczi, who had also explored how physical expressions and resistances could mirror psychological ones. Ferenczi, for example, experimented with techniques that encouraged emotional expression through body movements, which influenced Reich’s therapeutic approach.

Differences Between Perls and Reich

While Fritz Perls drew heavily on Reich’s theories and methods, particularly in terms of focusing on the here-and-now and the bodily expressions of psychological states, he diverged in his conceptualization of the therapeutic process. Perls developed Gestalt therapy, which emphasized awareness, the holistic aspect of the self, and the environment interacting as parts of a greater whole. This approach shifted somewhat from Reich’s more singular focus on sexual and character dynamics.

Key Importance for Perls: For Fritz Perls, the key lay in awareness and the present moment, which were essential in helping clients to understand and resolve their issues. His therapy style focused less on the analyst’s interpretation and more on the client’s current experiences and perceptions.

Wilhelm Reich’s pioneering work on the integration of body and psychological processes heavily influenced Fritz Perls and the development of Gestalt therapy. Although inspired by Reich, Perls adapted and evolved these concepts to form a new therapeutic approach that emphasized holistic integration and present awareness, marking a significant evolution in psychotherapeutic practices.

Early Conceptualisation of Gestalt Therapy’s Understanding of Introjection

Gestalt therapy, a distinctive form of psychotherapy, developed by Lore and Fritz Perls, offers a nuanced approach to understanding and facilitating human growth and development. This method emerged from the Perls’ personal and professional experiences, as well as the influence of their peers and the cultural environment surrounding them.

In the early stages of their exploration, Lore Perls focused on what might seem mundane—infant feeding and weaning practices. However, her observations provided profound insights into human behavior and psychology. She noted that the manner in which food is introduced to infants—often hurried and without allowing the child to “chew”—parallels how people are introduced to new knowledge and experiences. Lore Perls identified this rushed process as “introjection,” where individuals absorb information without fully processing it, a concept that would become central to Gestalt therapy.

Expanding on this idea, Lore argued that true understanding and learning require time and patience, akin to the physical act of chewing. This metaphor highlighted the importance of fully engaging with and processing new information, rather than passively accepting it. In her 1939 lecture “Child Raising and Peace,” she further discussed the role of aggression in creative change, warning against the suppression of aggressive impulses as it could lead to intellectual inhibition and a lack of critical thinking.

Her insights were complemented by Fritz Perls’ contributions. At the 1936 International Psychoanalytic Congress, Fritz presented a lecture on “Oral Resistances,” where he explored children’s natural resistance to forced feeding. He argued that such resistance is not limited to eating but can extend to intellectual matters as well. Fritz observed that most people conform to the intellectual “diet” they are allowed, while only a few question and choose what truly resonates with them.

These ideas were further elaborated in Fritz Perls’ book “Ego, Hunger and Aggression,” co-written with Lore during their exile in South Africa. The book critiqued traditional psychoanalytic techniques, emphasizing the need for a self-directed assimilation of experiences—a stark contrast to the often authoritarian approach observed in conventional psychoanalysis. Fritz criticized these methods for projecting predetermined notions onto patients, which he termed “intropress,” borrowing from the concepts discussed by Sándor Ferenczi, another influential psychoanalyst who advocated for considering psychoanalytic interpretations as mere suggestions.

Gestalt therapy, thus, encourages individuals to actively engage with their experiences and emotions in the present moment. It promotes awareness and personal responsibility, enabling individuals to navigate their own psychological landscapes independently. This approach stands in contrast to the intellectual passivity and reliance on authority that the Perls critiqued, particularly within the rigid educational and political systems of their time.

By integrating these psychological insights with broader socio-political observations, the Perls developed Gestalt therapy not just as a therapeutic method, but as a form of intellectual and emotional liberation, advocating for a more mindful, autonomous, and critically engaged way of living and learning.

References

Bocian, B. (2015). Fritz Perls in Berlin 1893-1933: Expressionism Psychoanalysis Judaism. EHP-Verlag Andreas Kohlhage.

Perls, L. (1997). Der Weg zur Gestalttherapie. Lore Perls im Gespräch mit Daniel Rosenblatt. Wuppertal

Psychological test: Psychosis Symptom Check-list

Psychosis is a symptom, not a disease or illness. It happens more commonly than one would think. Most of us experience some kind of psychosis in our lives without us being aware of it. When it happens to others around us, and if we were acutely aware of the interaction, we may sense a kind of disconnect or a tension in the relationship.  Psychosis becomes a problem if it affects the ability of the otherwise physically healthy individual to live autonomously. Usually family members and care givers bear the brunt of having to support loved ones who have psychotic symptoms that get in the way of the psychotic individual’s daily function.  Sufferers who aren’t fortunate enough to get support, often end up impoverished.

 

This is an informal test for educational purpose. It is a means to consider if the symptom observed in yourself or someone you are close to resembles psychosis or pre-psychosis. Use it if you want to evaluate if you need to consult a mental health professional.

Important disclaimer: This test does not have scientific or empirical value, and should not be used to formally diagnose anybody!

Gestalt Therapy: A Tapestry Woven from Psychoanalysis, Gestalt Psychology, and Field Theory

This passage explores the intellectual milieu of Frankfurt in the 1920s, highlighting the cross-pollination of ideas that significantly influenced the development of Gestalt therapy by Fritz Perls. Bocian’s book “Fritz Perls in Berlin” is a great resource for those who wish to fully grasp the theoretical foundations of Gestal therapy.

A Fertile Ground for Interdisciplinary Exchange

The Frankfurt Institute for Social Research (IfS) served as a central hub for intellectual exchange. Here, renowned figures like Gestalt psychologists Ademar Gelb and Kurt Goldstein, social philosopher Paul Tillich, and Marxist sociologists all interacted and debated. Both Lore Posner (later Perls) and Fritz Perls were deeply impacted by these thinkers, particularly Goldstein and his emphasis on the organism as a self-regulating whole.

Psychoanalysis and the South West German Working Group

In 1926, the South West German Working Group for Psychoanalysis was established. Key members like Karl Landauer and Erich Fromm fostered a space for critical engagement with psychoanalysis. Lore Perls underwent training analysis with Clara Happel, a member of the group, and later with Landauer, who Perls greatly respected. The Frankfurt Psychoanalytic Institute (FPI), founded in 1929, further solidified Frankfurt’s position as a center for psychoanalytic thought. Perls and Lore Posner attended lectures by prominent psychoanalysts like Anna Freud and Siegfried Bernfeld at the FPI.

Bridging the Gap Between Psychoanalysis and Gestalt Psychology

While both psychoanalysis and Gestalt psychology explored the human mind, they did so from distinct perspectives. Psychoanalysis focused on the unconscious mind and the role of past experiences, whereas Gestalt psychology emphasized present experience and the formation of meaningful wholes. However, there were attempts to bridge this gap.

  • Siegfried Bernfeld’s work in 1934 explored the relationship between these two schools of thought, highlighting the potential for Gestalt psychology’s holistic view of perception to inform psychoanalytic theory.
  • Psychoanalysts like Alfred Adler and Imre Hermann (Ferenczi’s student) saw connections between their work and Gestalt psychology. Adler’s individual psychology, whichwas already establishe, like Gestalt therapy, viewed humans as integrated wholes within social contexts.

  • Wilhelm Reich and Fritz Perls, who had both studied under Paul Schilder (who reviewed Kurt Koffka), believed Gestalt psychology could contribute to refining psychoanalytic concepts. Perls went on to be in analysis with Reich after having been with Karen Horney.
  • Georg Gero, who also was in analysis with Reich, reviewed and studied the work of Kurt Lewin (theory of the field) and Kurt Lewin’s colleague, Bluma Zeigarnik (unfinished business).
  • Thomas French introduced the concept of “insight” into psychoanalysis, which he had taken over from Wolfgang Köhler, attempting to create a synthesis of psychoanalysis and Lewin’s field theory.
  • Siegmund Fuchs (S.H. Foulkes) who worked with Perls as assistant to Goldstein employed Gestalt and Field theory to groups.
  • George Deveraux drew on gestalt psychology to explain how confrontation stimulate rudimentaty gestalts, while interpretation uncover repressed elements.
  • Wolfgang Hochheimer studied under Goldstein and Gelb published “on the analysis of the therapeutic field, investigating the application of analytical field theory. He acknowledged how the therapist and client’s respective “life fields” overlap has therapeutic significance.

Shared Interests and the Rise of Gestalt Therapy

Fritz Perls, influenced by his exposure to both psychoanalysis and Gestalt psychology, sought to create a synthesis. He was likely further drawn to this path due to his background in Mynona’s polarity philosophy, which emphasized the interplay of opposing forces.

  • Later developments such as the work of René Spitz (a friend of Kurt Lewin who explored Zeigarnik’s unfinished business and their connection to dreams) and the contextualist psychoanalysts further demonstrate the ongoing dialogue between Gestalt therapy and psychoanalysis. Spit developed a concept called “action cycles” that are similar to Gestalt Therapy’s “contact cycle”.
  • This group of psychoanalysts sought to integrate Gestalt psychology and field theory into their practice, focussing attention to the world beyond the client’s inner psyche, the environment (the field) that reciprocates its influences.

Conclusion

Even before Gestalt psychology became a formalized school of thought, Freud, particularly in his Interpretation of Dreams, began to employ concepts that resonated with a Gestalt understanding of the mind. Perls and other Gestalt therapists would later draw on these elements as evidence of psychoanalysis’ latent acknowledgment of the role of wholes and patterns in mental life.

The intellectual ferment of Frankfurt in the 1920s provided a fertile ground for the birth of Gestalt therapy. Perls, drawing inspiration from psychoanalysis, Gestalt psychology, and other influences, wove these diverse threads into a unique therapeutic approach that emphasized present experience, self-awareness, and the organism’s capacity for self-regulation and growth.

Erving Polster (1922-2024): Gestalt Therapy

I’m posting this marking the passing of Erving Polster at 102 last week.

According to the video, Erving Polster, then at 98-years of age, talks about his life and work in Gestalt therapy. The interview is conducted by Talia, who has known Erving for 40 years.

Erving talks about his early experience with Gestalt therapy when he attended a workshop led by Fritz Perls, the founder of Gestalt therapy. He was impressed by Perls’ charisma and the simplicity and power of Gestalt therapy. Erving had previously been interested in making psychotherapy more accessible to the public, and he thought Gestalt therapy could be a way to achieve this.

Erving describes his work in the 1960s, where he tried to bring Gestalt therapy into everyday life by running therapy sessions in coffee houses. People would come and discuss themes of life, such as hippies and policemen, and act out conversations related to these themes. Erving found this to be a more communal and engaging way to do therapy.

Erving also talks about the importance of enchantment in therapy. He believes that people are often drawn to therapy because of a sense of enchantment with the mystery of life and the possibility of new experiences. However, this enchantment is often overlooked in traditional therapy approaches.

Erving reflects on his life and says that he is proud of having found a way to work that is hospitable to his skills. He talks about his ability to tune into what is going on with another person and his interest in the world around him. Even though he is old, Erving says that he still feels attended to and interested in life.

Here are some points that Erving made:

  • Gestalt Therapy and Fritz Perls: Erving became interested in Gestalt therapy after attending a workshop led by Fritz Perls, the founder of Gestalt therapy. He was impressed by Perls’ charisma and the simplicity and power of Gestalt therapy. Perls’ ideas about focusing on the present moment and the client’s experience resonated with Erving’s own beliefs about the importance of authenticity and connection in therapy.
  • Transforming therapy into a communal event: Erving believed that psychotherapy should be more than just one-on-one sessions in a therapist’s office. He envisioned therapy as a communal event that could help people explore life’s themes in a more engaging and supportive setting. In the 1960s, he experimented with running Gestalt therapy groups in coffee houses. People would come and discuss themes of life, such as hippies and policemen, and act out conversations related to these themes. Erving found this to be a more engaging way to do therapy than the traditional approach.
  • Focus on the present moment: Gestalt therapy emphasizes the importance of focusing on the present moment rather than dwelling on the past or future. Erving believed that people often get stuck in unhelpful patterns of thinking and behavior by focusing on what has already happened or what might happen in the future. By focusing on the present moment, people can become more aware of their thoughts, feelings, and sensations, and this can lead to greater self-awareness and growth.
  • Client-centered approach: Gestalt therapy is a client-centered approach to therapy, which means that the therapist follows the client’s lead and helps them explore their own thoughts, feelings, and experiences. The therapist does not provide advice or direction, but rather creates a safe and supportive space for the client to explore themselves.
  • Holistic approach: Gestalt therapy takes a holistic approach to therapy, considering the person’s mind, body, and spirit. Erving believed that it is important to address all aspects of a person’s experience in order to help them grow and change.

Here is a collection of Erving Polster’s books, a couple of which were co-written with his late wife, Miriam:

Erv Polster on YouTube Interview in 2013

Erv Polster on YouTube

Kurt Goldstein’s Influence on Fritz Perls Gestalt Therapy

Fritz Perls’ arrival in Frankfurt during 1926-1927 marked a pivotal point in his career. At Frankfurt University, a renowned center for social sciences in Germany, Gestalt psychology held significant influence. Lore Perls earned her doctorate at this institution, where prominent figures such as Max Wertheimer, Wolfgang Kohler, and Kurt Goldstein shaped the intellectual landscape.

Goldstein, director of the Neurological Institute, based his research on war-related brain injuries. Perls served briefly as an assistant within Goldstein’s research group. Renowned for his holistic and organismic approach, Goldstein conceptualized neuronal function as an integrated network. He was among the physicians advocating for a multidisciplinary psychosomatic perspective on human suffering, urging the medical profession to view individuals as integrated wholes. Goldstein criticized both somatic medicine and psychoanalysis for their failure to incorporate the organism’s environment and their reliance on abstractions of reality rather than the integrated mind-body experience.

Perls embraced Goldstein’s organismic theory, which resonated with his professional background and his adoption of contextual, relational thinking influenced by Friedlander. This foundation shaped Perls’ subsequent contributions to the development of Gestalt therapy.

Kurt Goldstein’s ideas on health and self-realization deeply impacted Perls’ personal and professional development.

  • Health as Self-Actualization: For Goldstein, health wasn’t a fixed state but rather the ability of an individual to live authentically and fulfill their potential. As Harrington (2002) explains, health hinges on “the degree to which individual human beings can realize their nature, in other words, that which is important for their lives” (p. 277).
  • Therapy for a Meaningful Life: Goldstein believed therapy shouldn’t just analyze problems; it should empower individuals. The goal, as quoted in Harrington (2002, p. 277), is “a transformation of the patient’s personality” that allows them to “make the right choice” – a choice that aligns with their true nature and makes life feel worthwhile again.
  • Navigating Challenges: A healthy organism actively shapes its environment and experiences clashes, disruptions, and crises. Goldstein emphasizes the importance of courage in facing these challenges, making decisions, and overcoming difficulties.
  • Perls’ Personal Connection: Perls throughout his life exemplified courage in the face of fear. He might have found inspiration in a quote by Kierkegaard, relayed by Goldstein: “To dare is to lose one’s footing momentarily. Not to dare is to lose oneself” (in Harrington, 2002, p. 286).

References:

Harrington, Anne. (2002). Die Suche nach Ganzheit. Die Geschichte biologisch-psychologischer Ganzheitslehren: Vom Kaiserreich bis zur New-Age-Bewegung. Hamburg

Karen Horney’s Influence on Fritz Perls & Gestalt Therapy

Karen Horney (1885-1952) was a pioneering German-American psychoanalyst who challenged traditional Freudian views and made significant contributions to our understanding of personality, neurosis, and feminine psychology. Horney was also Fritz Perls’ analyst, who made an impact on him. Fritz Perls, the founder of Gestalt therapy, was deeply influenced by various thinkers, including psychoanalysts Karen Horney and Wilhelm Reich. Karen Horney, a significant figure in the Berlin psychoanalytic scene during Perls’s formative years, left a profound imprint on his intellectual development and shaped his therapeutic approach. This article delves into Horney’s influence on Perls, examining the historical context of their interaction, the key theoretical tenets Horney espoused, and their lasting impact on Gestalt therapy.

Why Perls Chose Horney

Several factors likely drew Fritz Perls toward Karen Horney as a psychoanalytic trainer. Firstly, Horney embodied an accessible and less jargon-laden style of psychoanalysis compared to many of her contemporaries. Perls, with his rebellious spirit and disdain for intellectual abstractions, would have found her approach refreshing. Her emphasis on “human involvement without terminology” (Perls 1981, 50) would have resonated with him.

Secondly, Horney was a rare female voice in a field dominated by male theorists, particularly Freud. Her groundbreaking work on feminist psychology challenged the patriarchal biases prevalent in traditional psychoanalysis. This perspective offered Perls a counterpoint to the dominant Freudian discourse.

Thirdly, Horney’s interest in the impact of culture on the human psyche would have aligned with Perls’s later emphasis on the here-and-now and the individual’s interaction with their environment. This focus on social and cultural forces represented a shift away from the purely instinctual drives emphasized by classical Freudian theory.

The Nature of Their Relationship

The book by Bocian, Fritz Perls in Berlin, describes the relationship between Perls and Horney as positive and influential. Perls felt a “kind of love” for Horney and viewed her as one of the few trustworthy people in his life. He admired her warmth, pragmatism, and commitment to a human-centered psychoanalysis. They shared a passion for theatre. In Horney, Perls said that he found “human involvement without terminology” as opposed to most psychonalytic trainers.

Key Influences: Values and Concepts

Karen Horney’s impact on Fritz Perls can be distilled into several crucial points:

  • Growth-Oriented Therapy: Horney’s belief that analysis could not only treat illness but also foster personal growth became central to Perls’s work. She proposed that “analysis … can liberate a person … so that she is free to draw on her own resources again” (Olvedi 1992, 139). This focus on human potential and self-actualization is a key principle of Gestalt therapy.
  • Neurosis as a Coping Strategy: Horney viewed neurotic mechanisms less as inherent pathologies and more as resource-oriented attempts by the individual to navigate a challenging environment, believing they represented attempts “to find paths through a jungle full of unknown dangers” (Horney 1977, 9). This perspective contributed to Gestalt therapy’s focus on understanding how present behaviors, even maladaptive ones, serve the individual.
  • Challenging Freud on Female Psychology: Horney’s pioneering work on female psychology contested Freud’s theories of penis envy and female inferiority. She argued that envy centered on the social advantages granted to men in a patriarchal society, rather than anatomical differences. Horney’s insights into the social construction of gender likely sensitized Perls to the power imbalances that can shape individual experience.
  • Cultural Critique: Horney emphasized the role of culture in shaping individual psychology, rejecting Freud’s drive-based universalism. Her belief that “our whole civilization is a masculine civilization” (Horney 1926, 361) influenced Perls’s attention to the influence of environment and social context on human experience, a core tenet of Gestalt therapy.

Legacy: Horney’s Imprint on Gestalt Therapy

Excerpt from Bocian, 2015, which to contributes to Gestalt Theory of Creative adjustment:

Even her first publication in 1917, »The Technique of Psychoanalytic Therapy,« contains hints of her later independent development. Perls integrated Horney’s early idea that therapy entails not only the treatment of illness, but also helps people to grow. In the article mentioned, Horney writes:

Analysis … can liberate a person whose hands and feet have been bound so that she is free to draw on her own resources again, but it cannot provide her with new arms and legs. Nevertheless, experience has shown that many factors which analysis assumed to be constitutional are merely the results of impediments to growth and can be removed.

Karen Horney in Olvedi 1992, 139

For Horney, many symptoms did not appear to result from inner instinctual conflicts; instead, they were direct reactions to an unloving, hurtful environment and upbringing. Moreover, she viewed neurotic mechanisms as resource oriented as well, and not merely pathological, proceeding from the assumption that these mechanisms are the individual’s attempt »to find paths through a jungle full of unknown dangers« (Horney 1977, 9).

Karen Horney’s influence on Gestalt therapy manifests itself in several key areas:

  • The Here-and-Now Focus: Gestalt therapy prioritizes the client’s present experience, emphasizing the individual’s interaction with their current environment. This reflects Horney’s focus on the influence of current conflicts and social conditions, rather than solely focusing on past childhood experiences.
  • Emphasis on Awareness and Responsibility: Gestalt therapy encourages clients to become more aware of their thoughts, feelings, and bodily sensations in the present moment. This emphasis on awareness fosters self-responsibility and the ability to make conscious choices, aligning with Horney’s view of analysis facilitating personal growth.
  • Holism: Gestalt therapy’s holistic perspective considers the individual as a complex interplay of mind, body, emotions, and their relationship to the environment. This holistic approach echoes Horney’s recognition of the intricate ways cultural and social factors shape individual experience.

Key Facts (Bocian, 2015):

  • Psychoanalytic Training: Perls trained under Horney in Berlin (1925) (Bocian 1992a, Cavaleri 1992)
  • Theoretical and Therapeutic Influence: Perls valued Horney’s ideas and incorporated them into his approach (Perls 1977, 49).
  • Focus on Cultural Factors: Horney challenged Freud’s view on female development and emphasized cultural influences (Horney 1926, 361).
  • Concept of Growth: Perls adopted Horney’s view of therapy promoting growth, not just treating illness (Horney 1917).
  • Non-pathological Neurosis: Horney viewed neurotic mechanisms as coping strategies, not purely negative (Horney 1977, 9).
  • Humanistic Approach: Perls appreciated Horney’s focus on human connection over jargon (Perls 1981, 50).
  • Gender Equality: Horney’s influence may have contributed to Perls’ view of Lore Perls as an equal partner (Sreckovic 1999).

Note: Perls did not publicly acknowledge Horney’s work on female psychology.

Reference

Bocian, B. (2015). Fritz Perls in Berlin 1893-1933: Expressionism Psychoanalysis Judaism. EHP-Verlag Andreas Kohlhage.

Significance of Karen Horney’s Work

Here’s a breakdown of her significance, life, and influences:

  • Challenging Freud: Horney disagreed with Freud’s emphasis on biological drives, particularly the concept of penis envy. She believed that personality development was primarily shaped by social and environmental factors, not solely instinctual forces.
  • Neurosis as a Coping Mechanism: Horney viewed neurosis as the result of basic anxiety stemming from childhood experiences of neglect or lack of genuine love. To cope with this anxiety, she theorized that people develop neurotic needs (like needs for affection, power, or submission), which become problematic if overly rigid.
  • Feminine Psychology: Horney was a key figure in founding feminist psychology. She criticized the male-centric bias in traditional psychoanalysis and highlighted how cultural and societal factors shape women’s psychological experiences.
  • Emphasis on Self-Realization: Horney placed self-realization at the center of her theory. She believed that people have an innate drive for growth and self-actualization, which can be hampered by anxiety and the adoption of a false idealized self-image.

Life References

  • Early Life and Education: Born in Germany, Horney endured a difficult childhood marked by a distant father and a depressive mother. She excelled academically and became one of the first women in Germany to study medicine.
  • Psychoanalytic Training: Horney trained in psychoanalysis in Berlin, where she became a founding member of the Berlin Psychoanalytic Institute.
  • Move to the United States: In 1932, she emigrated to the United States, fleeing the rise of Nazism. She settled in New York City and became a prominent figure in the American psychoanalytic scene.
  • Founding the American Institute for Psychoanalysis: Disagreeing with some orthodox Freudian perspectives, Horney co-founded the American Institute for Psychoanalysis, which reflected her more socially-oriented theories.

Influences and Influence

  • Influences: Horney was initially influenced by Freud but later diverged from his views. She was also likely influenced by her personal experiences of gender discrimination and the social and political turmoil of her time. Alfred Adler’s ideas, with their emphasis on social factors, may have also resonated with her.
  • Those Influenced: Horney’s work has influenced numerous fields, including:
    • Neo-Freudians: Psychoanalysts like Erich Fromm and Harry Stack Sullivan were influenced by Horney’s emphasis on social and cultural factors in personality development.
    • Feminist Psychology: Horney is considered a foundational figure in feminist psychology, inspiring later writers and theorists.
    • Humanistic Psychology and Self-help: Horney’s theory of self-realization and the emphasis she placed on self-analysis resonate with approaches in humanistic psychology and the self-help movement.

Further Reading