- There were two central metaphors that developed
near the end of the treatment.
Mary's love of colors and flowers
also became the basis for one of these metaphors.
As she was sharing with me tearful memories,
it was of her family when she was a girl
moving during her childhood away from home,
that had an specially beautiful garden,
to another part of the country
that was more arid and desolate.
And I had, when she was talking about the moving
and how sad she was, I had this reminiscence about
an experience I had years before
backpacking in the desert after a rainstorm,
and I told her she reminded me of a desert flower.
Though she experienced her early environment as arid,
and she adapted by being all closed up,
under the right conditions she opens up with emotions,
showing her colors with such poignancy and radiance,
the way desert flowers do when it rains.
In moments such as this Mary would
smile and cry all at once,
and she even joined in the metaphor play
by teasing herself light-heartedly
that this also explains her self-protective thorniness.
During the last phase of the treatment
the second central metaphor emerged
in a session in which Mary noticed herself
lapsing from her new found openness back into
a temporary lapse into a kind of cold,
bitter and battled attitude towards a colleague.
But she interrupted her own bleak trajectory
and reflected with wry humor,
"I'm at it again", putting a negative frame on everything,
and she shifted out of it and she coined the term
"the malevolent picture framer".
She said, "That's what I do, that's what--
"I'm the malevolent picture framer".
And she and I could now chuckle together
at the appearance of an old scenario,
one which we had grown over the years now
to know so well, and which now
had much less power in her inner world.
The phrase she coined, "The malevolent picture framer",
became our private language for the imposition
of her old cataclysmic and deadening scenarios.
It became a kind of talisman, the phrase itself,
a reminded generated within our relationship
for her to touch base with when she felt herself
begin to lapse into the old negative world view.
The two phrases, the "desert flower"
and "the malevolent picture framer"
encapsulated Mary's old inner grim and hopeless world,
while both phrases also represented
transformations as the utterance of these phrases
was imbued emotionally with life's new possibilities
discovered and developed within our relationship.
I'll read now her commentary
in the final session and termination.
Needless to say, I've become very fond of Mary,
and this was a powerful part of our new narrative
and it helped her to become fonder of herself.
Here's her comment in the final session
on our re-writing of the narrative
about how I initially did not much like her.
She said, "I guess in a weird way,
"even the memories of that conversation
"we've spoken of so many times,
"you said you had feelings of liking for me.
"As a way in which that memory has become
"more positive than negative it's a useful one for me.
"It thought the mixed natured of the human condition.
"Liking is not an all or nothing thing."
She smiles warmly.
"There are moments when I can think about a person now,
"I feel like this person experiences
"some feelings of liking for me",
she says it a little bit sarcastically and laughs.
"At first this can sound like a really bad thing
"but it's okay, there once was a person
"who had feelings of liking for me,
"yet we went on to have a very good friendship."
Maybe needless to say, but it was by virtue
of our working through the old patterns
in the therapy of relationship that Mary could find
liberation from the imprisonment within
the old deadening patterns in her ways
of experiencing herself and others.
These developments in treatment enabled her
in her day-to-day life to receive and to feel
more of life's nurturing elements.
Now when her boyfriend puts his arms
around her she can feel his arms around her.
These developments also helped her to show
more of her colors to herself and to others.
A break? Just wanna check-in about the time too.
Oh, I can, how are we on time for this tape?
I mean, for this card or whatever?
- [Voiceover] Yeah, we have 18 minutes left.
- Okay. - [Voiceover] On this card.
- Okay, I'm good to go.
- [Voiceover] Although, we (mumbling) real quick.
- Okay.
Good to go?
Sound still working?
Okay.
- [Voiceover] Let's see, it's four minutes left here,
or whatever works for you,
I can do like two or three, or just like...
- Yeah, maybe I can do four, three, two-- Yeah.
Okay.
I'm going to, now, talk about enactment,
and I'm gonna be making reference to Mary's work with me
and talk about some ideas about enactment.
And I'm gonna start with reading a quote from Phil Bromberg,
very important interpersonal stimulational theorist.
He says beautifully, there's some overlap,
there's overlap with some of the ideas
I've been saying but he says it, I think, so well,
"In brief, I'm arguing that personal narrative
"cannot be edited simply by more accurate verbal input.
"Psychoanalysis must provide an experience
"that is perceivably, not just conceptually,
"different from the patient's narrative memory.
"A central aspect of this process is that
"the patient-analyst or patient-therapist relationship
"itself is inevitably drawn into the telling
"of the narrative and experienced by both parties
"as a living entity that must be continually
"renegotiated as the analysis proceeds.
"The core of the negotiation is that the meaning
"of the relationship is intersubjectively,
"though asymmetrically, constructed out of
"the patient's self-narrative
"and the differences from it."
So it's the patient's self-narrative
that is allowed to develop in the
therapeutic relationship, but then there are
the differences from it.
I'll go on with the quote,
"It is in this sense that psychoanalytic inquiry
"breaks down the old narrative frame,
"the patient's 'story', by evoking
"through enactment perceptual experience
"that doesn't fit it, thus allowing
"narrative change to take place."
You know, Mary's experience of me as recognizing her
and being really attune and really with her,
for example, scrapping experience.
"Alternative, consensually validated narratives
"that contain events and experience
"of self-other configurations formerly excluded",
those that are the narratives that were formerly excluded,
"begin to be constructed and symbolized,
"but not by words themselves but by new
"relational context that the words come to represent".
It's the evolution in the new relational context,
is central to therapeutic action.
As Bromberg puts it elsewhere,
"meaningful analytic change comes not
"from bypassing old object relations
"but from expanding them from the inside-out",
getting into them and then working
one's way out of them.
"And this requires the therapist openness
"and capacity to engage with these
"different configurations."
There's a kind of redefining of neutrality here
that some theorists will talk about.
Neutrality, the therapist capacity to engage
with various relational configurations
of the patients, keeping the enactments fluid
and changing and open and moving.
And this, as I said earlier, this is,
this whole view of enactment as part
of the central part of therapy,
and repetition, is an expansion of
Freud's playground in repeating,
remembering and working through the analytic space
as a playground where the past is allowed to,
and the internal world is allowed to come to life,
but here it's there intersubjective coming to life,
the relational coming to life of that story.
Repeating, we might say now,
repeating intersubjectively,
revising in the relationship,
working through in the relationship,
and internalizing the new experience.
And here that in Mary's termination statement,
the revision of her internal configuration
of self and others, now when she experiences
something in the world,
the experience that evolved
in her relationship with me is there
and it revises the old grim scenarios.
Inside is a part of this process,
but sometimes the inside comes even after
the relational working through and revision.
There's a quote, a little quip that
I really like from an article on repetition
by Eva Hoffman, and it says, it's a play on the old,
the philosophy statement,
"Those who do not understand the past
"may be condemned to repeat it. But...",
here's the play on that,
"those who never repeat it
"are condemned not to understand it."
And the idea that is through repetition,
but repetition with change that we come
to understand our past.
It's a beautiful way that Loewald commented on this,
about how we hold our past inside us.
"The modifications--", this is Loewald,
"The modification of the past by the present--"
It's a really, that's a wonderful
beginning of a sentence,
"The modification of the past by the present
"does not change 'what objectively
"'happened in the past', but it changes
"that past which the patient carries within him
"in his living history."
And that's what the work with Mary,
I think, illustrates beautifully her work.
So, I want to just conclude this section
on enactment by talking about--
I'm just gonna touch base with those six themes,
those six dimensions and themes connected
with enactment and with Mary, with her treatment.
And some of it may be obvious but I wanna
just go through and make a few connections explicit,
and they overtwine, I mean they overlap
intertwine with each other.
Okay, first, intersubjectivity.
Go to the same six, intersubjectivity,
the work in that mode to expand and explore
the inner world, I've just been commenting on this.
The transference, "you don't like me",
is both brought by Mary and co-constructed
in our own particular way with me,
it's intersubjective, it's subjective,
it's broad, but it's intersubjectively, it comes alive.
How does that happen?
Through her selective attention,
she pays attention to signs of dislike
and doesn't pay attention to signs of liking
or whatever, and through enlistment,
she enlist me, she evokes in me as well as her.
In any case, my screen was not blank and it never is.
Number two, cure by action or interaction.
It's clear my verbal responses are not
merely informative, as I emphasized already,
they're performative, and as the treatment
and our relationship grew and deepened
it was the poetic and playful exchanges
in our dialogue that was hugely important.
And the metaphor of the desert flower,
my creation of that image,
while interpretive, recognizing through the image
certain aspects of her character,
is clearly also an action, my generating that
and sharing that with here is an action,
it's an expression, that theme it's an expression
of appreciation and love of who she is.
And as Mitchell says,
"Every interpretation is a relational event."
When I interpreted her passive-aggression with the weeding
and her boyfriend it was the lightness
and the playfulness that's part of it,
that's all part of it.
The third area, expressive participation.
I don't, I think I won't even say.
So, runs throughout the treatment.
That, yes, there's analytic restrain and discipline
on how I work with her,
but the expressive participation was crucial.
The fourth point of mutuality,
that was the counterpoint of asymmetry,
the poetic and playful exchanges between us,
that's in the area of mutuality.
My sharing associations, I'm not just
interpreting I'm sharing associations,
the desert flower.
My speaking with conviction.
You're not just some efficiency machine,
it's different from objectivity.
The mutuality of impact, there's a paper
by Slavin and Kriegman about how
the analyst needs to change.
I needed to change, there's a mutuality impact,
it's not just that she's changing,
the therapist needs to change if a deep level
of work is gonna happen, and there's clear
there's evolution in my feelings towards her,
that was a crucial part, the mutuality of this treatment.
The fifth theme was the repeated relationship,
that's what enactment is all about,
but as we said, the repeating intersubjectively,
relationally, not just repeated in the patient's mind.
And the sixth theme, needed relationship.
If you remember when I said,
for example, to Mary, "It helps to have
"a better sense of you in you by hearing that
"there is a sense of you in me."
When I was reflecting and holding on to her,
her vitalizing sense of humor...
And as I said earlier, it's so touchture ,
there were smiles and tears, it's so touchture
that even a mis-herself loathing,
I can hold this positive image.
That's part of the nurturing
of the relationship as well.
And so, concluding this whole section
now on enactment, and the work in this area,
it inherently involves the greater sort of freedom
and spontaneity for the therapist,
and it's part of this counterpoint
with the needed analytic restrain and discipline
of the expressive participation,
and enactment being a co-actor on a stage
involves that spontaneity and that
expressiveness and authenticity.
So that concludes the enactment section,
and we're gonna move on to the last section now
for the course which is a relational view of the mind,
'cause so far all what we've been doing all along
has been focused on the therapy process,
therapeutic style, therapeutic ambiance,
therapeutic options, therapeutic action.
And we've been focusing on that and
the different paradigms.
Now we're gonna shift gears and talk about
the view of the mind, the view of human psychology
'cause in the beginning, as I said,
relational theory has focused on being a clinical theory,
but it also is, does have theories of mind in it,
theories of human psychology, and it's now to that we turn.
As a way of beginning to talk about
relational model of the mind I'm gonna talk
a little bit about Freud's model of the mind,
the relational model is very different
but it helps to contextualize it.
Freud's model of the mind, as you may know,
there's the topography of the mind,
a kind of an archaeological model,
as we've talked about, with layerings and surface and depth.
His original model, the topographic model,
had the conscious, preconscious and then unconscious,
and the repressive barrier.
Later he added the structural theory
of id, ego and super-ego, and held on to both
of those as aspects of his way of looking
at the human mind at the structural features.
And so when Freud talks about the dividedness of the mind
you can think about, well if the mind is divided,
what are the joints between the parts?
And what are the joints between?
Well, the joints are between these layerings,
the conscious and the unconscious,
the id, ego and the super-ego.
A relational model of the mind which is
being developed by various theorists,
very important contributions from Phil Bromberg,
Jody Davies, among others.
We're talking about, as we've been saying, internal--
The parts of the mind, these internal configurations,
this one, this one, this one
multiple internal configurations
of these narratives of self-another,
and so the dividedness is between the configurations,
the joints are there between these different configurations.
And as I'm gonna develop, this is a model
unlike Freud's which was based primarily
on repression between the unconscious and conscious,
this model will incorporate much more dissociation
as the force that holds the parts apart from each other.
And, the notion that we have,
these multiple configurations,
and the configurations become the basis
for states of the self, and that we all have
multiple states of the self.
Now, these ideas may not make sense at all yet,
I'm gonna give an example, so if you're not familiar
with these ideas hopefully by the end
these ideas will make sense.
And it can sound this idea,
we have multiple states and multiple configurations
like little homunculus in there,
it can sound strange like we all have
multiple personality or Dissociative Identity Disorder.
And we can think about that as a metaphor
for this structure or model of the mind,
but of course, you know, not that
we all have those conditions.
So first let's begin by talking about
dissociation before I get into models of the mind
'cause it's a crucial concept here,
and it's a concept that covers a lot of territory.
We can think about dissociation as a defense,
like a response to trauma or threat
of being emotionally or psychologically overwhelmed,
you can think about dissociation as a symptom
as in flashbacks with PTSD,
you can think about dissociation as in disorders,
dissociative disorders, and you can think about
dissociation as a dynamic force in the mind,
and that's our focus here,
a major organizer of interpsychic life
having to do with these multiple configurations
and multiple states of the self.
But whichever meaning of dissociation
that we're talking about, it involves
a break in integration, you know,
dis-association, breaks in association of parts,
that's what it's about.
And it has purpose and function to hold apart
elements of the psyche and soma that if
brought together would cause problems,
too much pain, too much strain,
because the parts are too incompatible
or discontinuous with each other,
or maybe kept apart because one part
would threaten to overwhelm, there'd be a flooding,
an overwhelm activation in emotion from one part
that would infiltrate other parts.
So, different reasons, pain, strain,
incompatibility, flooding, different reasons
that the mind holds things apart.
The very different forms of dissociation too
in terms of what they feel like,
you know phenomenologically.
I think of them in two different categories,
one kind of dissociation involves vagueness,
vague, diffuse states that lack articulation,
and another kind of dissociation
involves articulated states but they are disjointed
and disconnected from each other.
So, like with the first one, the vague,
diffuse, think of a continuum,
on one end the most normal kinds of
diffuse dissociative states would be things like
day-dreamy states or so called highway hypnosis,
you're driving along, somehow you got off
at the right exit but you don't remember
having thought about it consciously at all.
We get in these kind of vague diffuse mental states.
On the other end of that though,
of the continuum in terms of problematic vague,
diffuse states, are things like fugue states,
derealization, depersonalization, numbing,
freezing states, numbing states, things like that,
where is vague and diffuse
but in a much more intense and problematic way.
Likewise there's a continuum of severity
for the disjointed states, articulated but disjointed,
the most ordinary would be, you know you say
something to somebody and you think,
"I can't believe I said that, you know?
"I'm like not myself today."
That's an ordinary experience, we all have it.
"I'm not myself today", if I'm not myself, who am I?
The idea that there's some sub-organizations
inside and there's some part of the self
or state of the self that said that thing,
that other states or parts of the self think,
"that's not like me", that's ordinary.
That's one end of this disjointed
or discontinuous experience or feeling,
at the other end is multiple personality
or Dissociative Identity Disorder where there are
really fixed, articulated personalities
that are rigidly kept apart.
Okay, so having talked a little bit about
dissociation...
I'm gonna shift into talking about a case,
and then what I'm gonna do is use the case
to talk about the whole model of the mind,
and dissociation is gonna come back in.
So I'll call this patient John, he's now in his 40s,
as you'll hear he's been in treatment with me
off and on for a period of years,
and he's progressed enormously, so a lot of
what I'm gonna present it's earlier,
so it's when some of his difficulties were more prominent.
But he's in his 40s, he's returned for therapy
after a number of years since his first therapy.
He first came to see me with his then girlfriend
about 12 years ago, and I'm gonna present one--
They came as a couple.
I'm gonna present one vignette
that's from that therapy and then
I'll move forward in time.
And what you'll hear in this vignette,
I'm gonna be working, you'll hear me working
with him around the issue of splitting,
splitting of the other, the object,
seeing another person as all good or all bad,
and I'm gonna contrast that with later work
that I do with him...
Well, we'll get there, I don't wanna get ahead of myself.
So let me describe John a little bit,
he's tall, handsome, very athletic, very athletic-looking.
When he came in with his girlfriend
back then they would come in to the sessions,
they could be very affectioning and friendly,
but they could also be in very heated conflict,
and when in conflict what would happen
they would review their past fights from the day before
and they would get into huge battles in my office
over who had said what to whom,
two different histories to tell.
In one particular session, the same familiar argument,
this time the argument at home had come up around...
He had been doing a project at his desk
and she had come in and asked him if he could stop
and come and help her do something,
and he had been, he is facing a deadline with this project,
was feeling very pressured about it,
and he got very angry, and he saw her
as showing no consideration for his time
'cause she knew he had a deadline.
She had requested his help and at the time
she accused her of being totally selfish.
Years later we would identify a certain state
he was in at his desk,
a state that he would call "ching-ching-ching",
a kind of semi-manic state of working on something,
immersed in that task.
But anyway, so they fought about it,
he said she was being totally selfish,
the fight spilled in over into my office,
he accused her of being totally self-centered,
said he had to protect himself and his interest
so she wouldn't take advantage of him.
She began to argue back that maybe they both
at times could be oblivious to the needs of the other
but she felt that actually she had trouble,
mostly asserting her needs towards him,
and as she spoke he was fuming,
and he was looking away, and he was looking at me
like this, without saying it as if saying to me,
"Can you believe this?"
And before she could finish each statement
he would interrupt and he would repeat this accusation
that she was totally self-centered
unwilling to look at her faults,
and he started to like cross-examine her
and sort of badger her into silence,
and then eventually submission and then tears.
And once she was silent and crying he kept going
and he was insisting that his rendition
was 100 percent accurate
and hers was 100 percent distortion, and she sobbed.
And this process was not unusual
when they would get in these conflicts,
he would enter this mode of being rigid
and superior and devaluing her,
and she would be silenced and tearful.
And though he could at times speak quite friendly
and warm and charming, when they were in conflict,
with her, I think with others too,
he could get like this.
So, for me, sitting with them was difficult,
it's difficult to try to figure out
how to try to enter into this process,
and I struggled along in different ways,
but I chose this particular session
'cause it illustrates something I wanna illustrate.
Anyway, I thought, as this was going on,
I though about to myself, "How much he's vilifying her?"
Yet is not that long ago in another session
he did express feelings of love for her
and admiration, bordering on idealization of her.
So the first thing I did was I interrupted him
and I asked him, first I asked him
just what his reaction was to her tears
in the face of his arguing, I wanted him
to take notice first of how much he was hurting her.
No sale, he said, kind of looked at her a little,
but he said he recognized he was angry
and he was being somewhat aggressive,
but he didn't feel badly about it,
he thought she deserved it and he didn't wanna
let her off the hook just because she was crying
for her failure to take responsibility
and for her attempts to blame him
for what he saw as her fault.
He reiterated that he thought she was trying
to take advantage of him and his time
and did never guard for him and his time,
and she wouldn't admit her own selfishness.
And he said, he's thought she was being cowardly,
too weak and too scared to take responsibility
for her own actions.
So then I said to him,
"I know that's how you're seeing her now,
"and I know this is gonna be difficult to do,
"but I wanna ask you to talk about
"how you see her at times when
"you're feeling good with each other."
And after a long pause he reluctantly replied,
but very flat, he wasn't really there,
but he did say, "Well, yeah, at those times
"I think she's beautiful and highly intelligent
"and accomplished and an enrichment to my life, but...",
and he kind of pulled back from it but said it.
And he looked a little bit shaking at first
and then he resumed to a kind of cold,
steely posture towards her.
I started to speak further but I could see
that he was protecting himself from the impact
of what I was saying by looking often to space,
he wasn't making eye contact with me nor with her,
she was still crying, so I asked him
if he would look at her while I spoke,
and he did look at her, she's still crying,
he's looking at her, and I make the following statement,
I said, "While you feel justified and righteous
"in punishing the coward who blames you
"for what is her fault,
"the one that is too weak to admit it,
"the problem is that at the same time
"you're punishing the one who is the most important
"source of enrichment to you,
"the one who is beautiful, and whom you greatly admire.
"When you punish one, you punish the other,
"there's no getting around that."
And as he looked at her now, and she's still crying,
he finally shift, he shifts, and dramatically,
and he did two things that both of which he rarely did
at that point in time, though much has changed,
but he said, one was he started to cry,
and the other was that he apologized,
he said, "I'm sorry, I'm sorry, I'm so sorry."
And that session was a very, very meaningful
piece of work, it was a matter in the session
working to resolve a kind of splitting in his mind
of the all good and the all bad girlfriend,
and his tendency to get into that mode.
But to bring this now, to frame our focus now,
'cause I'm gonna continue talking about John,
what I'm gonna focus on now today for this
is not just how he's distorting his view of her,
of the object, but also I wanna take the focus
more into the internal for John,
the internal configuration of self with other.
There is, in other words, there is a self inside
who is seeing her that way.
And to expand this idea to multiple states of self,
that each state of self is organized
around specific configurations of self and other.
So here's the thing, it's not just
how does he see her at this moment,
how does he see the other person at this moment,
the question it's more to the point of
where I'm getting to now, who is it in him
who sees her that way?
And then, who is it differently in him
who sees her in another way?
There's a whole internal configuration
of the self that's paired with the way
the other is seen.
So, to illustrate that, more on the treatment.
The couple's therapy, they broke up amicably,
they broke up with each other
so the couple's therapy ended.
He continued for a time in individual therapy
with me back then and made some reasonable progress,
and at a certain point
he left treatment after some progress.
And then he called me a few years ago
and he said that he had a different girlfriend now,
but he recognized, and you can hear the growth,
he recognized that he still has issues
and it makes him unable to be involved
in a healthy way in a relationship,
and he wants to work on them.
So he comes back, we start to work individually,
and then about a year into that he made a request to me,
he asked if I would meet with him
together with his current girlfriend.
And we talked about that,
I debated about that in my mind,
they were talking about maybe going
into couple's therapy, it was clear that
they weren't gonna do that with me,
and I was clear about that,
but I was trying to help them kind of
get over the hurdle to actually do that,
so I decided to, agreed to a few sessions
to meet with the two of them.
It's a little unconventional but anyway I did that.
So, I'm gonna be presenting process from
both a couple's session and from individual sessions,
and again, what I wanna illustrate here
is not just how he can have disjointedness
and how he views the other person but working more directly,
kind of internally, with the state of the self
that is experiencing this other person
in this different ways.
Here's a bit of process from one of the couple's,
one of these few couple's sessions.
They begin the session warmly towards each other,
she put a reassuring hand on his knee
which he accurately sensed that she's preparing
to bring up heated stuff for recent conflict.
His state, and I'll be coming back
to say more about this but, his state,
he starts to get very anxious,
he has a look of dread on his face,
he gets a bit pale, his shoulders hunch forward a bit,
he's leaning but he's leaning also lean back,
and his hands are gripping his legs,
he's very, very anxious.
She begins to talk about a recent conflict
when she was angry with him for
something he had said, then there was a familiar process,
they started to have a diametrically opposed views
of the history of that argument,
they're in the office disagreeing about what,
"No, I said this", "No, you said that", "No, you didn't".
And part of their argument had been in person,
part had been on email, so he starts to
now shift in this back and forth of disagreement
from anxious to anger.
And she starts to argue his case,
and she disputes him, and now he starts to
really ramp up in anger, and now we're seeing
a pronounced shift into a different state
from this anxious state.
His body leans forward, his posture straightens,
he's at full height, his arm comes up,
and he's pointing his finger with staccato movements
towards her like this, and his speech is getting louder
and more pressured, and the content becomes
kind of threatening, not literally threatening,
but it has a quality like that.
He makes prosecutorial references to evidence
that he's got on his email, he can show her
that what he's telling is the truth, and that she's wrong.
And I feel as I'm watching this, he,
I see this activation of his anger and I felt anxious,
I mean I didn't literally felt frightened
that he was gonna do something physical,
but it's this sense of anxiety with how intense he was.
She reacted by putting her hands up like this
and leaning away, frightened.
And he protests saying he's not even
being that aggressive, yeah, he's angry,
but not that intense, he's just arguing the facts.
Now, what you'll hear next,
and this is getting into the theme
for the section of the day here,
I do not work so much with the content
of what he's saying now, you know like,
years before I was working with the content
of how he was seeing the prior girlfriend,
the good girlfriend, the bad girlfriend,
the content, but now I'm gonna work
more directly with his state.
So when he's like this, with this grimness
of anger and leaning forward and finger pointing,
I jumped in and I asked him, I asked him not to move,
just to stay like he is, and I asked him to take his,
if he would take his attention away from her
and just attend to what does he sense in his body.
And he sits there for a moment, and he's like this,
and he sits there, his arm and finger extended,
his jaw still clenched, the blood is pumping,
he's in a state of rage, he's extending into her space.
And then he softens a bit, he looks a bit limp,
his upper body, and he begins to speak,
and he's a little bit dazed and tense,
tentative, but he starts to admit that he's been,
he's actually being pretty aggressive,
he's realizing that he's being pretty aggressive.
He'll tell me, in an individual session
the following week, he would then tell me that he came,
it was only after the session
that he really came to realize how aggressive he gets,
how pumped up with anger he gets.
In the session itself he kind of didn't want to admit it,
he tells me later, he acknowledged it
but he didn't really want to admit it fully.
But during the week in-between after that
couple's session and the next week
when he and I meet individually,
he's tuned into it, he's now aware of it,
and he's realizing what state he's in
and how incredibly angered
and aggressive he is in that state.
And then we start to explore that state,
"John the righteous, angry avenger",
and with the pointing finger,
and there's a wonderful openness for him
of really overtime looking at that state.
And he's acknowledging all this
in a reflective way, how we--
He's like ever right and ever righteous,
lose no battle, take no prisoners,
vanquish the opponent in the argument,
and they're 100 percent wrong, and...
And he's working on that now over a period of time
in the therapy about how he gets this way.
And we explored kind of the whole associational networks
in his mind connected with that state,
and it comes up through the visual image
of his father doing the same thing,
and associations to a heroic father.
And he loved his father, as a boy he loved his father,
he still he loves his father,
and admires his father deeply.
But he starts to explore and open up
to all kinds of memories and experiences
and visual images connected with his father
who would be in that same mode.
Never lose the argument.
So a bit of background about John
to connect this, and his father.
He...
This is another case where a person
whose family moved a lot, they moved a lot.
His father worked as a very high-level executive,
he ran factories, and in different parts of the world
they lived and would move to various countries
in Asia and the Middle East,
and the father worked at these very high levels.
And he described his father as getting
into this "ching-ching-ching" state
with his frenetic pace with his work projects,
kind of glossy-eyed, half-stunned, completely immersed
in the next project.
And the father was just, he described him,
he's such a powerful figure, he's this powerful,
admired figure, larger than life, very macho,
kind of a drinker and a carouser and a bad boy,
and he had his bad boy buddies
that he get together with.
And there was also something in essence
of a boyhood looking up to his father
as his father being such a large presence
that he was kind of,
he could live on the margins of society,
he could be above its rules.
His father just, there were stories
about his father that was just omnipotent
and fearless, there were stories of them living
and working in areas where war was breaking out,
and people shooting father, having the situations
of being shot at but continuing to work at the factory.
And he was just heroic in John's eyes,
and John was his beloved protege from a very young age.
There were stories about John as a little,
fairly little boy being taken with his father,
his father would take him around with him
and kind of sit him on the counter,
even at the bars and he didn't let John drink
as a kid but he would take him with him,
and he would be there with father and his buddies,
and he would see his father getting in arguments
with some guy in a bar and his father
would like stare the guy down,
and the pointing finger, and would win,
and he can see his father
really, really just dominating other men.
And anything about people, about weakness,
like employees who worked for him who made mistakes,
or where, you know, messed up on things,
the father had this powerful kind of wrath
toward these people, and putting them down,
or people who would disagree with his father.
And they were, he was also his protege
that would go out and occasionally sort of
doing little pranks together.
Anyway, one other thing about the father
which relates to relationships with women,
father expressed a lot of sexist attitudes,
some devaluing women sometimes in terms
of them being irrational and things like that.
And father made clear to John that he was
to be a man's man from an early age,
to be independent, and to be hard and not soft.
He had one particular memory,
though most of his memories were of his father
being very affirming of him,
but he had one particular memory about age nine
of feeling shamed by his father for crying.
John was talking to his father about his fears,
they were in a particular scary situation,
John was in a street situation in one of the countries
where they lived, and the father's response,
John was really scared and upset,
the father's response was,
"Well, you know, that's nothing compared to
"what happened in this other city",
and John had been crying, he felt really ashamed,
and he vowed he would never cry again.
And he said until therapy he had mostly held to that.
There's a real disavowal,
a need to disavowal the vulnerable states of the self.
I'll just say a little bit about his mother,
she was much more of a shadowy figure.
He's fond of her, they have a reasonable
relationship now but, and he's a supportive son
but his memories of being raised by her,
she's in many ways more benign but sort of
ineffectual in his eyes, and emotionally pretty cut off.
He saw her as kind of being cheaper
and kind of minimizing, if he was upset or something,
so it wasn't that he felt he could go to her
with his vulnerable self.
But his father was so much the dominant figure for him
in his mind and what he talks about.
And the presence of his mother sort of pales
in comparison in his mind.
One little bit of his, a little bit more
in his history and then we'll get back into the process.
The things changed in a big way
when he was about 10, the family,
father stopped working internationally,
the family moved to the United States,
and he, John, was sent to boarding school,
and so there's this shift from this tremendous closeness
and being the beloved protege to this
beloved heroic figure of his father,
to being suddenly relocated, sent to boarding school,
he's no longer...
He felt overseas, he was kind of often
the cool American, he was kind of more unusual among peers,
now he's put in a boarding school,
in a prep school with kids who, where he's now,
he wasn't academically as prepared as they were
so he's near the bottom of the class,
he was late in these growth spurts
so he was the smallest in the class.
And so here he is, separated much of the year
from his beloved heroic father in the boarding schools,
and feeling at the bottom and the smallest.
Very difficult situation for him.
He then, he got a growth spurt,
he got taller, he took up boxing
and he became very strong and adept at boxing,
so there were other ways in which his, he found ways
to develop certain skills and develop his self-esteem,
and he emerged eventually running now
a successful Internet business.
And he's had a series of girlfriends,
but none of them have ever,
hasn't worked out for the reasons that we're talking about.
So that's as much background
as I'm gonna give about John,
I wanna get back into the, some of the process
and then illustrate these models of the mind.
So to set way into the next vignette,
the next clinical piece, what I'm gonna illustrate here,
a couple of things about relational model of the mind.
One is the idea of these multiple
internal configurations of self-another.
Two is that they form the basis for states of the self.
Third point is that these multiple self states
can become rigidly dissociated from each other.
And then I'm gonna, fourth,
I'll be talking about how to work with this in therapy.
So here we go.
I'm gonna interweave talking about
John's clinical process and these ideas about the mind.
Same process, once while telling me
of a reason fight with his current girlfriend
in a regular individual session, John starts
to get ramped up, and he starts,
he says, as if she's in the office,
and he's saying, "You know, she said this,
and I was like, 'you know'",
and he's feeling it, and then he notices it
because he's become more self-aware,
and he starts to inhibit his own activation
of his own, this angry state.
And I said to him at this point,
I invite him to let this angry self be here
and let's have this here, I said,
"Maybe you should just stick with it,
"why don't you stick with it here, don't inhibit it,
"this is the place for it."
And I invited him, and he did,
he got more and more into his anger,
continuing to argue as if she's there,
and the staccato movement with his finger.
And then, and then he starts to back away
and I keep inviting him, and what I suggested him is,
"You know, your arm and your finger,
"your hand, they're very, they're expressing a lot,
"stay with it and sort of tune into it,
"like it's not just to sort of point your finger
"but feel what it's like to be doing that, feel,
"experience yourself doing that
"and let's see what comes up."
And he starts to, you know he gets more into it,
the anger, but it doesn't last long,
and the staccato movements, and then he starts
to soften and he looks pained,
and this surprised me, I didn't expect this,
he looks pained, and he says,
again as if speaking to her,
"You're supposed to care about me."
And then he started to cry.
And this and other moments like it opened up
new connections to a whole other state of the self,
the vulnerable, needful boy self,
and he starts to become aware of how vigorously
he fends this off and uses other self states
like this one, the "staccato, angry avenger",
to fend off this particular self state.
And he senses, it's really hard for him
to sit still with it.
And we've worked a lot with that self state.
It's genuinely disavowed, and he says,
when somebody criticizes him
he gets immediately defensive, he says,
"No, I didn't. No, I didn't."
in a kind of knee-jerk reaction.
And he can feel when somebody says he messed up
on something, he starts to feel a lump in his throat
and he'll shift into either "No, I didn't"
or he'll shift into jocularity,
he'll shift into something to stay away
from this vulnerable state.
We started to try to explore why does he need
to stay away from this state,
and what we started to find were a set of,
a kind of fusion of two sets of things in his mind.
On the one hand the idea of making mistakes,
of being wrong, of being imperfect,
of even of having vulnerable or needful feelings,
vulnerability and imperfection are parts
of the human condition, but for him any of that,
any of that is immediately fused with feeling
like he's a loser, he's a weakling, and he's screw up,
and otherly devalue itself,
is completely paired with anything about
experiencing imperfection or vulnerability.
And we started to explore
why is this packaged together like this?
To experience himself making a mistake,
or being vulnerable and needful,
is a loser, weakling, screw up.
And in the exploration of this,
the connection through these experiences,
of his father...
A couple of different experiences,
one is the way his father would go at people
who made a mistake, or him when he was crying,
somebody who's vulnerable or needful,
somebody who's made a mistake, who's not perfect,
the way the father could just really go
at somebody and humiliate them.
So that, yes, that person, if you make a mistake
or if you're vulnerable like that you're a weakling,
you're a loser, you're a screw up like that.
That was one way that we looked at
the developmental forging or fusion of these two things.
Another aspect was, there was John
at the boarding school,
there was John in relation to his father,
with his father as the protege to this heroic man
where he could feel strong and great about himself
in a kind of sense of perfection,
and then there's John at the boarding school,
at the bottom of his class, the smallest kid,
and not having the immediate connection
to his father to help support his sense of self.
So there was this kind of swing back and forth
between the value itself and then devalue itself,
that was another contribution to this vulnerability,
to the feeling like he's the screw up, the weakling.
And all of this helps explain, you know
when I said the couple's session when his girlfriend
placed the reassuring hand on his knee,
and he could tell that she was about to bring up
a conflict where she was angry with him,
and the anxiety that he showed, that's what,
as he and I understand it that's what that was about,
it's the threat of "She's gonna criticize him,
"he's imperfect, oh, he's this devalued weakling,
"screw up guy."
It was the threat of that where his anxiety is
and then he fights it off as the "angry avenger",
kind of restoring his connection to the heroic father.
Those were some of the ways we've been understanding it
and working with it, these different states of the self.
Several other states that have emerged,
another state, what I would call
"the good guy, one of the guys, one of the bad boys",
that's a single title,
"good guy, one of the guys, one of the bad boys".
And I'm gonna describe some stuff,
here's a remarkable piece of the illustration
of the dissociative phenomena.
In this state he's jocular, he's agreeable,
he's easygoing, everything's cool,
he seems very friendly, but sometimes
when it's in a more defensive mode
it feels disconnected from kind of being present,
and he's come to recognize this himself.
His girlfriend doesn't like this state,
and I can feel distanced by it when he's in this state.
It's kind of like he's not really there,
it's like a persona.
And he's learned, he'll come into session
sometimes in this state and he'll say to me,
"You know, I can just tell
"I'm not really in touch with myself."
This is a dissociative phenomena.
Here's one place where the state came in.
He was telling me about a recent fight,
and this is an individual session,
a recent fight he'd had with his girlfriend,
and he'd been at the dinner table
with her and her kids,
and he was talking with them,
this is the story he's telling me,
he was at the dinner table
with his girlfriend and her kids,
and he was telling them stories,
escapades about a friend of his that drinks a lot,
he's a kind of drinker and carouser,
and he was saying to them,
"You know, this guy, he really gets himself in trouble,
"he shouldn't drink like this,
"it's really bad for him that he drinks like this."
And his girlfriend became very angry with him
and accused him of encouraging her kids to drink
by telling these stories.
And he says, "No, I didn't, I was telling,
"in the story I said it's really bad that he does this."
And he had a fight with her.
But when he told me the whole story
I asked him to kind of relive it, you know,
tell me, so what did you tell them at the dinner table?
So he starts to tell me the stories
that he told them about his friend,
the drinker and carouser, and I can see that
as he's telling me the stories his eyes are kind of,
he's kind of rolling his eyes but smiling,
and he's clearly delighted with the stories,
and chuckling with fondness and admiration
for his wild and crazy friend who's out there
drinking and getting himself in trouble,
on the wild side.
And so I asked John to tell me...
What I asked him to tell me,
what is he experiencing right now
as he's telling me these stories?
And he totally gets it, he realizes that
when he tells the story of his friend,
the drinker, even if he's saying the guy shouldn't drink,
it's a problem, he's full of excitement with this guy,
with the stories, and he realizes now
his girlfriend was absolutely right,
that he was, not explicitly but implicitly,
he was encouraging drinking
by telling the stories with all,
because of the affect with which he told them.
So, you know, now John he really realizes it,
he gets it that she was right,
but that he's tuning into his own state,
in the session, and that's what I wanna,
I'm emphasizing here is a matters of the state of the self,
not so much the content but the state,
'cause as therapists we often tend to focus
on the content, the narratives, the stories
and people's feelings,
but this is about focusing on shifting states.
And now in the session when he's sitting there
with me saying, "She was right, you know?"
I was so excited when he realizes he was so excited
when he told the stories that he is encouraging
drinking to her kids.
Now he's in a reflective state,
it's a very different state than he was
just a moment ago in the jocular,
"good guy, one of the guys, one of the bad boys" state
when he's enjoying his friend's drinking escapades.
So on the one hand he can be in the state telling me,
and now he can be over here reflecting on the state,
not inside of it but seeing it
and reflecting on it, stepping outside of it.
So he can be partly in the "good guy, bad boy" state,
and he can be outside of it, and that illustrates
a central concept about the, an important
narrative development that Bromberg talks about,
the capacity to stand in the spaces
between these different self states.
And that's what John is developing as we're working,
he's not sort of stuck in the jocular,
"good guy, one of the guys, bad boys" state,
or the "angry, avenger" state,
he's learning to shift out of the state
and be able to reflect upon it.
But now, after all that work,
and we did this work on that particular issue
of he really wasn't encouraging the kids to drink,
a few weeks later--
It's just remarkable the power of dissociation,
he came in a few weeks later and he's in,
he's clearly in the "good guy, one of the guys" state,
and he's jocular and he's friendly,
and he's again aware, he said,
"You know, I'm not so in touch with myself
"but I'm in a good mood."
And he brings up that fight, he forgets in the moment,
he forgets that he's talked about it with me,
and he says, "You know, I had this dinner
"with her and the kids and I was telling stories
"about my friend and how does he drink..."
And he repeats the story
as if we've never talked about it
'cause he's forgotten that we talked about it,
that's okay, so he repeats the story.
But then he says, "So she tells me
"I'm encouraging her kids to drink,
"can you believe it?
"I mean she's totally wrong!
"I didn't tell them, I told them it was bad
"that this guy drink."
So what happened?
It was as if we never had the prior conversation.
That dissociation, and it's not just John,
we all have, Bromberg wrote about this,
we all exhibit this, we all have this.
It's, in different states, our memory state depended,
depends what state we're in.
Is it true that John no longer knows
that we ever talked about this?
No, that's not true, as soon as I remind him,
I said to him in the session,
"You know, we did talk about this."
And I ask him, "Do you remember
"when we spoke a few weeks ago?"
And as soon as it clicks in he's like,
you know like, "Oh my God", you know,
he couldn't believe that he didn't remember it,
and he feels kind of sheepish that he blinded himself
to something that he knew and he shifts state
right in the moment, when I tell him,
he's now no longer the jocular, "good guy" state,
he's now more kind of centered and
he's self-reflective, and he's like,
"I can't believe I didn't remember that."
So who is it who doesn't remember
and who is it who does,
and feel sheepish for, you know,
that the other guy didn't remember?
So we're talking about these different states of self,
and the dissociative forces that keep them apart.
Freud wrote about this too, even though
he emphasized repression.
There's a concept called "the unthought known",
Christopher Bollas writes about that,
Freud originally wrote about something
that you can think it--
You can know it, but you can't think it.
Here's a quote from Freud,
"Forgetting impressions, scenes or experiences
"nearly always reduces itself to
"just shutting them off."
This is dissociation, this is John not shutting off
the memory that he and I spoke about this thing.
More on Freud, "When the patient talks about these
"'forgotten' things he seldom fails to add,
"'as a matter of fact I've always known it,
"'only I've never thought it'".
So Freud is talking about this,
that we have different parts of ourselves
and the different parts remember different things
and forget different things.
Here's how Wachtel talks about this,
"Mental contents are not simply conscious or unconscious",
it was the original Freud M.O.,
"they are capable of being experienced
"and being articulated and elaborated
"to varying degrees depending on
"one's particular state of mind,
"and on the situational, relational and cultural context".
Well, the last state that I'm go--
Actually I already made reference laying out
different states that John gets in,
and as we're saying, there's some dividedness
between the states.
I've already talked the, what we call
the "ching-ching-ching" state,
it's a kind of semi-manic,
completely immersed in something, kind of state,
he does kind of air typing when he tries
to portray that state to me,
and it identifies very much
with his father and himself.
So here's what we're leading up to,
I'm gonna take all that material now about
these different states and how they work
in some of these vignettes, and we're gonna
now talk about a relational model of the mind.
Normatively, the normative,
normal relational model of the mind
that involves multiple self states
and dissociative forces, and we're talking about
how it becomes problematic.
So, self states based on structures,
based on internal configurations self-another.
And, I'm gonna make reference to John,
so I'm just gonna, just gonna summarize
like five states that we've talked about.
There's the "ching-ching-ching" state,
there's "the righteous avenger" state,
always right, always perfect.
There's the jocular "good guy,
"one of the guys, one of the bad boys" state,
and then there's these two other states
that get fused together.
There's the fallible, vulnerable, needful boy
who is not perfect, but that gets fused with this
devalued, loser, weakling, screw up.
So those are some states that, of the self,
that we've identified.
Now to move to the larger model.
We all have internal configurations,
we all have multiple, organized centers of awareness
and agency within the mind, they're like
multiple sub-organizations,
and multiple personality is a metaphor.
Each such sub-organization has specific
associational networks, like John with this
and the associational networks
through experiences with his father.
And each state of the self sub-organization
has particular narratives about self-another,
thematic storylines, certain emotions
that are more prone to, certain physiologic states,
imagery that are more characteristic
of that configuration.
Here's what Jody Davies says about this model
of the mind that it "emphasizes the dynamic interplay
"of multiply organized centers
"of agency and awareness", as I said.
"The setting up of discontinuous veers
"of a associational communication,"
these continuous veers of associational communication
within the spheres, "the partitioning
"of mental contents into non-communicating centers
"of awareness and activity."
That's actually Davies talking about
some of Freud's very early writings about the same thing.
And in this ordinary example,
"I'm not myself today.
"You know, I said this thing,
"that's not me, I'm not myself today",
that's exactly this phenomenon in a totally ordinary way.
So how is it that we don't all have multiple personality?
What about--?
'Cause there's something about a sense of self
where there's the opposite of this,
there's a sense of, and in health we wanna think
there's something about continuity,
sense of self, continuity, cohesiveness
as well as vitality and authenticity.
So, how does these two things fit together?
The idea that a sense of self would be continuous
and integrated, and yet it's all
discontinuous and disjointed?
Here's Davies talking about exactly that,
she uses the image of a kaleidoscope
and she's talking about the unconscious,
it's just differently viewed than the Freudian unconscious.
"We deal not with one unconscious but
"with multiple levels of consciousness and unconsciousness,
"a multiply organized associationally linked network
"of meaning, attribution and understanding.
"Within such interactive, dynamic system,
"past experiences infused to present,
"and present experiences,
"evoke state dependent memories of formative,
"interactive representations."
Let's pause there.
Past experiences evoke,
and present experiences evoke the past.
Somebody criticizes John, he suddenly like this,
past experiences of John with his father,
watching his father, somebody arguing with his father,
criticizing his father, and his father doing this.
So there's an associational set of networks
that's linked with this state of the self,
and it's very different from the jocular,
easygoing, good guy state,
or some of these other states,
it's a specific configuration within that state.
"In previous writings", this Davies,
"I've compared this organization of mind
"to the working of a child's kaleidoscope".
Think about a kaleidoscope,
"Intricate patterns varied but finite,
"conflating and reconfiguring themselves
"from moment to moment.
"These are patterns whose components
"will become recognizable over time,
"they are patterns, yet whose parts will come to light
"in different constellations of prominence and obfuscation,
"in different states different things come to light
"and different things are hidden.
"Those patterns that repeat themselves
"with regularity inherit representations,
"and later elaborations, of the most
"essential formative relationships,
"it's elaborations of the central configurations
"experienced early on, come to form a sense of character,
"order and agency.
"There will make us knowable to ourselves,
"familiar patterning within the kaleidoscopic settings,
"make us knowable to ourselves and others
"despite the kaleidoscopic melange of multiple selfs.
"They order our world, they create order
"out of chaos, and they're personal templates
"of constructed meaning."
So there is a sense of continuity of the self,
and when there's not excessively rigid dissociation
then there is much more the sense of continuity.
Let me try to illustrate this with John
'cause that's very complex,
this whole kaleidoscopic thing...
Think about this, what I'm gonna do is portray
an scenario of John in the most least dissociative state
but still illustrating that there are multiple parts
that comprise something that does not look disjointed,
so this is the more normative picture of
how multiple configurations and multiple self states
can kind of come together in an averaging
and interspersed way, fluidly moving
rather than rigidly stuck on one particular
setting of the kaleidoscope.
Here's the example, the scenario,
say his girlfriend criticizes him
for not attending to something,
not buying groceries when he was supposed to buy groceries.
And now I'm gonna portray John,
and I'm gonna portray him with
a series of reactions to her.
What you're gonna hear are the different self states
but I'm gonna portray in a way that is more fluid
and doesn't have a disjointed sound.
So the girlfriend say, this is hypothetical,
she criticizes him for not buying the groceries,
at first he's a little argumentative
and a little defensive, you know,
"Come on, what's the big deal?"
So we hear, this is just a little bit of this,
"the righteous avenger", but not rigid,
not stuck, not intense.
Then he's a little playful, he's "Well, alright."
You know, it's, "Come on, can't we just,
"can't we just, you know, like
"not make too big a thing of it?"
Now we see this is shifting into the playful
"good guy, one of the guys" jocular self.
Then he says, "Well, you know, I just didn't feel like it,
"I was tired, and I just didn't wanna go get the groceries."
So we hear a little bit of, he can be
a little bit vulnerable, he's tired.
And then he remembers why she gets so upset,
because he knows that she has a history,
she grew up with very neglectful parents,
and so he's like, "Oh, that's why she's so upset.
"You know, I didn't buy the groceries but,
you know, she grew up with a lot of things
"not being done for her."
And all of these things, these bits and pieces,
are things that have come up in sessions,
that's the kind of awareness,
he does have that kind of awareness.
And then he says, "You know
"I'm sorry I didn't buy the groceries."
So what I've done is,
I just put together a kind of flow
of trying to portray what it's like,
how can we make sense of this kaleidoscopic--
These different settings of the kaleidoscope.
But when the kaleidoscope is more fluidly moving
rather than getting stuck in one setting,
and you can hear different elements of John
come through in a more fluid way,
where here's a little argumentative,
he's a little playful, he's a little tired,
and then he's sensitive to her that she's this,
not getting the groceries has a big impact on her,
he can understand that, and he's reflective, and...
So we hear, in the way I've portrayed that,
that kind of flow where the kaleidoscope doesn't get stuck.
That's, that's what I'm getting at here is,
how you can take this model of multiple configurations
but not have somebody look like they're all disjointed.
So, and the contrast of that is when
the kaleidoscope get stuck, that's when
she's annoyed he didn't buy the groceries
and he's like this with her, and he stays like this
for the next half hour, and he can't consider anything else,
where she's upset about the groceries
and he's only the light-hearted,
"good guy, one of the guys",
"Come on, honey, you know, don't worry about it,
"why are you so worried?"
And he's just in that mode, and that's where
the kaleidoscope is stuck in another way.
And neither of those modes are effective
in terms of relating well to somebody,
when the setting get stuck.
That's what I'm trying to illustrate with that piece.
Here's how Davies describes and talks about that.
She talks about when you have the averageable
and containable, versus the irreconcilable,
and what I portrayed in those two examples,
the first one where's different elements
of John can be averageable and containable
in one conversation, and the contrast it
when this kaleidoscope get stuck and it's irreconcilable,
so he's only in this mode or something like that.
Here's what Davies says,
"This view of the relationable unconscious
"suggests a dissociatively-based system of average,
"of on the one hand averageable,
"and on the other hand not averageable,
"irreconcilable representations of self and other."
And, so when they're averageable then
there's the fluidity,
when they're irreconcilable you get stuck
and the person can't shift out of state,
they can't stand between the spaces of the different states
and they get stuck in one state,
and then they're thinking in a way,
and emotions and everything gets stuck in that character.
What Bromberg talks about,
not only the capacity to stand in the spaces
between different states of mind without losing any,
and he says, "The capacity to feel like one self
"while being many others."
Another quote, I love it where he says,
"To thine own selves be true".
And instead of compartmentalization
there's to use term mentalization,
the capacity to kind of hold behold picture
rather than stuck in one compartment.
Bromberg uses the sort of compartment metaphor,
Davies is using the kaleidoscopic setting metaphor,
but they're getting at exactly the same thing.
Now that we've talked about this whole
relational model of the mind, the kaleidoscope,
the multiple self states, role dissociation,
fairly complex ideas and try to illustrate
that with John's different states,
I wanna now talk a bit about trauma,
really major trauma, and specially situations
of early developmental trauma, trauma in relation
to central attachment figures,
because this is kind of the ultimate in irreconcilable.
There's my parent who maybe sometimes takes care
of me and sometimes seems to love me,
and there's my parent who flies into a rage
and beats me and locks me in a closet,
and how is that emerging young child,
how is the mind supposed to put these things together.
And dissociation is needed as a defense,
it's really necessary.
Partly is kind of a quarantine model,
when things are that bad in certain states
there need to be other states where that
doesn't flood in, where it doesn't leak in,
and so there tends to be more rigid,
a need for more rigid dissociation and fragmentation,
and this tends to cause in early development,
if there's profound and ongoing trauma,
enormous fragmentation, and in the formation
of the internal representational world,
these narrative configurations of self with other.
And it has adverse effects
on all aspects of development.
Davies describes this really, really well,
"The deeper--" She's talking here about
the deeper relational unconscious
where the trouble resides, here's what she says,
"But what of those representations of
"self and other that elude codification,
"those that are unencoded, irretrievable, yet ever present?
"Those experiences of self with other
"that feel irreconcilably different,
"strangely incompatible, linguistically inexplicable,
"or affectively uncontainable?
"They fall away into the nascent underpinnings
"of the relational unconscious.
"In a fanciful use of metaphor,
"I like to think of these unformulated
"dyadic representations as the 'free radicals'
"of the relational unconscious,
"roaming the mind in a hungry search for vulnerable moments,
"using their magnetic charge to disrupt
"the established order and to pull the patient
"into all forms of mystifying, inexplicable reenactments."
The case of Harriet to talk about this,
to illustrate this.
Harriet...
I've been working with Harriet for a period of time,
she's in her 40s, she's a survivor of horrendous,
horrendous physical and sexual abuse at the hinds of her,
all of her central attachment figures
throughout her childhood and into adolescence.
Through tremendous personal strains
and resilience and two long-term psychotherapies,
she's been able to build a life
with self-respect and integrity.
She's a mother, she works with elders at a day care,
she genuinely does both of those things very well.
She can be loving, generous, warm, empathic.
She can be kind of feisty, she can be playful,
though she's anxious about people,
but she can move through that anxiety.
And she has some close friendships
and can really relate very well to people
when she's in a constituted good place,
a constituted state.
But she's vulnerable to being triggered
into highly fragmented states.
For example, say a situation with her young daughter
where there's some conflict between them,
they're arguing about whether or not the daughter
can go to a certain place or not,
the daughter gets angry and the daughter starts
to grab at her, at Harriet's leave,
and starts to get aggressive with Harriet.
That's one particular example, there are others but,
where it just sent her and Harriet was just
completely flipped into a different state of herself,
highly activated the old traumatic experiences.
That's the associational network now that's vibrating,
even though she's not at every moment conscious of it.
And she's completely activated, frightened,
and she becomes enraged and flooded.
And the self other configurations that are now active,
are the other person, the other person
is dangerous and malevolent,
and the self is under terrible threat.
And physiologically she's completely activated
in terms of the fight flight
but into freeze kind of mode,
the emotions are terror and rage.
And her behavior, she has enough awareness to hold--
She holds on to some awareness when
she's with her daughter,
some awareness that this is her daughter,
and that it's 2014, but only it's a thin strand of awareness
so she can become, at this moment,
she can become very harsh, yell in ways
that she later feels terrible about.
And then, but mostly she withdraws
because she knows enough,
she wants to protect her daughter,
so she'll withdraw, and she'll end up retrieving
into her room, she can lose hours of time curled up,
flooded with terror and rage and shame, specially shame.
And flashbacks, she'll have lots of
disjointed bits and pieces of memory images
of her abused as a child.
And yet she can be in these
other states and be so different.
So each state has it's characteristic
kinds of representations of self and other,
those configurations, the emotions that
one is prone to in certain states,
physiological aspects of the state, etcetera.
I wanna talk about implications for therapy.
Davies writes really well about this,
the idea of essentially working
associatively versus dissociatively,
the idea that as a therapist we can try
to facilitate association, or reassociation,
if somebody is prone to too much fragmentation.
Or we can, in that sense we're trying to relief
the dissociation and bring back reassociation.
Or in other way, in another way of working,
we invite, actually invite the dissociation,
and I'll illustrate each but I'm gonna start with Harriet.
When she gets into these kind of states
I am not trying to facilitate more dissociation,
I'm trying to work with her to help her reassociate
because those states, when she starts
to talk about things in a session,
she'll start to experience that,
and she can go into these full-blown states in the session,
and she can no longer hear me
when things get that far.
We've worked to try to not let them get there
but it does happen.
But once she's in that kind of state
we spend a lot of time trying to help her recover
and she genuinely doesn't fully recover
even by the end of the session,
she recovers a great deal but she's still very shaking,
and so I try to interrupt this early
and try to work with her around reassociating.
Here's what I mean, just to illustrate
working associatively rather than dissociatively.
When she shows some,
there's certain characteristic signs,
physiological signs, and certain gestures,
that I've come to know in her that show
that she's starting to enter that state,
and she starts to lose her visual focus on the present,
her eyes move around but she's not
really focusing on what she's looking at,
and if you watch you can see that,
and you can see the sort of activation
of her way of breathing and things like that.
So when that starts, rather than
inviting a deepening into that,
I will say things like the following,
I might say to her, "Can you feel your feet
"on the floor right now?"
There are lots of grounding techniques,
there are a lot of different styles therapists use,
and people who work a lot with trauma.
But more to the point of what we're talking about today,
of the dissociated self states,
I might say something like the following,
but I have to say this soon before
she gets too into that state,
because then it's harder for her to hear me and process it,
but I might say something like,
"The terrified and enraged child in you
"is activated right now, but that part of you
"doesn't know that you're here in my office.
"There are other parts of you that do know that,
"that you're here now, that it's 2014,
"that you're a mother,
"that you work in a day care for elders,
"that you're sitting here in my office with me,
"and that nothing is gonna happen to you
"while you're sitting here with me."
And trying to speak really firmly
and directly to her as she's starting to collapse
into a part of her mind that is completely
the kaleidoscope of the rigid setting
and it compartmentalizes away everything else.
I'm speaking to her to try to help her reassociate
to other states of her being,
other senses of herself,
and help her restore also a sense of time and place.
That's trying to help her reassociate,
and trying to help her stand in the spaces
and get out, in particular,
stand outside of this, the trauma state.
Contrast that with John when I,
when I invited him to...
Now, this is a completely different example,
different from the trauma, this kind of problem
of a trauma and complete over-activation
and catastrophic dissociation that happens
where Harriet, where I'm trying to help her reassociate.
If we think about, say the exemplary talked about
with John where he's in an individual session
doing this and he starts to inhibit it,
and when I invited him, I suggested that
he stay with this, right?
That, what I'm doing in doing that is I am inviting,
I'm inviting in a specific kaleidoscopic setting,
John "the angry avenger", I'm inviting that in,
I'm encouraging him to let himself enter
and be in that state and to dissociate away,
'cause when he starts to inhibit it he's got
other self states that are telling him,
that are more reflective, but for the purpose of a therapy
to work with this particular state,
I'm inviting dissociation by saying,
"What if you let yourself get more into that?
"What does your hand and arm, what does your finger want?"
I'm really inviting him physically,
physiologically, viscerally, and
emotionally and psychologically into this
"angry avenger" dissociated state.
Why do I do that? I do that to explore it,
but I also do it because, unlike Harriet,
I'm not worried about him, I'm not worried
because I don't sense that this is gonna be,
cause him to crash and regress.
That he'll be able to enter that
and he'll be able to get back out of it
before the session's over, and recover his ability
to stand in the spaces again, not to be caught
in that one configuration of this,
not to be caught in that kaleidoscopic setting.
So because I think he can tolerate it,
and because I think it can help to explore it,
that's why I invite the dissociation
further into that self state.
And as we saw what happened, he started
to get more ramped up, the staccato gesture,
and then he started to,
something deepened by doing that,
and that's when, you'll remember,
he started to, he then shifted after he had permission
to really get into it, he shifted and softened
and that's when he said, speaking to her,
as if speaking to her, "You're supposed to care for me",
and he started to become tearful,
and it opened up to the vulnerable, needful self state
that this was fending off.
So sometimes it's kind of like,
you can't get around it, you have to go through it.
We were going through, we were entering
more deeply into this, the "righteous avenger" self state,
and by going through it, able to reach
and access another self state which is the one
he really needed to get to was
the vulnerable, needful boy in him.
So these are two, you know they're really different
ways of working, trying to facilitate association,
reassociation with Harriet, and trying to invite
and facilitate dissociation with John.
Now, with John there were other moments
when I did vary, where I was working associatively.
If you remember the session, the couple's session
when he's ramped up like this with his girlfriend there,
this is the current girlfriend,
when he's ramped up like this,
you know the session when I said to him,
"Can you just be still right where you are
"and sense what's going on in your body?"
And that's when he became aware of how aggressive
and angry and enraged he was, and pumped up.
What I did in that moment was different,
he was stuck, his kaleidoscopic setting was stuck,
and I sensed that he was just gonna stay stuck there,
and just be in the "righteous avenger" mode,
and he had lost his capacity, in that session,
in that moment, and inhibited it
because his girlfriend was there,
he'd lost his capacity to work more flexibly,
to be able to stand in the spaces,
and then he was just gonna get stuck in this.
So when I said to him, "Can you just be still
"and notice what's going on in your body?"
That is calling upon self-observation,
that's calling upon a part of his mind that is outside,
that stands outside of the "righteous avenger" part
in order to observe himself, self-awareness,
and then that moved into self-reflection.
So I in that question I was calling upon him
not to get more into the dissociative state
but to reassociate outside of it
in order to work with that state.
And it seems like that was helpful for him.
So whether or not we work associatively,
trying to help the person stand in the spaces
and get outside of the state,
whether or not we work dissociatively
entering to the state,
it depends on the situation and what's going on,
and what the goals are, and what they can tolerate.
You know, with Harriet as I say,
when she's in that state she can't tolerate that,
it's not tolerable.
So the only option I feel is to try to help her
reassociate until there's enough developmental capacity,
once she has enough capacity we do
wanna go into those trauma states,
we do wanna enter the realm of those memories,
but not when she doesn't have
the capacity to tolerate it,
when she's gonna get stuck there.
So that's the difference in terms of,
technically, working associatively versus dissociatively.
Okay, that...
That concludes the section,
the final section on the relational view,
a relational model of human psychology,
of the structure of the mind,
and working with some new ounces around that
about more normative situation,
ordinary kaleidoscopic melange,
intermediate levels of difficulty like John had,
more pronounced dissociative dividedness
and difficulties like Harriet,
in situations of early trauma tend to cause that.
And then some considerations about,
therapeutically, how to work with those
under different circumstances.
So I'll just say now that overall,
just looking back over the whole course,
tried to present a foundation of relational theory,
how it evolved from the early paradigms,
and its relationship to the earlier paradigms,
and to present, as I say, both the clinical theory
and the theory of mind.
And although I've discussed these theoretical paradigms
as distinct conceptually I just wanna say,
when we look at any therapy,
whether we're looking at the level of the clinical moment,
or whether we're looking at an entire therapy,
I think it's tremendously enriching to be able
to look through multiple theoretical lenses.
We talked in terms of multiple lenses,
we talked about three different ways of looking at
how we are therapeutic as "interpreter",
most associated with the classical paradigm,
as "nurturer", most associated with the self paradigm,
as "co-actor", most associated closely
with the object paradigm into personal theory,
relational theory.
I would say there's a--
I think there's a fourth that I intentionally
left out today because it's not part
of the foundation of relational theory.
For those of you familiar with it,
it's the client, contemporary client model,
where in addition to "interpreter",
"nurturer" and "co-actor" I think
there's really a fourth model which is "container",
a lot of the contemporary client work on therapist,
analyst does "container", but that was
beyond the scope of what we were talking about today,
but I did wanna just mention it.
The relational, as we've been saying,
relational places particular emphasis
on the "co-actor" aspect and enactment,
but of course any in-depth and effective therapy
involves the therapist in all these different functions,
interpreting, being nurturing, co-acting, etcetera.
And in any moment of our responding,
as I said earlier, we may be embodying any or all of these,
any or all of these three in the same utterance
rather than to be overly simplistic
in how we look at these things.
So in the same utterance we can be interpreting,
we can be nurturing,
we can be acting something out, co-acting.
And my last utterance for this course is that
I hope it's been interesting,
I hope it's been helpful for you as you continue
on in your learning and in your work.