Monday, October 31, 2011

An Examination of Psychoanalysis (Part 12/13)


Pain and Ego Disintegration


Psychoanalysts tend to view intense outpourings of emotion as a threat to the ego. The ego must be protected against "disintegration" -- against being overwhelmed by unconscious forces.
Of course, patients do cry in analysis. Some analysts even encourage crying. Most stop it short, however, when it nears Primal intensity, because they fear the patient will "fall apart." It is seen as an episode bordering on hysteria, and the patient will be given anything from tranquilizers to shock treatment to calm him, particularly if it goes on for any length of time.
I believe that one reason analysts cannot tolerate Primal feelings is because of their view of the unconscious, and more importantly because they are defending against their own repressed feelings. From my own experience doing conventional therapy, I rarely if ever saw the intensity of feelings we see in Primal Therapy. For a therapist to have one primal is to know the force of primal trauma. It is also to stop being afraid of powerful feelings. In addition, the therapist would never again have to guess or theorize about the unconscious. Paradoxically, because analysis does not go directly to the unconscious, analysts are forced to theorize about it.
We all know that the expectations of the therapist can have a tremendous impact on the patient. I believe that when the analyst distrusts intense emotions as dangerous and disintegrating, the patient picks up and internalizes this distrust. Then, what might have been a solidly intense experience becomes a fearful, hysterical one -- not because the emotions are disintegrative, but because of the distrust and suspicion inherent in expressing emotions.
Psychoanalysts fear Pain also because they do know what to do with it, and do not see that there is any permanent way to relieve it. We might all agree that neurosis starts with repression; we might agree that repression is necessary because we could not bear to fully experience something at the time it occurred and thereafter. Yet psychoanalysts cannot see that reliving the trauma -- or actually living it fully for the first time -- would in itself resolve the neurosis. Feelings and neurosis cannot co-exist. Concepts and neurosis can.
In many ways it seems that analysts equate the ego with the constellation of neurotic defenses. They do not want the defenses to disintegrate because they perceive their task to be that of reorganizing them into a strong ego. The paradox which analysts do not grasp is that it is the perpetual containment of Pain that is disintegrating. This great reservoir of agony weakens the defense system year after year.
In Primal Therapy, we aim for the controlled disintegration of neurotic defenses; we want a "nervous breakdown," a breakdown of the repressive defense system. This does not mean inviting psychophysiologic chaos, as our critics assume. We guard against the collapse of the whole neurotic structure all at once, working instead toward a gradual dissolution of repression both in specific instances of re-experience (a primal) and as an overall aim of therapy. The dialectic to which Primal Therapy conforms is that "falling apart" (of defense---if appropriately handled) leads to integration. Otherwise there is disintegration where one level of consciousness is alienated from another, thus ensuring the fragmentation of the individual.
People suffer because they are in Pain and cannot feel it. Primal Therapy provides an environment in which the Pain can be felt; not looked at, not understood, not analyzed nor even "felt" about, but felt as and for what it is. It is not disintegrating. We can measure the integration with our brain maps. We can measure integration in the slowing of heart rate and lowering of blood pressure. The person is becoming whole again.
I can understand how intense feeling might appear disintegrative. If it is abreactive in nature and not properly connected to the past it will be. The defensive impulse to rush in with one sort of anesthetic or cognitive smokescreen or another is very strong and is supported by an entire culture that is very heavily geared to the suppression of Pain. The trainee in Primal Therapy often has to learn not to intervene, not to try to close off the patient's feeling; he has to learn how to avoid satisfying his own need for control. If healing is to occur, losing control is crucial: not in the sense of mindless abandonment to insane impulses, but in the sense of a total (yet survivable) loss of repression so that the rage felt is enormous, the terror really terrifying down to the bones of personality structure. Losing control over one's neurosis is the way to rediscover the natural self-regulation which exists within any organism.
It is not up to us to define the so-called "ego" and then make our patients fit themselves into our concept of its well-adjusted version. That makes the patient's reality subordinate to the analyst's concept. Our job is to allow patients to define themselves and to discover their own health, which they will do if we do not constantly get in the way of that process.

Transference and the Corrective Emotional Experience


In analytic theory, the patient develops what is termed a "transference relationship" with his analyst. This means that the patient's unconscious reactions toward his parents are projected onto the doctor. The patient then encounters the difference between the analyst's reaction and his parents' past reactions and theoretically experiences a "corrective emotional experience." Psychoanalysts believe that experiencing neurotic behavior patterns from childhood in relation to the analyst now will aright the neurosis by showing the patient that his reactions are no longer suited to adult life. So important has the corrective emotional experience become that Franz Alexander, who coined the phrase, called it the "central therapeutic agent" in the psychoanalytic procedure.[1]
If, for example, a patient's parents were strict disciplinarians, unjustly harsh and critical, then a good experience with a different kind of authority (one that is understanding, accepting, and reasonable) should correct the old neurotic view. The idea is that the patient displays all his neurotic patterns toward the analyst. He can't take it when the analyst is nice because he never had it. He may even get paranoid about it, believing that the analyst is trying to trick him or manipulate him. But when he gets permissiveness and acceptance from the analyst, he should begin to understand that not all authority is harsh, unyielding, or unfair. He begins, according to Alexander, "to experience intensely the irrationality of his own emotional reactions."
It seems to me that the analysts have stood the process on its head! The problem with their corrective emotional experience is that:

  • the trauma is old while the ending is new;
  • the focus is on irrational behavior in the present when it should be on Pain; and, 
  • the real problem is with the parents, not with the analyst. 
 No present relationship, even one with a skilled and compassionate therapist, can in itself resolve irrational behavior. It can be deterred, redirected, but not resolved -- because it is not irrational. It is logical behavior given the antecedent circumstances. One needs to match the behavior with the original context in order to make it rational again. People experience the truth of this every day. A person who feels worthless because he was made to feel that way when very young can be told repeatedly by teachers, friends, and colleagues that he or she is really worthwhile and successful, all in vain. The old, worthless feelings are prepotent because childhood experience has engraved them throughout the person's entire system. So a person can be praised to the heavens yet hear criticism and that is what sticks. That is what matches the underlying feeling.
Even in apparently happy circumstances the neurotic will act neurotically. An example is the neurotic who marries a compatible, cheerful, and understanding person, and yet continues to suffer from chronic depression. Why doesn't that love alter the depression? Is a corrective emotional experience limited only to someone with a title "doctor," or can it apply to other lesser souls, as well?
If we are trying to change a viewpoint, then the analytic method may achieve it. The corrective emotional experience may well enable people to mentally separate past from present and to identify what is "irrational" in their present attitude. But such activity occurs at the most refined mental level, with emotion regarded as nothing more than a point of reference.
The premise of a corrective emotional experience might be expressed as follows:


Analyst to patient: You feel that people, especially those in authority, don't care. I'm here to help you see where that thought comes from, and to demonstrate by my behavior that that is a false assumption.

This is all well and good but misses the mark. It ignores the fact that the patient's idea that no one cares is a statement about his life (no one did care), not just an item from his private thought collection. It is the tip of the psychophysiologic iceberg. What if the person feels better and is relieved to learn that his feelings are irrational, out of tune with current reality? So much the better. That is helpful, not curative.
There is nothing wrong with changing an unrealistic view of authority, but it does not happen by telling a patient how irrational his feelings are. Feelings and irrational conduct toward the analyst are only symbolic substitutes for the original Pain. Why bother with substitutes when the original experience can be recovered via feeling?
Changing a viewpoint is well and good, but it is not enough. The irrationality of present feelings is only half of the neurotic picture. The other half that contains the seed of healing is the rationality of those feelings in their original context. A parent who is constantly harsh with a child forces the child to be defensive and "tough." Given the early context, this defensiveness is logical. The only way to experience that rationality is to relive the original event, not with a new ending in the present, and not in relation to the analyst. It must be relived with the very ending it actually had before repression set in, the ending that meant great suffering. Then the therapist will not have to convince the patient that it is irrational to be terrified of the waiter, the postman, or the doctor. The patient will simply no longer be terrified because he has finally released the original terror belonging to the original trauma. Once this occurs, he will automatically treat current relationships rationally and appropriately. This is not simple theory. This is what we see in our patients after a course of Primal Therapy. Neo-Freudian analysts have made important modifications in the stance of the therapist from the strict "blank screen" neutrality of the Freudian model. That is a good thing. The aloofness of the traditional analyst promotes transference because the patient can so easily project all his needs and repressed feelings onto the therapist. If this "blank screen" is inviolable, then the transference is maintained at the instigation of the therapist. When this is done deliberately it is because transference is seen as one way to unearth the subconscious.
What we are really talking of here is a trick. The blank screen tricks the patient into delivering up the repressed, unresolved conflicts of childhood. It is a device because the analyst is not being himself. The analyst hides so that the patient may reveal himself. But we have found that you really don't need tricks. In spite of their defenses, most people are willing to tell someone what is hurting them. Furthermore, it can be a hindrance if the therapist is forever neutral and aloof.
While discarding the barrier of the blank screen is a good thing, we must not regard the more human interaction of the therapist as fundamentally therapeutic in and of itself. Though it helps, the genuineness of the therapist is not the key to health except to the degree that it supports and encourages the real key, feeling, to have its way. It must be tied to the dynamics of the disease under treatment. The more human relationship is to be supported because it enhances the feeling process. It is easier to let go in front of someone you feel you know than in front of a detached figure who reveals nothing of himself. Total detachment may be appropriate for analyzing transference but it does not provide an atmosphere for full emotional expression.
In Primal Therapy, we recognize the inevitability of transference, but we do not make it the center of therapeutic attention. We do not try to enhance it or diminish it. All deprived people symbolize onto others. Unmet need attaches to whomever may seem likely to fill it. There is no doubt that the therapy situation lends itself to an exaggerated transference, particularly because it is an unequal relationship. The therapist is inevitably an authority, the one in the know. The mere fact that he is in a position to accept trust and provide help has a lot to do with the patient's symbolization. The patient reveals much more of himself than the therapist does, which may make the patient feel small and the therapist appear big or grown up. So transference exists willy nilly. The question is what to do with it.

[1]Alexander, Psychoanalytic Psychotherapy, p. 42.

8 comments:

  1. Hi,

    Art, you have used the word 'hijack' before and I feel you could use it in the context of the (so called) 'helping relationship', the 'therapeutic alliance'.

    A long time ago, just before I became a single parent I had dealings with the UK child protection dept. I also met an ex social worker from that dept. who categorically stated that some of the senior social workers were actually "IN COMPETITION WITH THE VICTIM".

    Well, I think this is also very common with psychotherapists. I mean basically if you haven't dealt with your shit and you get into a relationship with someone wanting and needy and you're charging them money and you're seeing them week after week after week. I mean, there's a dependency going on isn't there? Who's paying for it though? Who's dependent on who? Who wins the competition when the client finally 'believes' in the mind, body and soul of the therapist and then leaves, perhaps after many years, 'cured'. . .

    Paul G.

    ReplyDelete
  2. The misconception… Mr. President!

    The tone of love does not sound so good in our lives... tone we are doing every possible thing to forget... it is out of tone and impossible to listening to.

    Alcohol and drugs induces “hopefully” satisfactions for need of love…love we hopefully can "feel" by using alcohol and drugs. Need of love...something alcohol and drugs eases the pain from… eases the pain more than any therapy can perform.... if we do not enter primal therapy… of cause.

    We should not be surprised... or is that what we are... as laws punishes use of alcohol and drugs for need of love... the tone... the song... the wonderful beautiful melody of love life really entails.

    Maybe the society should pay for primal therapy instead of using all these billions to hunt those who using Alcohol and drugs… all the problems it causes… pay primal therapy for those who want to listen to their tone of love… tone of life?

    Frank

    ReplyDelete
  3. Frank: Now that is a good idea, spending on therapy instead of chasing users. The alcoholics I have seen always say the warmth they get from whiskey is just like mother's love. art

    ReplyDelete
  4. Paul: and you mean to say????? art

    ReplyDelete
  5. Paul: No one leaves any therapy cured unless that have addressed and relived those key imprints. They are the basic neurophysiology of neurosis. art

    ReplyDelete
  6. Hi Art,

    Yes, well exactly.

    I was being ironic (it's an English thing) and pissed off at the same time because your last few posts exactly describe me & my therapists' relationship over 5 years. Except I finally got to my true feelings and now I've nowhere to take them to except Ted and my car.

    The one hr regular appointment is hopeless for all the reasons you say.

    Paul G.

    ReplyDelete
  7. An email comment:" Hello art,
    For me , as an outsider to the world of psychotherapy, but affected by the psychiatric industry though my brother's schizophrenia illness, i find your article on disintegration the crux of the challenge for primal therapy's application in the treatment of major psychiatric disorders. And as a consequence replacing conventional treatment processes. After forty years battling schizophrenia, with the use of modern drugs, my brother has described the moments before his breakdown in very lucid terms. He described it as fear, extreme fear.He suffered a catatonic psychotic break. The circumstances of his breakdown did not appear unusual. He attended a college pre term camp. He was the victim of pranks he recounts and may have been exposed to marijuana, although i know he wasn't a regular user.

    He lost a promising university graduate life and scientific career as a result of his illnes. I have read alot of your thoughts in your books and publications which relate to the treatment of psychosis generally. If you published a systematic approach to the treatment of psychosis which could address the fear of disintegration with patients like my brother, I'm sure many families like my own would look to your treatment for assistance.

    I look forward to your thoughts on this.
    "

    ReplyDelete
  8. And my answer:
    I am not sure what you mean. A day by day exposition of how we treat psychosis? I cannot do it for many reasons. It would be taken up by charlatans and used to hurt people. It is different with each person. But I can tell you this: it begins very early, so early that nearly all therapies never touch the causes. And you need in-house therapy. Patients must be supervised. art janov

    ReplyDelete

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Washington State University

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Editor