The Mystery “Talking Cure” For Grief: a brief history
As soon as anyone concentrates his attention to a certain degree, he begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded, and in making this selection, he will be following his expectations and inclinations. This, however, is precisely what must not be done. In making the selection, if he follows his expectations he is in danger of never finding anything but what he already knows.” - Freud (1912b/ 1928, p. 112)
Cicely Mary Strode Saunders was born in Barnet, Hertfordshire, in 1918, the eldest of three children, in a well-off but unhappy family. Her demanding father was an estate agent, and they lived in some comfort in a large house with lawns and tennis courts. Her mother was cold and withdrawn. Like Kubler-Ross, her father disapproved of her desire to be a nurse, and so instead she went to St Anne’s College, Oxford, where she read politics, philosophy, and economics, intending to become a secretary to an MP. After the Second World War outbreak she abandoned her course and defied her parents’ advice, enrolling as a student nurse at St Thomas’ Hospital in 1944, where she was recognized as gifted. A year later, during her work as an almoner, at Archway Hospital, she cared for a dying 40 year old Polish Jewish immigrant named David Tasma.
David felt that his life had been wasted. He had no relatives in England and only a handful of friends. In a brief and intense relationship, they discussed the idea that she might find a home for dying people to find peace in their final days. He left her £500, then a substantial sum, and the wish of "can I be a window in your home?" A window is now dedicated to him at St. Christopher’s; it is plain and has a view of the car park.”
Dame Cecily Saunders, the founder of the hospice movement writes in a 1966 paper, The Care of the Dying, “a patient being admitted to St Joseph’s used the phrase: ‘It was all pain’ and this ‘” total pain”’ calls us to analyze, to assess and to anticipate’ the whole life and experience of death. The evolution of hospice care has been extraordinary since these early days; however, it remains committed to helping people cope with dying and navigate the pain of loss.
What kinds of pain? She writes,
So what Cecily was saying is that when we see someone in pain, we may not see the total story. We may not understand where the pain is coming from. When I think of a person's grief story, I naturally think of the endings that person might have experienced but locating the pain there might not be the total story. What if we don’t just grieve endings but also beginnings - meaning, we can grieve how life may not seem to start over after loss, rather, the same pain keeps mysteriously repeating over and over again.
THE MYSTERY CURE FOR MELANCHOLIA
Come along with me to solve a mystery - the mystery cure for complicated grief. Meet a family with authority, trusted theory thieves. They have left behind curious clues to find and we need not travel far. Just look inside right where you are, the clue is the letter ‘r’.
This story about grief is told through the lens of a family. In a way, it is the modern grief family and we will begin our story with their most famous daughter.
Against her father's wishes, Elizabeth Kubler-Ross became a doctor and not a secretary. She worked as a medical professional in the military and then left Switzerland to work in America as a professor in the Psychiatry department at the University of Colorado. Seeing how the medical profession had become inhumane and less bonded with their patients, she decided to teach her students a real lesson. She invited terminally ill patients to come to her class and be interviewed by her medical students. She made the point that the sufferer had as much to teach as they had to learn, and as you can imagine, this changed the conversation about grief. Let’s not skip over this. End-of-life care such as Skilled Nursing, Palliative Care, Critical Care departments, and hospice care providers are indebted to this work of patient-centered care. It is hard to imagine our world of patient autonomy without Dr. Ross’ work. She gave the dying a voice in their treatment that had not been given before.
As a result of this pioneering research, she wrote her seminal work On Death and Dying where she presented 5 stages of grief: Denial, Anger, Depression, Bargaining, and Acceptance. These stages have become a global model for grieving. Now in the therapist's office, her model was being tested for its real results. When some read the stages of grief, they felt that if they passed through the stages into acceptance they would feel better and move on, but for many grievers - that is not what happened. Mourners got stuck in their grief. Like a dying person stuck in their bed, grief can feel restraining instead of releasing and it can illuminate patterns that have formed in our life.
For my daughter, I mean, Doctor Ross, depression was part of the normal grief process. The depression stage in grief doesn’t start as a clinical illness but it manifests as a deep sorrow, however, when a depressive position is resisted, it splits off and becomes more complicated (persecutory) in our grieving. The resistance to death was not only externalized by anger, but it needed to be internalized into a stage of depression so that the fear of death could be faced and a new identity or sense of self could be created. This resoluteness in grief is captured in a poem by Rabindranath Tagore placed in the preface of Dr. Ross’ book: “Let me not pray to be sheltered from dangers but to be fearless in facing them. Let me beg not for the stilling of my pain but for the heart to conquer it.”
There is a point when the dying person realizes he or she will not be rescued but rather must take on the courage to be, and conquer the fear which is to accept it by faith. This is an ancient paradox of accepting fear as a friend, rather than a foe. Authorities have used our fears for manipulation and coercion, most particularly religious authorities, but who knew there was a forgotten wisdom to allow fear to be a sacred spiritual guide? Fear can help the human heart identify their needs in grief which is to encounter a new form of love we have yet to encounter. Dr. Ross doesn’t talk too much about love. Most doctors don’t. But one of Dr. Ross’ patients mentions a loving encounter with a visitor,
“He was here the other day. Yes, he sent me a beautiful bouquet. But from him, I got my faith. It’s my faith now. And it’s faith, it isn’t a theory of someone else, meaning I don’t understand God’s way and many things that happen, but I believe that God is greater than I am, and when I look at the young people dying, and their parents, and everyone says what a waste and that, I can see. I say, ‘God is love,’ and I mean it now. It isn’t words, I mean it. And if he is in love, then he knows that this moment of this person’s life is their best moment.” (pg. 70)
For years Dr. Ross’ answer to becoming unstuck was to insist mourners participate in an act of faith which is to accept death and grief as a part of life so we can move on. Interestingly she later changed her message, perhaps because many of her colleagues did not like her stages and the assumption that grief took on a linear path towards getting over it. I mean, what if grief remains with us even if we aren’t consciously invested in its pain? Dr. Ross joined David Kessler to correct some myths about her stages in a book called On Grief and Grieving where she updated the stages to include guilt and shock (maybe her feelings when her book was so misunderstood) but she included in the afterword of the book:
“the reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”(pg. 230)
What does it mean to rebuild oneself ‘around’ a loss? Does our sense of self over our loss to hide it in some way? Does the loss become front and center and take over our identity? What does it mean to change in grief? If you love a good mystery to solve this is where the fun begins. We will rebuild the narrative by looking back to ancient history for the first letter ‘r’ in grief work. When we find the first ‘r’ we find where this mystery puzzle began to unfold. But let us pause for a moment and consider what may have happened at this point in the story or any story. You see once Doctor Ross constructed the stages she told a story about grief. Stories are dangerous things. It is very difficult to construct a story without splitting the narrative between a hero and villain, what is good or bad, even right or wrong. Grief plays by the same rules. If we are stuck in feeling the one we grieve is ‘all bad’ or ‘all good’ with no blend of human imperfections then we lose something within our experience of love.
The first ‘r’ repression was not discovered but integrated into therapy by the Father of the modern grief family- Dr. Sigmund Freud. It was a term used and expounded upon in the 1840s by Ludwig Feuerbach to describe how a society's internal conflicts can be repressed by religion. His particular critique was the Christian religion. Interestingly, Freud associated religious repression with the ‘father complex.” Father Freud writes after developing his method over many years,
“psychoanalysis teaches us with quite special insistence that the god of each of them is formed in the likeness of his father, that his relation to God depends on his relation to his father in the flesh and oscillates and changes along with that relation, and that at bottom God is nothing other than an exalted father.” (1)
This father complex ( also known as superego), or internal voice of ‘the law’ denies one pleasure and speaks of the limits of reality. I think it is important to acknowledge that Freud also repressed his religious belief because of unresolved conflict with his father along with an attempt to maintain scientific credibility. But a closer look into history shows us there were other really good reasons for Father Frued’s defenses and repression which we will take up later on in the book. It is also important to note that not all gods are Zeus-like fathers. It is also fair to say, some individuals have gods more like their mother. A god that promises a future reality that is a fulfillment of one's dreams which can make us whole and complete where we can get what we wish for.
But if the family gives space for the Father to be disciplinarian, he is the one who denies the children free association and his moral voice is appropriately internalized. But this demanding, unrelenting voice of the superego was not characterized as a moral voice, it was just a stronger voice that demanded authority. The Father’s ideal role for teaching in the home not only religious values but all matters of morality can become an attempt to control all manners of conflicts within the family instead of working them through.
Dr. Freud insisted that his patients not filter their thoughts and feelings, rather, allowed them to let their thoughts and feelings speak through free association. But even if we fill up a session with all our words and stories something can still seem hidden. Like the epitaph on a tombstone that says, “Gone but Not Forgotten”, Father Freud noticed there was a phenomenon of “Forgotten but Not Gone” in the psyche which he called repression. Repression is a mechanism that allows the mind to consciously deny what it knows to be true because the patient is strangely inhibited or prohibited from freely associating with themselves. To put it plainly, the mind refuses to know what it knows about the trauma of life until a later experience ruptures our reality and pulls us backward to an earlier life memory.
When it comes to modern mental health, there is an emphasis on what is normal or maladaptive behavior or healthy or unhealthy emotional coping. For Dr. Frued, or as he will be referred to here, Father Freud, his concern was with what is real or unreal in the mind of the subject. This may sound unimportant, or even insensitive, but this split is the beginning of a new model of the mind. Notice he was not exploring what was real or not real in the subject but was exploring the ‘unreal’ or the fantasy structure in the mind that gets woven into our ideals where we miss something in real of life. In his theory, the trauma was often in accepting life as it is, when the mind can create a too-much-ness that must be integrated. An experience can be very good or very bad and how we experience this too-much-ness on either side is within our fantasy as a way to mark it in memory. Trauma is a Greek word for wound and in a subjective or emotional sense, the wound is quite invisible and thus it becomes unspeakable for the patient. In other words, the wound is repressed but can be seen by the third eye in the counseling office.
The third eye Freud identified in the counseling office was the symptom. The symptom most identified with grief is often depression but Freud was interested in anxiety. Not to analyze grief, as it were, but an attempt to analyze what was lost (or hiding) in the subject, which to him was an unintegrated memory. Anxiety also spoke of a too-much-ness in desire, which he called libido, and this anxiety is what makes grief sexy. The symptom always tells the truth when our words and even actions can hide the truth in some way. The symptom is speaking the unspeakable of the unconscious and comes most alive in our dreams. If you think about it, why are our dreams hiding truth from us? That’s right. We are in our bed at night watching these movies we have made in our head and we won’t even disclose the truth of what they mean to ourselves. What?!
The symptom would be speaking the unspeakable in the patient’s grief and also would slip out in how something was heard/misheard or said/mis-spoke. He termed this parapraxis. The unconscious was also speaking through the characters in the stories told by the patient as they borrowed from the conflicts of others rather than facing their inner conflicts. The patient talking about these other things was talking about themselves but they were not aware of those associations.
Another clue for the mystery cure for grief is in the symbolic structure of the counseling session itself. Dr. Freud used another ‘r’ word and created a technique called reality testing which was his exploring the conflict between what feels real and unreal to the subject and to unpack the trauma of human relationships. Because the patient could not see their projections - or put off their inner conflicts with others - Father Freud made projection visible by how he and the patient sat in the counseling office. Father Freud, and modern analysts, have patients lie down on a couch. This image has been depicted in movies and television for decades but the reason for this technique is rarely explained. Father Freud would sit at the head of the couch so that the patient would be looking in the same direction as the analyst - like they were both watching a movie together.
Father Freud's choice of not looking face to face was more intimate in that the words meant so much more than the stories themselves. Not what words were used, but how they were used - even misused. Their words became a map of the meaning or signification of the symptom. Once Father Freud enters the world of the patient's words it becomes clear how the patient is attempting to speak the unspeakable by what words are said and omitted, and in particular words that are misspoken. This gentle listening to the wounds in their words is how the analysis can reconstruct the trauma and therefore can reconstruct reality through the reconstruction of one's relationship to a listening cure. We can get caught up on meaning or answers, which strokes the ego validating intelligence, alone. To me, the wound in our words of grief is less about our relationship to answers and more about our relationship to mystery and the non-answers in life. The meaning is most pungent in the ways the absence of meaning takes meaningful form. To cope with this absence we can be looking for a type of mother when our grief is looking for a mirror. This search for comfort strangely seems more like an unconscious search for conflict as loving support just can’t do enough to make us happy and feel nourished. The mourner can be protesting how they feel unseen and invisible, yet, when the caring person sees their life falling apart they refuse the mirror and demand a mother.
In everyday life, it actually might be rare to see people face to face even when we are talking to their eyes. We look at someone and see what we want to see in them and make judgments instead of creating the space of their subjectivity to speak about their experience of their world and even their experience of us. When we talk to another person we are projecting on them our needs and wishes through association. If they are a person of authority we try to read what they think or feel about us which interestingly gets linked or associated with other authority figures in our past. We can not control this because it is how our minds are structured when making meaning with words.
This is also another key to the mystery cure for grief which is how Father Freud centralized the unconscious in counseling ensuring counseling remains compassionate. We are asking people to reconstruct their painful associations with the world which were likely taught to them by their parents (or lack thereof) and this is very precarious. A patient's defense to discovering these unconscious associations is sustained by a loyalty to love. Reality testing loss has a triangular effect. No matter what is lost by Freud’s patient - use of a hand, side of the face, death of a parent or child - the patient has a third person in mind, often the parent. This means the patient, the thing lost, and a third is always present in the counseling room and slowly the counselor begins to symbolize this third person.
This notion that we can be unconsciously grieving for an audience creates meaningful associations to uncover how we suffer. Freud’s use of the Oedipus complex, which will be taken up later in the book, speaks of how our individual needs may be caught up in the flaws we perceive in our parents. As we come to terms with the humanity of our parents, the conflicts of grief are more associated and located within rather than in them. So we get it, the symptom is the third eye in the counseling office to show us the unconscious - blah, blah, blah. What about the mystery cure for grief and when does Father Freud tackle this idea of mourning?
Freud authored a paper in 1917 called Melancholia and Mourning where he addressed this very issue of what makes mourners stuck in their grief and this is when he introduced the idea of Melancholia in grief which is understood today as clinical manic depression. Mourning is a natural process of coming to terms with a loss in our world. Melancholia is when the loss is split off in the subject and internalized as a sense of lack. A bereaved person may speak of their loved one in idealistic terms as if the goodness in the relationship is only in the deceased and now the bereaved person must hold all the badness of the relationship keeping them stuck in a false sense of themselves. Modern ideas of reminiscing or continuing a bond with the deceased speaking only of the good of a relationship usually means the mourner remains in the imagination of love rather than working through the conflicts of love which can’t be addressed directly and need symbolic representation and thus the symptom of melancholia speaks this unspeakable story in modern mourning. And we wonder why grieving gets complicated and so many mourners feel depressed.
Father Freud's psychoanalysis was less about helping his patients ‘let go’ of what was haunting them as if the pain was primarily linked to a regressive state from childhood and more about ‘letting it out’ because something was speaking in the here and now of their life. Freud resisted naming the ‘it’ (known as the id - in German is literally ‘it’ - in classical ego psychology) as a deeper essence within us. Freud argued that the ‘it’ - perhaps the wound within - is often hiding in everything we do. He invited his patients to ‘let out’ (hypercathaxis) their free associations so that he could catch the subtleties of their language understanding the ‘it’ would slip through almost unnoticeably in what was wished for. Stories of loss are so linked with stories of love that we can not separate the two - even if what we have lost can feel so benign. Like losing our hair, keys, or losing a presidential election. In Freud’s paper about mourning, he interestingly didn’t discuss the literal death a person mourned. In his paper, he used the example of a symbolic death of ‘a woman who had been jilted on the altar.’ For Father Freud, grief was an invitation to explore this symbolic world often in our dreams where there should not be limits but yet our mind creates them. When within our mind there becomes an impasse between limit and loss, a lack can form and feed self-reproach. He writes,
Father Freud explored the trauma in the loss of love throughout his career, finding helpful insights into human sexuality and the way we deal with limits within our loving relationships. Father Freud taught us that feeling stuck in mourning may not only be an encounter with painful endings but also a resistance to healthy beginnings. Maybe we have felt stuck for a very long time repeating the same conflict just with a different face. Maybe there are repeated patterns, and loops of behavior, that prevent us from creating a new story with our life.
This is the key to going to the unknown of grief because the temptation is to find the ‘it’ or core meaning, deep within the story; however, Father Freud discovered that the ‘it’ is always hiding in plain sight and slips through within human relation not in what we say to each other but in how the patient tries to tell a story to make the the suffering story complete and coherent when it is split.
Freud found an unlikely pupil who would help reorient psychoanalysis back to science in the creation of what she called object relations theory. It’s here where we find the mother of psychoanalysis - Melanie Klein. Mother Melanie, also from Vienna, Austria, was about fourteen when she began to dream of being a doctor and with her mother’s help learned enough Greek and Latin to secure a path to medical school. But her dream was cut short by an early marriage at 17 years old which subsequently led to three children. It was during the First World War that she returned to her interest in Freud and began studying psychoanalysis independently. Her husband's work moved them to Budapest where she was analyzed by one of Freud's dear pupils, Sandor Ferenczi who encouraged her to work with children. After the war in 1921, she was invited to Berlin by Dr. Karl Abraham where her ideas blossomed and her career was established.
After her training, her scary German accent prohibited her from finding many clients, so she started treating her children. Freud did not treat children, believing they were not able to fully participate in the internal dynamics of the unconscious transference relationship. But Mother Melanie observed how children play with objects and use them to tell stories about the conflicts in their inner life of love and naturally created a relationship to the symbolic. She developed what would be called object relations theory by carefully witnessing how children relate or play with objects like a toy, a sibling, or even their mother’s breasts. Klein makes many beautiful and important discoveries but one most critical is what she calls projective identification. Projection is what Freud calls this ability to project onto someone else what we have repressed about ourselves. This is a fundamental Freudian psychoanalytic insight to understand whereby it is human nature to blame or praise others when our unconscious desire might be the opposite.
Now this blame game causes a lot of war within families, but for Klein, she wanted to look closer to interpret the unconscious anxiety in the child. Children are taught, “I’m rubber and you’re glue, what you say bounces off of me and onto you.” What if a trusted caregiver does project onto the child something they don’t like about themselves and the child identifies with the projection? It would be great if the child thought of a parent's criticism, “oh, yes, dad’s just feeling insecure today.” Or, “Mom just doesn’t think she is beautiful today.” But the child often thinks, “I am not good enough.” A child can feel trapped in this identification which was a projection from their primary caregiver who needs something and yet they have told their child they need it.
But this phenomenon tends to happen most when the child engages in infantile rage, acting out in screams and fights with the parent. Instead of engaging with the child's needs, the parent can neglect them. But if the parent engages the rage, understanding how the child needs to experience all of their emotions in a facilitated environment, otherwise, these things will discharge in an environment that may irreparably harm others and themselves. As we grow, and conflicts become more complex and less spoken in adult relationships, we can fantasize about what others are feeling instead of integrating our inner conflicts. In this fantasy, we can project our self-hate on the other and they begin to hate us. We taught them to be afraid of us. We condition them to hurt us by our sense of hurt. Parenting takes on this impulse by children to engage in projective identification and not be bamboozled by it. The ‘good- enough’ parent sees this manipulation and creates a space for limits and loss without agreeing with the child on their sense of lack.
Another insight from Mother Melanie is how children are taught the psychological technique of ‘splitting’ by the nature of survival. Splitting is the infantile early development of the super-ego. Our parents teach us that this is hot and this is cold. This is safe and this is unsafe. This is good and this is bad. But more fundamentally - this breast will feed me this breast won’t. This breast is good and this breast is bad. Coping with the limits of love are threshold of growth. But often when a child is testing the limits, it is not based on their fantasy sense of reality, rather, there is some unconscious wish for repair of security and care from the parent. Object relations theory teaches us how rebelling against limits (as children or adults) often hides through symbolization, some kind of loss about the primary caregiver. Entering the world of a child's words is often entering the world of words of the parents and detecting their ‘voice’.
“Thus, the phenomenon which was recognized by Freud, broadly speaking, as the voices and the influence of the actual parents established in the ego is, according to my findings, a complex object-world, which is felt by the individual, in deep layers of the unconscious, to be concretely inside himself, and for which I and some of my colleagues, therefore, use the term ‘internalized objects’ and ‘inner world’. The inner world of innumerable objects taken into the ego, corresponding partly to the multitude of varying aspects, good and bad, in which the parents (and other people) appear to the child’s unconscious mind through all the real people who are continually becoming internalized in variety of situations provided by the multitude of ever-changing external experiences as well as phantasied ones. If, in our patients, analysis diminishes the anxieties of destructive and persecuting internal parents, it follows that hate and thus in turn anxieties decrease, and the patients are enabled to revise their relation to their parents - whether they be dead or alive - and to rehabilitate them to some extent even if they have grounds for actual grievances.” (pp. 362-369)
For Mother Melanie, the mourner, no matter how old, can enter these repeated patterns of childhood persecution. This means the mourner is not only searching for the comfort of a primary caregiver but may be searching for a conflict to deal with feeling neglected and their needs unwitnessed. The mourner, through grief work, learns that these re-enactments in the here-and-now are projections from their past that have been internalized, and there's work to be done to see the world more ambivalently.
In her book Love, Guilt, and Reparations Mother Melanie shares a case study about a young boy named Fritz and proceeds to illustrate this process of entertaining the machine gun-like questions from the anxious child testing limits. Mother Melanie entertains his questions about existence and sex, his ‘interest’ in poop and urine, and the discovery of real things in the world like the sun, garden, electric cars, and even a train. After the onslaught of questions, the child notices his parents (and therapist) do not have the answer and begins to explore this with ambivalence, which is to say, the parent has what he wants and sometimes doesn’t. She writes,
“When the reality principle gets the upper hand in this struggle and maintains the necessity to limit the boundlessness of one's omnipotence-feeling, a parallel need arises to discover mitigation of this painful compulsion in the detraction from parental compulsion. If however, the pleasure principle conquerors, it finds in parental perfection a support that it tries to defend.” (2)
It’s funny how sometimes the parent is really smart and kind of dupes their kid into thinking they do have all the answers which is not true. When Fritz went to school, this re-enactment continued, but now with his friends. It was Fritz's playmates who started teaching him about truth and lies and he was conflicted inside. At first, he didn’t want to admit their unkindness hurt him, rather, he defended them until his brother said they couldn’t be trusted. And Melanie shared,
“Aggressive tendencies now appeared quite openly; he spoke about shooting them dead with his toy revolver, about shooting them in the eye; and showed his death wishes in his remarks and in his play.” (3)
Oh yes, ‘normal’ children have destructive tendencies, even criminal tendencies. But like Fritz, this splitting is repressed and so he returns to his playmates as friends and ambivalently accepts that they are just kids. The therapy allowed for this expressed aggression to exist and thus the child became unstuck in the need to act out this sense of loss. Mother Melanie expanded reality testing to what she called reparation which was to explore how our primary caregiver or friends may not be what we have hoped but also might not have been what we had feared. Reparation paradoxically begins to accept that our primary caregiver is like us - full of wishes and lack - and often we are trying to fill in the story of love without all the right details. Sometimes a child's belief/projection that their parents think they are bad, can become a self-fulfilling prophecy which creates guilt and a paranoid schizoid position. It’s when the psychotic core of good or bad is further split in two rather than integrated as good and bad within the subject.
Mother Melanie's last paper published three years after her death is titled The Sense of Loneliness in which she mirrors the end of life with the beginning of life. Since we begin life usually in a clinic in need of a caregiver, any subsequent illness is a return to the clinic where we find we continue our dependence upon a primary caregiver, and the longing for a mother persists.
For Mother Melanie, the mourner has a lifelong journey to experience the losses in life as limits and not punishments or a sense of withholding, rather use this empathy to give voice to the exiled experience. Similar to Kubler-Ross’ acceptance, Mother Melanie invites mourners to embrace what she called the depressive position which is to experience the lack within as less punitive or persecutory and more universal. Loneliness and loneliness are a trauma that all of us will encounter no matter our socio-economic position. When faced with the possible meaninglessness of our sufferings, it is easier for the sufferer to find meaning in a belief they are being punished rather than absorb the possibility that their suffering is quite normal and therefore, quite meaningless. The anger towards this predicament can point outward or inward and surface old traumas of desertion and forgottenness to remind us how mourning is not only about endings but beginnings whereby we are repeating behavior patterns we are not aware we are repeating.
The Modern grief care story goes beyond the daughter, father, and mother to who I think of as the son of the modern grief family and he was attached to ‘mother’ Melanie’s hip. John Bowlby also studied mourning through the lens of beginnings, not endings. Before the 5 stages of grief, Dr. Bowlby created the four stages of grieving to describe the separation from a caregiver. 1) shock/numbness, 2) yearning/searching, 3) disorganization-despair, and 4) reorganization. Dr. Bowlby explored the idea of ‘separation anxiety’ when he wrote,
“my view is that the principal trauma, which is potentially present in the life of a young child, is loss of a mother, or loss of her love.” (4)
Consider this analogy. As a child transition to school, their teacher (now mostly female) becomes a new type of mother and their pencils and crayons become their new objects to tell stories of what feels missing in their young world. As they grow older, perhaps their coaches become new fathers and even give them balls to play with. These balls become what Donald Winnicott called ‘transitional objects’ which beyond mother breasts, are our first ‘not me’ objects we connect to who are not enmeshed with mother. For example, the ball becomes a symbolic object with profound internalized relations. But some kids struggle to pick up sports, so they choose an instrument or other object of meaning and these objects mediate conflicts that were unspoken at home with primary caregivers.
When Dr. Bowlby offered this idea of attachment to his classical psychoanalyst friends they rejected him and he was kicked out of their cohort. Jerks. How could these psychoanalysts be so brutal with their ideology and exile a dear friend? They were jerks, but like many jerks, they thought something essential was being threatened. Attachment seemed to be going in the opposite direction from individuation and the formation of a healthy ego/self. Now let's be clear, these psychoanalytic therapists likely would have been a bit insecure of Bowlby's claim on therapy because they weren’t even called therapists - they were analysts. They were to analyze at a distance as their clients' internal movies/ thoughts and feelings were objects of study and didn’t even look them in the eye.
But the work of object relatedness was to reveal how this distance just wasn’t always therapeutic. Children need a bond, a nearness, a parental figure to attach to. Since psychoanalysis often is a guided quest into our childhood aggression and regressions, patients transfer a need for the security and support of a parental figure. Bowlby's theory about attachment ultimately invited the therapist to be vulnerable so that the patient can transfer this need of a caregiver upon them and over time can experience their inner world of needs. But it takes discipline for the therapist to see themselves as a symbol of an unsettled attachment.
Modern therapists understand that assuming this position of attached caregiver, knowing they can’t fulfill a primary caregiver role, is very fragile and can cause psychological harm if not facilitated skillfully. Sometimes patients can form a co-dependent relationship with their therapist as a surrogate parental figure and the patient never learns to face the world with their own courage. This is also why many therapists wish to be your mentor, guru, or coach, because it is too uncomfortable working around the profound transferences within the relationship. But if therapists are symbolic, they are taught to re-enact the symbolic inner conflict the patient is seeking to have with a caregiver, which means exploring their destructive impulses and ambivalent feelings, so they can become a healthy individual through an encounter with the conflicts and limits of love.
Brother Bowlby’s attachment theory helped psychoanalysts lean in further and build better alliances with their patients so they understood the unconscious power of a transference relationship and need for a secure bond. Dr. Bowlby argued that emotional individuation is always the goal, but the healthiest place to start was to allow this projection of primary caregiver to animate the story of what the inner child feels is lacking within themselves. Bowlby's attachment theory is now adopted broadly by psychotherapists who are taught to model a caregiver role to not only patients but also parents to help the family attach for the sake of healthy differentiation over the discovery of their child's deeper capacities for resilience through vulnerability. Dr. Bowlby and broadly psychoanalysis, maintains that the lost object in therapy is often the lost attachment with one's mother.
Bowlby’s theory of forming an early attachment with mother has also undergone great scrutiny as it functions with one major assumption; the mother ought to celebrate her primary role of nurturing a child within the family system. Some cultures do not give the mother the primary responsibility to raise the children, rather the father or even ‘the village’ (extended family or hired caregivers) raises them. The village, which is a cross-cultural phenomenon for the survival of the poor in society, has become more popular in western culture, however, most psychologists agree that without the establishment of a secure bond with a mother/primary caregiver figure, development is critically disturbed. Within this model of development, grieving was part of growing and affirmed as the cost of feeling attached and healthily separated. John Bowlby brought to our attention how even Freud later noted that children and infants grieve and its effect even though not pathological, is heart-shaping:
Bowlby searched for Freud's overall view of grief and mourning, knowing that in bereavement in particular, a child is searching for a primary caregiver. But so are adults. Mourners can unconsciously reach back in the past to anchor their sense of love, to feel like they belong to a larger story. But in mourning, we are often uprooted from a caring world. We don’t recognize this new path forward, so we go where it is familiar - we go backward and can get lost searching for ghosts. Bowlby believed the stage in which the mourner was most likely to be stuck was in the yearning or searching stage.
But who has that much time to explore with a patient all this content of lost stories in family, work, religion, history, etc? Don’t we have patients who just need cognitive and behavioral guidance? To think and do more positive things for their family and themselves. Well . . . the ‘r’ list keeps growing as other grief experts keep using the alliteration. Dr. Robert Neimeyer teaches the idea of reconstructing the meaning of the loss through narrative therapy and keeping journals of one's grief experiences. Dr. Alan Wolfelt says to reconcile internal grief with external mourning through more journaling exercises. Dr. Richard Schwartz teaches how one should re-script the grief narrative in some way to serve the inner needs of the traumatized person. As it turns out, the best grief therapy still honors holding a deep story of suffering for patients needing more therapy rather than less to understand what it is that still feels lost to make the story more nuanced and the patient enjoys the sense of incompletion so they may remain curious to their own choices in the meaning of their life.
It was the French Psychoanalyst, Jaques Lacan, (aka French Freud) who took the old Freudian garden of the unconscious seriously and went to work pulling the weeds. He began to re-language the unconscious through the frames of the imaginary, symbolic, and the real to make restitution with the past. What is fascinating to me is this framing had been the history of psychoanalytic work up to this point. The lost story of the repressed unconscious was still stuck in finding what feels hidden rather than missing, perhaps stolen in the subject. It creates a tremendous amount of therapeutic activity to keep going through this content in hopes we recover something that had been lost in the past. Lacan believed the tradition of healthy therapy should take the storytelling of narcissistic musings seriously but be willing to wound it if necessary with a discipline of seeing ‘the real’ coming out in the here and now of therapy.
Of course ‘the real’ is metaphoric as well because finding it was not seen but rather a part of the discourse. It was speaking through the symptoms of what the patient was (un)doing to cope with the truth. Therapy can get lost in addressing unmet needs when in truth its power is in confronting desire in engagement with what Donald Winnicott called the ‘False Self’. One can know when grief needs therapy and not counseling when there is an obsession with grieving the right way or good way or after a trauma there is a voice of righteous rage that becomes persecutory. Health mourning becomes less about making us be good and more about making us more true - which is to have a more ambivalent relation to what we want out of love.
Dr. Winnicott writes in his paper Maturational Process, “On the basis of this, one could say the False Self deceives the analyst if the latter fails to notice that, regarded as a whole functioning person, the False Self, however set up, lacks something, and that something is the central element of creative originality.” (pg. 152) In other words, while grieving the lost object of love which feels be missing in one’s life Winnicott notices that mourning becomes unstuck only when the mourner becomes aware that what is missing is not outside of themselves, rather it is their true self which has become missing from their own story.
(1) Freud, S. 2001 (orig. 1913). Totem and Taboo: Some Points of Agreement between the Mental Lives of Savages and Neurotics (trans. James Strachey). Oxford: Routledge Classics.
(2) Klein, M Love Guilt and Reparation, Love, Guilt and Reparation: And Other Works 1921-1945 (The Writings of Melanie Klein, Volume 1; pg. 16
(3) Klein, M Love, Guilt, and Reparation, Love, Guilt and Reparation: And Other Works 1921-1945 (The Writings of Melanie Klein, Volume 1; pg.1 7
(4) John Bowlby, Grief and Mourning in Infancy and Early Childhood, Psycho-anyltic study of a child, 1960., pg 13.
BORDERLINE: Abondement, Projective Identification, and Parental Provocation
“To be authentic we must cultivate the courage to be imperfect and vulnerable.” Dr. Brene Brown
Vulnerability is the royal road to encounter our authenticity. Without vulnerability, there is no core identity from which we can freely share genuine expressions of thoughts, emotions, and behaviors. There are individuals in our midst who are committed to this sacred path of living authentically and have much to teach us, but instead of learning from them, we have often diagnosed them. Paradoxically, these individuals can feel lost and be hiding in identities that are not fully themselves, struggling with self-harming behaviors like addictions and eating disorders. They may pass through inpatient and outpatient mental health services and encounter providers who experience their neediness and manipulation as a victimization mentality rather than the creation of a mental health system that benefits from their patient's illness. This perhaps is the near impossibility of changing the character of these individuals because they can be caught up in the performance of illness even learning the therapeutic language and sustaining diagnostic criteria, such as weight loss or substance relapse to find their way back to their mother, who is the clinic. So maybe our collective imagination needs to change so that the clinician's vulnerability shifts first and then their patient may follow.
ABANDONMENT
Abandonment lies at the core of many individuals with BPD, as they often experience intense fear of being rejected or left alone. This fear stems from early childhood experiences where they may have felt emotionally or physically abandoned by significant others. These individuals may struggle to form stable and secure relationships, constantly seeking reassurance and validation. Unfortunately, the misuse of the BPD diagnosis often leads to further abandonment, as they are labeled as difficult or attention-seeking rather than understood and supported. This perpetuates a cycle of invalidation, reinforcing their fear of abandonment and making it more challenging to develop authentic connections.
PROJECTIVE IDENTIFICATION
The concept of projection is the idea that we project what we don’t like about ourselves onto the vulnerable other who has little power to defend themselves properly. Instead of using defenses like humor, deflection, and disavowal, the person may identify with who they are suggested to be to avoid shame and guilt and their personality transforms into the person they are not authentically. Projective identification is another theme that emerges in the context of BPD diagnosis. As noted, projection is a defense mechanism that involves unconsciously projecting one's undesirable thoughts, feelings, or attributes onto others, often followed by a profound urge to control and manipulate them. While this behavior can be observed in individuals with BPD, it is crucial to recognize that it is a learned behavior. Caregivers, and therapists, can also project onto the patient this idea of borderline and the patient or client identify with this message and begin acting out the behavior in the room with the clinician and thus enacting a vicious cycle of inauthenticity and further abandonment of the patient.
PARENTAL PROJECTIONS/PROVOCATIONS
Abusive provocation by caregivers is a third theme that contributes to the misuse of the BPD diagnosis. The individuals I have worked with who have BPD symptoms have often experienced deep trauma in their life in particular the provocation to perform by caregivers. The intelligent child is often provoked to argue and debate with the parent. The attractive child is often provoked to manage her modesty and remain thin and attractive. The entertaining child is often provoked to regulate and manage the ever-changing moods of their caregivers. This trauma can result in difficulties regulating emotions and interpersonal relationships. However, the misuse of the BPD diagnosis can absolve caregivers of their responsibility, attributing all challenges faced by individuals to their supposed pathology. This perpetuates the cycle of abuse and denies individuals the opportunity to heal and reconnect with their authentic selves. True understanding and intervention should address the root causes of the distress, including the abusive environments in which individuals have grown up. And to be more disturbing, if we analyze their performance through the lens of projective identification, we may learn more about the clinician's unconscious mode of perverse enjoyment. This could mean, the patient has detected, by way of an uncanny ability to sense the desire of the other, and the clinician unconsciously perversely enjoys their illness and finds it entertaining.
HOME IS WHERE WE START FROM: The Interplay of Transitional Phenomena and Healthy Faith
“Art is the only way to run away without leaving home.” -Twyla Tharp
Donald Winnicott introduced the concept of transitional phenomena in working through painful intrapsychic conflicts related to our primary object relationships which could apply to our relationship with God. These phenomena, initially explored in the context of child development, have significant implications for understanding the relationship between religion, specifically Christianity, and the human experience. Transitional phenomena, as conceptualized by Winnicott, refer to the transitional objects and spaces that facilitate the transition from an inner world to an outer reality. These intermediary aspects serve as a bridge between the self and the external world, connecting the evolving sense of self with the realm of spirituality in the context of Christianity.
Winnicott’s concept of the transitional object, often exemplified by a child's attachment to a blanket or stuffed toy, corresponds to the individual’s need for a tangible object through which to dramatize their love and hate of a primary caregiver. Just as a child seeks security and destruction through their attachment to an object, Christians often seek a tangible connection to their faith to work through God protecting the faithful from an outside ‘other’ and God protecting the faithful from the ‘otherness’ within. Even Christ himself tried to engage in the loving and hate dialogue of his home, the Jewish community. And yet, he became very attuned with the idea that home is where we start from but it is in the world where we become who we are.
Beyond transitional objects and understanding that home is where we start from, Winnicott also emphasized the importance of transitional spaces, which are intermediate realms between subjective and objective reality. These spaces enable individuals to explore imagination, creativity, and the potential for spiritual growth. In the Christian context, such transitional spaces manifest in rituals, places of worship, and spiritual practices. Churches, for example, are transitional spaces where Christians can transcend their everyday concerns and connect with the divine. Within these sacred spaces, they engage in communal rituals, prayer, and reflection, creating an environment that encourages spiritual growth, self-reflection, and the building of a relationship with God. And if healthy faith is developed, the faithful’s destructive capacity is sublimated through a (de)constructive practice to rethink and reimagine what home could be out in the world away from the primary objects of our past. The (de)constructive practice engages with the conflicts of love whereby we acknowledge there was never an idyllic past, like Eden, to return to. Rather, we are tasked with creating a world that has never existed before. One might say, it is a world after the death of God and the faithful become the transitional object they have been seeking, which is an encounter with the spirit of Christ in the act of loving itself.
Of course, this elevates the role of creativity and imagination as it teaches the mind to relate and even communicate in the realm of the symbolic which is so often the language of love and hate. Reflecting on the transitional experiences, such as engaging with transitional objects or spaces, can foster authentic faith and mature development.
What is (modern) Psychoanalysis?
Understanding Psychoanalysis
Psychoanalysis “…is a method of treatment that offers a way of understanding ourselves, our relationships, and how we conduct ourselves in the world. Since its inception, psychoanalysis has captured great thinkers' imaginations and had an enduring influence on modern society and culture. Originally called the talking cure, psychoanalysis is the foundation of all talk therapies and helps people learn how they became who they are and why they do and feel the things they do, paving the way toward the emotional freedom necessary to make substantive, lasting changes. It helps people recognize and manage their strengths and weaknesses, accept themselves, and realize their fullest potential as human beings in a complex world.”
-About Psychoanalysis by Gail M. Saltz, M.D. and published by the American Psychoanalytic Association (2008).
Psychoanalysis is a type of therapy that focuses on examining a patient's unconscious mind to uncover hidden, missing, or forgotten emotions, thoughts, and memories that may be causing negative behaviors or emotions in their daily life. It was first introduced by Sigmund Freud in the late 19th century and has since evolved into various branches with different theories and techniques. It is the most common form on therapy in other parts of the world, in particular South America.
Psychoanalysis sessions can involve the patient lying on a couch while the therapist sits behind them, letting the patient free-associate thoughts and emotions without interruption. This method allows the patient to explore their unconscious without the distractions of conscious thought or social norms. However, Psychoanalysis is often done face to face if the therapeutic relationship needs this form of object constancy. Modern psychoanalysis focus’ less on drives and repressed sexual feelings and more on the discovery of a more integrative, authentic identity through a profound therapeutic relationship. Dreams are discussed and defenses are analyzed but not merely to expose one’s vulnerability but to help you be an active participant in a healthier defensive style with the capacity to be intimate with secure attachments. Psychoanalysis in its literal sense is ‘soul’ analysis.
Benefits of Psychoanalysis
One of the major benefits of psychoanalysis is its ability to uncover deep-seated issues that may not be immediately obvious through other forms of therapy. By exploring the unconscious, a patient can gain insight into patterns or behaviors that may have developed from childhood experiences or traumatic events. This process can help patients gain a better understanding of why they behave the way they do and develop the skills to change those patterns.
Another benefit of psychoanalysis is its focus on the therapeutic relationship between patient and therapist. The therapist's role is not just to listen and offer solutions but to serve as a guide in the patient's journey of self-discovery. This trusting relationship built over time can help patients develop greater emotional stability and self-awareness.
Is Psychoanalysis Right for You?
Psychoanalysis may not be the best fit for everyone. It requires a significant time commitment and can be a long and difficult process. However, it can be an effective treatment option for those struggling with severe anxiety, depression, personality disorders, and other complex mental health issues.
In conclusion, psychoanalysis is a powerful form of therapy that can help people explore their unconscious mind and gain insight into complex mental health issues. If you're considering psychoanalysis as a treatment option, it's important to understand the commitment involved and what the journey entails. Many training centers like the Dallas Psychoanalytic Center offer analysis at a reduced fee if you wish to start this journey.
The Transformative Journey of Psychodynamic Therapy: From Sickness to Well-being
Psychodynamic therapy, a dynamic and evolving form of psychotherapy, has long been recognized for its ability to guide individuals through an exploration of their innermost selves. Initially focusing on the concern of what it means to be sick and meeting diagnostic criteria, psychodynamic therapy gradually shifts towards the desire to understand what it truly means to be well. This essay will examine the transformative nature of long-term psychodynamic therapy, exploring how it facilitates the establishment of new relationships with dreams, love, gender, sexuality, and, most importantly, desire.
Understanding Sickness and Meeting Diagnostic Criteria
Psychodynamic therapy frequently begins with an individual seeking help due to a sense of emotional distress or the presence of symptoms. The therapist and client collaboratively work towards understanding the manifestations of their distress, letting the patient guide the therapist into their suffering. This initial phase focuses on holding space for the individual's pain, providing what Donald Winnicott called a holding environment for the conflicts in the patients life exploring this present state un-wellness.
Shift towards Well-being: Reconceptualizing the Meaning
As the therapeutic journey unfolds, the focus of psychodynamic therapy undergoes a profound shift from sickness to well-being. The therapist encourages the client to delve deeper, beyond the symptoms, towards the roots of their distress. Through self-reflection, clients gain insight into the underlying psychological processes that contribute to their emotional challenges and often a patient is constructing an identity based on what they feel they should be. Even the founder of modern talk therapy, Sigmund Freud, questioned wellness to the degree it appeared to drive him to write a few books on topics like dreams, civilization, and even an idyllic figure from his childhood - the Jewish patriarch, Moses. Sometimes we discover ideals are the root of our ills.
Exploring New Relationships: Dreams, Love, and Gender
As Freud’s psychoanalysis splintered, it became less concerned with universal, macro Ideals to more personal, micro ideals found in the relational dyad whereby we explore topics like love, gender, sexuality, and even desire. Long-term psychodynamic therapy offers a unique space for clients to establish new relationships with various aspects of their lives. One such aspect is the exploration of dreams. Dreams serve as a gateway to the unconscious mind, providing valuable insights into repressed desires, fears, and unresolved conflicts. The therapist assists the client in deciphering the symbolic language of dreams, facilitating a deeper understanding of their inner world.
Love, a fundamental human experience, also takes center stage in the therapeutic process. Psychodynamic therapy allows clients to explore their past and present relationships, understand attachment patterns, and work towards cultivating healthier connections. By uncovering unresolved conflicts stemming from early life experiences, individuals can develop more fulfilling and meaningful relationships.
Similarly, psychodynamic therapy invites an exploration of the complex nature of gender and sexuality. Clients are provided with a safe space to examine and challenge societal norms and expectations surrounding these topics, enabling a deeper understanding of their own identities and desires.
Dreams: Memory, Conflict, and Affect
Memory is a fascinating aspect of human cognition. It allows us to store, retrieve, and process information from our past experiences. However, memory is not just a mere recorder of events; it is intertwined with our emotions and conflicts. In this essay, we will delve into the complex relationship between memory, conflict, and feelings. Furthermore, we will explore the intriguing concept of our unconscious mind repeating trauma from our past in an attempt to somehow master it.
MEMORY
Memory is the cornerstone of our identity, shaping our perception of the world and influencing our decisions. Memories are stored in different forms within our brains, such as episodic, semantic, and procedural memories. Episodic memories are autobiographical and include specific details about our personal experiences, while semantic memories are facts and general knowledge. Procedural memories govern the skills we acquire over time. Together, these memories form the framework upon which we navigate life. When conflict arises, our memories play a pivotal role in shaping our perceptions.
CONFLICT
Conflict can arise in various forms, such as interpersonal disputes, inner turmoil, or even cognitive dissonance. Our memories, particularly the emotional aspects intertwined with them, can influence how we perceive and interpret conflicts. For example, a person who experienced betrayal in a past relationship might be more skeptical and guarded in future relationships, leading to conflicts when trust is challenged. Similarly, a person who faced financial struggles in the past might develop a fear of financial instability, leading to conflicts around money management.
The intertwining of memory and conflict gives birth to a rich array of feelings.
AFFECT
Emotions color our experiences and provide a subjective lens through which we interpret events. The emotions associated with specific memories can vary greatly, ranging from joy and love to fear and anger. These emotional imprints can shape our response to conflicts, sometimes leading to heightened reactivity or the avoidance of certain situations altogether. Our feelings can become intertwined with the conflict at hand, creating a complex web of emotions that need to be navigated.
Interestingly, our unconscious mind has a curious way of repeating trauma from our past in an attempt to somehow master it. This concept, known as repetition compulsion, is a central tenet of psychodynamic theory. According to Freud, repetition compulsion arises from our unconscious desire to revisit unresolved conflicts and traumatic experiences. By bringing these experiences to the forefront of our minds, our experiences to create unique narratives. Exploring these memories within dreams can offer valuable clues about unresolved issues or unprocessed emotions from our waking lives. Secondly, dreams frequently illuminate internal conflicts or dilemmas we may be facing. By examining these conflicts within the dream realm, we can gain a fresh perspective and potentially find solutions or resolutions. Lastly, emotions experienced within dreams are often intensified, providing a window into our deepest desires, fears, and anxieties. Analyzing these emotions can lead to a better understanding of our emotional landscape and the underlying psychological factors influencing our well-being. Overall, dream analysis offers a rich opportunity to explore the intricate connections between memory, conflict, and emotion, providing valuable insights into the inner workings of the human mind.
THE IMAGINARY, SYMBOLIC, AND THE REAL
One might say, CBT focus’ on a specific behavior and DBT focus’ on specific distressing and dysregulated emotions with the hope that we can reconcile how we behave or feel simply by working through present, apparent individual problems. Psychodynamic work focus’ on specific behavior and very specific distressing and dysregulated emotions also, but not as a phenomenon arising out of the individual. Thoughts and feelings are profoundly impacted by the social world one inhabits and internalizes in early developmental years of life through not only how we acquire language but how language seems to acquire us by possessing us with desires which may not be our own yet give shape to the characters we play in the grand narrative of life. Psychodynamic work takes a harder look at deeper (often older) processes whereby it explores the imaginary, symbolic and the real of what feels lacking in love. In this essay, we will explore three key reasons why psychodynamic therapy stands out as a wise choice for therapeutic intervention.
1. Uncovering the Root Causes:
Psychodynamic therapy delves deep into the unconscious mind, aiming to bring underlying, unresolved conflicts and traumas to the surface. Unlike CBT and DBT, which primarily focus on symptom reduction and behavior modification, psychodynamic work seeks to identify and understand the root causes of emotional distress and psychological difficulties. This in-depth exploration allows clients to gain insight into their motivations, behaviors, and patterns of thinking that may stem from early childhood experiences. By addressing these underlying issues, psychodynamic therapy lays the foundation for lasting transformation and healing.
2. Building a Meaningful Therapeutic Relationship:
Another distinctive advantage of psychodynamic therapy lies in the emphasis placed on the therapeutic relationship. Unlike the relatively structured and time-limited nature of CBT and DBT, psychodynamic work offers a safe and supportive environment where individuals can freely express their thoughts, feelings, and concerns without fear of judgment. Through this process, a strong and trusting relationship forms with the therapist, enabling clients to explore their emotions and vulnerabilities at a deeper level. This authentic connection often becomes a catalyst for profound personal growth and self-discovery, fostering lasting positive changes in one's life.
3. Holistic Approach to Growth and Development:
Where CBT and DBT tend to focus primarily on symptom management and skill-building, psychodynamic therapy takes a more holistic approach to growth and development. By addressing the underlying emotional conflicts and unconscious processes that impact our lives, psychodynamic work facilitates a profound transformation in various areas, including relationships, self-esteem, and overall well-being. Moreover, psychodynamic therapy recognizes the significance of the unconscious mind and the intricate interplay between past experiences and present difficulties. By tapping into these unconscious dynamics, individuals can achieve profound self-awareness and make lasting changes that extend far beyond mere symptom reduction.
In conclusion, psychodynamic therapy offers a significantly more poetic and comprehensive approach to psychotherapy compared to CBT and DBT.
Freud’s Pastor
Oscar Pfister's relationship with Sigmund Freud was an intriguing and complex one, characterized by both admiration and disagreement. Pfister, a Swiss pastor became fascinated with Freud's groundbreaking theories on the human mind and subconscious. Their interactions and correspondence, which spanned the course of 30 years, shaped the early development of psychoanalytic theory and its integration with religious beliefs.
In the book Psychoanalysis and Faith, which is a compilation of that correspondences between Freud and Pfister, we get a glimpse of how faith was a part of psychoanalysis. Freud writes to Pastor Pfister:
In itself psycho-analysis is neither religious nor non-religious,
but an impartial tool which both priest and layman can use in
the service of the sufferer. I am very much struck by the fact that
it never occurred to me how extraordinarily helpful the psycho-
analytic method might be in pastoral work, but that is surely
accounted for by the remoteness from me, as a wicked pagan, of
the whole system of ideas. While grieving his daughter, Sophie’s, death (who died from Spanish Flu in 1912) Freud writes to Pastor Pfister:
That afternoon we received the news that our sweet Sophie in Hamburg had been snatched away by influential pneumonia, snatched away in the midst of a glowing health, from a full and active life as a competent mother and loving wife, all in four or five days, as though she had never existed. Although we have been worried about her for a couple of days, we had nevertheless been hopeful; it is so difficult to judge from a distance. And this distance must remain distance, we were not able to travel at once, as we had intended, after the first alarming news; there was no train, not even for an emergency. The undisguised brutality of our time is weighing heavily upon us. Tomorrow she is being cremated, our poor Sunday Child! Our daughter Mathilde and her husband are leaving for Hamburg the day after tomorrow, thanks to an unexpected connection with an Entente train; at least our son-in-law was not alone; two of our sons who were in Berlin are already with him, and our friend Eitingon has gone with them.Despite their mutual respect, however, Pfister and Freud had fundamental disagreements. One significant point of contention was religion itself. Freud, famously known for his views on religion as wish fulfillment and illusion, found it challenging to grasp Pfister's commitment to both psychoanalysis and Christianity. In turn, Pfister believed that religion had a valid place in understanding the human psyche and emphasized the importance of spiritual experiences.
Their differing perspectives became more pronounced when they debated the role of sexuality in religious experience. While Freud viewed sexual repression as a source of neurosis and believed that religious rituals served as a substitute for repressed sexual desires, Pfister argued that religion provided a way to channel and transform sexual energy into a higher spiritual state. This clash highlighted the contrasting views of the two men, with Pfister seeing sexuality as an essential part of human nature, whereas Freud saw it primarily as a source of conflict and repression.
Despite these differences, Pfister remained dedicated to Freud's groundbreaking theories. He saw the value in Freud's approach to psychoanalysis and the therapeutic benefits it could bring to individuals suffering from mental health issues. Additionally, Pfister admired Freud's pioneering efforts in challenging societal taboos and stigmas surrounding mental health, paving the way for a more open discourse on psychological well-being.
Their relationship extended beyond professional interactions, with Pfister inviting Freud to visit him in Switzerland. Their meeting was marked by intellectual discussions and conversations on the human condition, as well as walks in the serene Swiss countryside. These personal encounters allowed for a deeper understanding of each other's viewpoints and fostered a sense of mutual appreciation.
Understanding the Differences Between Family Based Systems and Emotion-Focused Family Therapy
When it comes to family therapy, there are different schools of thought. Two of the most commonly used methods are family-based systems therapy and emotion-focused family therapy. Both approaches have their own unique strengths and weaknesses. In this article, we will discuss the differences between these two methods and why one might be a better fit for your needs.
Family-Based Systems Therapy
Family-based systems therapy is a type of therapy that helps families to identify and change the patterns of behavior that contribute to their problems. This approach is based on the idea that individual problems are not just the result of personal flaws, but are the result of systemic dysfunction within the family. Therefore, the family as a whole must be treated, not just the individual with the problem.
Therapists who use this approach will work with the entire family to identify common issues, learn effective communication techniques, and develop conflict resolution skills. The aim is to help families understand and address issues that are contributing to the problem so that they can move forward and recover.
Emotion-Focused Family Therapy
Emotion-focused family therapy is a type of therapy that focuses on the emotional experience of family members. This approach recognizes that emotional trauma can be passed down from generation to generation, and that family members may have unresolved emotions that are contributing to their problems.
Therapists who utilize this approach will work with families to help them understand how emotions are impacting their behavior and relationships with each other. This is done by creating a safe space where family members can express their emotions freely. The aim is to help families work through their emotional challenges and create a stronger bond amongst themselves.
Differences Between the Approaches
The main difference between family-based systems therapy and emotion-focused family therapy is their focus. Family-based systems therapy focuses on the patterns of behavior that contribute to the problem, while emotion-focused family therapy focuses on the emotional experience of family members.
However, both approaches recognize the importance of addressing issues within the context of the entire family and understanding that individual problems cannot be solved in isolation. Additionally, both approaches believe in creating a safe space where family members can come together and work towards healing.
Choosing the Right Approach
When considering family therapy, it's important to choose an approach that will be most effective for your unique circumstances. If your family is struggling with communication and conflict resolution, family-based systems therapy may be the right choice. However, if emotional issues are more of an issue emotion-focused family therapy may meet your needs more efficiently.
Love, Work, and Play
Therapy is a powerful tool for achieving personal growth and improving the quality of life. The primary goal of therapy is to help people gain a better understanding of themselves and their relationships with others. The three main goals of therapy are to improve relationships with love, work, and play. Each of these areas plays a critical role in our lives, and when they are in balance, we are more likely to feel fulfilled and content.
Goal 1: Improving one’s Relationship to Love
Love is an essential part of human connection. Whether it be between friends, family, or a romantic partner, healthy relationships bring a sense of joy, comfort, and security and are essential for emotional well-being. Unfortunately, when relationships are not functioning correctly, they can lead to feelings of sadness, anxiety, and loneliness. Therapy helps people identify and address unhealthy patterns in relationships, providing the tools and support needed to communicate effectively and create more meaningful connections. Which means, we become more tolerable to our more uncomfortable feelings such as hate.
Goal 2: Improving one’s Relationship to Work
Work takes up a significant portion of our lives and our identity, and it's crucial that we have a healthy relationship with it. When we experience work-related problems such as stress, burnout, and dissatisfaction, they can quickly spill over into other areas of our lives. A therapist can help individuals explore and identify underlying issues, set boundaries, and develop healthy coping skills to address work-related stress.
Goal 3: Improving one’s Relationship to Play
In a highly meritocratic society, people often prioritize work over leisure and forget the importance of play and leisure time. Engaging in mindfulness and leisure activities can reduce stress, increase creativity, and establish positive daily routines that promote mental and emotional well-being. Therapy can help individuals identify and incorporate more enjoyable, fulfilling activities into their daily lives to promote self-care, balance, and overall well-being. Play also promotes creativity and challenges cognitive rigidity in problem solving.
In conclusion, the three goals of therapy are to improve relationships with love, work, and play. Each area contributes to our overall sense of well-being, and when these areas are not balanced, emotional and mental health can suffer. Therapy can help individuals gain the tools, insights, and strategies needed to create more fulfilling relationships, establish healthy boundaries, and promote self-care and daily routines that nourish their minds and bodies. With these tools and support, individuals can achieve optimal mental and emotional well-being and live a fulfilling and satisfied life. At Lost Stories Counseling, therapy itself is an experience of these three values where as it is an encounter with love as work and character growth which happens through play.
Becoming A Secure Base
Emotional co-regulation is the process by which two people can work together to regulate their emotional states. The idea is that one person's emotional state can influence the other person's emotional state, and through communication and empathy, they can work together to regulate their emotional experiences. This process is especially important in intimate relationships, where individuals are often heavily intertwined with each other's emotional states.
Effective emotional co-regulation requires active listening and validation of the other person's experience. It involves being present with the other person, understanding their perspective, and creating a safe space for them to express themselves. This process can help reduce conflict and increase feelings of trust and security within the relationship. By co-regulating emotions, individuals can also learn new coping strategies and resilience skills that can be applied to future situations.
While emotional co-regulation can be challenging, it is an important aspect of building healthy relationships. With practice and open communication, individuals can create a secure base from which to explore their own emotions and support each other through difficult times. Whether it's through verbal communication or nonverbal cues, the ability to co-regulate emotions can be a powerful tool for developing intimacy, deepening connections, and building resilience in relationships.
A Backpack Full Of Rocks
Are you a caregiver for an elderly parent? Are you a caregiver for a developmentally delayed child? Are you a caregiver for someone struggling with an addiction to substances or an eating disorder?
Imagine you are on a beautiful hike with your loved one through the mountains, each of you with their own backpack full of rocks. You reach a large hill and your loved one can no longer carry their load of rocks. As a good caregiver you take their rocks (guilt, shame, self-blame, disappointments, resentments, etc.) and put them in your backpack. Now you have a backpack full of rocks and you realize, why am I trying to be the hero? Maybe I need someone to help me carry my rocks and what if we let some of our rocks go?
As a caregiver, it can be easy to become so focused on caring for your loved one that you forget to care for yourself. However, neglecting your own needs and wellbeing can actually be detrimental to both you and the person you're caring for. That's why self care is essential for caregivers.
Here are just a few reasons why taking care of yourself should be a top priority:
Burnout Prevention
Caregiving can be physically and emotionally draining. If you don't take time to rest and recharge, you might find yourself feeling exhausted, frustrated, and overwhelmed. This can lead to burnout, a state of chronic stress and exhaustion that can make it difficult to continue providing quality care.
By engaging in self care activities like getting enough sleep, exercising, and taking breaks throughout the day, you can help prevent burnout and stay energized for the important work you do.
Improved Physical Health
When you're providing constant care for someone else, it can be easy to let your own health take a backseat. But neglecting your physical health can have serious consequences, both for you and for your loved one.
Taking care of your body by eating well, exercising regularly, and attending to any health concerns you might have can help you feel better physically and reduce your risk of developing health problems down the line. Additionally, by modeling healthy behaviors for your loved one, you can encourage them to make healthier choices as well.
Better Mental Health
Caregiving can be incredibly stressful, and it's not uncommon for caregivers to experience feelings of anxiety, depression, or other mental health challenges. Engaging in self care activities like journaling, meditation, or therapy can help you manage your stress levels and prioritize your mental health.
Taking care of yourself is absolutely essential for anyone working as a caregiver. By prioritizing your own physical, emotional, and mental wellbeing, you can provide better care for the person you love and avoid burnout and other negative consequences.
What is complicated grief?
It all begins with an idea.
Complicated Grief
Complicated grief is a condition in which an individual experiences intense and long-lasting bereavement symptoms. The grief is complicated when the emotions and behaviors related to the loss are prolonged, intense, and difficult to manage. Individuals with complicated grief may feel trapped in their grief, unable to move forward or find joy in life. They may experience feelings of meaninglessness, bitterness, and despair, and may have difficulty adjusting to life without their loved one. Complicated grief can have severe effects on an individual's physical and mental health, and it is essential to seek support and treatment if you are struggling with this condition. At Lost Stories Counseling Services, we offer therapy and support groups for individuals navigating the complexities of grief. Another way of describing complicated grief is Prolonged grief disorder.
Prolonged grief disorder (PGD) is a debilitating and complex condition that affects individuals who have experienced the loss of a loved one. While it is natural to go through a period of grief, sometimes the individual may find themselves unable to move past their sadness and return to their daily life. PGD is characterized by deep and intense feelings of yearning for the deceased that lasts for more than six months after the loss.* The symptoms of this disorder include anxiety, depression, difficulty sleeping, and a persistent sense of loneliness and sadness. To cope with PGD, it is important to seek professional help and support from loved ones who can help to navigate the grieving process and find a path to healing and recovery.
*https://www.webmd.com/mental-health/prolonged-grief-disorder
Eating Disorders and Depression
It all begins with an idea.
When we think about eating disorders, the first thing that comes to mind is probably anxiety. It is undoubtedly true that eating disorders are often related to anxiety, as individuals may feel anxious and stressed about their weight, body shape, and food intake. However, what many people fail to recognize is that eating disorders are also closely related to depression and depressive symptoms.
To begin with, many individuals with eating disorders struggle with feelings of sadness, hopelessness, and low self-esteem. They may feel that they are not good enough or that they do not have control over their lives, leading to feelings of helplessness and despair. These feelings are commonly associated with depression and can significantly impact an individual's mental health and well-being.
Furthermore, eating disorders can also lead to physical symptoms that are associated with depression, such as fatigue, sleep disturbances, and difficulty concentrating. These symptoms can further exacerbate feelings of sadness, hopelessness, and low self-esteem, contributing to the cycle of depression and disordered eating.
Interestingly, recent research has suggested that eating disorders and depression may share common genetic and neurochemical factors. For example, both eating disorders and depression have been linked to abnormalities in the serotonin neurotransmitter system, which is responsible for regulating mood, appetite, and sleep.*
In conclusion, although eating disorders are frequently associated with anxiety, it is essential to recognize that they are closely related to depression as well. Individuals with eating disorders often experience feelings of sadness, hopelessness, and low self-esteem, as well as physical symptoms that are associated with depression. Given the significant impact that eating disorders and depression can have on an individual's mental and physical health, it is crucial that we consider both anxiety and depression when treating these complex conditions.
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847054/
Men with Eating Disorders
Eating disorders are often associated with women, but men can also struggle with these disorders.
Here are some stats:
25% of those diagnosed with eating disorders are males [1].
33% of males have used unhealthy behaviors an attempts to alter their weight [1].
Eating disorders will impact 10 million males at some point in their lives [2].
From 1999 to 2009, hospitalization of males for eating disorders increased by 53% [2].
15% of gay or bisexual men report struggling with an eating disorder [2].
5% if heterosexual men report struggling with an eating disorder [2].
Men with eating disorders may have a higher mortality risk than women [2].
There are many reasons why men develop eating disorders. Like women, they may feel pressure to conform to cultural ideals of beauty and thinness. They may also use food or exercise as a way to cope with stress or difficult emotions. In addition, men who participate in sports or bodybuilding may feel pressure to maintain a certain weight or body composition.
Despite the fact that men can suffer from the same eating disorders as women, they may exhibit different symptoms. For example, men with anorexia nervosa may become obsessed with building muscle rather than losing weight. Men with bulimia nervosa may be more likely to engage in excessive exercise or fasting, rather than purging.
It is important for men to understand that eating disorders are not a sign of weakness or failure. It takes strength and courage to reach out for help. Treatment for eating disorders typically involves a combination of therapy, nutrition counseling, and medication as needed.
At Lost Stories Counseling Services, we provide a safe and confidential space for men to explore and heal from their eating disorders. We believe that recovery from an eating disorder is possible and we are committed to supporting our clients throughout their journey.Sources
Anorexia in men and boys: treatment and statistics. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/male-eating-disorders/anorexia.
Men and eating disorders. National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/men-eating-disorders.
5 Faces of an Eating Disorder
Eating disorders are complex mental health conditions that are characterized by abnormal eating habits, distorted body image, and obsessive thoughts about food and weight. There are several types of eating disorders, each with their own unique symptoms and behaviors.
1. Anorexia Nervosa: This eating disorder is characterized by an intense fear of gaining weight and a distorted body image. People with anorexia may restrict their food intake to the point of starvation, exercise excessively, and have a preoccupation with their weight and body shape. They may also engage in purging behaviors such as vomiting or using laxatives.
2. Bulimia Nervosa: People with bulimia engage in recurrent episodes of binge eating, followed by purging behaviors such as vomiting or using laxatives. They may also engage in extreme exercise or fasting to compensate for their binge eating. Like anorexia, people with bulimia have a distorted body image and are preoccupied with their weight and body shape.
3. Binge Eating Disorder: People with binge eating disorder regularly consume large amounts of food in a short period of time, often feeling out of control during these episodes. Unlike bulimia, they do not engage in purging behaviors. This can lead to obesity, as well as physical and emotional discomfort.
4. Avoidant/Restrictive Food Intake Disorder (ARFID): Previously known as selective eating disorder, ARFID is characterized by an extreme pickiness or aversion to certain foods or textures. This can result in the avoidance of entire food groups and can lead to malnourishment and other health problems.
5. Other Specified Feeding or Eating Disorder (OSFED): OSFED is a category for individuals who display disordered eating behaviors, but do not meet the full criteria for any of the other eating disorders. This can include subthreshold anorexia or bulimia, as well as purging disorder, where individuals regularly engage in purging behaviors without binge eating.
It is important to seek professional help if you believe that you or someone you know may be struggling with an eating disorder. Early intervention and treatment can greatly improve the likelihood of recovery.
Pros/Cons of CBT and Psychodynamic Psychotherapy
Pros/Cons of CBT and Psychodynamic Psychotherapy
Pros and Cons of Cognitive Behavior Counseling and Psychodynamic Psychotherapy
Cognitive Behavior Counseling
Pros
Short-term approach that is usually cheaper than other forms of therapy
Focuses on specific problems and teaches clients practical skills to cope with their thoughts and feelings
Structured sessions help clients set goals, track progress, and develop coping strategies
Evidence-based therapy with a proven track record of effectiveness in treating a wide range of mental health disorders
Considers the present and future, rather than focusing solely on past experiences
Cons
May not be as effective for individuals who need deeper exploration of their past or underlying issues
Emphasis on changing thought patterns and behaviors can feel jarring or invalidating to some individuals
Requires active participation from the client and may involve challenging work outside of therapy sessions
Psychodynamic Psychotherapy
Pros
Emphasis on uncovering unconscious patterns and unresolved conflicts from the past can provide deep insight and understanding
Allows patients to explore their emotions and experiences in a safe and supportive environment
Can lead to long-lasting, transformative change in the patient's life
Provides a holistic view of the patient's life and experiences, helping them make connections between past experiences and current behaviors
Cons
Session frequency is higher and therefore more expensive than other forms of therapy
May focus on past experiences and feel repetitive and make therapy more recursive than a linear path forward
Emphasis on exploration and introspection may not be as effective for individuals who need practical solutions for immediate problems
Lack of clear structure or goals may make it difficult to track progress or measure effectiveness
Disordered Eating and the Role of Character Development
Nancy McWilliams is a renowned psychoanalytic psychologist who has written often on the subject of eating disorders and the way our personality structure impacts how a person communicates emotional needs through their good and bad behavior. Her work has focused on the psychological and emotional factors that contribute to the development of eating disorders, and on the ways in which treatment can be effectively tailored to address these underlying issues.
According to McWilliams, eating disorders are often rooted in damaged character development often caused by unhealthy emotional co-regulation from supporting caregivers and environments. People who struggle with eating disorders use food as a way to manage feelings of anxiety, depression, and other difficult emotions, often feeling that they are unable to cope with these feelings in any other way.
This is why McWilliams has emphasized the importance of therapy in treating eating disorders. Psychoanalytic therapy, in particular, can be helpful in addressing the deeper emotional issues that are at the root of many eating disorders. Through therapy, patients can learn to identify and regulate their emotions in healthier ways, gaining a greater sense of control over their lives and their eating habits.
McWilliams has also suggested that treatment approaches should be tailored to the individual needs of each patient. This means taking into account factors such as past experiences, family dynamics, and personal beliefs about food and body image. By understanding these factors, therapists can develop treatment plans that are more effective and more likely to lead to lasting recovery.
Overall, Nancy McWilliams' work has been an important contribution to our understanding of eating disorders and how they can be effectively treated.
Grief and Eating Disorders: The Dangerous Connection
It all begins with an idea.
Losing a loved one can be one of the most challenging experiences one can face. With that loss, comes a tremendous amount of pain and suffering that can result in physical and emotional consequences, including an eating disorder. Grief can be the catalyst for an eating disorder, and it is imperative that we recognize the danger and identify the warning signs before permanent damage is caused.
The Connection Between Grief and Eating Disorders
It is no surprise that grief and loss can trigger feelings of anxiety, depression, sadness, and even anger. These powerful emotions are what make grief so challenging to navigate. These emotions can also trigger significant changes in one's eating habits, leading to the development of an eating disorder.
Research has suggested that people who experience grief or loss have a higher risk of developing an eating disorder. This connection is primarily associated with the need for stability that people seek after a loss. During the grieving process, individuals may feel a sense of helplessness and loss of control. They may turn to food as a way of regaining control over their lives, causing physical harm to themselves in the process. Sometimes the lack of food has a symbolic resonance of what has felt lacking in the relationship one has lost.
The Signs and Symptoms of an Eating Disorder Triggered by Grief
Recognizing the warning signs of an eating disorder triggered by grief is essential. This is a highly complex mental health issue that requires careful observation and understanding. But, grief and eating disorder behaviors can be closely linked, as not all coping skills are healthy or adaptive. For example, a common method of coping for grieving individuals is through food, whether that involves binge eating episodes or restricting food intake, and exercise, which may include compulsively working out. And while they may provide some temporary relief from unwanted emotions, like depression or sadness, these coping skills can ultimately lead to many problems. Not to mention depression and eating habit changes, such as emotional eating or even night eating, can complicate your health, leading to disordered eating behaviors.
Some of the common signs of an eating disorder include a sudden change in weight, avoiding social events that involve food, skipping meals, excessive exercise, using substances to suppress appetite, and the development of a negative body image.
The Consequences of Ignoring Eating Disorders Triggered by Grief
Eating disorders caused by grief are dangerous and can result in an array of medical problems. From malnourishment to organ failure, the consequences of this condition can be severe and life-threatening.
Moreover, grief-based eating disorders are extremely challenging to treat. It is paramount that individuals who have experienced grief and have noticed signs of an eating disorder seek professional help immediately.
Conclusion
Eating disorders triggered by grief can have lasting and permanent impacts on one's physical and emotional health. A proactive approach to recognizing the warning signs, educating others and seeking professional treatment is essential in addressing this issue. As a community, we must work toward recognizing the danger of grief-based eating disorders and provide support to those in need.
Sources
Centers for Disease Control and Prevention. (2022, September 6). Grief and loss. Centers for Disease Control and Prevention. June, 10, 2023.
How Therapy Is The Best Editor of an Authentic Story
Robert Neimeyer is a renowned psychologist and scholar who has made seminal contributions to the field of grief therapy. One of his key concepts is "meaning reconstruction," which refers to the process by which individuals make sense of their experiences in the wake of loss.
According to Neimeyer, meaning reconstruction involves three key components:
1. Making sense of the loss: This involves acknowledging the reality of the loss and understanding its implications for one's life. It may also involve grappling with complex emotions such as guilt, anger, and regret.
2. Revising one's sense of self: Loss often disrupts our sense of who we are and our place in the world. Meaning reconstruction involves reevaluating our self-concept in light of the loss and revising it as necessary.
3. Rebuilding a sense of purpose: Loss can challenge our sense of meaning and purpose in life. Meaning reconstruction involves finding new sources of meaning, whether that be through personal growth, spiritual exploration, or other means.
Neimeyer's work on meaning reconstruction has had a profound impact on the field of grief therapy, providing a framework for clinicians to help individuals navigate the complex and often overwhelming experience of loss. His approach emphasizes the importance of integrating loss into one's life story in a way that promotes resilience and growth rather than despair and stagnation.
At Lost Stories Counseling Services, we are committed to helping individuals find meaning and healing in the aftermath of loss. We draw on Neimeyer's insights and other cutting-edge research to provide compassionate, evidence-based support to our clients. Whether you are struggling with the loss of a loved one, a job, or another significant aspect of your life, we are here to help you find your way forward.