adaptability

I’m very interested in forgiveness, including the forgiveness-related work of Fred Luskin (http://learningtoforgive.com/) and Everett Worthington (http://www.people.vcu.edu/~eworth/). In a nutshell, forgiveness involves empathy. People are often not ready to forgive, but choosing to do so is for one’s own benefit, not for the benefit of the other person. It facilitates an unburdening. There are a number of exercises that Luskin and Worthington suggest, including re-writing the narratives of what happened in a way that sticks closer to the facts and avoids the attributions that we make that involve malice on the part of the other person. I strive to make benevolent or at least benign attributions about the actions of others. If I can’t seem to do that, then I assume that if I had been in the other’s shoes and lived his or her life, I might well have felt or acted as he or she did. I work at this every day; it is a constant challenge. Luskin also incorporates breathing, relaxation, and imagery exercises, and he suggests that we begin our forgiveness work by “forgiving ourselves, and other people we like.” I have a previous brief blog post about Luskin’s ideas at http://jimsturges.wordpress.com/2010/05/06/forgiveness/.

When I was at Kelly Wilson’s workshop at a mindfulness and acceptance conference about a week ago, we abandoned our problem-solving mode for a bit and practiced simply being present with each other while discussing early experiences of things we did not like about ourselves. Part of what happened in those moments was the cultivation of understanding and compassion that was incompatible with anger. Compassion for ourselves, and compassion for others.

Yesterday I attended an all-day seminar by psychoanalyst Martha Stark, which came at all of this from yet another perspective, and was really intriguing. Stark talked about “relentless hope: the refusal to grieve,” and “relentless outrage.” She described patterns in which we are faced with disappointment from others, and instead of adapting to it, we often maladaptively and persistently keep trying to get what we want. This is a defense mechanism, in that it is a reaction to stress that we are not ready to cope with.

When the parent leaves the infant alone briefly, the infant loudly protests. Over time, and repeatedly experiencing the reliable return of the parent, the infant begins to learn to self-soothe during the absences. When the unmet needs are too traumatic, however, the ability to self-soothe is overwhelmed, and defense mechanisms kick in. This may manifest in relentless pursuit of the object or relentless anger and hopelessness. There is a defensive need, it is traumatically frustrated and thus strengthened, but then eventually hopefully transformed into adaptive capacity. We become stronger at the broken places.

The therapist helps the client by both being supportive when needed and challenging when possible. The challenges involve interpretations that help the client to gain insight into the behavior, re-experience the feelings involved, and re-enact the earlier unresolved issues. This happens naturally, because therapist is inevitably less than perfect, as the parent was. The client reacts to this with characteristic defenses.

Stark formulated several models of therapeutic work. In Model I, the mode of therapeutic action is enhanced knowledge. The therapist and client work through resistance to gain insight. Resistance is the defensive reaction. Over time, with more insight and knowledge, a more thoughtful and reflective response develops, and the client becomes more aware of the dysfunctional dynamics.

In Model II, which we shift in and out of, we listen empathically. We adopt the client’s affect. We share the experience. In Model I we are opaque, not bringing ourselves into the interaction. In Model II we bring the best of ourselves into the room. The client as child needs to grieve deprivation. Ideally this results in structure, internalization, an adaptive ability to handle grief within. If it is too overwhelming, defenses can include narcissism or a stereotyped posture of shame or disappointment such as, “I knew no one would like me.” Model II is about acceptance of the object as “separate, limited, immutable.” It cannot be controlled even though we want to control it and may relentlessly pursue trying to make over the object into what we want.

The same dynamics get co-created again and again to allow this re-enactment. Stark quoted Warren Zevon: “If you won’t leave me, I’ll find somebody who will.” In Model III, the therapist is engaged in an authentic relationship with the client (whereas model II is for the client). As therapists we strive for “benevolent containment” of the “toxic mud balls” that the clients give us. The internal yearning that has been traumatically frustrated is displaced onto the therapist. The client has found a new bad object. “The therapist brings to bear her own ability to adapt: benevolent containment of toxicity.” The therapist has the capacity to relent. Together with the client we repair the disruption in the relationship. The bad becomes good. What were knee-jerk re-enactments become structural change.

We repeatedly have to come back and join with the client. In those instances it is not about what we think, it is instead expressions such as, “it just hurts so bad.” We are listening with every molecule of our being, and the clients go ever deeper, as Stark puts it. They lead the dance and we follow. In Model III we “stay centered in self and take in their stuff.” It is a “co-created story.” The story is “about there and then and also about here and now–the therapeutic relationship.” Part of all of this is accountability. That is, we have to look at what we have contributed to the transference and hold ourselves accountable in an honest way. This is echoed by Yalom and others.

We “challenge when possible and support when necessary, so they can re-organize at a higher level.” Our interpretations are anxiety-provoking, and have to be done in the right amount with adequate support. Like sands in the hourglass, minor avalanches of stress contribute to the reconstitution of the pile. This optimal stress helps the patient to go back and forth between reality and the experiences she finds herself having. We provide “conflict interventions,” such as “You do know that he’s gone, but you find yourself still hoping.”

To work through resistance clients first come to understand how they create the situations and how they gain from them. They know that they need to let go, but they so desire what they want that they engage in masochistic hope, or they lash out in sadistic outrage. As therapists, our response to their outrage toward us should be, “How did I fail you?” They often think we are being critical, and set us up to be so; that’s what they know. Yet being too loving is perceived as controlling. We must allow ourselves to be turned into the bad object (projective identification), and even take responsibility for our part in all of it: We relent. However, we also challenge: “How did you imagine that I might respond?” Or, “You are really angry, but you know that if you’re ever going to get better, someday you’re going to have to slow down and give someone a second chance” (!).

At the end of the day, Stark shared a touching story in which she described a re-connection with her mother, who had disappointed Stark in her childhood, by never being that into parenting. This re-connection was essentially facilitated by compassion for her older, frailer mother, and appreciation for the good qualities that her mother did have–forgiveness by Stark involving empathy, acceptance, and adaptability.

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