Tag Archives: Object Relations

I climb a mountain

 

I can’t think what will have changed. From the first moment to the most decisive, beginning with distant anticipation, and climaxing with a relaxed strut towards the podium, the range of me was on show. In my imagination, those last few steps should have been heart-stopping. Terror should have taken over, halting my breath, and stripping my voice of all power. My blank gaze, peering into hot lights and eager, expectant faces, should have betrayed my fear, my clammy need to be absent.

In December of last year, while doing some e-mail housekeeping, I sent a message to organizers of the Creativity and Madness Conference, asking them to clarify the status of my then 3-month old application to present my Tommy paper at their next event. Given the lack of response prior to this point, I expected a polite form letter, thanking me for my proposal but rejecting my request. It would have sounded like the kind of letters I get from publishers when they dismiss my queries regarding my novels. No big deal. I was simply striking something off my to-do list, and tidying my ambitions. I’d move on to the next writing project, I figured.

Then came a pleasant surprise, not that my negative streak was anywhere near done with me. Within days of my e-mail, I received a reply from event organizers, apologizing for their delayed response, and asking me to present my paper at the next conference, scheduled for this August. I laughed in semi-belief. The only other time I’d gotten such an affirmation was when I’d…when I’d gotten word that my Tommy paper was to be published, come to think of it. Of course, conference organizers would be interested, I suddenly thought. This was a great opportunity. Those doors that seemed impenetrable now squeaked and moved, showing a gap behind which I saw smiling, inviting faces. It was January. I had seven months to prepare a talk based upon a paper I’d spent ten years writing, off and on. I knew the material like the front and back of my hands. Not only was this not a problem, I was ready to slam dunk, hit a home run; I’d even invent a new sporting metaphor to predict the imminence of my success.

Hold on, I soon cautioned my excitable mind. Hold on. I’ve been saying that short phrase over and over again these last few months. Sometimes the words contain, as in restrain, drunken, inflated thoughts, which otherwise fuel my flights. They pull back upon ideas that leave me breathless, floating on momentum, feeling good but also weightless, like Wylie Coyote finally looking down, realizing he’s in mid-air and that his plan actually sucked. Hold on, I likewise say to nagging doubt, to cynical pride; to envious heart and fearful spirit—four horses of my private apocalypse, ever ready to close ranks and bring me down. Caution reminds me of sober days after, when moments have passed, my carpe has not been diemed, but nobody really notices but me.

That’s what it’s like at night when the mind won’t rest, won’t let go of its spin cycle, and sleep is like a forgotten skill. I feel a portent of failure, hitting me like a dull thud, as that’s the sound of a joke that doesn’t work. Between April and June, I happily distilled my seven-thousand-word Tommy paper into an hour’s power-point display. I selected its best ideas, embroidered with an amusing anecdote or two; I included a dozen or so images, all torn from the internet, to stir associations, give my presentation a powerful edge. I even discovered a few tools in my PP program to inject drama, like fade-ins on photographs. Come late July, I was ready to talk, and barely needed a single note before me to aid my oration. Fascinating insight, profundity, even a song would spin effortlessly off my tongue. Or, at least I’d recite the lines of Tommy’s finale, “Listening to you”:

Listening to you

I get the music

Gazing at you

I get the heat

Following you

I climb a mountain

I get excitement at your feet

Then I traveled to Santa Fe, the site of the conference. On the first day, I regarded the audience, its three-hundred-person-deep girth, and gulped. I listened to speakers whose bio profiles took minutes to announce make dry yet content-thick deliveries. An expert on Leonard Cohen and Carl Jung recited song lyrics and quoted Rumi. A vast crowd of erudite baby boomers gazed lovingly at him and other speakers like they were core members of an established fan base. Suddenly I was in mid-air, gazing at a fan base that was not there, and believing that my plan sucked. No one was interested in Tommy, much less my infantile notions of attachment theory and rock and roll. My jokes were leaden; my anecdotes deadening. The baby boomer crowd would fall asleep, and snore loudly during the lulls within my stuttering delivery.

When my presentation began, my mic failed. Seriously. I felt like uttering that line— ‘is this on?’—to signify a kind of comic parallel, but the failure wasn’t mine. The failure: it wasn’t mine. I looked to my right, at the sound man, who looked slightly panicked, under more pressure than me. His boss, the conference director, appeared to snatch from him a hand-held microphone and then walk towards me. We were already behind schedule because he’d privileged a previous speaker with an extra few minutes. There was no way I’d get similar slack. But it was alright. I don’t recall exactly how I felt walking to the podium—only that I felt okay. My breath was there. I felt reasonably embodied, present; the demons seemed sidelined, and I was relaxed, ready to have fun. I got this, I thought. Then I spoke of Tommy, attachment and object relations theory, including self and other representations: in short, all the stuff that had been stirring for…I want to say forever.

 

Graeme Daniels, MFT

 

 

 

 

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Politics and psychotherapy

 

“Hi all, been thinking about political content on this list-serve recently, especially after a member was recently rebuked for posting a link in support of Bernie Sanders. I asked administrators for the policy pertaining to such posts and saw in the supplied policy an item that asks members to refrain from making political endorsements.

Endorsements of what? I wondered, as the policy didn’t specify endorsement of individual candidates or campaigns, which appears to have been inferred. What about endorsement of political opinions, or of political realities (via presumed consensus), as they are implicitly described sometimes in this forum. For example, when members post articles about single payer/payor systems, or police brutality, or white privilege, the articles don’t so much endorse candidates or specific referendums, but they tend to presume consensus as to what our world is like. So, when clinicians speak of “bringing awareness” about a social condition, they are not inviting debate so much as asserting authority, more or less dispensing what they think are facts about a world situation.

This sets up a tricky situation for mental health professionals and for this list-serve. If we have clients who proclaim a mental health condition that is dominantly attributable to an external reality, such as a social condition or political situation, versus a greater weight of attention to an internal disorder, then the onus is upon us to become educated as to that external reality, (perhaps eschew focus upon internal pathology) to educate colleagues about that external reality, which in effect means we will be endorsing a social/political view, and instructing those who don’t appear to perceive the political reality, such as others on a list-serve.

In light of this, it seems arbitrary to censor endorsements of individuals or their campaigns–merely a rebuke of the unsubtle–when the infiltration of politics into our profession is another kind of reality.”

That’s from a message I posted last week on an EBCAMFT list-serve. About the same time I fielded a compelling suggestion from a client who hadn’t read my post, to the effect that politics were a part of people’s lives and are therefore a valid topic for psychotherapy. Didn’t I agree? she more or less challenged. Sort of, I more or less replied, intrigued by her argument, but not wanting to study up on each political topic she seemed to want my interest in.
What’s most compelling is the idea that a person’s external reality, the community (or polis) in which people live, is inextricable from a person’s psychology, no less so than a person’s intimate relationships, or their unconscious functioning. I am reminded of a discussion some years back with a Mastersonian consultant, to whom I asked about the cultural lens within the Masterson model. It’s not there, she said, though I’m paraphrasing her. Indeed, it’s not explicit or otherwise clear, unless you comb through libraries worth of material, that the discipline of psychoanalysis has ever been influenced by cultural relativism, though it surely has by politics (think influence of two world wars on notions of death instinct and repetition compulsion).
However, I think the reverse is true. Take the concept of internalized oppression, for example. This idea, derived firstly from Sigmund Freud’s writings, latterly from object relations theory, holds that individuals formulate representations of self based upon what is introjected from caregivers. Thus, if a child is demeaned, he or she will formulate a negative experience of self and act accordingly. Cultural relativists simply take this principle and apply it to peoples, especially those marginalized. And so this is part of the individual’s experience, this attachment to a community, a system. Well, that’s a lot to fit in the room, at least.

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Tommy

 

No essay, just a link. Check it out…

 

http://cap.sagepub.com/content/22/1/94.abstract

 

and read the following blogs: “Ever since I was a young boy”, “Your mind must learn to roam”, “You didn’t hear it. You didn’t See it”, “Listening to you”

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An Argument for Depth Therapy in Drug Rehab

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You might think that drug treatment with adolescents and psychoanalysis are terms that don’t go together, and you’d be right…sort of. Actually, a psychoanalytically-derived therapy is precisely what James Masterson, considered by many the father of adolescent psychiatry in the United States, intended for a residential treatment of troubled youth. His 1967 book, The Psychiatric Dilemma of Adolescence, offered the view that troubled kids do not “grow out of” problems of anxiety, depression, and acting out behaviors, as many of Masterson’s contemporaries appeared to assert. In this review, Masterson found that upon five years upon initial evaluation, over 50% of the adolescents previously treated in hospital settings for psychiatric conditions remained severely impaired. Although symptoms of anxiety, depression, and delinquent behaviors achieved modest reduction, some psychiatric disorders, such as pathological character traits, had not been touched upon in treatment at all.
Subsequently, Masterson was invited to take charge of adolescent inpatients at the Paine Whitney Clinic connected with Cornell University, which later resulted in his seminal text, Treatment of the Borderline Adolescent, in 1972. This book introduced the stage progression system of movement through a long-term residential program, intended to mirror the child development stages of separation-individuation as observed by Object Relations theorist Margaret Mahler. In this book, Masterson describes an initial “testing” phase of treatment in which patients relentlessly break rules or challenge staff, testing the limit-setting capabilities of staff, substituting them as parents (alloparenting, some call this), unconsciously determining who cares enough about them to maintain said limits and thus provide safety. The job of the therapists in such a setting is to convert patients from “actors and non-feelers” to “feelers and talkers”. Twenty years after this text was published, I began my career working in the field of adolescent drug treatment, though it was a further ten years before Masterson’s ideas really sunk in.
During my early years at Thunder Road in Oakland, a Therapeutic Community whose structure once bore a distinct resemblance to that described at Payne Whitney, I adapted to a cohesive treatment structure that more or less supported the Masterson approach (though few referenced him specifically), while adhering to the psychodynamic underpinning. Staff commonly used terms that were of psychoanalytic pedigree, such as “containment”, “splitting”, and “failure to thrive”; interns such as myself were repeatedly encouraged to observe transference (feelings in present relationships that are unknowing reflective of past relationships) meanings in the behaviors of patients, and more importantly, to attend to countertransference feelings in ourselves that may impinge upon therapeutic goals. Even staff not trained or educated in psychoanalytic concepts appeared to observe unconscious process in patients; in confrontation groups, counselors would routinely call out the negative behaviors, tease out the secrets of “acting out”. Then, upon the dropping of defenses, staff would zero in, often compassionately, sometimes not, upon the deeper meanings, the unacknowledged feelings.
For many in treatment this seemed not only fruitful, but also necessary, even exciting. They appreciated feeling understood. Furthermore, it seemed like common sense, this in-depth approach. Firstly, the adolescents lived in the facility and were kept clear of substances (at least, much more so than they otherwise would have been). There was clearly an opportunity for multiple therapy sessions per week, in various formats: individual, family therapy, and group. Even daily meetings were possible, and so the table was set for an in-depth therapy to occur. But the truth is that psychoanalytically-derived therapies, which call for an exploration of attachment patterns, links between family of origin memories and latter day behaviors, is frowned upon in many community mental health settings, even rehab settings wherein the intensive structure would seem tailor made for an in depth approach. There are several reasons for this, in my opinion: most concern either expediency or cost, but other reasons constitute a pronounced, if subtle devaluation of not only adolescent capacities, but also the dedicated staff that typically comprise drug treatment teams.
One assumption is that shorter term therapeutic orientations, solution-focused or cognitive behavioral therapies, for example, are easier to train to newer professionals. Their elements are easier to bullet point, sound-bite, and thus install into memory, left-brain functioning, versus the more unwieldy task of integrating a fuller experience. This is why many patients leave rehab centers armed with jargon, making glib pronouncements as to how they’ve changed; promises that all too often they cannot sustain. Often, these patients haven’t changed—not really. They’ve learned some “tools”, can parrot some phrases, maybe a few 12-step slogans. But their complex feelings haven’t about themselves and others haven’t changed, much less their understandings about those feelings. A second reason for the proscription of in depth therapy is that it is presumed to be cost-ineffective. But short term methods mean short-term outcomes, in my opinion, while short-sighted research conceals long-term effects, the attrition of growth that leads people back to rehab without understanding why earlier lessons didn’t stick. Reading this, a proponent of brief models would likely break out the sales pitch language and declare short term models “evidence-based”, and imply that psychodynamic models are not. This is untrue. Don’t believe me? Check out University of Colorado professor Jonathan Shedler’s comprehensive, 10-year meta-analysis research of over 70 studies upon the efficacy of psychodynamic models. It was published in the March 2010 issue of American Psychologist. It’ll open your eyes.
Regardless, especially in my latter years at Thunder Road, I experienced the unfortunate devaluation of psychodynamic models of care, and heard that similar things were happening at other programs. Managers began making philistine comments in staff meetings, deriding psychodynamic models as “that Freud stuff” while unknowingly using psychodynamic terms to reference current and longstanding practices. Few around me seemed to know or remember who James Masterson was, much less perceive his legacy within adolescent psychiatry. Borrowing models concurrently used in schools, clinical managers began using language connected with the Strength-based movement, which presumes a normative population of youth as the focus of care, emphasizes encouragement of adolescents’ strengths versus what is disparagingly termed a deficit-based approach. Thankfully at least, short-term models with worthy methods are coming to the forefront, muscling into the competitive arena of ideas. Most notable are the mindfulness-based therapeutic approaches, which are teaching affect (affect roughly corresponds to feeling) regulation skills (Important note: addiction is increasingly understood as a problem of affect dysregulation, not faulty cognition!), which draw their principles from advances in the area of neurobiology.

 

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