Archive for the ‘Uncategorized’ category

Source: J. Shedler On the Efficacy of Psychodynamic Psychotherapy

December 18, 2016

Jonathan Shedler, Ph.D. has written an excellent review of psychotherapy outcomes. His description of essential elements characterizing a psychodynamic approach are accompanied by an in depth review of the psychotherapy outcome literature (see link above).

“Distinctive Features of Psychodynamic Technique

Psychodynamic or psychoanalytic psychotherapy refers to a range of treatments based on psychoanalytic concepts and methods that involve less frequent meetings and may be considerably briefer than psychoanalysis proper. Session frequency is typically once or twice per week, and the treatment may be either time limited or open ended. The essence of psychodynamic therapy is exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship…

…Seven features reliably distinguished psychodynamic therapy from other therapies, as determined by empirical examination of actual session recordings and transcripts (note that the features listed below concern process and technique only, not underlying principles that inform these techniques; for a discussion of concepts and principles, see Gabbard, 2004; McWilliams, 2004; Shedler, 2006a):

1. Focus on affect and expression of emotion. Psychodynamic therapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs; Blagys & Hilsenroth, 2002; Burum & Goldfried, 2007). There is also a recognition that intellectual insight is not the same as emotional insight, which resonates at a deep level and leads to change (this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties).

2. Exploration of attempts to avoid distressing thoughts and feelings. People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on. Psychodynamic therapists actively focus on and explore avoidances.

3. Identification of recurring themes and patterns. Psychodynamic therapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life ex-periences. In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.

4. Discussion of past experience (developmental focus). Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.

5. Focus on interpersonal relations. Psychodynamic therapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.

6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationship is often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.

7. Exploration of fantasy life. In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.

The last sentence hints at a larger goal that is implicit in all of the others: The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self-esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility. Such ends are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and deeply authentic relationship between therapist and patient. (For a jargon- free introduction to contemporary psychodynamic thought, see That Was Then, This Is Now: Psychoanalytic Psycho- therapy for the Rest of Us [Shedler, 2006a, which is freely available for download at http://psychsystems.net/shedler. html]).”

In My View, the Experiential State Complex Generates the Blur

December 10, 2016

There, I’ve said it more simply than ever before. I am working on my essay on the importance of the observation healing only occurs in the blur.

This is why we need to learn to work with/in the blur. An expectation to become conscious enough to avoid the blur is doomed to fail. Very much like the movie The Sixth Sense, our unfinished emotional business will show up to haunt us at some point. In reality, it is always present if we can but perceive. Best to prepare for these encounters up front.

At some point psyche will make a move, or, as Alice Miller puts it, the body will present its bill:

“The truth about our childhood is stored up in our body, and although we can repress it, we can never alter it. Our intellect can be deceived, our feelings manipulated, our perceptions confused, and our bodies tricked with medication. But some day the body will present its bill, for it is as incorruptible as a child who, still whole in spirit, will accept no compromises or excuses, and it will not stop tormenting us until we stop evading the truth.” (Miller, Alice, Thou Shalt Not Be Aware)

Recall the point of remembering is not to establish blame and then shame on “you.” Rather we want to embrace our full experience; call back into awareness lost parts of our deep emotional selves. As D.H. Lawrence phrased it in his poem Healing:

“I am not a mechanism, an assembly of various sections.

And it is not because the mechanism is working wrongly, that I am ill.

I am ill because of wounds to the soul, to the deep emotional self…”

The blur brings the core of the original wounding into the present.

Take Two: Conscious Enactment

December 10, 2016

Conscious Enactment: from the Blur to Healing and Wholeness

What do I mean by the concept of  conscious enactment?

Let’s start with what it isn’t. Take a moment to reflect on an encounter with the blur.

When the blur is working, we believe in the reality of the manifest content. This means what gets our attention is our here and now problem, and our best guidance is too call it out and commit to resolving it together through conscious action. Sounds good. But, from the dream time perspective, if either of us has a sense of there is more here, something about the tone and intensity of the problem or need, then we want to consider the blur aspect.

This means examining the difficulty from the perspective of microfractures in communication.

What is being shown through the blur is an out-picturing of an original wounding episode(s). Psyche’s shorthand is to reduce this to an experiential state scene: something has happened, self and composite other are captured with expressions reflecting the core primary affects associated with the scene, eg: shame, abandonment, fear, anxiety.

This is the layer of the latent content.

In short, I am proposing conscious enactment as the intention to revisit the blur for the purpose of  surfacing the underlying experiential state driver of the microfracture.

Hence, take two. We want to embrace as many takes as it takes(!) to satisfy the opening and experience the deeper affects and witnessing attendant to the recovery of split off emotional life.

One more important idea: from the co-created system perspective, it is helpful to consider each participant is contributing to the core material being evoked through the blur. When consciousness can not contain an activation, if the complex is allowed to expand and split, then the figures in the experiential state, eg: raging/abandoning parent and reactive terrified child, will each attempt to hijack the ego and command the bus. When this happens, with the split, the “other” is projected onto the environment. We are both at risk for being possessed by either of the complex entities. This dance is now in the service of the re-enactment of the wounding. When one can see the blur as a kind of threshold, the opportunity for deeper healing is at hand.

In calling for Conscious Enactment, I am proposing we turn our attention to identifying the experiential state component hypothesized to be driving any blur state.

How directly might we make the shift from wound/defense to opening to the opportunity to have the most longed for dialogue? Can we imagine what would be the most satisfying expression of connection for both parties? This is the guiding image take two: conscious enactment strives for through this consciously authentic encounter. We can’t will it to occur, but it seems we can create the conditions to support dropping into the depth of the wound and then/there, bring something to the moment which was unavailable at the time of the wounding. This is what heals the complex, in some happy moment.

The micro-fracture in communication again offers a simple template: ruptures are the way in, repair and reconciliation of both the present and original wound the way to wholeness and health. More to follow…

Sacred Space pulls for the De-structuring of the Ego

December 6, 2016

We need language to frame the special conditions which allow us to access core emotional wounds, so that we may heal. For me, this is an ego-Self reunion state issue.

The “de-structuring” of the ego refers to a shift in consciousness which supports a dis-identification with the ego, the known, and an experience of the not-self, or non-ego.

In the Sandner/Beebe discussion about what it takes to heal a split, we can picture and imagine how painful it will be to suffer a direct reconnecting with original trauma episode(s). The wounds of overwhelm, intense enough to trigger a temporary amnesia, a petite symbolic death, are split off from consciousness. What is required to heal that split is the return into consciousness of the lost experience. Without enough consciousness to contain such a direct experience, this return will be re-traumatizing. With enough consciousness and containment, one may now suffer directly the re-membering of the original dismembering experience. Bearing witness and giving the experience it’s grief  is what allows the split to be healed. Jung’s discussion of abreaction as insufficient still holds true.

When Sacred Space is present…

November 15, 2016

…that which is a source of conflict for the individual or group will come in.

This observation on the nature of sacred space was very  powerful when I first heard Robert Moore say it in the early 1990’s. It continues to be an important guiding principle for me today.

 

 

 

 

Possession 101? Taking another look at my page “Observation: Healing Only Occurs Within the Blur”

August 26, 2016

From an interaction and process perspective, the presence of emotion or feeling tone is a very reliable signal indicating the unconscious is activated and something is at risk for being projected onto someone or something in the environment. The emerging priority at this point of awareness is to create a bridge from the content of the issue to include the reality of the emotional tone. Emotion is meaningful in alerting us to important complications involving the unconscious.

The Experiential State as Complex symbol supports beginning to consciously connect to a primary, felt relationship experience within a particular feeling tone. In its symbolic aspect, it both informs and protects ego consciousness. Something has happened. This “scene remembered” exits in a betwixt and between place. This activated emotional state is the “blur” referred to in the psychoanalytic observation “healing only occurs in the blur.”

As we become conscious of the presence of the blur, the here and now wounding is revealed, through associations to the emotional state, to be sharing the stage with an earlier encapsulated relationship failure episode(s). This may be sensed/experienced as a peculiar swirling of sensation, feeling, images, affects, and memories; associations which somehow reveal connections between one’s past, present, and anticipated/intuited future. The felt vividness suggests the plausibility of time tripping or time slipping. One’s usual experience of time and space has shifted. What has happened is the emotion evoked by the conflict in this moment has initiated a time transport, as if opening a time portal, pulling into the now an earlier wounding via an uncanny match of emotional resonance. How might we understand this phenomenon?

Edward Edinger (1992) observed: “… experience teaches us that the collective unconscious does transcend time and space. Time and space are categories of the ego so they are necessary for ego consciousness but they do not apply to the unconscious. … archetypes… are eternal entities that erupt into the temporal process. … On such occasions the ego is caught in a piece of the divine drama and lives it out, more or less consciously or unconsciously. Another way of putting it is that the ego is in time and the Self is in eternity. The ego is the agent of the Self in time so to speak. When certain archetypal entities erupt into ego existence, then it is the task of the ego to embody those entities, incarnate them, and realize them as consciously as possible. If there is little consciousness attached to the event, then the ego becomes the tragic victim of the archetype it is constellating. If there is more consciousness involved, then the ego does not have to be a tragic victim, because the ego knows what is happening to it. It behaves in a much different way, and can mediate the archetypal pattern much differently.”  (Transformation of the God-Image, 1992, pp. 68-69)

I recognize that depending on where you are with regards to a working orientation to complexes and archetypes, this quote may be quite obscure. The concept of archetypes as eternal entities is central to our understanding of what the ego is up against in the face of an emotional activation. This challenge, captured conceptually in the idea of the image of the nucleus of a complex, is at the center of the symbol system.

When complexes activate and succeed in temporarily possessing one or more parties, in the blur, the significance of “the ego is in time and the Self is in eternity” takes center stage. The complex, in contributing its archetypal dynamism to the experience, pulls for a shift in the time and space continuum. With this activation, it is as if the gates to eternity open, and what needs to come in comes in. Importantly, this is not just random material erupting into consciousness from the collective unconscious, but rather, these are the highly charged images and affects usually bound to and contained by the split off complex. Their energetic emergence into the present moment is the blur. Now it is as if our personal, intimate conflict, here and now, is to be played out in the dream time, in the presence of towering episodic memories.

The significant others who show up include younger versions of ourselves. Traveling through time and space to be here, they all have something essential to contribute to our deep healing. Imagine what might happen if we chose to “embody those entities, incarnate them, and realize them as consciously as possible.” This waking dream time stage includes/represents a casting call for generational experiential state figures. These are as if emotional bodies, longing to incarnate, pressing for a holographic enactment at the interface of conscious and unconscious experience.

Love Interruptus – Are Smart Phones the New Menage a Trois?

July 27, 2016

Love Interruptus? This link will take you to an interesting article in the August 2016 Psychology Today.

Portions of Eternity too Great for the Eye of Man?

July 20, 2016

“The roaring of lions, the howling of wolves, the raging of the stormy sea, and the destructive sword, are portions of eternity too great for the eye of man.”

Blake’s “too great for the eye of man” frame here helps us not pathologize self and others when it comes working through post traumatic stress level experiences.

My opening to poetry really began with a workshop with Robert Bly dedicated to orienting to the archetypal energies of the King, Lover, and Wild Man. I was 39 years old at the time. Bly opened the session with the observation images are the language of the soul. This meant a lot to me at the time because I identified with being a very visual, image and affect based processor. What was less consciously familiar at the time was the idea of the reality of soul. I found myself thinking what is soul really? I resonated deeply with Robert Moore’s reflection on the importance of the “good enough ritual elder” function in supporting community in recognizing and negotiating rites of passage. The men who carried this mythopoetic work brought me the gift of the realm of the soul. I am forever indebted and feel great gratitude for them all.

For your reading and puzzling pleasure, check out the full poem below.

Proverbs of Hell
William Blake, 1757 – 1827

From “The Marriage of Heaven and Hell”

“In seed time learn, in harvest teach, in winter enjoy. Drive your cart and your plow over the bones of the dead. The road of excess leads to the palace of wisdom. Prudence is a rich ugly old maid courted by Incapacity. He who desires but acts not, breeds pestilence. The cut worm forgives the plow. Dip him in the river who loves water. A fool sees not the same tree that a wise man sees. He whose face gives no light, shall never become a star. Eternity is in love with the productions of time. The busy bee has no time for sorrow. The hours of folly are measur’d by the clock, but of wisdom: no clock can measure. All wholsom food is caught without a net or a trap. Bring out number weight & measure in a year of dearth. No bird soars too high, if he soars with his own wings. A dead body, revenges not injuries. The most sublime act is to set another before you. If the fool would persist in his folly he would become wise. Folly is the cloke of knavery. Shame is Prides cloke.

~ Prisons are built with stones of Law, Brothels with bricks of Religion. The pride of the peacock is the glory of God. The lust of the goat is the bounty of God. The wrath of the lion is the wisdom of God. The nakedness of woman is the work of God. Excess of sorrow laughs. Excess of joy weeps. The roaring of lions, the howling of wolves, the raging of the stormy sea, and the    destructive sword, are portions of eternity too great for the eye of man. The fox condemns the trap, not himself. Joys impregnate. Sorrows bring forth. Let man wear the fell of the lion, woman the fleece of the sheep. The bird a nest, the spider a web, man friendship. The selfish smiling fool, & the sullen frowning fool, shall be both thought wise, that they may be a rod. What is now proved was once, only imagin’d. The rat, the mouse, the fox, the rabbit: watch the roots; the lion, the tyger, the horse, the elephant, watch the fruits. The cistern contains; the fountain overflows. One thought, fills immensity. Always be ready to speak your mind, and a base man will avoid you. Every thing possible to be believ’d is an image of truth. The eagle never lost so much time, as when he submitted to learn of the crow.

~ The fox provides for himself, but God provides for the lion. Think in the morning. Act in the noon. Eat in the evening. Sleep in the night. He who has suffer’d you to impose on him knows you. As the plow follows words, so God rewards prayers. The tygers of wrath are wiser than the horses of instruction. Expect poison from the standing water. You never know what is enough unless you know what is more than enough. Listen to the fools reproach! it is a kingly title! The eyes of fire, the nostrils of air, the mouth of water, the beard of earth. The weak in courage is strong in cunning. The apple tree never asks the beech how he shall grow, nor the lion, the horse, how he shall take his prey. The thankful receiver bears a plentiful harvest. If others had not been foolish, we should be so. The soul of sweet delight, can never be defil’d. When thou seest an Eagle, thou seest a portion of Genius, lift up thy head! As the caterpiller chooses the fairest leaves to lay her eggs on, so the priest lays his curse on the fairest joys. To create a little flower is the labour of ages. Damn, braces: Bless relaxes. The best wine is the oldest, the best water the newest. Prayers plow not! Praises reap not! Joys laugh not! Sorrows weep not!

~ The head Sublime, the heart Pathos, the genitals Beauty, the hands & feet Proportion. As the air to a bird of the sea to a fish, so is contempt to the contemptible. The crow wish’d every thing was black, the owl, that every thing was white. Exuberance is Beauty. If the lion was advised by the fox, he would be cunning. Improvement makes strait roads, but the crooked roads without Improvement, are roads of Genius. Sooner murder an infant in its cradle than nurse unacted desires. Where man is not nature is barren. Truth can never be told so as to be understood, and not be believ’d. Enough! or Too much!”
This poem is in the public domain.

Thank you Poets.org

Proverbs of Hell, William Blake, 1757 – 1827

Rilke: “The Man Watching”

April 7, 2016

Just pondering this morning on the importance of relationship in our work with healing trauma. Rilke opens this poem with:

“I can tell by the way the trees beat after

so many dull days, on my worried window panes

that a storm is coming,

and I hear the far-off fields say things

I can’t bear without a friend,

I can’t love without a sister….”

 

“Progress of the Soul” Series by Alex Grey

March 20, 2016

After a very informative weekend workshop exploring the reality of the subtle body with Monika Wikman, I wanted to share her website and this link to Alex Grey’s work with you. Grey’s Progress of the Soul series captures the possibility we are all participating in an energetic field of incredible beauty. Check it out for yourself.

Dr. Wikman’s website includes several links to her podcasts and some written material.