1 00:00:00,351 --> 00:00:03,887 - Hello, and welcome to this course on 2 00:00:03,887 --> 00:00:05,644 Relational Theory. 3 00:00:05,644 --> 00:00:08,846 I'm gonna start by introducing myself, and then 4 00:00:08,846 --> 00:00:12,331 orient you to the course, kind of introduce the course. 5 00:00:12,331 --> 00:00:13,966 My name is David Levitt. 6 00:00:13,966 --> 00:00:17,086 I'm a clinical psychologist and psychoanalyst. 7 00:00:17,086 --> 00:00:19,859 I have a private practice in Amherst, Massachusetts, 8 00:00:19,859 --> 00:00:23,017 just a few towns over from Smith, 9 00:00:23,539 --> 00:00:26,781 and I teach now in the Continuing Education Program 10 00:00:26,781 --> 00:00:29,521 at Smith, have taught there in the 11 00:00:29,521 --> 00:00:31,973 masters and doctoral program before. 12 00:00:31,973 --> 00:00:33,892 I'm currently on the faculty at the 13 00:00:33,892 --> 00:00:37,251 Massachusetts Institute for Psychoanalysis, or MIP, 14 00:00:37,251 --> 00:00:42,251 in Boston, and also at Tufts Medical School. 15 00:00:42,371 --> 00:00:46,282 But I spend most of my time in my office 16 00:00:46,282 --> 00:00:50,462 working with patients where these ideas really come alive. 17 00:00:52,522 --> 00:00:56,875 So let me introduce you to what we're gonna do today. 18 00:00:57,875 --> 00:01:00,635 Relational theory, I'm gonna talk about relational theory, 19 00:01:00,635 --> 00:01:05,111 and relational theory developed both a theory of 20 00:01:05,111 --> 00:01:09,086 psychotherapy and a theory about the mind. 21 00:01:09,086 --> 00:01:11,122 So it's both a clinical theory, 22 00:01:11,122 --> 00:01:14,279 and it's a theory about human psychology. 23 00:01:15,680 --> 00:01:19,240 I'm gonna start today with the big picture, 24 00:01:19,240 --> 00:01:22,215 in kind of broad brush strokes, and then get into 25 00:01:22,215 --> 00:01:25,011 more elaboration and complexity about the theory. 26 00:01:25,011 --> 00:01:28,515 Because you can only understand relational theory 27 00:01:28,515 --> 00:01:31,933 if you understand it in the context of the other 28 00:01:31,933 --> 00:01:35,153 psychoanalytic paradigms that came before it. 29 00:01:35,646 --> 00:01:38,268 So here's the big picture, and this will be a 30 00:01:38,268 --> 00:01:41,833 sort of schematic, simplified way of looking at it 31 00:01:41,833 --> 00:01:44,715 that we're gonna get into in greater depth. 32 00:01:46,145 --> 00:01:50,012 If you think about three major paradigms, 33 00:01:50,012 --> 00:01:52,411 and even think about it spatially, 34 00:01:52,411 --> 00:01:55,930 classical paradigm, the object paradigm 35 00:01:55,930 --> 00:01:57,979 and the self paradigm. 36 00:01:58,886 --> 00:02:02,852 The classical paradigm, also you can think about it 37 00:02:02,852 --> 00:02:04,864 in terms of, it's talked about in terms of 38 00:02:04,864 --> 00:02:06,630 drive and ego psychology. 39 00:02:06,630 --> 00:02:10,774 It's the model developed originally by Freud, 40 00:02:10,774 --> 00:02:14,003 developed originally in the 1890's, 41 00:02:14,003 --> 00:02:18,112 and the foundation for that paradigm was really 42 00:02:18,112 --> 00:02:21,377 evolved from the 1890's into roughly the 1930's. 43 00:02:21,377 --> 00:02:23,624 Now it's developed over time. 44 00:02:23,624 --> 00:02:25,658 There are contemporary thinkers 45 00:02:25,658 --> 00:02:27,360 developing those ideas further. 46 00:02:27,360 --> 00:02:29,791 But I'm gonna be laying out the foundations 47 00:02:29,791 --> 00:02:31,947 of these paradigms and then talking about 48 00:02:31,947 --> 00:02:35,752 the evolution of relational theory from that. 49 00:02:35,752 --> 00:02:39,741 So we have the classical paradigm over here. 50 00:02:39,741 --> 00:02:43,204 Then the object paradigm, very broadly speaking, object, 51 00:02:43,204 --> 00:02:46,060 including, and you may be familiar with some of these 52 00:02:46,060 --> 00:02:49,019 names and theories, including the British object 53 00:02:49,019 --> 00:02:52,499 relations theorists, Klein, Fairbairn and Winnicott, 54 00:02:52,499 --> 00:02:53,798 but I'm gonna be talking about 55 00:02:53,798 --> 00:02:55,891 the object paradigm very broadly. 56 00:02:55,891 --> 00:02:58,665 So it will include those theorists, but also include 57 00:02:58,665 --> 00:03:02,717 interpersonal theory developed largely in the United States, 58 00:03:02,717 --> 00:03:06,636 which is hugely important for relational theory 59 00:03:06,636 --> 00:03:08,401 that evolved out of it. 60 00:03:08,401 --> 00:03:12,734 So the relational paradigm, which developed the foundations, 61 00:03:12,734 --> 00:03:16,093 excuse me, the object paradigm, where the foundations 62 00:03:16,093 --> 00:03:21,093 developed roughly from the 1930's into the 1960's. 63 00:03:22,077 --> 00:03:24,659 And then the third paradigm, the self paradigm, 64 00:03:24,659 --> 00:03:27,865 associated most closely with Kohut, self psychology. 65 00:03:27,865 --> 00:03:30,272 Then we're looking at the late 1960's, 66 00:03:30,272 --> 00:03:33,630 really the 1970's and into the 80's. 67 00:03:33,630 --> 00:03:37,199 So first just laying out those three paradigms 68 00:03:37,199 --> 00:03:40,432 in very broad brush strokes, and then looking at how- 69 00:03:40,432 --> 00:03:43,159 What we're gonna trace out today is how relational theory 70 00:03:43,159 --> 00:03:47,778 developed in the 1980's, largely in the United States, 71 00:03:47,778 --> 00:03:52,778 largely in New York originally, and we're gonna talk about 72 00:03:52,859 --> 00:03:55,243 its relationship to these other three paradigms, 73 00:03:55,243 --> 00:03:56,873 and that's how we'll kind of put together 74 00:03:56,873 --> 00:03:59,797 what comprises the relational paradigm. 75 00:03:59,797 --> 00:04:04,797 We'll talk about it as it developed largely in response to, 76 00:04:05,577 --> 00:04:09,074 and in critical response, to the classical paradigm, 77 00:04:09,074 --> 00:04:11,642 particularly about the stance of the therapist, 78 00:04:11,642 --> 00:04:14,607 or the style of the therapist. 79 00:04:14,607 --> 00:04:16,938 So that's one relationship. 80 00:04:16,938 --> 00:04:20,431 We'll talk about how relational theory evolved in 81 00:04:20,431 --> 00:04:25,062 an enormously important way from the object paradigm, 82 00:04:25,062 --> 00:04:27,249 particularly interpersonal theory. 83 00:04:27,249 --> 00:04:29,258 A lot of the original relational theorists 84 00:04:29,258 --> 00:04:31,409 were from the interpersonal school. 85 00:04:31,409 --> 00:04:33,074 We'll also talk about Fairbairn, 86 00:04:33,074 --> 00:04:35,093 one of the object relations theorists. 87 00:04:35,093 --> 00:04:38,034 But anyway, we'll talk about this direct line of, 88 00:04:38,034 --> 00:04:42,728 legacy of theoretical ideas, from the object paradigm 89 00:04:42,728 --> 00:04:44,599 into relational theory. 90 00:04:44,599 --> 00:04:47,435 And then also we'll talk about the self paradigm 91 00:04:47,435 --> 00:04:49,527 and ways in which relational theory, 92 00:04:49,527 --> 00:04:51,282 even though there are important differences, 93 00:04:51,282 --> 00:04:54,272 it incorporates a lot from that paradigm. 94 00:04:54,272 --> 00:04:57,672 So that's, in terms of the theoretical landscape 95 00:04:57,672 --> 00:04:59,350 of what we're gonna talk about today, 96 00:04:59,350 --> 00:05:01,600 that kind of lays out the groundwork. 97 00:05:01,600 --> 00:05:06,368 But one thing I wanna emphasize, and I will be emphasizing, 98 00:05:06,368 --> 00:05:10,527 beyond that simplified way of looking at it is 99 00:05:10,527 --> 00:05:13,765 I'm gonna be talking about particularly the relationship 100 00:05:13,765 --> 00:05:18,315 between relational theory and the classical paradigm 101 00:05:18,315 --> 00:05:21,560 because that relationship is very complex. 102 00:05:21,560 --> 00:05:25,309 Even though in one sense they can seem like polar opposites, 103 00:05:25,309 --> 00:05:28,876 or the relational rebellion or the revolution can seem like 104 00:05:28,876 --> 00:05:31,587 it was trying to overthrow, in some ways, 105 00:05:31,587 --> 00:05:35,120 the classical, the Freudian paradigm. 106 00:05:35,120 --> 00:05:39,922 When looking at it in a more sophisticated and complex way, 107 00:05:39,922 --> 00:05:42,708 those two paradigms, the classical and the relational, 108 00:05:42,708 --> 00:05:46,135 even though they have major differences and in some ways 109 00:05:46,135 --> 00:05:50,627 opposing sensibilities about many issues, 110 00:05:50,627 --> 00:05:53,315 that they actually need each other, that there's a kind of 111 00:05:53,315 --> 00:05:56,540 dialectic tension that needs to be sustained, 112 00:05:56,540 --> 00:06:01,540 and that, this is from my perspective, one can't practice 113 00:06:02,275 --> 00:06:05,455 as a relational therapist without an appreciation 114 00:06:05,455 --> 00:06:08,956 of some of the classical sensibilities and how these 115 00:06:08,956 --> 00:06:11,380 tensions are actually healthy and important 116 00:06:11,380 --> 00:06:13,645 and need to be sustained. 117 00:06:13,645 --> 00:06:15,701 So that's something I'll be developing 118 00:06:15,701 --> 00:06:17,617 in the course of the talk. 119 00:06:17,970 --> 00:06:22,110 So the first part of the course will be laying out 120 00:06:22,110 --> 00:06:26,059 that groundwork, the three paradigms, the evolution of 121 00:06:26,059 --> 00:06:30,846 the relational paradigm, and I'll then, when I talk about 122 00:06:30,846 --> 00:06:33,796 the relational perspective or paradigm itself, 123 00:06:33,796 --> 00:06:37,506 I'm gonna be tracing out six particular themes 124 00:06:37,506 --> 00:06:41,789 or dimensions, and as you'll see, I'll be talking about 125 00:06:41,789 --> 00:06:44,224 this is a relational approach to therapy. 126 00:06:44,224 --> 00:06:46,511 How to think about therapeutic options, 127 00:06:46,511 --> 00:06:51,511 therapeutic style, therapeutic action, in terms of these six 128 00:06:53,020 --> 00:06:56,506 themes or dimensions that exists as kind of continua, 129 00:06:56,506 --> 00:06:58,073 these themes or dimensions. 130 00:06:58,073 --> 00:07:01,246 And we'll talk about relational theory on one side 131 00:07:01,246 --> 00:07:05,018 of each of those dimensions and the classical view, 132 00:07:05,018 --> 00:07:06,758 or classical voice, on the other side 133 00:07:06,758 --> 00:07:10,410 of each of these dimensions, and we'll be tracing that out. 134 00:07:10,794 --> 00:07:15,794 So that's the, a large part of the first part of the course 135 00:07:15,893 --> 00:07:20,371 will be that, tracing out the theory. 136 00:07:20,371 --> 00:07:23,516 I'll be presenting some case material interwoven in that 137 00:07:23,516 --> 00:07:27,732 that we'll be using to highlight and illustrate those ideas. 138 00:07:28,471 --> 00:07:31,870 The second part will be specifically on enactment, 139 00:07:31,870 --> 00:07:34,304 enactment in the therapy relationship, 140 00:07:34,304 --> 00:07:37,353 which is such a central idea for relational theory. 141 00:07:37,353 --> 00:07:40,931 And then the third part of the day, the first two parts 142 00:07:40,931 --> 00:07:43,232 are really focused on clinical process, 143 00:07:43,232 --> 00:07:45,556 on psychotherapy or analysis. 144 00:07:45,556 --> 00:07:48,139 The third part and last part of the day, we'll be shifting 145 00:07:48,139 --> 00:07:51,078 over to talk about relational theory as a model 146 00:07:51,078 --> 00:07:53,655 of human psychology, a model of the mind. 147 00:07:53,655 --> 00:07:56,471 So it won't be focused as much on the therapeutic process 148 00:07:56,471 --> 00:08:00,771 as it will be on understanding the essence of human nature 149 00:08:00,771 --> 00:08:03,060 and the structure of the mind, as conceived of 150 00:08:03,060 --> 00:08:05,820 in relational theory very differently from, 151 00:08:05,820 --> 00:08:08,247 for instance, classical theory. 152 00:08:15,478 --> 00:08:20,336 So one kind of preface to this now, the first part, 153 00:08:20,336 --> 00:08:22,875 the theoretical part where we trace all these paradigms. 154 00:08:22,875 --> 00:08:27,600 This part of the course is heavy on theory. 155 00:08:27,600 --> 00:08:31,036 I'll be interspersing and intertwining clinical process, 156 00:08:31,036 --> 00:08:33,784 but this will be heavier on theory because we have to 157 00:08:33,784 --> 00:08:37,509 develop central ideas from these other paradigms. 158 00:08:37,509 --> 00:08:41,618 The other parts of the day, the enactment part of the day 159 00:08:41,618 --> 00:08:45,603 and the third part of the day where we talk about the mind 160 00:08:45,603 --> 00:08:48,716 will be, the balance will be more on the, 161 00:08:48,716 --> 00:08:51,208 also on the clinical process, kind of more even 162 00:08:51,208 --> 00:08:54,259 with theory and clinical vignettes. 163 00:08:54,259 --> 00:08:56,320 So this first part's a little dense on theory, 164 00:08:56,320 --> 00:08:58,861 but just to let you know. 165 00:08:58,878 --> 00:09:02,885 OK, so, here we go, and there are some handouts 166 00:09:02,885 --> 00:09:07,358 that you can follow along with that I'll be referring to, 167 00:09:07,358 --> 00:09:10,550 to just help stay oriented to what we're doing. 168 00:09:10,920 --> 00:09:15,078 And you can start by looking at, if it helps, to refer to 169 00:09:15,078 --> 00:09:20,078 the page three and four, first page three of the handouts. 170 00:09:23,423 --> 00:09:27,002 So here we go into the theory section. 171 00:09:27,002 --> 00:09:29,950 Relational theory, as it emerged in the 1980's 172 00:09:29,950 --> 00:09:32,740 as a response to the classical paradigm, as I said. 173 00:09:32,740 --> 00:09:35,710 Let's start, I'm gonna start with talking about 174 00:09:35,710 --> 00:09:39,686 the classical paradigm, and particularly the critique of it. 175 00:09:39,686 --> 00:09:44,301 If you think about the kind of satire, the satire version 176 00:09:44,301 --> 00:09:47,093 of the classical analyst or therapist, 177 00:09:47,093 --> 00:09:50,866 well-known in many New Yorker cartoons over the years, 178 00:09:50,866 --> 00:09:53,332 and this is the satire image. 179 00:09:53,332 --> 00:09:57,403 The orthodox Freudian, the blank screen, 180 00:09:57,403 --> 00:09:59,699 the dispassionate surgeon of the psyche, 181 00:09:59,699 --> 00:10:02,967 is caricatured in cartoons and films. 182 00:10:02,967 --> 00:10:06,700 He, and I mean specifically he, is a gray-haired, 183 00:10:06,700 --> 00:10:09,467 white-skinned man sitting behind the couch, 184 00:10:09,467 --> 00:10:12,727 cold and objective, withholding, silent, 185 00:10:12,727 --> 00:10:14,725 emotionally expressionless. 186 00:10:14,725 --> 00:10:16,310 As patients bare their souls 187 00:10:16,310 --> 00:10:18,391 and cry out to be understood, 188 00:10:18,391 --> 00:10:23,391 the therapist strokes his beard and replies, "Um hmm." 189 00:10:24,526 --> 00:10:27,332 Though he occasionally manages an entire sentence, 190 00:10:27,332 --> 00:10:30,016 the austere character in these images 191 00:10:30,016 --> 00:10:32,888 makes his pronouncements from afar, 192 00:10:32,888 --> 00:10:35,269 and the picture is a bit chilly. 193 00:10:35,269 --> 00:10:40,269 This iconic icicle is held up by the more vociferous critics 194 00:10:40,424 --> 00:10:42,873 as evidence that Freud is dead. 195 00:10:42,873 --> 00:10:45,011 This is, you know, the cover of Time Magazines. 196 00:10:45,011 --> 00:10:45,781 If Freud Dead? 197 00:10:45,781 --> 00:10:47,963 Newsweek, Freud is Dead. 198 00:10:47,963 --> 00:10:50,555 And that psychoanalytic ideas are an irrelevant 199 00:10:50,555 --> 00:10:53,587 anachronism in today's world. 200 00:10:53,587 --> 00:10:57,521 The funeral dirge is inspired in part, in part, 201 00:10:57,521 --> 00:11:00,315 by the unfortunate fact that the caricature is not 202 00:11:00,315 --> 00:11:05,026 entirely without basis, at least historically. 203 00:11:05,463 --> 00:11:09,538 Freud, in an attempt to establish his then radical 204 00:11:09,538 --> 00:11:12,260 new field of psychoanalysis as a science, 205 00:11:12,260 --> 00:11:15,802 he did emphasize the need for objectivity and warned 206 00:11:15,802 --> 00:11:19,697 of the dangers of the analyst becoming emotionally drawn in. 207 00:11:19,697 --> 00:11:23,606 The voice of caution, though, was greatly amplified 208 00:11:23,606 --> 00:11:27,126 in North American psychoanalysis during the 1940's 209 00:11:27,126 --> 00:11:31,441 through the 60's, resulting in sometimes stultifying, 210 00:11:31,441 --> 00:11:35,993 austere stance by all too many analysts and therapists. 211 00:11:36,436 --> 00:11:38,542 Hence the New Yorker cartoons. 212 00:11:38,963 --> 00:11:41,301 Ironically, the American version 213 00:11:41,301 --> 00:11:43,306 was more Freudian than Freud. 214 00:11:43,306 --> 00:11:46,189 It's been well documented that the founder did not keep 215 00:11:46,189 --> 00:11:48,617 as strictly kosher a consulting room 216 00:11:48,617 --> 00:11:51,655 as many of the colleagues from across the Atlantic, for 217 00:11:51,655 --> 00:11:55,833 he could be quite engaging and involved with his patients. 218 00:11:55,833 --> 00:12:00,242 Despite this emphasis on neutrality, Freud clearly knew 219 00:12:00,242 --> 00:12:02,746 that the analyst, and I'll quote here, 220 00:12:02,746 --> 00:12:07,386 "cannot pull away, cannot merely sit back, observe, 221 00:12:07,386 --> 00:12:11,847 "interpret and practice similar explanatory arts", 222 00:12:11,847 --> 00:12:14,997 unquote, for it was Freud who said this. 223 00:12:15,910 --> 00:12:20,251 In any case, relational theory developed, as I say, 224 00:12:20,251 --> 00:12:23,075 in critical response to the perception 225 00:12:23,075 --> 00:12:26,291 of a therapeutic stance that was problematic. 226 00:12:26,291 --> 00:12:31,291 And the real beginning of this was in 1983. 227 00:12:31,685 --> 00:12:35,090 There was a watershed book by Greenberg and Mitchell 228 00:12:35,090 --> 00:12:39,695 that looked at all of the psychoanalytic paradigms to date. 229 00:12:39,695 --> 00:12:41,249 It was a very scholarly work, 230 00:12:41,249 --> 00:12:43,068 and it looked across these paradigms, 231 00:12:43,068 --> 00:12:47,222 the classical, the object, the self paradigms, 232 00:12:47,222 --> 00:12:49,656 and in looking across them, they made the case that 233 00:12:49,656 --> 00:12:52,894 you can take those theories and basically break them down 234 00:12:52,894 --> 00:12:54,387 into two categories. 235 00:12:54,387 --> 00:12:57,247 Those that center around drive 236 00:12:57,247 --> 00:13:01,058 and those that center around relationality. 237 00:13:01,058 --> 00:13:04,397 And what they meant was that, if you look at these theories, 238 00:13:04,397 --> 00:13:08,095 that each one has a kind of foundation or bedrock 239 00:13:08,095 --> 00:13:10,841 in one of these two positions. 240 00:13:10,841 --> 00:13:13,866 When each theory looks at what is the essence 241 00:13:13,866 --> 00:13:16,435 of human motivation, of human psychology, 242 00:13:16,435 --> 00:13:19,222 of the human condition, that it's either centered 243 00:13:19,222 --> 00:13:21,058 on drive or relationality. 244 00:13:21,058 --> 00:13:24,472 Drive, as you probably know, back in the Freudian sense, 245 00:13:24,472 --> 00:13:27,004 sexual and aggressive drives, competitiveness, 246 00:13:27,004 --> 00:13:31,498 seeking pleasure, are drivenness from within. 247 00:13:31,498 --> 00:13:36,498 And the relational model, the notion that the essence 248 00:13:36,956 --> 00:13:39,996 of the human condition is something more about seeking 249 00:13:39,996 --> 00:13:43,101 some kind of attachment or relationality. 250 00:13:43,101 --> 00:13:45,155 And what Greenberg and Mitchell traced out when they 251 00:13:45,155 --> 00:13:48,192 looked across the paradigms was that the classical paradigm 252 00:13:48,192 --> 00:13:53,187 was very much in the drive model, essentially by definition, 253 00:13:53,187 --> 00:13:55,917 but of the object and self paradigms and all the 254 00:13:55,917 --> 00:13:58,789 different theories within them, many of those theories 255 00:13:58,789 --> 00:14:03,789 were in the relational direction, that they were 256 00:14:03,920 --> 00:14:06,210 organized around relationality. 257 00:14:06,210 --> 00:14:08,941 Not all of them, but most of them. 258 00:14:10,721 --> 00:14:13,843 And in particular, the models that we're gonna look at, 259 00:14:13,843 --> 00:14:16,709 the theories that we're gonna especially focus on today 260 00:14:16,709 --> 00:14:20,339 of those, and in particular, interpersonal theory 261 00:14:20,339 --> 00:14:23,706 and Fairbairn's object relations theory, those two 262 00:14:23,706 --> 00:14:27,827 were very much relational theories. 263 00:14:27,827 --> 00:14:30,043 And I'm using now relational with a small r. 264 00:14:30,043 --> 00:14:32,881 We're not yet at the school, the relational school. 265 00:14:32,881 --> 00:14:37,530 These are theories that focus on human relationality 266 00:14:37,530 --> 00:14:39,137 at the center. 267 00:14:41,868 --> 00:14:44,844 Now I'm gonna make, I'm just gonna make reference now 268 00:14:44,844 --> 00:14:49,844 to the development of the Relational with a capital R, 269 00:14:49,923 --> 00:14:53,147 the Relational with a capital R that develops in the 1980's 270 00:14:53,147 --> 00:14:58,147 after this groundbreaking and watershed book in 1983. 271 00:14:58,782 --> 00:15:02,323 Developed in a particular context 272 00:15:02,323 --> 00:15:05,314 and a particular cultural, intellectual, 273 00:15:05,314 --> 00:15:07,806 epistemological and philosophical context. 274 00:15:07,806 --> 00:15:11,085 I'm not gonna be discussing this today. 275 00:15:11,085 --> 00:15:12,251 It's beyond the scope of what- 276 00:15:12,251 --> 00:15:15,149 But I wanna at least name some of this. 277 00:15:15,149 --> 00:15:18,406 And this is on page four in the handout. 278 00:15:18,406 --> 00:15:21,570 Relational Theory in the 1980's, now with a capital R, 279 00:15:21,570 --> 00:15:23,157 was evolving and developing. 280 00:15:23,157 --> 00:15:26,480 This was post 1960's, post Watergate. 281 00:15:26,480 --> 00:15:29,213 There were changing views of authority, 282 00:15:29,213 --> 00:15:32,603 very different from Victorian Viennese society. 283 00:15:32,603 --> 00:15:36,041 This is post feminism with critiques of the ideal 284 00:15:36,041 --> 00:15:40,434 of autonomy and separateness, and now a new prioritizing 285 00:15:40,434 --> 00:15:43,386 of connectedness and relationality. 286 00:15:43,707 --> 00:15:46,260 It's post Heisenberg, post modern. 287 00:15:46,260 --> 00:15:48,043 There are changing views of what it means to 288 00:15:48,043 --> 00:15:51,057 quote unquote know something. 289 00:15:51,057 --> 00:15:54,725 There are shifts from the notion that we can hold 290 00:15:54,725 --> 00:15:57,462 certainty and objective knowledge about many things 291 00:15:57,462 --> 00:16:01,226 to the notion that what we think we know is much more 292 00:16:01,226 --> 00:16:04,230 subjective and socially constructed. 293 00:16:05,290 --> 00:16:09,105 And one other factor in the psych guides. 294 00:16:09,105 --> 00:16:11,441 At this time, in the 1980's and 90's, 295 00:16:11,441 --> 00:16:14,167 when these relational school was developing, 296 00:16:14,167 --> 00:16:16,970 there was a revolution in infancy research, 297 00:16:16,970 --> 00:16:20,298 and the discoveries of the remarkable abilities 298 00:16:20,298 --> 00:16:25,298 of newborn infants and very young infants was just... 299 00:16:25,544 --> 00:16:27,561 There were so many studies, one after another. 300 00:16:27,561 --> 00:16:30,357 And one of the areas of study was how much was 301 00:16:30,357 --> 00:16:34,011 developing from the get go about relationality 302 00:16:34,011 --> 00:16:35,692 and relationships. 303 00:16:35,692 --> 00:16:37,895 Even when babies can seem like 304 00:16:37,895 --> 00:16:41,026 they're not so oriented yet towards the other- 305 00:16:41,026 --> 00:16:43,134 When they're so little and so young, 306 00:16:43,134 --> 00:16:45,085 and they seem not socially connected, 307 00:16:45,085 --> 00:16:49,892 that there's more going on than what we can see and realize. 308 00:16:49,892 --> 00:16:52,605 So those are some of the cultural, intellectual 309 00:16:52,605 --> 00:16:56,684 and philosophical factors in the background. 310 00:16:57,988 --> 00:17:01,309 Well, what is Relational Therapy? 311 00:17:01,309 --> 00:17:03,092 I mean, what is it? 312 00:17:03,092 --> 00:17:05,371 By the end of the course, you'll hopefully 313 00:17:05,371 --> 00:17:08,212 have a lot you can say about that 314 00:17:08,212 --> 00:17:10,703 added to what you already know. 315 00:17:10,703 --> 00:17:13,470 I wanna start just for this moment before we launch into 316 00:17:13,470 --> 00:17:17,651 the theories section, what it isn't. 317 00:17:18,830 --> 00:17:22,099 Being a relational therapist, it doesn't mean one 318 00:17:22,099 --> 00:17:24,625 necessarily talks more. 319 00:17:24,625 --> 00:17:28,254 It doesn't mean one necessarily does an enormous amount 320 00:17:28,254 --> 00:17:29,577 of self-disclosure. 321 00:17:29,577 --> 00:17:31,510 These are some of the sort of stereotypes 322 00:17:31,510 --> 00:17:33,676 of a relational therapist. 323 00:17:34,723 --> 00:17:38,296 It doesn't mean one, it's not about being nicer, 324 00:17:38,296 --> 00:17:40,490 or being more supportive. 325 00:17:41,357 --> 00:17:42,820 That's not what it means. 326 00:17:42,820 --> 00:17:47,820 Being relational, it's not a specific set of guidelines. 327 00:17:47,908 --> 00:17:51,218 It's more a way of thinking about and understanding 328 00:17:51,218 --> 00:17:55,666 and working with what's going on within our patients, 329 00:17:55,666 --> 00:17:57,713 what's going on within ourselves, 330 00:17:57,713 --> 00:18:01,045 what's going on within the therapeutic process, 331 00:18:01,045 --> 00:18:03,262 and a way of expanding and thinking about 332 00:18:03,262 --> 00:18:06,582 therapeutic options and therapeutic action. 333 00:18:09,744 --> 00:18:13,355 OK, so now we're gonna move into talking about 334 00:18:13,355 --> 00:18:17,943 the classical paradigm, and I wanna start by- 335 00:18:18,605 --> 00:18:23,263 This is an homage to Freud, a kind of acknowledgement 336 00:18:23,263 --> 00:18:27,320 of the centrality of Freud's ideas and that they 337 00:18:27,320 --> 00:18:31,409 are enduring, even with all of the newer ideas 338 00:18:31,409 --> 00:18:33,425 evolving in addition. 339 00:18:33,425 --> 00:18:35,935 And this is a quote from Stephen Mitchell, 340 00:18:35,935 --> 00:18:39,258 who was the most central founding figure 341 00:18:39,258 --> 00:18:41,598 of the relational school. 342 00:18:43,653 --> 00:18:48,266 Here's what Mitchell said, and he said that 343 00:18:48,266 --> 00:18:52,305 psychoanalytic treatment, therapy, analysis, 344 00:18:52,305 --> 00:18:56,668 would be unrecognizable without the following. 345 00:18:56,668 --> 00:18:59,913 Without quote, "thinking about the mind 346 00:18:59,913 --> 00:19:02,356 "in terms of unconscious processes". 347 00:19:02,356 --> 00:19:03,825 And think about this list. 348 00:19:03,825 --> 00:19:06,005 It's a long list of central, 349 00:19:06,005 --> 00:19:09,290 crucial ideas going back to Freud. 350 00:19:09,290 --> 00:19:13,292 "thinking about the mind in terms of unconscious processes, 351 00:19:13,292 --> 00:19:17,177 "exploring the dialectic between present and past, 352 00:19:18,525 --> 00:19:22,575 "grounding states of mind and bodily experiences, 353 00:19:23,203 --> 00:19:25,479 "a careful, patient listening 354 00:19:25,479 --> 00:19:30,479 "to the analysand's, or patient's, associations, 355 00:19:30,704 --> 00:19:35,512 "a play in the dialectic between fantasy and reality, 356 00:19:36,776 --> 00:19:41,115 "a focus on feelings about the analyst or therapist, 357 00:19:41,115 --> 00:19:46,115 transference, and psychical obstacles to uncomfortable 358 00:19:46,955 --> 00:19:50,921 thoughts and feelings, defense or resistance. 359 00:19:50,921 --> 00:19:54,299 But these ideas remain central. 360 00:19:55,312 --> 00:19:59,111 But as I said, we're gonna be also talking about 361 00:19:59,111 --> 00:20:02,667 important tensions between the relational and the classical. 362 00:20:02,667 --> 00:20:04,205 Let's begin with the classical. 363 00:20:04,205 --> 00:20:06,701 Let's begin our story with Freud. 364 00:20:07,307 --> 00:20:10,778 First I wanna just think out loud with you 365 00:20:10,778 --> 00:20:13,126 about Freud in a particular way. 366 00:20:13,126 --> 00:20:17,444 This is from Joseph Schwartz talks about that in a book, 367 00:20:17,444 --> 00:20:19,329 Cassandra's Daughter. 368 00:20:19,329 --> 00:20:20,842 What he says about Freud is he says, 369 00:20:20,842 --> 00:20:23,845 if you think about Freud, I mean you can think about Freud 370 00:20:23,845 --> 00:20:26,755 as somebody who developed all these revolutionary ideas 371 00:20:26,755 --> 00:20:28,739 about the mind, and of course, he did. 372 00:20:28,739 --> 00:20:33,140 But he also said think about Freud as an inventor. 373 00:20:33,140 --> 00:20:38,140 That Freud invented a means of studying the mind 374 00:20:38,475 --> 00:20:42,663 in the analytic hour, or what we now have, the therapy hour. 375 00:20:42,663 --> 00:20:44,724 Explore what comes to mind. 376 00:20:44,724 --> 00:20:46,615 Follow the twists and turns. 377 00:20:46,615 --> 00:20:50,066 Look at the obstacles to things coming to mind. 378 00:20:50,066 --> 00:20:53,079 And that the creation, the invention of the analytic 379 00:20:53,079 --> 00:20:56,613 or therapeutic hour was a monumental invention. 380 00:20:56,613 --> 00:20:59,926 And the way that Schwartz puts it, it's equivalent to 381 00:20:59,926 --> 00:21:03,130 the discovery of the microscope for the physical sciences. 382 00:21:03,130 --> 00:21:05,519 So it's just an interesting way to think about 383 00:21:05,519 --> 00:21:08,219 an aspect of Freud's contributions. 384 00:21:11,964 --> 00:21:15,724 But what did Freud focus his microscope on? 385 00:21:15,724 --> 00:21:18,261 He focused it on the depths and intricacies 386 00:21:18,261 --> 00:21:20,078 of what goes on in the human mind, 387 00:21:20,078 --> 00:21:22,281 the forces and counterforces. 388 00:21:22,281 --> 00:21:25,458 He focused on the study of human subjectivity, 389 00:21:25,458 --> 00:21:28,117 and he developed revolutionary ideas 390 00:21:28,117 --> 00:21:30,554 based on what he saw there. 391 00:21:30,554 --> 00:21:34,428 And if you now turn in the handout to page eight, 392 00:21:34,428 --> 00:21:36,680 and we'll go on to page eight and nine. 393 00:21:36,680 --> 00:21:41,680 I've traced out some basic ideas about the 394 00:21:41,878 --> 00:21:44,684 classical or Freudian paradigm, and I'm gonna 395 00:21:44,684 --> 00:21:45,998 largely read through that, 396 00:21:45,998 --> 00:21:48,740 adding some commentary in addition. 397 00:21:50,636 --> 00:21:53,154 We are born into this world. 398 00:21:53,154 --> 00:21:55,337 What's the view of human motivation? 399 00:21:55,337 --> 00:21:56,921 We are born in the classical position. 400 00:21:56,921 --> 00:21:59,751 We are born into this world with the imperative to satisfy 401 00:21:59,751 --> 00:22:03,700 deep, primordial drives, sexual, aggressive, competitive, 402 00:22:03,700 --> 00:22:06,969 seeking pleasure, the id of Freud's model. 403 00:22:06,969 --> 00:22:10,020 Freud emphasized our inner world of desires 404 00:22:10,020 --> 00:22:13,614 and our fears and our fantasies, and the powerful role 405 00:22:13,614 --> 00:22:16,053 of these inner forces in shaping 406 00:22:16,053 --> 00:22:19,219 our ways of experiencing everything. 407 00:22:19,807 --> 00:22:22,088 While actual outer reality is, of course, 408 00:22:22,088 --> 00:22:26,219 tremendously important in terms of the world of others, 409 00:22:26,219 --> 00:22:29,665 who our parents are, who our attachments figures are 410 00:22:29,665 --> 00:22:32,948 when we grow up, Freud's emphasis was on how 411 00:22:32,948 --> 00:22:36,048 our inner worlds shape our ways of experiencing 412 00:22:36,048 --> 00:22:39,110 our outer world throughout life. 413 00:22:42,405 --> 00:22:44,714 A brief clinical vignette. 414 00:22:44,714 --> 00:22:47,299 This is a child case. 415 00:22:47,993 --> 00:22:52,993 This was a six-year-old boy who was brought to therapy. 416 00:22:53,076 --> 00:22:56,436 He used to be a very lively younger boy, 417 00:22:56,436 --> 00:23:00,175 but he became very passive at home and at school. 418 00:23:00,175 --> 00:23:02,650 Listless, he stopped doing his school work, 419 00:23:02,650 --> 00:23:04,966 he stopped interacting very much. 420 00:23:04,966 --> 00:23:07,996 And the parents brought him for therapy, 421 00:23:07,996 --> 00:23:10,291 and the parents told the therapist about 422 00:23:10,291 --> 00:23:11,820 a traumatic incident, an experience 423 00:23:11,820 --> 00:23:14,667 the boy had at age about four. 424 00:23:14,667 --> 00:23:16,364 The boy had some medical problems, 425 00:23:16,364 --> 00:23:19,108 and it required a series of abdominal procedures 426 00:23:19,108 --> 00:23:23,509 that involved a lot of pain for him in his abdomen. 427 00:23:23,724 --> 00:23:27,032 So he went through that for a period of time at age four. 428 00:23:27,512 --> 00:23:31,060 And then at age six, he's this listless little boy. 429 00:23:31,060 --> 00:23:33,910 Well, they bring him for therapy, and in the play therapy, 430 00:23:33,910 --> 00:23:37,090 he's doing drawings, and in one of the drawings, 431 00:23:37,090 --> 00:23:40,409 there's a drawing of a little boy, and the little boy 432 00:23:40,409 --> 00:23:45,218 is peeing on another little boy in the picture. 433 00:23:45,218 --> 00:23:49,249 And there's a figure of a man stabbing the boy, 434 00:23:49,249 --> 00:23:52,671 the boy who's doing the peeing, stabbing him in the stomach 435 00:23:52,671 --> 00:23:54,400 with a big knife. 436 00:23:55,282 --> 00:23:58,295 The therapist asks the boy in the therapy 437 00:23:58,295 --> 00:24:00,928 to talk about the drawing, and as they explore 438 00:24:00,928 --> 00:24:02,928 what his thoughts and fantasies are 439 00:24:02,928 --> 00:24:07,300 about this drawing he did, what emerged was, 440 00:24:07,300 --> 00:24:09,249 and you might already be guessing this, 441 00:24:09,249 --> 00:24:14,249 what emerged was, and this is very much a Freudian story, 442 00:24:14,980 --> 00:24:17,113 that the boy was being punished, 443 00:24:17,113 --> 00:24:19,759 he was being savagely punished by this man, 444 00:24:19,759 --> 00:24:22,902 being stabbed in the stomach, the boy in the picture. 445 00:24:22,902 --> 00:24:24,319 Why is he being punished? 446 00:24:24,319 --> 00:24:27,180 Well, here he is performing this aggressive act 447 00:24:27,180 --> 00:24:29,632 towards another little boy. 448 00:24:29,632 --> 00:24:34,444 Now the boy, this patient, the boy, had a younger brother. 449 00:24:34,444 --> 00:24:38,686 So the Freudian understanding and interpretation of this 450 00:24:38,686 --> 00:24:43,686 is that the little boy, like all little children, 451 00:24:45,460 --> 00:24:48,817 has a whole range of sexual and aggres- 452 00:24:48,817 --> 00:24:52,310 sensual and sexual and aggressive kind of wishes 453 00:24:52,310 --> 00:24:54,670 and wishes for pleasure and competitive wishes. 454 00:24:54,670 --> 00:24:57,388 And so here he is as a four-year-old 455 00:24:57,388 --> 00:25:01,181 with those feelings and desires towards various people, 456 00:25:01,181 --> 00:25:03,516 including his little brother. 457 00:25:03,516 --> 00:25:06,999 And then he has this experience of terrible pain 458 00:25:06,999 --> 00:25:10,225 in his abdomen, as in a confused four-year-old's mind, 459 00:25:10,225 --> 00:25:12,539 being committed by these adults. 460 00:25:12,539 --> 00:25:16,355 So in the fantasy construction within the boy's mind 461 00:25:16,355 --> 00:25:20,430 and the way he put this together, the story is 462 00:25:20,430 --> 00:25:24,228 that he was being punished for his aggressiveness 463 00:25:24,228 --> 00:25:26,012 towards the younger brother. 464 00:25:26,012 --> 00:25:29,517 And this aggressiveness, the image in the picture, 465 00:25:29,517 --> 00:25:33,774 as the boy's peeing on the littler boy, there may also, 466 00:25:33,774 --> 00:25:37,566 Freudian way of thinking, there may be some confused 467 00:25:37,566 --> 00:25:42,368 sort of sexualized kind of desires also in that. 468 00:25:42,368 --> 00:25:45,871 But even whether you put that in there or not, 469 00:25:46,936 --> 00:25:50,125 that this is a story that gets created in the fantasy 470 00:25:50,125 --> 00:25:53,394 is based on his desires and wishes that are sort of 471 00:25:53,394 --> 00:25:55,551 forbidden, that he's supposed to be nice 472 00:25:55,551 --> 00:25:56,738 to his little brother, 473 00:25:56,738 --> 00:25:59,261 but yet he has these desires, etc., etc. 474 00:25:59,261 --> 00:26:03,268 And so the four-year-old boy puts together 475 00:26:03,268 --> 00:26:06,588 in his fantasy life that he's being punished for being bad. 476 00:26:06,588 --> 00:26:07,669 And why, how is he bad? 477 00:26:07,669 --> 00:26:09,376 He's being bad for being aggressive. 478 00:26:09,376 --> 00:26:11,893 So as he moves into four-, five-, six-year-old, 479 00:26:11,893 --> 00:26:14,500 the oedipal phase, when he's internalizing 480 00:26:14,500 --> 00:26:17,744 the super ego, into the super ego, these outer figures, 481 00:26:17,744 --> 00:26:20,559 a kind of harsh super ego that's telling him 482 00:26:20,559 --> 00:26:23,139 he's bad because he's aggressive. 483 00:26:23,139 --> 00:26:26,310 And so he better stop being aggressive. 484 00:26:26,310 --> 00:26:31,310 And so the boy starts shutting down on lots of desires 485 00:26:31,348 --> 00:26:34,915 and lots of activation of his wishes and expressions 486 00:26:34,915 --> 00:26:37,474 of them in the world, and he's listless. 487 00:26:37,474 --> 00:26:42,465 And in the therapy, this whole fantasy construction 488 00:26:42,465 --> 00:26:46,223 gets explored and worked out, and the boy is freed up 489 00:26:46,223 --> 00:26:50,929 and able to go on and be an active little person again. 490 00:26:51,854 --> 00:26:55,303 If you imagine this boy not having gotten any treatment, 491 00:26:55,303 --> 00:26:58,097 and let's say this persisted, and let's say 492 00:26:58,097 --> 00:27:00,852 he's a 30-year-old coming in for therapy, 493 00:27:00,852 --> 00:27:02,646 and he's still very passive and listless, 494 00:27:02,646 --> 00:27:06,807 where this whole fantasy is in the unconscious. 495 00:27:08,413 --> 00:27:09,992 Then what might happen? 496 00:27:09,992 --> 00:27:11,097 We can just imagine. 497 00:27:11,097 --> 00:27:13,309 Say he's meeting with his therapist. 498 00:27:13,309 --> 00:27:16,025 He tends to be quiet and passive and restrained. 499 00:27:16,025 --> 00:27:17,452 Let's make up a little vignette. 500 00:27:17,452 --> 00:27:22,030 One day he starts talking with therapist about his work, 501 00:27:22,030 --> 00:27:25,070 at his job, and how he wants to get a promotion. 502 00:27:25,070 --> 00:27:26,840 And there's a competitor there, 503 00:27:26,840 --> 00:27:30,092 but he wants to get it over this other colleague, 504 00:27:30,092 --> 00:27:32,203 and he really wants this promotion. 505 00:27:32,203 --> 00:27:34,750 And then after he says this, 506 00:27:34,750 --> 00:27:37,366 he starts to get anxious and quiet. 507 00:27:37,366 --> 00:27:40,885 And then the therapist asks what's going on, 508 00:27:40,885 --> 00:27:42,682 and then he might say, 509 00:27:42,682 --> 00:27:46,643 "Oh, I don't know where this came from, but I thought, 510 00:27:46,643 --> 00:27:48,073 "you know, I was just talking, 511 00:27:48,073 --> 00:27:50,376 "and I thought you might getting, 512 00:27:50,376 --> 00:27:52,412 "becoming distant or you might even have been 513 00:27:52,412 --> 00:27:54,959 "a little irritated with me." 514 00:27:54,959 --> 00:27:57,702 So that's just, that's a story that starts to develop 515 00:27:57,702 --> 00:28:00,262 in the therapy relationship, where something is getting 516 00:28:00,262 --> 00:28:03,765 projected in the transference onto the therapist about, 517 00:28:03,765 --> 00:28:05,777 something about this person being bad 518 00:28:05,777 --> 00:28:09,351 for his aggressive, whatever, wishes. 519 00:28:09,351 --> 00:28:13,064 So that's a Freudian way of understanding 520 00:28:13,064 --> 00:28:14,615 something about the inner world. 521 00:28:14,615 --> 00:28:17,708 Even though this case involved an outer experience, 522 00:28:17,708 --> 00:28:21,473 and in fact, a traumatic one, but the Freudian sensibilities 523 00:28:21,473 --> 00:28:25,171 are about appreciating how it get's put together inside. 524 00:28:27,285 --> 00:28:32,285 So following along on page eight in the handout. 525 00:28:32,664 --> 00:28:34,206 The drive ego model. 526 00:28:34,206 --> 00:28:36,425 Throughout life, our inner drivenness 527 00:28:36,425 --> 00:28:38,400 continues to play a central role. 528 00:28:38,400 --> 00:28:42,253 Drives, passions, desires, impulses, our id nature. 529 00:28:42,253 --> 00:28:45,257 Much is unconscious, and it's shaped and tamed, 530 00:28:45,257 --> 00:28:47,116 as you may be familiar with in the model, 531 00:28:47,116 --> 00:28:48,636 by the ego and super ego. 532 00:28:48,636 --> 00:28:51,764 And there are repressions and layers of defense. 533 00:28:53,434 --> 00:28:56,541 Psychopathology or suffering or people's problems 534 00:28:56,541 --> 00:29:00,425 are understood in terms of insufficiently resolved 535 00:29:00,425 --> 00:29:05,123 unconscious conflicts, like our little boy. 536 00:29:05,123 --> 00:29:07,642 The unconscious conflicts between his wishes 537 00:29:07,642 --> 00:29:09,629 and his feelings of guilt. 538 00:29:10,767 --> 00:29:14,378 Unconscious conflicts, drives, super egos, defenses, etc., 539 00:29:14,378 --> 00:29:15,499 the Freudian model. 540 00:29:15,499 --> 00:29:18,352 And this creates inhibition symptoms, anxieties, 541 00:29:18,352 --> 00:29:20,120 and character problems. 542 00:29:20,889 --> 00:29:23,350 So if that's the way of understanding the inner world, 543 00:29:23,350 --> 00:29:25,376 if that's the way of understanding 544 00:29:25,376 --> 00:29:28,763 the nature of people's problems, therapeutic action. 545 00:29:28,763 --> 00:29:32,041 The forbidden, deep, instinctual desires 546 00:29:32,041 --> 00:29:33,824 and the inner conflicts about them 547 00:29:33,824 --> 00:29:36,139 that are causing the suffering need to emerge 548 00:29:36,139 --> 00:29:38,628 into consciousness to be worked through. 549 00:29:38,628 --> 00:29:42,213 They emerge in free associations, dreams, 550 00:29:42,213 --> 00:29:45,461 drawings, for children, play therapy. 551 00:29:45,461 --> 00:29:47,279 They emerge in transference. 552 00:29:47,279 --> 00:29:49,288 And as Freud famously said, 553 00:29:49,288 --> 00:29:52,810 what was unconscious becomes conscious, 554 00:29:52,810 --> 00:29:54,717 where id was, ego shall be. 555 00:29:54,717 --> 00:29:58,435 The underlying conflicts are lifted and worked through. 556 00:29:58,961 --> 00:30:02,306 Now as an aside, but an important aside, 557 00:30:03,284 --> 00:30:05,678 Freud's early entree into psychoanalysis, 558 00:30:05,678 --> 00:30:08,428 he started by focusing on free association, 559 00:30:08,428 --> 00:30:11,707 not on transference, per se, but free association. 560 00:30:11,707 --> 00:30:14,752 What's just gonna emerge in the free associations? 561 00:30:14,752 --> 00:30:18,972 But one of the things that happened was that 562 00:30:20,505 --> 00:30:22,771 problems emerged because sometimes patients 563 00:30:22,771 --> 00:30:26,062 would feel fearful that he was gonna judge them 564 00:30:26,062 --> 00:30:28,568 about whatever came out of their minds, 565 00:30:28,568 --> 00:30:30,426 and they started to inhibit and shut down 566 00:30:30,426 --> 00:30:33,579 and not be able to have the associations freely 567 00:30:33,579 --> 00:30:36,367 or not be able to say, not want to say them, 568 00:30:36,367 --> 00:30:40,509 fearing the therapist's judgment, negative transference. 569 00:30:41,251 --> 00:30:45,459 And in this sense, transference looks like an obstacle. 570 00:30:45,459 --> 00:30:47,518 It blocks things, it shuts things down. 571 00:30:47,518 --> 00:30:49,040 But Freud, in his brilliance, 572 00:30:49,040 --> 00:30:51,799 continued working with the model, and eventually 573 00:30:51,799 --> 00:30:55,056 what he developed was the ways that transference, 574 00:30:55,056 --> 00:30:57,955 which can, in one way, look like an obstacle, 575 00:30:57,955 --> 00:31:01,016 can become a vehicle, because then what do you do? 576 00:31:01,016 --> 00:31:03,072 You look at the transference itself. 577 00:31:03,072 --> 00:31:06,367 You explore the patient's experience of their analyst 578 00:31:06,367 --> 00:31:10,133 or therapist, and you work with that, and that becomes 579 00:31:10,133 --> 00:31:13,697 one of the central inroads into the inner life 580 00:31:13,697 --> 00:31:15,655 and where the problems are. 581 00:31:17,639 --> 00:31:22,416 But, of course, with transference as a central aspect 582 00:31:22,416 --> 00:31:25,450 of therapeutic action, there are implications of that. 583 00:31:25,450 --> 00:31:27,692 How should the therapist be? 584 00:31:27,692 --> 00:31:30,694 If you want the therapist to be a projective screen 585 00:31:30,694 --> 00:31:34,724 upon which patients are free to project whatever, 586 00:31:34,724 --> 00:31:37,244 including negative stuff, onto the therapist, 587 00:31:37,244 --> 00:31:41,942 well you need a projective screen that's gonna be blank, 588 00:31:41,942 --> 00:31:44,046 the blank screen model. 589 00:31:45,208 --> 00:31:47,389 You don't wanna fill up the screen too much because 590 00:31:47,389 --> 00:31:50,073 you wanna leave freedom, open space, for the patient 591 00:31:50,073 --> 00:31:52,379 to experience and construct the therapist 592 00:31:52,379 --> 00:31:54,682 from the patient's inner life. 593 00:31:54,682 --> 00:31:56,744 So better start with a blank screen. 594 00:31:56,744 --> 00:32:00,826 And hence Freud's three central ideas about the 595 00:32:00,826 --> 00:32:04,643 therapist's stance, to be neutral, to be anonymous, 596 00:32:04,643 --> 00:32:06,910 anonymous, not provide too much information 597 00:32:06,910 --> 00:32:10,309 about the therapist, and abstinence, not to be 598 00:32:10,309 --> 00:32:14,403 too gratifying of what the patient might want 599 00:32:15,504 --> 00:32:18,409 because you want the forbidden desires to emerge. 600 00:32:18,409 --> 00:32:22,950 It's like if you're hungry and you have an appetite. 601 00:32:22,950 --> 00:32:25,831 If you eat, you don't experience the appetite anymore. 602 00:32:25,831 --> 00:32:27,695 So the idea was something like that. 603 00:32:27,695 --> 00:32:32,646 Being relatively abstinent, not being too gratifying 604 00:32:32,646 --> 00:32:34,722 of what the patient might wish for in the 605 00:32:34,722 --> 00:32:38,143 moment-to-moment from the therapist helps the appetites, 606 00:32:38,143 --> 00:32:40,868 the wishes emerge more. 607 00:32:43,684 --> 00:32:47,776 So that's a kind of overview of the Freudian model, 608 00:32:47,776 --> 00:32:51,480 and if you look at page six in the handout. 609 00:32:51,480 --> 00:32:53,673 We're gonna take a minute to orient towards this chart 610 00:32:53,673 --> 00:32:56,906 because this combines all three paradigms, 611 00:32:56,906 --> 00:33:01,906 the classical, the object and the self paradigms. 612 00:33:02,465 --> 00:33:05,825 But we're now just gonna focus on the classical, 613 00:33:05,825 --> 00:33:06,793 but I'm gonna take a minute 614 00:33:06,793 --> 00:33:08,814 to help you orient to this chart. 615 00:33:08,814 --> 00:33:09,919 It's page six of handout. 616 00:33:09,919 --> 00:33:12,333 Three models of therapeutic action. 617 00:33:13,764 --> 00:33:15,795 If we start with the boldface heading, 618 00:33:15,795 --> 00:33:17,525 Classical Freud, at the top, 619 00:33:17,525 --> 00:33:20,253 and if we go down to the middle. 620 00:33:20,253 --> 00:33:24,460 The patient's problem, in this column, the classical column. 621 00:33:24,460 --> 00:33:28,991 The patient's problem, driven by inner unconscious desires 622 00:33:28,991 --> 00:33:31,103 that are overly conflictual. 623 00:33:31,103 --> 00:33:32,872 This is just a schematic summary. 624 00:33:32,872 --> 00:33:34,608 That's the nature of the patient's problem 625 00:33:34,608 --> 00:33:36,365 in the classical paradigm. 626 00:33:36,365 --> 00:33:40,914 If you look down in the column, therapeutic action. 627 00:33:40,914 --> 00:33:44,209 Transference onto a neutral therapist, 628 00:33:44,209 --> 00:33:47,510 the unconscious conflicts and desires emerge 629 00:33:47,510 --> 00:33:51,296 and are interpreted and worked through and resolved. 630 00:33:51,296 --> 00:33:54,647 That's a central aspect of therapeutic action. 631 00:33:55,120 --> 00:33:57,401 If you look to the top of the column, 632 00:33:57,401 --> 00:34:01,125 the therapist as interpreter, my term, 633 00:34:01,125 --> 00:34:02,600 therapist as interpreter. 634 00:34:02,600 --> 00:34:05,135 The therapist is gonna be interpreting 635 00:34:05,135 --> 00:34:09,626 and helping the patient discover and work with 636 00:34:09,626 --> 00:34:14,361 these inner conflicts that become visible. 637 00:34:15,066 --> 00:34:17,758 Martha Stark's term is here the therapist is 638 00:34:17,758 --> 00:34:19,760 a neutral drive object. 639 00:34:19,760 --> 00:34:23,656 The therapist is the object of the patient's drives 640 00:34:23,656 --> 00:34:28,582 and the desires and hence, this blank screen model. 641 00:34:28,582 --> 00:34:32,699 So that column of this chart, that's a schematic way of 642 00:34:32,699 --> 00:34:37,203 representing therapeutic action in the classical paradigm. 643 00:34:37,203 --> 00:34:39,466 We'll come back to the other paradigms. 644 00:34:42,273 --> 00:34:46,368 And now, to conclude about the classical paradigm, 645 00:34:46,368 --> 00:34:50,374 I'm gonna trace out six themes, 646 00:34:50,374 --> 00:34:54,964 six themes or dimensions about the therapist's stance 647 00:34:54,964 --> 00:34:58,273 or therapist's ways of working, and I'm gonna trace out 648 00:34:58,273 --> 00:35:01,957 the Freudian or classical end of these continua 649 00:35:01,957 --> 00:35:03,652 around these six themes. 650 00:35:03,652 --> 00:35:08,022 Later we'll come back to the corresponding relational ways 651 00:35:08,022 --> 00:35:11,638 of looking at these same themes or dimensions. 652 00:35:11,638 --> 00:35:15,538 But I'm gonna name the six dimensions now and just put 653 00:35:15,538 --> 00:35:19,774 the Freudian part to the dimension on one side of it. 654 00:35:19,774 --> 00:35:23,054 And this is on page ten of the handout. 655 00:35:23,054 --> 00:35:25,423 It'll probably help if you look at that. 656 00:35:28,218 --> 00:35:33,098 So the first theme or dimension, subjectivity. 657 00:35:33,098 --> 00:35:37,090 This is about exploring the individual mind, 658 00:35:37,090 --> 00:35:39,166 the intrapsychic world, and this was the richness 659 00:35:39,166 --> 00:35:41,179 of Freud's theory. 660 00:35:41,179 --> 00:35:42,236 How do you do that? 661 00:35:42,236 --> 00:35:43,587 I mean, you're looking at free associations. 662 00:35:43,587 --> 00:35:46,108 The associations come from the patient's mind. 663 00:35:46,108 --> 00:35:50,797 There's the space in treatment to explore the interior. 664 00:35:52,028 --> 00:35:54,327 This is also, subjectivity, this is also 665 00:35:54,327 --> 00:35:56,589 sometimes called a one-person psychology. 666 00:35:56,589 --> 00:35:59,357 We're looking at the mind of the patient. 667 00:35:59,357 --> 00:36:03,619 Transference, in this subjective way of looking at it, 668 00:36:03,619 --> 00:36:05,645 transference is brought. 669 00:36:05,645 --> 00:36:07,307 It's brought by the patient. 670 00:36:07,307 --> 00:36:11,767 The patient comes with an inner world and a readiness 671 00:36:11,767 --> 00:36:15,216 to see and experience, to project that onto the therapist 672 00:36:15,216 --> 00:36:17,313 and how they experience the therapist in the transference, 673 00:36:17,313 --> 00:36:19,763 and that is revealed in the therapy. 674 00:36:20,840 --> 00:36:22,650 Freud wrote about counter-transference, too, 675 00:36:22,650 --> 00:36:26,156 in terms of also a one-person or subjective model. 676 00:36:26,156 --> 00:36:29,467 He emphasized that the therapist also brings their own 677 00:36:29,467 --> 00:36:32,485 inner stuff, and sometimes that gets stirred up 678 00:36:32,485 --> 00:36:34,529 and can be a problem, and then the therapist needs 679 00:36:34,529 --> 00:36:37,927 to get some consultation or some more treatment themselves 680 00:36:37,927 --> 00:36:40,124 in order to work with that. 681 00:36:40,124 --> 00:36:43,432 But the transference is brought by the patient. 682 00:36:43,432 --> 00:36:45,971 Counter-transference is brought by the therapist. 683 00:36:45,971 --> 00:36:48,734 This is the subjective model. 684 00:36:49,509 --> 00:36:54,295 Number two, the talking cure, therapy as the talking cure. 685 00:36:54,295 --> 00:36:56,308 It's about interpretation, 686 00:36:56,308 --> 00:36:59,436 verbal interpretation and insight. 687 00:36:59,436 --> 00:37:03,703 Communication from the therapist is informative. 688 00:37:03,703 --> 00:37:07,164 It's to help inform the patient about their inner life. 689 00:37:07,164 --> 00:37:09,555 And it's an archaelogical model. 690 00:37:09,555 --> 00:37:11,918 In the talking cure, the idea is you, 691 00:37:11,918 --> 00:37:14,282 through interpretation and insight, were unearthing 692 00:37:14,282 --> 00:37:17,000 archaelogically, deeper layers of where 693 00:37:17,000 --> 00:37:19,495 the problems are in the psyche. 694 00:37:20,202 --> 00:37:24,541 The third dimension, analytic restraint or discipline. 695 00:37:24,541 --> 00:37:26,878 This was what I referred to before, neutrality, 696 00:37:26,878 --> 00:37:28,962 anonymity and abstinence. 697 00:37:29,681 --> 00:37:33,681 Another term here is optimal frustration. 698 00:37:33,681 --> 00:37:36,454 That's what I said about abstinence. 699 00:37:36,454 --> 00:37:38,773 You don't wanna gratify too much because you want 700 00:37:38,773 --> 00:37:42,294 the patient's desires to be there 701 00:37:42,294 --> 00:37:44,951 and to be felt by the patient and to emerge. 702 00:37:44,951 --> 00:37:48,985 But restraint or discipline for the therapist. 703 00:37:48,985 --> 00:37:53,516 The fourth dimension on this side of it is asymmetry. 704 00:37:53,516 --> 00:37:55,850 The therapeutic relationship has asymmetries. 705 00:37:55,850 --> 00:37:59,610 From any school of thought, that's true. 706 00:37:59,610 --> 00:38:02,679 In the original, sort of classical stance, 707 00:38:02,679 --> 00:38:05,005 classical position, the emphasis was on 708 00:38:05,005 --> 00:38:08,765 the patient free associates and the therapist interprets. 709 00:38:08,765 --> 00:38:10,830 That's an asymmetry. 710 00:38:11,537 --> 00:38:16,033 Another asymmetry in the original Freudian ideas, 711 00:38:16,033 --> 00:38:18,990 about authority and knowledge, that the therapist 712 00:38:18,990 --> 00:38:22,994 speaks from a position of authority and knowledge. 713 00:38:24,012 --> 00:38:29,012 And we'll see, there's other ways to look at this 714 00:38:29,687 --> 00:38:32,935 in the relational thinking. 715 00:38:32,935 --> 00:38:35,723 Another asymmetry, the therapist sets the frame 716 00:38:35,723 --> 00:38:39,510 about time, about costs, about the fee. 717 00:38:41,643 --> 00:38:46,285 Another aspect of asymmetry, which is true in any therapy, 718 00:38:46,285 --> 00:38:48,666 is the priority is obviously on the patient's welfare 719 00:38:48,666 --> 00:38:50,648 and well-being and growth. 720 00:38:50,648 --> 00:38:55,006 But in any case, asymmetries within the relationship. 721 00:38:55,006 --> 00:39:00,006 The fifth and sixth points, dimensions, relate to- 722 00:39:00,276 --> 00:39:03,624 I'm gonna use a phrase to preface them. 723 00:39:03,624 --> 00:39:05,915 It's used by Steven Stern in an article he wrote 724 00:39:05,915 --> 00:39:10,080 that had in the title "needed and repeated relationships". 725 00:39:10,080 --> 00:39:11,332 I like that. 726 00:39:11,332 --> 00:39:14,280 Needed relationships and repeated relationships. 727 00:39:14,280 --> 00:39:16,816 So first, what about repeated relationships? 728 00:39:16,816 --> 00:39:20,756 This is the fifth dimension of these dimensions. 729 00:39:20,756 --> 00:39:23,511 Actually, I already covered this. 730 00:39:23,511 --> 00:39:24,958 This is about the transference. 731 00:39:24,958 --> 00:39:28,028 The idea that the repetition, the patient's experience 732 00:39:28,028 --> 00:39:30,893 of something being repeated in the therapy relationship 733 00:39:30,893 --> 00:39:34,236 is generated from the patient's internal world. 734 00:39:34,236 --> 00:39:36,750 That's the nature of the repetition. 735 00:39:37,354 --> 00:39:40,305 With an engaged but neutral therapist. 736 00:39:41,566 --> 00:39:46,566 The sixth theme, needed relationship with the therapist. 737 00:39:47,687 --> 00:39:51,291 What about the needed aspects in the therapy relationship? 738 00:39:51,291 --> 00:39:56,291 In a classical model, that's more of a background factor. 739 00:39:57,450 --> 00:40:00,329 The way Otto Kernberg once put it was, 740 00:40:00,329 --> 00:40:02,753 empathy is important, but empathy 741 00:40:02,753 --> 00:40:05,016 is a precondition for treatment. 742 00:40:05,016 --> 00:40:08,589 He didn't see empathy, when he was speaking about this, 743 00:40:08,589 --> 00:40:12,387 he didn't see empathy itself as so much a curative factor. 744 00:40:12,387 --> 00:40:17,126 It's a precondition, and that the classical model 745 00:40:17,126 --> 00:40:21,147 tends to look at the interpretation and the insight 746 00:40:21,147 --> 00:40:23,156 and the working out of the transference 747 00:40:23,156 --> 00:40:26,736 as the therapeutic action, not things like empathy, 748 00:40:26,736 --> 00:40:30,015 not the needed aspects of a relationship. 749 00:40:31,209 --> 00:40:34,285 So we're now, now we're gonna really shift. 750 00:40:34,285 --> 00:40:39,285 We're gonna come into the emergence of relational theory, 751 00:40:39,952 --> 00:40:43,080 and I'm gonna be talking about the other two paradigms. 752 00:40:44,360 --> 00:40:47,402 But the emergence of relationality 753 00:40:47,402 --> 00:40:49,980 within the other paradigms. 754 00:40:49,980 --> 00:40:53,243 Freud focused his microscope, as I said, on the study 755 00:40:53,243 --> 00:40:56,044 of human subjectivity, the intrapsychic world, 756 00:40:56,044 --> 00:40:58,880 not on intersubjectivity. 757 00:40:58,880 --> 00:41:01,412 And I'm gonna use the terms relational and 758 00:41:01,412 --> 00:41:05,978 intersubjective interchangeably as I speak. 759 00:41:05,978 --> 00:41:10,182 And these weave throughout different theorists 760 00:41:10,182 --> 00:41:13,378 in the object and self paradigms in differing degrees. 761 00:41:13,378 --> 00:41:16,133 First, what does intersubjectivity mean? 762 00:41:16,133 --> 00:41:20,222 One way it's been defined by Natterson and Friedman, 763 00:41:20,222 --> 00:41:23,989 quote, "Intersubjectivity is the over-arching term 764 00:41:23,989 --> 00:41:28,296 "that refers to the reciprocal influence of the conscious 765 00:41:28,296 --> 00:41:31,401 "and unconscious subjectivities of two people 766 00:41:31,401 --> 00:41:32,955 "in a relationship." 767 00:41:32,955 --> 00:41:34,191 Let me read that again. 768 00:41:34,191 --> 00:41:37,557 "Intersubjectivity is the over-arching term 769 00:41:37,557 --> 00:41:41,321 "that refers to the reciprocal influence of the conscious 770 00:41:41,321 --> 00:41:44,130 "and unconscious subjectivities of two people 771 00:41:44,130 --> 00:41:46,308 "in a relationship." 772 00:41:47,465 --> 00:41:50,825 This is different from, by the way, if you're familiar, 773 00:41:50,825 --> 00:41:53,670 some of you may have familiarity with other very different, 774 00:41:53,670 --> 00:41:56,356 and legitimate, but different ways of defining 775 00:41:56,356 --> 00:41:58,675 and using the term intersubjectivity. 776 00:41:58,675 --> 00:42:00,654 Stolorow has a whole school of thought 777 00:42:00,654 --> 00:42:03,053 that's called intersubjectivity. 778 00:42:03,053 --> 00:42:05,549 Benjamin develops really rich ideas, 779 00:42:05,549 --> 00:42:07,627 Jessica Benjamin about intersubjectivity. 780 00:42:07,627 --> 00:42:09,209 Daniel Stern uses the term. 781 00:42:09,209 --> 00:42:11,788 But I'm meaning it differently than any of those. 782 00:42:11,788 --> 00:42:15,113 I'm meaning it in the way that I'm talking about now. 783 00:42:17,315 --> 00:42:21,471 An intersubjective view of the child's development. 784 00:42:21,471 --> 00:42:25,017 Now this is shifting from a focus 785 00:42:25,017 --> 00:42:27,976 more towards the intrapsychic view. 786 00:42:29,161 --> 00:42:32,680 An intersubjective view of the child's development. 787 00:42:32,680 --> 00:42:37,249 That it's shaped by not only what goes on inside 788 00:42:37,249 --> 00:42:41,608 the psyche and soma of the child, but also what goes on 789 00:42:41,608 --> 00:42:46,608 inside the parent or attachment figure, and what goes on 790 00:42:47,206 --> 00:42:49,475 in the interplay within the child 791 00:42:49,475 --> 00:42:53,031 and within the parent or attachment figure. 792 00:42:53,861 --> 00:42:57,424 It's this rich view of interplay between what's going on 793 00:42:57,424 --> 00:42:59,440 in the insides of each. 794 00:43:00,224 --> 00:43:04,533 It includes the descriptions of their interpersonal 795 00:43:04,533 --> 00:43:05,909 behaviors and interactions, you know, 796 00:43:05,909 --> 00:43:08,758 like what would be on the video, but it's broader. 797 00:43:08,758 --> 00:43:11,039 It's the unconscious and unconscious influences. 798 00:43:11,039 --> 00:43:13,651 It's played out very subtly in the flow of verbal 799 00:43:13,651 --> 00:43:16,754 and nonverbal communications, emotions, 800 00:43:16,754 --> 00:43:19,598 contours of nervous system activation, 801 00:43:19,598 --> 00:43:22,206 all sorts of back and forth flow 802 00:43:22,206 --> 00:43:24,667 of synchronies and dyssynchronies. 803 00:43:25,702 --> 00:43:28,959 The conscious and unconscious influence. 804 00:43:29,561 --> 00:43:32,612 Now that was about a child's development 805 00:43:32,612 --> 00:43:34,673 and it's attachment figures. 806 00:43:34,673 --> 00:43:38,010 There's an exact parallel for an intersubjective view 807 00:43:38,010 --> 00:43:40,928 of what goes on in therapy, in the therapy relationship. 808 00:43:40,928 --> 00:43:44,558 That it's not only about what goes on inside the psyche 809 00:43:44,558 --> 00:43:46,185 and soma of the patient, 810 00:43:46,185 --> 00:43:49,451 but also what goes on inside the therapist, 811 00:43:49,451 --> 00:43:51,578 about the interplay between what's going on 812 00:43:51,578 --> 00:43:55,531 inside the patient and within the therapist. 813 00:43:55,531 --> 00:43:59,840 It includes the easily observable behavioral interactions, 814 00:43:59,840 --> 00:44:01,894 and it includes all those more subtle 815 00:44:01,894 --> 00:44:04,063 interpersonal influences. 816 00:44:05,027 --> 00:44:10,027 And as all of the paradigms developed and emerged, 817 00:44:11,370 --> 00:44:14,383 there's increasing emphasis 818 00:44:14,383 --> 00:44:18,182 on the intersubjective dimension. 819 00:44:20,117 --> 00:44:24,126 This is the relational with a small r, and there's been 820 00:44:24,126 --> 00:44:26,500 a whole relational turn in all of psychoanalysis, 821 00:44:26,500 --> 00:44:29,404 including contemporary classical thinkers, 822 00:44:29,404 --> 00:44:30,697 Freudian thinkers. 823 00:44:30,697 --> 00:44:33,079 There's been a relational turn that is emphasizing 824 00:44:33,079 --> 00:44:35,970 more of this in all the schools of thought. 825 00:44:36,423 --> 00:44:41,183 But coming back to tracing out what we're doing. 826 00:44:41,183 --> 00:44:44,877 Let me orient you now, this is now... 827 00:44:44,877 --> 00:44:48,988 I wanna look together at a chart on page five. 828 00:44:50,275 --> 00:44:52,191 And we're gonna take a few minutes looking at this 829 00:44:52,191 --> 00:44:53,831 to orient to it. 830 00:44:53,831 --> 00:44:55,879 It's a little, there are a lot of lines, 831 00:44:55,879 --> 00:44:58,751 a lot of names and a lot of lines on it. 832 00:44:59,212 --> 00:45:01,289 This is psychodynamic theories, 833 00:45:01,289 --> 00:45:04,122 the theoretical and historical overview. 834 00:45:04,122 --> 00:45:06,584 And some of this is what we've been speaking about, 835 00:45:06,584 --> 00:45:10,892 but this chart really builds in a more complex way 836 00:45:10,892 --> 00:45:12,655 what I introduced in the very beginning 837 00:45:12,655 --> 00:45:15,313 about the different paradigms. 838 00:45:15,313 --> 00:45:18,492 First, if you look across at the boldface at the top, 839 00:45:18,492 --> 00:45:20,537 Drive, Ego, Object, Self. 840 00:45:20,537 --> 00:45:22,549 Oh and by the way, there should be a line drawn 841 00:45:22,549 --> 00:45:23,710 between drive and ego. 842 00:45:23,710 --> 00:45:26,172 They're so connected to each other. 843 00:45:26,172 --> 00:45:29,573 Between the word drive and ego there should be a line. 844 00:45:29,573 --> 00:45:33,071 Drive and ego, the classical paradigm, and Freud, 845 00:45:33,071 --> 00:45:36,037 Sigmund Freud and others, OK. 846 00:45:36,037 --> 00:45:37,181 Object. 847 00:45:37,181 --> 00:45:40,455 If you start where the boldface object at the top, 848 00:45:40,455 --> 00:45:42,345 the object paradigm, there are lots of lines 849 00:45:42,345 --> 00:45:43,668 coming out of object. 850 00:45:43,668 --> 00:45:45,080 Let's trace out a few of them. 851 00:45:45,080 --> 00:45:48,022 Just play with this a little bit to make sense of it. 852 00:45:48,935 --> 00:45:52,512 For example, look at the line that goes down to Klein, 853 00:45:52,512 --> 00:45:57,055 down towards the left, from object to Klein, Melanie Klein. 854 00:45:57,055 --> 00:46:00,127 And there's a line from Klein, if you trace it out, 855 00:46:00,127 --> 00:46:02,094 also up to drive. 856 00:46:02,094 --> 00:46:04,415 Melanie Klein, the founding mother 857 00:46:04,415 --> 00:46:06,548 of object relations theories. 858 00:46:06,548 --> 00:46:09,574 Major, major figure in object relations theories. 859 00:46:09,574 --> 00:46:11,927 The first major figure. 860 00:46:11,927 --> 00:46:15,131 But her thinking was still very much influenced 861 00:46:15,131 --> 00:46:18,812 by a drive paradigm, so she's kind of a hybrid 862 00:46:18,812 --> 00:46:22,329 of object and drive paradigms. 863 00:46:22,329 --> 00:46:25,918 But if you look at the lines coming down from object 864 00:46:25,918 --> 00:46:29,714 to interpersonal theory, Sullivan and to Fairbairn. 865 00:46:29,714 --> 00:46:31,265 Gun trip. 866 00:46:31,265 --> 00:46:33,815 Let's talk about those two lines. 867 00:46:33,815 --> 00:46:35,328 The line from object to interpersonal 868 00:46:35,328 --> 00:46:37,679 and object to Fairbairn. 869 00:46:37,694 --> 00:46:40,010 Interpersonal and Fairbairn don't have any other 870 00:46:40,010 --> 00:46:41,756 connecting lines above. 871 00:46:41,756 --> 00:46:45,373 They are purely, what I would call purely in this paradigm, 872 00:46:45,373 --> 00:46:47,494 about relationality. 873 00:46:47,989 --> 00:46:50,174 Most radically about relationality. 874 00:46:50,174 --> 00:46:54,025 Really moving away from the notion of drive 875 00:46:54,025 --> 00:46:57,337 as a central aspect of human nature. 876 00:46:57,337 --> 00:47:00,402 And those two theorists, if you trace the lines downward, 877 00:47:00,402 --> 00:47:03,753 they go towards Relational, now Relational with a capital R, 878 00:47:03,753 --> 00:47:05,111 Relational theories. 879 00:47:05,111 --> 00:47:07,934 From interpersonal and Fairbairn down to Relational. 880 00:47:07,934 --> 00:47:11,093 That's why we're gonna talk about them in some detail. 881 00:47:13,924 --> 00:47:15,874 If you look over on the right, the self paradigm 882 00:47:15,874 --> 00:47:19,415 in boldface, there's a line that goes down to Kohut, 883 00:47:19,415 --> 00:47:24,415 self psychology and connections there to relational theories 884 00:47:26,053 --> 00:47:28,609 because relational theories do incorporate 885 00:47:28,609 --> 00:47:30,975 much from Kohut. 886 00:47:31,883 --> 00:47:33,595 I'm not gonna go through all the intricacies 887 00:47:33,595 --> 00:47:35,079 of this diagram. 888 00:47:35,079 --> 00:47:38,336 We won't have time to go through all of this today. 889 00:47:38,336 --> 00:47:41,653 There's a separate online course that I do 890 00:47:41,653 --> 00:47:43,667 on the object relations theorists. 891 00:47:43,667 --> 00:47:45,049 On Klein, Fairbairn and Winnicott. 892 00:47:45,049 --> 00:47:47,150 It's a whole separate course, and so we won't have time 893 00:47:47,150 --> 00:47:50,204 to go into all of those theorists today. 894 00:47:50,204 --> 00:47:52,598 Winnicott also, there are important ways that 895 00:47:52,598 --> 00:47:54,739 Winnicott connects with relational theories too, 896 00:47:54,739 --> 00:47:58,068 but that's beyond what we can talk about today. 897 00:47:59,410 --> 00:48:03,376 OK, so that's, hopefully that chart will really help 898 00:48:03,376 --> 00:48:06,500 kind of keep the theories from swimming all together, 899 00:48:06,500 --> 00:48:11,416 and kind of a frame for how they flow into one another. 900 00:48:12,349 --> 00:48:14,384 So turning now, we're gonna shift 901 00:48:14,384 --> 00:48:15,527 from the classical paradigm. 902 00:48:15,527 --> 00:48:18,377 Now we're gonna talk about the object paradigm. 903 00:48:18,377 --> 00:48:20,136 And you can still refer to page five. 904 00:48:20,136 --> 00:48:22,931 That just orients you to what we're talking about. 905 00:48:25,243 --> 00:48:27,754 A radically relational view... 906 00:48:27,754 --> 00:48:29,521 Let's talk about a radically relational view 907 00:48:29,521 --> 00:48:31,221 of human development. 908 00:48:35,084 --> 00:48:37,365 I'll talk about Fairbairn for a moment. 909 00:48:37,365 --> 00:48:38,609 Fairbairn. 910 00:48:39,866 --> 00:48:41,882 The infant completely- 911 00:48:41,882 --> 00:48:45,008 He's a real revolutionary thinker for his time. 912 00:48:45,008 --> 00:48:48,047 The infant, and this, we're talking about human nature. 913 00:48:48,047 --> 00:48:51,330 The infant is not pleasure-seeking primarily. 914 00:48:51,330 --> 00:48:53,938 The infant is, as he put it, object-seeking, 915 00:48:53,938 --> 00:48:56,777 seeking the object, the other, the attachment figure. 916 00:48:56,777 --> 00:48:59,066 Seeking contact and connection. 917 00:48:59,066 --> 00:49:02,773 The infant wants the object of its love to love it, 918 00:49:02,773 --> 00:49:06,806 and it wants the object of its love to accept its love. 919 00:49:06,806 --> 00:49:10,007 Fairbairn developed a whole model of human psychology 920 00:49:10,007 --> 00:49:12,418 where the infant develops an inner world 921 00:49:12,418 --> 00:49:14,796 that is based on the internalizations 922 00:49:14,796 --> 00:49:18,090 of interactions with attachment figures. 923 00:49:19,104 --> 00:49:23,082 And now I'm gonna read a quote from Stephen Mitchell 924 00:49:23,082 --> 00:49:28,074 talking about Fairbairn that expresses this beautifully. 925 00:49:28,650 --> 00:49:32,042 Here's Mitchell on Fairbairn, 926 00:49:32,042 --> 00:49:33,370 and I'm gonna read an extended quote. 927 00:49:33,370 --> 00:49:34,628 It's one of my favorite quotes 928 00:49:34,628 --> 00:49:37,636 in really all of psychoanalytic literature. 929 00:49:39,427 --> 00:49:40,177 "Libido- 930 00:49:40,177 --> 00:49:44,101 the sort of motivational energy, 931 00:49:44,101 --> 00:49:48,819 "Libido is not pleasure-seeking", he, Fairbairn, argues, 932 00:49:48,819 --> 00:49:50,498 "but object seeking. 933 00:49:50,498 --> 00:49:53,832 "The superordinate need of the child is not for pleasure 934 00:49:53,832 --> 00:49:57,708 "or need gratification, but for an intense relationship 935 00:49:57,708 --> 00:49:59,679 "with another person. 936 00:49:59,679 --> 00:50:02,257 "If the caretaker provides opportunities 937 00:50:02,257 --> 00:50:05,900 "for pleasurable experiences, pleasure is sought, 938 00:50:05,900 --> 00:50:09,342 "not as an end in itself, but as a vehicle 939 00:50:09,342 --> 00:50:12,311 "for interactions with others. 940 00:50:12,311 --> 00:50:13,187 "If- 941 00:50:13,187 --> 00:50:14,245 now on the other hand, 942 00:50:14,245 --> 00:50:17,911 "If only painful experiences are provided, 943 00:50:17,911 --> 00:50:19,979 "the child does not give up and look for 944 00:50:19,979 --> 00:50:24,118 "pleasurable experiences elsewhere, but the child 945 00:50:24,118 --> 00:50:28,333 "seeks the pain as a vehicle for interaction 946 00:50:28,333 --> 00:50:30,414 "with significant others." 947 00:50:30,414 --> 00:50:32,993 That's a really radical idea. 948 00:50:32,993 --> 00:50:36,353 "It is the contact, not the pleasure, which is primary. 949 00:50:36,353 --> 00:50:38,590 "In Fairbairn's view, the central motivation 950 00:50:38,590 --> 00:50:41,830 "in human experience is the seeking out and maintaining 951 00:50:41,830 --> 00:50:45,629 "of an intense emotional bond with another person. 952 00:50:45,646 --> 00:50:48,740 "If we start with that premise, the adhesiveness 953 00:50:48,740 --> 00:50:52,097 "of early relationships and early modes of gratification 954 00:50:52,097 --> 00:50:56,237 "and the ubiquity of the painful redundancies, 955 00:50:56,237 --> 00:51:01,114 "of the repetition compulsion seem less puzzling. 956 00:51:01,114 --> 00:51:04,485 "Painful feelings, self-destructive relationships, 957 00:51:04,485 --> 00:51:08,699 "self-sabotaging situations, are recreated throughout life 958 00:51:08,699 --> 00:51:11,492 "as vehicles for the perpetuation 959 00:51:11,492 --> 00:51:14,908 "of early ties to significant others." 960 00:51:15,335 --> 00:51:17,635 This is why we repeat patterns, 961 00:51:17,635 --> 00:51:20,671 even though they're self-defeating or painful. 962 00:51:20,671 --> 00:51:21,997 Mitchell goes on, 963 00:51:21,997 --> 00:51:24,548 "The child learns a mode of connection, 964 00:51:24,548 --> 00:51:27,356 "a way into the human family, and these learned modes 965 00:51:27,356 --> 00:51:30,442 "are desperately maintained throughout life. 966 00:51:30,442 --> 00:51:33,488 "In some families, sensuality is the preferred mode 967 00:51:33,488 --> 00:51:35,039 "of emotional contact. 968 00:51:35,039 --> 00:51:38,332 "In others, it is rageful explosions. 969 00:51:38,332 --> 00:51:41,387 "In others, depressive longings. 970 00:51:41,387 --> 00:51:44,547 "In Fairbairn's system, it is precisely 971 00:51:44,547 --> 00:51:47,380 "the patient's character pathology to which the child 972 00:51:47,380 --> 00:51:50,586 "becomes most compulsively connected 973 00:51:50,586 --> 00:51:53,734 "and which he internalizes because it is there he feels 974 00:51:53,734 --> 00:51:57,037 "the parents reside emotionally." 975 00:51:58,057 --> 00:52:01,133 That's a radical idea, connecting specifically with 976 00:52:01,133 --> 00:52:04,457 the characters problems of the parent. 977 00:52:04,457 --> 00:52:05,487 Mitchell goes on, 978 00:52:05,487 --> 00:52:08,566 "By becoming like the depressed, masochistic 979 00:52:08,566 --> 00:52:10,962 "or sadistic parents, he, the child, 980 00:52:10,962 --> 00:52:13,697 "preserves a powerful bond to them. 981 00:52:13,697 --> 00:52:16,615 "Thus, in Fairbairn's system, at the core of the repressed 982 00:52:16,615 --> 00:52:21,427 "is not a trauma, a memory or an impulse, 983 00:52:21,427 --> 00:52:24,427 "but a relationship, a part of the self 984 00:52:24,427 --> 00:52:27,710 "in close identification with a representation 985 00:52:27,710 --> 00:52:31,766 "of actual caretakers which could not be contained 986 00:52:31,766 --> 00:52:33,543 "in awareness and in continuity 987 00:52:33,543 --> 00:52:35,934 "with other experiences of the self, 988 00:52:35,934 --> 00:52:38,941 "so it becomes unconscious. 989 00:52:38,941 --> 00:52:43,039 "To abandon these bonds and entanglements is experienced 990 00:52:43,039 --> 00:52:45,137 "as the equivalent of casting oneself off 991 00:52:45,137 --> 00:52:48,173 "from intense human contact altogether, 992 00:52:48,173 --> 00:52:50,323 "an impossible option. 993 00:52:50,323 --> 00:52:52,687 "Thus, patients in analysis or therapy, 994 00:52:52,687 --> 00:52:55,409 "who are beginning to sense the possibility 995 00:52:55,409 --> 00:52:58,466 "of living and experiencing themselves and their worlds 996 00:52:58,466 --> 00:53:01,077 "in a different way are genuinely terrified 997 00:53:01,077 --> 00:53:03,204 "of profound isolation." 998 00:53:03,787 --> 00:53:05,632 Change can be frightening. 999 00:53:05,632 --> 00:53:08,628 "To be different, even if that means being open 1000 00:53:08,628 --> 00:53:11,437 "to joyfulness and real intimacy with others, 1001 00:53:11,437 --> 00:53:15,161 "means losing ties to internal objects which have provided 1002 00:53:15,161 --> 00:53:18,426 "an enduring sense of belonging and connectedness, 1003 00:53:18,426 --> 00:53:23,426 "although mediated through actual pain and desolation." 1004 00:53:24,943 --> 00:53:26,886 That's, I think, a beautiful description 1005 00:53:26,886 --> 00:53:30,137 of the essence of what Fairbairn's relational, 1006 00:53:30,137 --> 00:53:33,888 with a small r, relational model was about. 1007 00:53:36,026 --> 00:53:37,587 Let's talk a little bit about Sullivan 1008 00:53:37,587 --> 00:53:41,265 and interpersonal theory, which is, as I said earlier, 1009 00:53:41,265 --> 00:53:45,815 in some ways the most contributing theory directly 1010 00:53:45,815 --> 00:53:48,928 to the formation of the relational school. 1011 00:53:49,837 --> 00:53:52,741 Sullivan, very much in line with Fairbairn, 1012 00:53:52,741 --> 00:53:54,584 radically different views of the inner world 1013 00:53:54,584 --> 00:53:56,656 than the Freudian view. 1014 00:53:57,638 --> 00:54:01,696 Here are quotes from Irwin Hirsch about Sullivan. 1015 00:54:01,696 --> 00:54:05,808 Quote, "Individual development and unconscious processes 1016 00:54:05,808 --> 00:54:08,554 "are based primarily on internalized and elaborated 1017 00:54:08,554 --> 00:54:11,687 "real experiences with significant others." 1018 00:54:13,099 --> 00:54:15,665 Another statement about interpersonal. 1019 00:54:15,665 --> 00:54:17,137 "Problems arise- 1020 00:54:17,137 --> 00:54:18,548 to talk about people's problems, 1021 00:54:18,548 --> 00:54:19,780 "Problems arise. 1022 00:54:19,780 --> 00:54:23,046 "Their identifications with troubled caregivers. 1023 00:54:23,046 --> 00:54:24,374 "Their anxieties- 1024 00:54:24,374 --> 00:54:25,501 the caregivers, 1025 00:54:25,501 --> 00:54:27,804 "and the child's attempt to adapt 1026 00:54:27,804 --> 00:54:31,802 "to the requirements of the caregivers." 1027 00:54:37,789 --> 00:54:41,175 If you turn to the handout on page 12 now, 1028 00:54:41,175 --> 00:54:44,285 I'm gonna partly read through that. 1029 00:54:44,285 --> 00:54:46,590 And these are some over-arching ideas 1030 00:54:46,590 --> 00:54:51,590 about the most relational core of the object paradigm 1031 00:54:52,939 --> 00:54:56,333 as we've heard about in Fairbairn and Sullivan. 1032 00:54:59,247 --> 00:55:02,829 We are born into this world, now human motivation, 1033 00:55:02,829 --> 00:55:05,763 with the imperatives to relate and connect to 1034 00:55:05,763 --> 00:55:09,022 attachment figures, regardless of how good or bad they are. 1035 00:55:09,022 --> 00:55:10,095 This is a sort of schematic. 1036 00:55:10,095 --> 00:55:12,434 It's reviewing some of what I said. 1037 00:55:14,029 --> 00:55:16,672 We're born with the imperatives to form internal 1038 00:55:16,672 --> 00:55:19,570 psychic structures based on these early experiences 1039 00:55:19,570 --> 00:55:22,169 of self in relation to others. 1040 00:55:22,169 --> 00:55:24,924 Internalizations and identifications in our inner worlds 1041 00:55:24,924 --> 00:55:26,615 based on these experiences. 1042 00:55:26,615 --> 00:55:31,145 And we have the imperative or motivation to sustain these 1043 00:55:31,145 --> 00:55:34,548 internally in order to sustain an internal connection. 1044 00:55:34,548 --> 00:55:38,291 So we have these internal configurations of self with other. 1045 00:55:38,884 --> 00:55:40,202 Psychic structure. 1046 00:55:40,649 --> 00:55:42,117 Psychic structure. 1047 00:55:42,117 --> 00:55:44,711 Now we're not talking about like id, ego, super ego. 1048 00:55:44,711 --> 00:55:46,839 We're talking about a different way of looking at structure. 1049 00:55:46,839 --> 00:55:48,893 Multiple configurations. 1050 00:55:48,893 --> 00:55:53,893 Configurations, templates, schemas, of self and others 1051 00:55:54,036 --> 00:55:59,036 imbued with certain specific relational themes or narratives 1052 00:55:59,102 --> 00:56:01,662 and certain emotional tones. 1053 00:56:01,662 --> 00:56:03,432 Different theorists and models 1054 00:56:03,432 --> 00:56:04,799 have different names for these. 1055 00:56:04,799 --> 00:56:08,091 Attachment theory calls them internal working models. 1056 00:56:08,091 --> 00:56:10,915 Klein has internal objects. 1057 00:56:11,715 --> 00:56:13,542 There's self and object representations. 1058 00:56:13,542 --> 00:56:15,621 There are different languages, but these ideas 1059 00:56:15,621 --> 00:56:20,365 of these internal templates or configurations. 1060 00:56:21,000 --> 00:56:26,000 Psychic structures serve as organizing framework 1061 00:56:26,329 --> 00:56:29,454 for how we experience and live our lives. 1062 00:56:29,454 --> 00:56:33,603 And there are two principles, just as Piaget 1063 00:56:33,603 --> 00:56:36,103 talked about them, assimilation and accommodation. 1064 00:56:36,103 --> 00:56:40,240 We have these inner templates, and so our new experiences, 1065 00:56:40,240 --> 00:56:43,725 moment-to-moment, we assimilate into existing frameworks 1066 00:56:43,725 --> 00:56:48,309 and templates and interpret things into them. 1067 00:56:48,924 --> 00:56:50,666 So our ways of experiencing things are shaped 1068 00:56:50,666 --> 00:56:53,556 by the templates, but if there's enough that's discrepant 1069 00:56:53,556 --> 00:56:56,321 and under certain conditions, the templates themselves 1070 00:56:56,321 --> 00:56:58,779 will revise, which in the Piagetian language 1071 00:56:58,779 --> 00:57:00,949 is accommodation. 1072 00:57:01,678 --> 00:57:03,007 What's the understanding in this model 1073 00:57:03,007 --> 00:57:06,076 of psychopathology or people's problems? 1074 00:57:06,076 --> 00:57:08,909 Continue on page 13 in the handout. 1075 00:57:08,909 --> 00:57:12,284 In early relationships, it's pathology, either pathology 1076 00:57:12,284 --> 00:57:15,858 of the attachment figures and/or problems 1077 00:57:15,858 --> 00:57:18,832 in the attachment relationships that are highlighted. 1078 00:57:18,832 --> 00:57:21,985 They become structuralized in the psyche of the child. 1079 00:57:21,985 --> 00:57:24,526 They become incorporated into the deep core 1080 00:57:24,526 --> 00:57:27,846 of these narrative configurations of self and other 1081 00:57:27,846 --> 00:57:29,800 and relational themes. 1082 00:57:29,800 --> 00:57:33,470 So then, there are these problematic, internalized schemas, 1083 00:57:33,470 --> 00:57:37,584 and that's what causes the problems later in life 1084 00:57:38,985 --> 00:57:42,096 because these schemas organize self-experience, 1085 00:57:42,096 --> 00:57:43,967 they organize experience of relationships, 1086 00:57:43,967 --> 00:57:47,442 and they organize how we engage or don't engage with others. 1087 00:57:47,442 --> 00:57:49,489 So psychopathology, in terms of these 1088 00:57:49,489 --> 00:57:53,296 internal configurations, one can be trapped 1089 00:57:53,296 --> 00:57:57,069 within overly confining and limiting narratives. 1090 00:57:57,069 --> 00:58:00,749 The narratives internally, themselves. 1091 00:58:00,749 --> 00:58:02,710 There can be configurations that are so much 1092 00:58:02,710 --> 00:58:05,833 in conflict with each other that it causes problems. 1093 00:58:06,801 --> 00:58:09,114 Different configurations of self and other. 1094 00:58:09,114 --> 00:58:12,090 Different stories that are too much in conflict. 1095 00:58:12,090 --> 00:58:15,120 There can be problems of excessive dissociation. 1096 00:58:15,120 --> 00:58:17,455 These are overlapping, some of these ideas. 1097 00:58:17,455 --> 00:58:21,783 Irreconcilable or poorly integrated configurations. 1098 00:58:21,783 --> 00:58:25,429 So one lives exclusively in one configuration 1099 00:58:25,429 --> 00:58:29,019 and can't connect with others, getting stuck. 1100 00:58:31,155 --> 00:58:35,458 What's the view of therapeutic action? 1101 00:58:36,490 --> 00:58:38,949 Now let's turn to therapy. 1102 00:58:41,102 --> 00:58:43,553 First I'll talk about Sullivan 1103 00:58:43,553 --> 00:58:45,697 and the interpersonal school. 1104 00:58:45,697 --> 00:58:47,792 And this is all gonna be extremely relevant 1105 00:58:47,792 --> 00:58:51,276 for the relational school on therapy. 1106 00:58:51,986 --> 00:58:56,057 Sullivan, the 1920's, 1930's, and the interpersonalists. 1107 00:58:58,436 --> 00:59:00,845 Three things to say here about Sullivan. 1108 00:59:00,845 --> 00:59:03,499 Two of them are radical, and one was conservative. 1109 00:59:03,499 --> 00:59:05,067 Radical for his day. 1110 00:59:06,621 --> 00:59:09,886 The first was, rather than looking at the therapist 1111 00:59:09,886 --> 00:59:13,583 as separate from the patient, the sort of, the interpreter, 1112 00:59:13,583 --> 00:59:16,751 the blank screen and the interpreter of what's going on 1113 00:59:16,751 --> 00:59:19,314 in the patient's subjective mind, 1114 00:59:19,314 --> 00:59:21,136 Sullivan talked about the therapist 1115 00:59:21,136 --> 00:59:23,977 as a participant observer, not just an observer, 1116 00:59:23,977 --> 00:59:26,173 and that the participation in the relationship 1117 00:59:26,173 --> 00:59:29,375 was part of the therapeutic process. 1118 00:59:31,969 --> 00:59:36,815 And with two ideas here, that the observer is part of 1119 00:59:36,815 --> 00:59:38,977 what's therapeutic, and also that the observer 1120 00:59:38,977 --> 00:59:40,291 affects what they observe. 1121 00:59:40,291 --> 00:59:42,878 I mean, this was post Heisenberg, 1122 00:59:42,878 --> 00:59:45,126 the idea that the active observing something, 1123 00:59:45,126 --> 00:59:48,001 observing a person, you influence them. 1124 00:59:48,001 --> 00:59:50,038 So the therapist is part and parcel of it, 1125 00:59:50,038 --> 00:59:51,667 in the participation. 1126 00:59:51,667 --> 00:59:56,659 And another aspect, Sullivan focused a lot on interactions. 1127 00:59:56,659 --> 00:59:59,548 He would do detailed inquiry with patients about 1128 00:59:59,548 --> 01:00:01,122 who said what to who and then, 1129 01:00:01,122 --> 01:00:04,331 and it was because he felt that through the interactions, 1130 01:00:04,331 --> 01:00:07,288 that's where the person's unconscious life would come alive 1131 01:00:07,288 --> 01:00:11,017 and emerge and could be worked with, is through interaction. 1132 01:00:11,754 --> 01:00:14,197 But the third point, which is the conservative one. 1133 01:00:14,197 --> 01:00:17,251 He focused away from the interactions 1134 01:00:17,251 --> 01:00:19,803 and the relationship with the therapist, 1135 01:00:19,803 --> 01:00:22,696 with like Sullivan himself with his patients. 1136 01:00:22,696 --> 01:00:26,699 He worked a lot with some people who were very fragile, 1137 01:00:26,699 --> 01:00:30,633 very disturbed people, so one thought was that this was 1138 01:00:30,633 --> 01:00:34,672 part of his way of helping modulate, help things 1139 01:00:34,672 --> 01:00:36,626 not get too intense and overwhelming. 1140 01:00:36,626 --> 01:00:40,523 But in any case, he tried to stay out of the fray 1141 01:00:40,523 --> 01:00:43,686 and sit, sort of metaphorically and literally 1142 01:00:43,686 --> 01:00:46,276 a bit side by side, looking out at the patient's world 1143 01:00:46,276 --> 01:00:50,337 with them, talking about their relationships out there. 1144 01:00:50,337 --> 01:00:54,003 This changed, though, as the interpersonal school evolved 1145 01:00:54,003 --> 01:00:57,690 past Sullivan, particularly Eric Frome. 1146 01:00:57,690 --> 01:00:59,519 What a major impact. 1147 01:00:59,519 --> 01:01:02,627 The participation aspect, and the therapist patient 1148 01:01:02,627 --> 01:01:06,443 relationship aspect, comes to the center 1149 01:01:06,443 --> 01:01:08,189 in the interpersonal school. 1150 01:01:08,189 --> 01:01:11,364 One shift in terminology, I think Hirsch said it, 1151 01:01:11,364 --> 01:01:13,569 from participant observer of Sullivan, 1152 01:01:13,569 --> 01:01:15,748 to observing participant. 1153 01:01:15,748 --> 01:01:18,355 The participation part is highlighted more. 1154 01:01:18,355 --> 01:01:19,725 In terms of Eric Frome, 1155 01:01:19,725 --> 01:01:22,816 think like encounter groups of the 1960's, 1156 01:01:22,816 --> 01:01:25,997 but in this case, a group of two in a therapy relationship. 1157 01:01:25,997 --> 01:01:29,813 An intense, existential human encounter. 1158 01:01:29,813 --> 01:01:33,810 Two people engaged in authentic, intimate interaction. 1159 01:01:34,835 --> 01:01:37,558 If the image of the Freudian therapist is sitting back 1160 01:01:37,558 --> 01:01:42,298 and neutral and reflective and interpreting, the Frome style 1161 01:01:42,298 --> 01:01:44,882 of therapist, the interpersonalist, is leaning forward, 1162 01:01:44,882 --> 01:01:49,277 nose to nose, engaged in an intense interpersonal encounter. 1163 01:01:49,277 --> 01:01:51,839 But, importantly, this is analytic. 1164 01:01:51,839 --> 01:01:55,430 Also reflecting and analyzing on what emerges 1165 01:01:55,430 --> 01:01:58,533 and comes out of the interaction. 1166 01:01:58,835 --> 01:02:02,325 That's what's worked with analytically, and interpreted. 1167 01:02:02,325 --> 01:02:05,675 And again, interpreting the ongoing internal ties 1168 01:02:05,675 --> 01:02:08,105 to early caregivers, early caretakers, 1169 01:02:08,105 --> 01:02:12,256 that's not conscious to the patient, but is being lived out. 1170 01:02:12,256 --> 01:02:14,617 To help the patient see how they are organizing 1171 01:02:14,617 --> 01:02:18,271 contemporary life and relationships to conform 1172 01:02:18,271 --> 01:02:23,271 to past configurations, which is a quote by Barnett. 1173 01:02:26,954 --> 01:02:30,089 An especially radical aspect of this, the therapist 1174 01:02:30,089 --> 01:02:35,089 now may at times share counter-transferential reactions, 1175 01:02:35,362 --> 01:02:39,570 how they are affected by the patient. 1176 01:02:40,293 --> 01:02:41,121 Why? 1177 01:02:41,121 --> 01:02:43,837 Because how the patient is affecting 1178 01:02:43,837 --> 01:02:48,004 the therapist's experience may reflect some 1179 01:02:48,004 --> 01:02:50,812 disavowed aspects of the patient's inner world. 1180 01:02:50,812 --> 01:02:53,859 So it's part of the analytic process. 1181 01:02:55,315 --> 01:02:58,719 And enactment is really right at the center here, 1182 01:02:58,719 --> 01:03:02,261 and we're gonna have a whole part of the seminar today 1183 01:03:02,261 --> 01:03:05,335 on enactment, specifically, where the therapists 1184 01:03:05,335 --> 01:03:07,813 gets drawn into repetitions. 1185 01:03:07,813 --> 01:03:11,993 One way, Levinson, an interpersonalist, said this is, 1186 01:03:12,824 --> 01:03:17,724 if the Freudian therapist asks, like, 1187 01:03:17,724 --> 01:03:22,145 what's going on inside you, the patient, Levinson asks, 1188 01:03:22,145 --> 01:03:24,937 so what's going on around here? 1189 01:03:24,937 --> 01:03:26,991 What's going on in this room, in this space, 1190 01:03:26,991 --> 01:03:28,340 in this relationship? 1191 01:03:28,340 --> 01:03:31,413 How can we work with this to help understand 1192 01:03:31,413 --> 01:03:33,728 the process here and understand the inner world 1193 01:03:33,728 --> 01:03:35,633 and work with the inner world of the patient. 1194 01:03:35,633 --> 01:03:37,764 The interaction is analyzed. 1195 01:03:37,764 --> 01:03:40,290 Another paraphrase of Levinson. 1196 01:03:40,290 --> 01:03:44,137 Treatment is what is said about what's been done. 1197 01:03:44,137 --> 01:03:46,128 So it's about what's already happening 1198 01:03:46,128 --> 01:03:48,410 and being done in the relationship. 1199 01:03:49,591 --> 01:03:53,175 And just to, as an overview of therapeutic action 1200 01:03:53,175 --> 01:03:58,175 in this model, you can refer to page 14 in the handout. 1201 01:03:58,339 --> 01:04:00,593 I'm gonna read through that. 1202 01:04:00,593 --> 01:04:01,787 Therapeutic action. 1203 01:04:01,787 --> 01:04:04,078 This is again in the object paradigm, 1204 01:04:04,078 --> 01:04:06,945 particularly Sullivan, Fairbairn. 1205 01:04:08,849 --> 01:04:13,606 What happens, various configurations of the patient's 1206 01:04:13,606 --> 01:04:16,543 internal world are engaged in the therapy. 1207 01:04:16,543 --> 01:04:20,056 And enactment, a central way to bring to life 1208 01:04:20,056 --> 01:04:22,144 and to work with these configurations, 1209 01:04:22,144 --> 01:04:25,713 and what better place than in therapy to have that happen? 1210 01:04:25,713 --> 01:04:28,389 Living out old dead end narratives, 1211 01:04:28,389 --> 01:04:30,151 old repetitives narratives. 1212 01:04:30,151 --> 01:04:34,412 But therapist and patient, after getting stuck for a time, 1213 01:04:34,412 --> 01:04:38,131 must get unstuck and find their way to new resolutions 1214 01:04:38,131 --> 01:04:40,930 within the therapeutic relationship. 1215 01:04:40,930 --> 01:04:43,296 This is a central aspect of therapeutic action 1216 01:04:43,296 --> 01:04:44,505 in this paradigm. 1217 01:04:44,505 --> 01:04:49,161 These new revisions to old internal narratives, 1218 01:04:49,161 --> 01:04:51,147 the old internal narratives evolved in the 1219 01:04:51,147 --> 01:04:55,020 therapeutic relationship, but the new revisions 1220 01:04:55,020 --> 01:04:59,171 are worked out intersubjectively in the relationship, 1221 01:04:59,171 --> 01:05:01,793 and that becomes internalized. 1222 01:05:01,793 --> 01:05:03,523 And the result is accommodation. 1223 01:05:03,523 --> 01:05:07,572 The result is revision, addition, elaboration and revision 1224 01:05:07,572 --> 01:05:10,389 of the patient's internal subject- 1225 01:05:10,389 --> 01:05:13,568 internal relational world, these internal configurations 1226 01:05:13,568 --> 01:05:16,096 by virtue of what's been worked out, old stories being 1227 01:05:16,096 --> 01:05:19,741 worked out in new ways in the therapeutic relationship. 1228 01:05:19,741 --> 01:05:23,061 Insight is a part of this process, an important part 1229 01:05:23,061 --> 01:05:26,823 and it consolidates growth, but there's a lot else 1230 01:05:26,823 --> 01:05:29,229 that's important in terms of the relational 1231 01:05:29,229 --> 01:05:32,415 working out of things in this paradigm. 1232 01:05:33,849 --> 01:05:38,849 And now, if you refer back to page six of the handout, 1233 01:05:41,569 --> 01:05:44,428 this is a familiar chart, it's one we looked at. 1234 01:05:44,428 --> 01:05:47,570 Because we're gonna pause now and just look at this chart 1235 01:05:47,570 --> 01:05:51,403 because now we've talked about the classical paradigm. 1236 01:05:51,403 --> 01:05:54,589 We went through the column on the classical paradigm 1237 01:05:54,589 --> 01:05:56,348 in the chart before. 1238 01:05:56,348 --> 01:05:59,130 This is three models of therapeutic action. 1239 01:05:59,130 --> 01:06:01,094 We talked about the classical. 1240 01:06:01,094 --> 01:06:03,736 Now, if you look in the third column now, 1241 01:06:03,736 --> 01:06:08,736 the third column is a sort of schematic or a brief statement 1242 01:06:08,851 --> 01:06:12,263 of the model of therapeutic action for this object paradigm. 1243 01:06:12,263 --> 01:06:15,897 I put relational on top, but for this paradigm. 1244 01:06:16,869 --> 01:06:19,455 If you start in the middle, under relational, interpersonal, 1245 01:06:19,455 --> 01:06:21,059 object relations, Fairbairn, 1246 01:06:21,059 --> 01:06:23,662 that column, start in the middle. 1247 01:06:23,662 --> 01:06:28,300 The patient's problems are understood as the internal world- 1248 01:06:28,300 --> 01:06:31,203 I'm repeating, but this is just to put it together. 1249 01:06:31,203 --> 01:06:34,487 The patient's problems are understood as the internal world 1250 01:06:34,487 --> 01:06:37,596 of self and others, multiple narrative schemas, 1251 01:06:37,596 --> 01:06:40,756 or configurations, that are overly problematic 1252 01:06:40,756 --> 01:06:44,970 or overly malevolent themes, or they're too irreconcilable 1253 01:06:44,970 --> 01:06:47,249 with each other, the different narratives. 1254 01:06:47,249 --> 01:06:49,346 But these narratives are what organize 1255 01:06:49,346 --> 01:06:51,587 how we live and experience life. 1256 01:06:51,587 --> 01:06:54,230 And they were internalized from early on 1257 01:06:54,230 --> 01:06:56,597 from relational patterns. 1258 01:06:57,573 --> 01:06:59,186 What's the therapeutic action? 1259 01:06:59,186 --> 01:07:02,006 Enactment in the therapy relationship, down below, 1260 01:07:02,006 --> 01:07:04,016 enactment in the therapy relationship of central 1261 01:07:04,016 --> 01:07:07,134 internal organizing narratives of self and other. 1262 01:07:07,134 --> 01:07:10,244 Therapist and patient co-create new resolutions 1263 01:07:10,244 --> 01:07:11,859 to old stuck narratives. 1264 01:07:11,859 --> 01:07:15,134 New relational experience is internalized then, 1265 01:07:15,134 --> 01:07:19,007 and the inner world of the patient is revised. 1266 01:07:19,930 --> 01:07:22,681 If you look at the top of that column, 1267 01:07:22,681 --> 01:07:26,034 the therapist as co-actor, in my language. 1268 01:07:26,818 --> 01:07:30,125 Stark calls it the therapist as authentic subject. 1269 01:07:30,125 --> 01:07:32,070 That's like Eric Frome, the therapist as 1270 01:07:32,070 --> 01:07:35,701 an authentic subject in this interpersonal encounter, 1271 01:07:35,701 --> 01:07:40,111 who also is involved in analying and interpreting, 1272 01:07:40,111 --> 01:07:43,000 but is an authentic subject. 1273 01:07:43,000 --> 01:07:45,240 So that, we've now gone through that whole diagram 1274 01:07:45,240 --> 01:07:50,116 to just summarize two of these three paradigms. 1275 01:07:51,541 --> 01:07:54,574 And now what we're gonna do now is turn 1276 01:07:54,574 --> 01:07:57,323 to the third paradigm, to the self paradigm, 1277 01:07:57,323 --> 01:08:02,323 and I'll ask you to refer to page 15 of the handout. 1278 01:08:02,559 --> 01:08:06,832 That will help as I talk about this paradigm. 1279 01:08:12,190 --> 01:08:14,099 Actually, we'll just read through 1280 01:08:14,099 --> 01:08:16,771 the first page of that together. 1281 01:08:16,771 --> 01:08:19,394 Now again, these all start the same, right? 1282 01:08:19,394 --> 01:08:21,809 We are born into this world with. 1283 01:08:21,809 --> 01:08:25,186 We're talking about what's the inate, inately human, 1284 01:08:25,186 --> 01:08:27,836 about human motivation, the essence of our motivation. 1285 01:08:27,836 --> 01:08:31,439 We are born into this world with, in this case, 1286 01:08:31,439 --> 01:08:35,302 the self paradigm, inate personal potentials 1287 01:08:35,302 --> 01:08:36,896 and proclivities. 1288 01:08:36,896 --> 01:08:41,896 A kind of potential self, a nuclear program for a self 1289 01:08:41,978 --> 01:08:46,978 that needs to be facilitated for its emergence. 1290 01:08:47,242 --> 01:08:51,379 It's not we're born into this world to seek pleasure. 1291 01:08:51,379 --> 01:08:54,858 And it's not we're born into this world to seek contact, 1292 01:08:54,858 --> 01:08:56,115 like Fairbairn. 1293 01:08:56,115 --> 01:08:58,514 We're born into this world with this kind of 1294 01:08:58,514 --> 01:09:02,626 inate set of proclivities that want to emerge and develop 1295 01:09:02,626 --> 01:09:05,034 and give expression to them. 1296 01:09:05,034 --> 01:09:06,631 It's the imperative towards the self's 1297 01:09:06,631 --> 01:09:08,951 emergence and evolution. 1298 01:09:08,951 --> 01:09:13,109 Relationally speaking, there are specific needs 1299 01:09:13,109 --> 01:09:16,703 for types of support from others. 1300 01:09:16,703 --> 01:09:19,215 Kohut calls it, refers to self objects, 1301 01:09:19,215 --> 01:09:21,551 but specific needs for types of support 1302 01:09:21,551 --> 01:09:24,217 to support this self's development. 1303 01:09:25,136 --> 01:09:26,767 Well in this view, what's the view 1304 01:09:26,767 --> 01:09:28,274 of the patient's problems? 1305 01:09:28,274 --> 01:09:30,504 People's suffering and problems? 1306 01:09:30,504 --> 01:09:33,619 When the early environment failed to be good enough 1307 01:09:33,619 --> 01:09:38,317 to nurture this development, if there are excessive 1308 01:09:38,317 --> 01:09:41,282 impingements and failures by the environment, 1309 01:09:41,282 --> 01:09:43,322 impingements is a Winnicottian term, 1310 01:09:43,322 --> 01:09:45,715 impingements and failures by the environment 1311 01:09:45,715 --> 01:09:47,821 that happen too early- 1312 01:09:47,821 --> 01:09:49,716 I mean, there are failures all the time. 1313 01:09:49,716 --> 01:09:51,945 I mean, there are lots of ways as babies and young children 1314 01:09:51,945 --> 01:09:55,295 we feel failed by our attachment figures in moments, 1315 01:09:55,295 --> 01:09:57,838 you know, but also we get, there's the mixture 1316 01:09:57,838 --> 01:10:02,128 of little mini failures and then when we feel supported 1317 01:10:02,128 --> 01:10:04,771 in our expression of self and development. 1318 01:10:04,771 --> 01:10:07,571 But when the impingements and failures are too early, 1319 01:10:07,571 --> 01:10:11,523 too intense, too chronic, too traumatic, 1320 01:10:11,523 --> 01:10:14,729 then the baby and child have to adapt too much 1321 01:10:14,729 --> 01:10:19,157 to the failing environment, and these excessive failures 1322 01:10:19,157 --> 01:10:21,921 become structuralized internally 1323 01:10:21,921 --> 01:10:24,073 in the development of the self. 1324 01:10:24,073 --> 01:10:26,122 There are arrests or derailments 1325 01:10:26,122 --> 01:10:28,481 in the development and unfolding of this self. 1326 01:10:28,481 --> 01:10:30,305 The self structure is vulnerable 1327 01:10:30,305 --> 01:10:33,730 or has deficiencies or fault lines. 1328 01:10:33,730 --> 01:10:38,730 The person becomes prone often to poor regulation of emotions 1329 01:10:38,903 --> 01:10:43,903 and self-esteem, impaired capacity for self soothing. 1330 01:10:43,988 --> 01:10:47,145 And there's, in these sort of self models 1331 01:10:47,145 --> 01:10:50,653 where there's a deficit in the self, 1332 01:10:50,653 --> 01:10:53,707 in the ways that people experience themselves, 1333 01:10:53,707 --> 01:10:57,050 there's a lack of feeling of cohesion, cohesiveness, 1334 01:10:57,050 --> 01:11:00,955 or a lack of continuity, or a lack of vitality, 1335 01:11:00,955 --> 01:11:03,377 or a lack of authenticity. 1336 01:11:03,377 --> 01:11:06,037 In other words, people feel poorly integrated, 1337 01:11:06,037 --> 01:11:08,657 or they feel disjointed and unstable, 1338 01:11:08,657 --> 01:11:10,772 or they feel deadened and depleted, 1339 01:11:10,772 --> 01:11:13,388 or they feel false, like imposters. 1340 01:11:13,388 --> 01:11:16,545 Those are the ways that these self models 1341 01:11:16,545 --> 01:11:19,482 would talk about, would describe people's problems 1342 01:11:19,482 --> 01:11:22,582 and talk about it in terms of this inner self structure 1343 01:11:22,582 --> 01:11:26,889 and how the environmental failures led to problems 1344 01:11:26,889 --> 01:11:29,350 in this inner structure of self. 1345 01:11:32,085 --> 01:11:36,220 Now if we turn to therapeutic action in this model. 1346 01:11:36,220 --> 01:11:38,603 Because with all these models, right, 1347 01:11:38,603 --> 01:11:42,763 the view of human nature, what flows out of that 1348 01:11:42,763 --> 01:11:44,902 is the view of what causes people's problems 1349 01:11:44,902 --> 01:11:47,763 and the view of therapeutic action. 1350 01:11:47,763 --> 01:11:49,860 Within each paradigm there's a cohesiveness 1351 01:11:49,860 --> 01:11:52,279 among these factors. 1352 01:11:52,834 --> 01:11:54,723 Now we're turning to therapeutic action 1353 01:11:54,723 --> 01:11:56,850 in the self paradigm. 1354 01:11:57,265 --> 01:12:02,265 And the model here, it's a provision model of therapy. 1355 01:12:04,152 --> 01:12:06,989 And this is on page 16 of the handout. 1356 01:12:06,989 --> 01:12:10,609 Archaic needs, or early needs, are reactivated, 1357 01:12:10,609 --> 01:12:14,714 but this time sufficiently met in the therapy relationship. 1358 01:12:14,714 --> 01:12:17,824 There's a provision of, I'll use the phrase I used before, 1359 01:12:17,824 --> 01:12:20,778 the needed relationship in therapy. 1360 01:12:20,778 --> 01:12:23,953 Empathy here is a central factor in therapeutic action. 1361 01:12:23,953 --> 01:12:28,134 It's not a background factor or a precursor. 1362 01:12:28,857 --> 01:12:32,743 Important also are the repair of relational attunement 1363 01:12:32,743 --> 01:12:36,767 when inevitable ruptures occur in the therapy relationship. 1364 01:12:36,767 --> 01:12:39,893 And in this whole process of this provision model, 1365 01:12:39,893 --> 01:12:44,059 there's a healing of damaged aspects of this self structure 1366 01:12:44,059 --> 01:12:47,449 and the self resumes its development. 1367 01:12:52,565 --> 01:12:55,955 Some specific theorists, you know Kohut is the theorist 1368 01:12:55,955 --> 01:12:58,551 most closely associated with this paradigm. 1369 01:12:59,289 --> 01:13:01,935 He had a very particular model about how he talked about 1370 01:13:01,935 --> 01:13:03,174 aspects of the self. 1371 01:13:03,174 --> 01:13:04,650 I'm not gonna get into all of that. 1372 01:13:04,650 --> 01:13:08,731 And particular forms that the self objects, 1373 01:13:08,731 --> 01:13:12,723 or the parental figures, have to meet the needs of the baby, 1374 01:13:12,723 --> 01:13:15,287 and the therapist has to meet the needs sufficiently 1375 01:13:15,287 --> 01:13:16,670 of the patient. 1376 01:13:16,670 --> 01:13:18,405 If you're familiar with it, there's a whole 1377 01:13:18,405 --> 01:13:22,630 conceptual language of mirroring and idealizing 1378 01:13:22,630 --> 01:13:24,970 that's a part of the provision, but I'm not gonna go 1379 01:13:24,970 --> 01:13:27,043 into detail about that. 1380 01:13:28,100 --> 01:13:30,628 Winnicott also, although Winnicott is 1381 01:13:30,628 --> 01:13:34,361 an object relations theorist, 1382 01:13:34,361 --> 01:13:37,474 the earlier paradigm we talked about, the object paradigm, 1383 01:13:37,474 --> 01:13:39,345 there are a lot of aspects of his theory 1384 01:13:39,345 --> 01:13:43,037 that also blend with the self paradigm. 1385 01:13:43,037 --> 01:13:46,592 In my chart on page five with all the, that tree, 1386 01:13:46,592 --> 01:13:51,592 Winnicott has lines both to object and self 'cause Winnicott 1387 01:13:52,008 --> 01:13:55,981 talks a lot about true self, false self, self development. 1388 01:13:56,623 --> 01:13:59,706 So those two theorists both have important 1389 01:13:59,706 --> 01:14:02,852 connections to this self paradigm. 1390 01:14:04,940 --> 01:14:09,898 Now if we turn back to page six again, the same, 1391 01:14:09,898 --> 01:14:13,519 we're going back to the same chart in the handout 1392 01:14:13,519 --> 01:14:16,145 of models of therapeutic action, 1393 01:14:16,145 --> 01:14:18,687 we're now ready to complete this chart. 1394 01:14:21,033 --> 01:14:23,663 We've talked about the classical, the first column, 1395 01:14:23,663 --> 01:14:24,860 the classical Freud. 1396 01:14:24,860 --> 01:14:27,823 We've talked about the relational interpersonal object, 1397 01:14:27,823 --> 01:14:29,419 the third column. 1398 01:14:29,419 --> 01:14:31,134 Now we're looking at the middle column, 1399 01:14:31,134 --> 01:14:34,484 which is the self paradigm that I just talked about. 1400 01:14:34,484 --> 01:14:36,662 Starting in the middle of that column, 1401 01:14:36,662 --> 01:14:40,385 the patient's problems are understood in terms of 1402 01:14:40,385 --> 01:14:44,812 a self structure that's fragmented, vulnerable, deficient. 1403 01:14:44,812 --> 01:14:47,441 There are fault lines due to arrested or derailed 1404 01:14:47,441 --> 01:14:50,695 development because early needs were poorly met. 1405 01:14:50,695 --> 01:14:51,814 That's what I've been saying. 1406 01:14:51,814 --> 01:14:53,639 That just summarizes that. 1407 01:14:53,639 --> 01:14:57,254 That's the nature of the patient's problems in this model. 1408 01:14:57,254 --> 01:15:00,935 Therapeutic action follows from the view of the problems. 1409 01:15:00,935 --> 01:15:03,849 Provision, down below, same column, 1410 01:15:03,849 --> 01:15:06,971 provision of the needed relationship. 1411 01:15:06,971 --> 01:15:10,786 Early needs are reactivated and met well enough this time. 1412 01:15:10,786 --> 01:15:15,786 Healing of the damaged self and resumed development. 1413 01:15:16,298 --> 01:15:19,777 And if you look at the top of that column, the therapist as, 1414 01:15:19,777 --> 01:15:23,920 my term here is nurturer, Stark calls it 1415 01:15:23,920 --> 01:15:25,849 empathic self object. 1416 01:15:27,894 --> 01:15:32,894 So now that chart puts together in a very summarized form 1417 01:15:33,041 --> 01:15:34,816 all of what we've talked about. 1418 01:15:34,816 --> 01:15:36,998 And if you just think about just the therapist, 1419 01:15:36,998 --> 01:15:40,042 the top line, the classical model, 1420 01:15:40,042 --> 01:15:43,187 the therapist as interpreter, the blank screen, 1421 01:15:43,187 --> 01:15:46,340 projective screen, and the interpreter. 1422 01:15:46,340 --> 01:15:48,025 The middle column, the self paradigm, 1423 01:15:48,025 --> 01:15:50,099 the therapist as nurturer. 1424 01:15:50,099 --> 01:15:52,461 And the third column, the object paradigm, 1425 01:15:52,461 --> 01:15:54,593 the therapist as co-actor. 1426 01:15:54,593 --> 01:15:58,219 Interpreter, nurturer and co-actor. 1427 01:15:58,219 --> 01:16:00,289 That's three different aspects that are 1428 01:16:00,289 --> 01:16:04,387 emphasized differently in the different models. 1429 01:16:07,982 --> 01:16:12,468 Next I'm going to take a break from theory. 1430 01:16:12,468 --> 01:16:14,047 That was a lot. 1431 01:16:14,047 --> 01:16:18,239 That was the big push for developing the theoretical ideas. 1432 01:16:18,239 --> 01:16:21,060 And now that we've talked about the three paradigms 1433 01:16:21,060 --> 01:16:22,814 and the ways in which- 1434 01:16:22,814 --> 01:16:25,048 We've set the stage for how they're gonna contribute 1435 01:16:25,048 --> 01:16:28,410 to the central theoretical ideas for Relational, 1436 01:16:28,410 --> 01:16:30,388 with a capital R, the Relational school, 1437 01:16:30,388 --> 01:16:32,156 what we're focused on today. 1438 01:16:32,156 --> 01:16:35,116 We're gonna take a break from theory, though. 1439 01:16:35,116 --> 01:16:38,452 I'm gonna present a case, a man I'm gonna call Bill, 1440 01:16:38,452 --> 01:16:41,139 and talk about this case. 1441 01:16:41,139 --> 01:16:44,239 And then when I talk about central ideas of 1442 01:16:44,239 --> 01:16:47,009 Relational school, the Relational theory, 1443 01:16:47,009 --> 01:16:51,146 the case will be there as a live kind of illustration 1444 01:16:51,146 --> 01:16:53,305 and elaboration of some of the ideas 1445 01:16:53,305 --> 01:16:55,045 that I'll be developing.