In the early years of psychoanalysis psychotherapeutic treatment was typically conducted six days per week with the patient doing free association laying on the couch out of sight from the analyst. In modern times many question the lack of actual relational contact between therapist and patient characteristic of this treatment situation. However, what is evident is the “deep emotional holding” that that daily sessions can potentially provide to the therapeutic journey. In fact, some patients and analysts doing this form of treatment report on the “Monday crust” that would often follow from having a Sunday break from treatment. Clearly, such treatment was intense and fully involving, even if limited in terms of much current psychotherapy understanding.
Most modern day psychoanalytic psychotherapy is conducted on a once per week basis, with some treatments two times per week, and other treatments every other week. While such treatments are often, in fact, invaluable in people’s lives, it is my current understanding that most psychotherapy inherently provides less than is truly needed; that is, most psychotherapy proceeds with inherent “psychotherapy deprivation.”
“Psychotherapy deprivation” is important because “deprivation in treatment” reenacts the deprivation in our patient’s histories that is so often implicated in our patient’s emotional wounding. At it’s worst, this amounts to a situation where the treatment that is entrusted to heal emotional wounds is itself inherently re-wounding. At it’s least, the “internalization process” that is at the heart of therapeutic healing is lessened.
What is to be done about this state of affairs?
Let me first talk about what is not done. Most therapists are in a state of denial; that is, most therapist, prohibit “their own knowing” about this limitation in the treatment they provide. Hence they interfere with “their patients knowing” about what is inherently missing or deficit in treatment. (to be cont)
There is this paradox. On the one hand there is the tendency in therapy for the therapeutic relationship to be less than fully alive for the patient; either not alive enough during the actual session or alive in the session but not held onto between the sessions. To a large degree this is simply part of the work of the therapy. However, it is my experience that in many therapies the vividness of connection between therapist and patient does not come fully into being. Hence, the patient leaves therapy without a fully rich internalization of the therapist, without the full development of a corrective emotional experience.
Now this understanding contrasts with another experience patient’s commonly describe in long term therapy, where they notice while driving to their next session that they have the subjective sense of having just been there, as if a week’s time has past in the flicker of an instant.
What I find especially interesting about this situation is the seeming paradox that both experiential situations can exist simultaneously in the same patient. That is, a patient can have a non-vivid experience of their therapeutic relationship, where they seldom think of their therapist between sessions, yet have a recurrent subjective experience of having just been there while arriving at their next session. How to understand this?
This, I think, is a complex state of affairs. My best current understanding is that while vividness of relationship is both a conscious and unconscious experience, the subjective sense of “having just been there” is primarily an experience within the unconscious that occurs in unconscious time. This highlights that therapeutic action takes place within conscious and unconscious spheres. This raises the question regarding how changes in the two spheres are different in their impact upon patient’s “actual lived lives.” And the additional question concerning how changes in each of the spheres interact and influence each other.
Going more to the point, it is very clear that unconscious changes are critically important in long lasting therapeutic change but… what I uncertain of,however, is how much these inner changes manifest in actual changed lives without being accompanied by changes in conscious awareness such as “vividness of therapeutic relationship.” In this vein, it is my experience that outside relationship changes such as “vividness of therapeutic connection” are powerfully assistive in the “phenotypic” manifestation of inner change in peoples actual lives. This is consistent, I think, with the findings from attachment-based marital therapy (see Sue Johnson), that outside emotional safety with ones partner is powerfully supportive of deep changes in ones interior psychological well-being. Again, this is very much a complex matter, that highlights how the two spheres interact and synergize with each other.
Winnicotte used to say, there is no such thing as a baby, there is only a baby and a mother. He, of course, is describing the intimate symbiosis between mother and child so characteristic of the human species in particular, and perhaps primates, even mammals, in general. Perhaps as a result of this long extended intermixing between mother and child, adult primary relationships are commonly characterized by repeated fusions/confusions about what resides within the self and what resides within the other.
Of late, I have come to recognize one kind of very common confusion in struggling marriages; that is, where belief about the other has come to be confused with who the other “really is.” I imagine that this is in fact true of most marriages, that one’s belief about the other is thought to be who the other really is. When the belief is generally positive this “error in thinking” probably does not as much present as a problem. However, when the belief about the other is persistently negative, as it is for most couples in marital therapy, this confusion between belief and reality often presents as an insurmountable obstacle to healing.
The problem is, as long as “the belief about the other” is believed to be the absolute or fundamental truth of the other (that is, not a belief at all but a perception) no true healing communication can happen between the two. At their rawest, the interactions boil down to some variation of a power struggle over who gets to author reality… “you are this and this, admit it… etc..” The result is “the person authoring reality” at the moment does not get heard for what is truly painful inside of them, and the other in the relationship is left profoundly unsafe and unable to do anything but defend. This becomes a therapeutic mess. (to be continued)
It is my experience that all primary relationships include inherent disappointment. The result is a drama of love & hate living within the psyche of each in relationship. The disposition of each partner’s inherent negative is hugely determining of the fate of relationship. A successful “conscious marriage” generally requires that each in the marriage “do something” with their inherent disappointment/negativity.
In the marriageofopposites situation one in the relationship is generally intruded on by longings/disappointment/protest while the other tends to avoid experiencing their own version of longings/disappointment/protest. The healing progression begins with containment for the purposes of communication on the part of the core styled and claiming acknowledgment of the “inner negative” on the part of the outer-styled. The healing progression moves from enmeshed acting-out, to deescalated communication, to the establishment of both empathic contact and internal differentiation, which then enables replacement of polarizing escalation with emotionally connected communication.
