Sunday 24 November 2013

Object-relations; relating to an object

I always thought that object relations was an odd term for that vast development of psychoanalytic theory that happened after the war. Some time later, I realised that the word “object” is used in the grammatical sense as in subject-verb-object! It developed our understanding of how our internal world is created by taking in, not just experiences but the relationship and above all the other person who was also present. It need not be a complete person but a fragment or an aspect or a distortion or an entity or an archetype that connects to the experience.  These inner people and fragments can then have a life of their own in a dance of dramas which attempt to control the person. Some parts are more conscious, some more benign, some nasty, some work away hidden in the background. All this internal noise keeps the person from developing a solid enough part to keep the rest in order. The process needs to be like turning a mob in to a committee with a strong enough chairperson or facilitator to draw on each member’s skill and point of view, but not to let anyone dominate or take over.

Self-help literature and much of the stuff I see on Facebook as useful quotes in interpersonal matters assumes that there is some sort of internal order and that the committee may need some help but all its members are known and can at least sit down together. What is needed is to strengthen the role of the chairperson or facilitator.

However for some people this is not true and their object relations which get put out on to the world is not one of other people, but of parts of people and sometimes functions and may change chaotically. Every baby and small child needs a secure base to operate from and return to regularly for emotional top-ups. If someone has the secure base projected on to them, they cease to be a person and become a function - a thing, a sort of slot-machine which is supposed to produce the goods when the button is pressed. This really is an object relation and no amount of non-violent communication methods, or dialogue or skilled help will change that in to a human relationship because that implies a sort of symmetry; two people together trying to sort things out.  This symmetry implies the loss of the function and that to the small baby part, is abandonment and death. This is the basis of much personality disorder where the whole issue is the impossibility of real human relating in the face of the demands of the most primitive parts of the psyche for security or admiration rather than real relating with its messy compromises. Self-help and sensible advice need a good-enough self which can at least begin to take in the reality of other people as autonomous beings not things.

Sunday 1 September 2013

PD - The Elephant in the Room

All humanistic therapists are suspicious of labels for people. The infinite complexity and marvel of a person can't be captured in any word, label or concept. Labels can easily also freeze time and imply that people can't change;  attract judgements and create hierarchy. However, the skilful use of words can help us to understand ourselves and others and communicate some of this understanding.
There are three related words which can be very helpful and are often not understood; particularly in the world of personal development. They can easily be lost into the world of psychiatry or clinical psychology. They are neurosis; personality disorder and psychosis and I want to briefly write about each.

Neurotic behaviour is simply when someone seems to not be able to learn from their experiences. They do the same unhelpful thing over and over again with the same unhappy results. Everyone makes many mistakes in their lives; neurosis prevents us from learning from them. It has a stuck and repetitive quality. Something is behind the behaviour and the failure to learn, which is not fully known and operates in the background - the subconscious. It is likely to be past fears and needs that now are not fully conscious. Neurotic behaviours simply doesn't work very well at making a life of relaxation, pleasure, intimacy, creativity and ease. All basic requirements of human beings.  Some behaviours can be seen as addictive but are fairly easily acknowledged as unhelpful. Often it is seen as "just the way I am" ; as if people can't change. But people can always change, neural pathways in the brain can be re-wired. Neurosis is almost always accompanied, and may be primarily signalled by either anxiety or, often the long term effect of constant anxiety; depression. Anxiety is "fear spread thin"; a sense of vigilance and arousal as if there is some immediate danger. The danger is unknown and the anxiety can often move from one focus to the other. Sometimes the anxiety itself is pushed in to the body and becomes physical illness. About one in ten people will have anxiety and a similar number depression at some time in their lives. People with a lot of neurotic behaviours can easily be labelled, but I hope not dismissed, as neurotic.  At its heart neurosis is a failing attempt to manage discomfort and dis-ease; some feedback and reflection can often allow the person to acknowledge the neurotic aspects of themselves and begin the process of healing; by the twin paths of removing the traumas that are behind the neurosis and learning and practising new behaviours which help them get more of what they really need in life.

Psychosis by contrast involves parts of the person which are not in contact with consensual reality and which either create fear or lead to behaviours which are ineffective or unhelpful to the person. They cannot be easily confronted by new information or feedback and are more deeply buried in the unconscious rather than the subconscious. They often have a quality of dominating a person's life leading to dramatic changes; though sometimes they have a contained psychotic part with an unshakable belief which does not usually totally dominate their life. As all people have different parts of their whole personality it is possible to have a psychotic part which can be contained. People who are actively psychotic need sanctuary; safe places where they are protected, supported and loved until the parts more able to deal with the ordinary world can get stronger. Rarely, they may benefit from some medication. Unfortunately in our society; the idea of an asylum; a safe place has largely gone and been replaced by chemical prisons which may sometimes be the only option but which often block any process of healing and re-connection. There are one or two conditions (perhaps schizophrenia and bi-polar disorder which each affect about 1% of people) where there may be an organic component and medication may be the best; just as a diabetic may need insulin to function.

The most interesting third term is personality disorder. This is the elephant in the room; the hidden iceberg which is all around us. Some studies suggest up to one in ten people have a personality disorder.  There are about ten recognisable varieties of personality disorder. Many are characterised by withdrawn, detached, fearful or eccentric behaviours and may be distressing for those who have to try and relate to them. However there are some personality disorders characterised by lack of empathy for others and severe disturbance in interpersonal functioning. The two largest of these are Narcissistic and Borderline Personality Disorders. They, like most personality disorders, are egosyntonic which means that nobody goes to a therapist and says that they have a personality disorder. Friends or a partner may push them to a therapist. Anyone who has worked, particularly in industries like finance, law, the theatre, politics will have come across people who are almost impossible to deal with and leave a trail of wounding and destruction behind them. It is very unconscious and has some of the characteristics of a psychosis in its disconnectedness from aspects of consensual reality and their unavailability for feedback and discussion. It is as if their relating is completely beyond all reflection. Unlike neurosis, they often are not troubled by high levels of anxiety or depression. In fact it is a sign of progress in therapy when they feel such things.

Our society rewards financial and career success so some forms of personality disorder can get considerable rewards for the effects for their personality disorder. One study found higher levels of three personality disorders in executives than in patients in Broadmoor secure psychiatric hospital. This is likely to be true for, for example psychopathic personality disorder, as being ruthless in business is likely to lead to success, at least in the short to medium term.  In some ways all personality disorders exist between neurosis and psychosis but they are a different to both while containing elements of both. Some, like borderline personality disorder have overt anxiety but often they do not. They exist with a degree of certainty which eliminates anxiety. This certainty and the interpersonal behaviours that it promotes, is damaging and confusing for those around. One of the best books on living with someone with Borderline Personality Disorder is subtitled "walking on eggshells" from the experience of what it is like being around someone with sudden and violent mood swings and an unstable sense of self.  Those around someone with Narcissistic Personality Disorder are being called on to admire and/or serve the other. Being an admirer or a servant is never very satisfying if you actually want intimacy; you are always either a resource or a threat as a narcissist lives mostly in their own world and can never really see or emphasise with another. For narcissists, ageing is often particularly difficult and they are prone to develop addictions later in life if the possibility of success is no longer enough of a drug.  For borderline personality disorder the intensity of their dramas exacts a big price on their body and they burn out or have to quieten down. Both are living with a weak ego which is always threatened by the world and swings between fear of abandonment and fear of engulfment and annihilation.

Personality disorder is the elephant in the room; an elephant which may be trashing the furniture. I'd rather such labels didn't exist but the disorders certainly do with varying degrees of severity.  At one end of the scale of severity is idiosyncrasies and interesting personality types and character structures; at the severe end are desperate people unable to function at all in the world of other people and of real relationships.  Psychotherapy certainly works with personality disorders but it is more or less impossible unless they can come to the realisation that they have one and it is often slow, steady work.

Monday 1 April 2013

On Tickling and being excited

Over the years I have come across several clients where being tickled has been a major trauma.  It meant having their boundaries crossed and their body and excitement taken over without any means of stopping it. If later they indicate that the did not like or want this, then it is received as if they cannot take a joke or dislike fun.

Having one's body at the mercy of another unasked is of course traumatic as in sexual abuse, but with tickling it is also the deliberate manipulation of their excitement into a place where it goes over from pleasure, excitement and fun to invasion and fear or even terror as the object of  fear is within - the effects of excess excitement on the system.

It may be in  such families it is just one example of not being listened to and lack of empathic attunement by caregivers. It is an exercise of power over which starts as fun with but leads to an objectification of the other with the refusal of recognition of the traumatic impact. The victim is invited to laugh it off as well.

It is part of the normal adult interaction with babies to play with their excitement and give an experience of the thrill of some danger with the return to safety. This is often done by throwing the baby or small child in the air and catching them.  I gather than men are more likely to let go than women and perhaps the role of the man is to expose the child to increasing risk as part of growth and adventure. However this is done within the frame of attunement and modulation of the level of excitement and the reality of the return to safety with a cuddle as they are caught.

With body psychotherapy with adults the question of what constitutes too much activation is harder to gauge. I remember many years ago a trainer saying to us that if you want to increase the flow of the river you need to increase the height of the banks; this was in the context of general working with energy. The general point is that the container of the therapy has to be strong enough to support the appropriate abandonment of safety in that moment with a certainty of return to earth; safety and the possibility of re-integration at a higher level with increasing ego-structure. We can only grow when we risk we can only know the strength of what we can test.

With tickling it is the child's weaker sense of self and their relative powerlessness along with the lack of attunement and empathy which is so destructive. Not being listened to and taken seriously afterwards, and often a sense of being played with, compounds the trauma. Tickling is one of the first self-other interactions which is why you cannot tickle yourself and can be formative or destructive.  If in doubt about your abilities to judge another; don't tickle!

Wednesday 30 January 2013

Connection or Contact?

When I started as a psychotherapist, long before mobile phones or email, it was easier to maintain a therapeutic relationship than it is now. I don't think my skill in managing the relationship has declined; it has to be that something else has changed. Technology has provided us with many more means of almost instant contact, mobiles, texts, tweets, Facebook and instant messaging, apps on your phone to find out  who is nearby...But contact is often momentary and to exchange small amounts of relatively superficial information. 

The requirement  of constancy and the perseverance that is needed to create a deep therapeutic relationship is so counter-cultural to the notion that the customer is king and gratification should be immediate or you should move on. Much of my practice is in Central London where this may be worse. Many people are just moving through or working in the media industry where they may have to change projects or go abroad or work late at a moment's notice.

My parents were born not long after the First world war and stability was desired after the turmoil, I was born not that long after the Second with probably a similar cultural need. Families often still had the static (even stiffling) structure that patriarchy provided so well. Now families and living arrangements are often re-formed in childhood, things are more fluid. Duty and commitment have given way to  "taking the waiting out of wanting" as one credit card advert put it; "Do it Now!" was a slogan of the late 60's. Things, rather than feeling rigid or monolithic now often feel rather fragile and temporary; including relationships. 

In conventional therapy terms we are talking about attachment and what can turn contact to connection to enduring relationship. Early good attachment in the first few years requires an adequately attuned and empathic caregiver with enough support and protection.  Sadly today many did not grow up with that and their sense of self and their attachment styles are more fluid, and sometimes chaotic. Their unconscious fears easily support the cultural permissions to make distance, move on, go shopping, and become too busy. I read recently that some American college students were seeking help from consultants in how to date. They were able to do the "hookup" for sex or to just "hang out together" arranged  through all the electronic media but what they couldn't do was create or deepen relationship. One of the reasons for this is the prevalence of shame as a core experience. The hallmark of shame is a wish to hide. The best way of hiding is to simply disappear from the relationship.There may be a positive side to this but it makes the job of psychotherapy much more difficult because I still have not found a substitute for a solid, continuing therapeutic relationship for real growth and healing.

Wednesday 2 January 2013

Ten Fundamental Principles of Psychotherapy

1. Psychotherapy comes from Psyche means “Soul” and Therapia means “to attend to” so psychotherapy is attending to the Soul for the purpose of healing.

2. The means of doing this is the application of Love, through relationship. Psychotherapy involves a conscious, boundaried professional relationship for applying love for the purposes of healing.

3. The healing and love are anchored into, and work through, the body which the seat of the Soul in this lifetime.

4. The form psychotherapy takes is many methods for the liberation of love and energy in the body, mind and spirit through the removal of blocks to the free flow of life, love and energy. "Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it."     Rumi 

5. These blocks can be dissolved through love and consciousness and increasing the energy flow of the body whilst being safely held in relationship and being witnessed. Tantra is the ancient science of using practices to bring energy and consciousness together to realise our Oneness to all.

6. At the deepest level this reconnects all to the Divine, healing the Soul and connecting to Spirit.  "Energy is of the Body,.. energy is eternal Delight."   William Blake

7. This is usually best accomplished by working from the foundations of the body and the places where trauma and blocks to the free flow of energy are principally held and love and consciousness, most absent.

8. This generally means the lower abdomen and the belly from the pelvic floor upwards. These foundational areas are damaged most by childhood trauma and in most cultures have been denied, distorted, invaded and shamed; particularly for women.

9. Attention and often touch support consciousness coming in to an area or an issue. Breathing, movement, sound, affirmation, support and loving strokes encourage the flow of energy into that area.

10. The form that life energy takes has to include sexual energy. To avoid working with sexual energy is to subtly maintain denial and shame and so to refuse to clear trauma and blocks. Basically Freud was right about this and psychotherapy has been retreating from his insight for a hundred years now.

Tantric Psychotherapy is the name I have given to the bringing of all the methods of tantra to the task of healing the Soul, through the body and mind and reconnecting to Spirit. See .