Monday, 23 February 2015

The therapist’s conflict – a precious ingredient in the therapeutic encounter


CPD Workshop in Brighton: 21 March 2015

How to Work When the Client’s Conflict Becomes the Therapist’s Conflict
Traditional academic teaching of counselling and psychotherapy assumes that our discipline is similar to any other subject - whether we are learning history or engineering or psychology, there is a body of knowledge and a range of models that we need to absorb and apply, and that we get examined on in order to achieve our qualification. And like a 'doctor for the feelings', our work supposedly consists of applying our theoretical understanding to the particular person (or the specific 'case') in front of us, much like a doctor would apply medical understanding and scientific theory.

Whether our theoretical understanding is based on person-centred assumptions of the core conditions, self-actualisation and our own congruent presence, on transactional analysis or CBT assumptions about the client's scripts or schemas, or on psychodynamic assumptions regarding developmental stages, object relations and the transference, supposedly - across the modalities - we are all applying our particular theories to our particular clients.

Admittedly, as the only tool of our work is our own complex 'self', our discipline distinguishes itself from history or engineering in that we obviously need to develop our own self-awareness, through our own process in therapy, through experiential group work, through continuing self-reflection and supervision. But in terms of the actual academic element, the assumption is that we learn our theory, particular to our therapeutic approach, with its corresponding models and concepts and assumptions; and out of that theory arises quite logically a particular way of working: a set of interventions and techniques and methods which are designed to apply the underlying theory and make it ‘work’. And the assumption is that if we - as well-intentioned and empathic practitioners - apply these sets of theories and techniques thoroughly and coherently, the therapy we will end up practising will have the desired effect on our clients.

However, the more we learn and develop and practice our craft, the more we tend to feel that these assumptions do not capture the heart of what we actually do and what we struggle with every day.

For a start, we know - and we are quite explicitly told by our elders - that the therapeutic space does not depend predominantly (let alone exclusively) on quick thinking, assured interventions and a sense of certainty. On the contrary: the therapeutic process appears to become deeper and more effective, the more uncertainty the therapist can allow as a significant feature of the atmosphere and their own inner experience.
And the longer we practice, the more obvious it becomes that any idea of a linear process, which supposedly takes the client out of the depths of their problem towards the heights of a ‘solution’, is misguided. The idea of such a linear process, as if therapy was a simple journey up a predictable mountain, with the client getting better from session to session until they reach the lofty heights of insight, self-understanding and psychological health, does not match our day-to-day experience in the consulting room – we find that such ideas and ideals of a linear process are actually inhibiting and destructive to what we are trying to do.

Yes, to the unsuspecting public it may seem fairly straightforward to listen actively and empathically like a good friend would, to provide insight and psycho-education, to deliver reassuring and normalising interventions, to take the client through relaxation and mindfulness exercises, to offer links and interpretations. But in order for any of these offerings and interventions to actually have the desired effect, to reach the client where it matters, to connect with the client's inner world, to link with their 'neuro-plasticity', it is not enough to deliver them effectively and professionally.

As Winnicott observed: it is not mainly the therapist's 'doing' of interpretations, but the therapist's 'being' which they arise out of that matters more. It is at that point that being a therapist stops being straightforward, and becomes a complex vocation, where unlike medicine and engineering we find ourselves in a hall of mirrors, where our own subjectivity becomes an inexorable part of the job.

When we pay attention to the detail of our ‘being’, our inner experience as therapists moment to moment (especially when we do not just include our stream of consciousness in terms of thoughts and fantasies, but also our whole bodymind experience), we notice it is full of conflict: conflicting feelings, conflicting perceptions, conflicting thoughts, conflicting ideas and therapeutic impulses, conflicting notions of what is going on or what is important, conflicting tendencies towards self-disclosure or not, conflicting theories and interventions which may be appropriate or not.

It is in processing these conflicts that we discover parallels to the client's conflicts (even though these may be unspoken, unthought and unconscious) which we have absorbed via empathy, through active identification with the client's experience or more passively via projective identification. As Freud observed, although it flies in the face of modern conceptions of individuality and though he did not understand the mechanism by which this occurs, the unconscious of one person can communicate and is linked directly with the unconscious of the other.

The laboratory of the therapeutic hour gives us privileged insight into human relationship, in a way that is rare in other contexts. In attending to our own conflicted experience and subjectivity within the therapeutic position, we recognise manifestations of the client’s unconscious conflicts.

For teaching purposes (see workshop on 21 March 2015) I summarise this recognition as: the client’s conflict becomes the therapist’s conflict. This is the key insight which constitutes what in the history of psychoanalysis we call the 'countertransference revolution': the recognition that our inner experience as therapists - our countertransference in the widest sense - is not only a disturbing obstacle to our otherwise neutral therapeutic position - it can also be another 'royal road' into the client's inner world and into the heart of the therapeutic encounter.

What appears to be - in humanistic terminology - our own 'stuff' (to be taken away and processed in our own therapy) is interwoven and interlinked with the client's 'stuff' in a way that cannot be neatly divided apart and segregated.

This is what two-person psychology and intersubjectivity is all about: we are engaged in a co-created encounter, where we do not have the privilege of a secure, outside position - no fixed point from which we can use some Archimedean lever to leverage the therapeutic process when it appears to be going down the plughole.

When the working alliance breaks down and we are caught in destructive or negative enactments, there is no way out, only a way in: the transformation of the enactment needs to occur from within the dynamic that we feel caught in. What helps us in these moments is not theory or understanding, but to surrender to what these days is called ‘implicit relational knowing’.

In the workshop I will be running on 21 March 2015, we will explore ways of enhancing our embodied understanding and our capacity to access such ‘implicit relational knowing’.

The vicissitudes of therapeutic assessment

The following piece was written in preparation for a training day on “First Sessions and Initial Assessments”.

Whether it is an assessment at school, university or at work, or by a medical specialist or other expert, the question always is also: “do I feel seen as a person?”
It is in the nature of assessment that a supposedly uniform, objective set of criteria gets applied to us, raising the question as to whether our subjective sense of self is being recognised, taken into account and appreciated in the assessment.
This tension between an objective, outer description versus the subjective inner reality becomes more charged and obvious in counselling and therapy, whether we are being assessed as clients, students in training or as qualified practitioners.
When coming to therapy, many clients demand from us a quasi-medical diagnosis of their ‘condition’ and ‘prognosis’, and some feel relieved when they get it. However, the longing to feel deeply seen and met in our unique subjectivity – with all our flaws, wounds and potential – is just as present.
As practitioners, how do we do justice to that tension, which is present especially in a first meeting and initial assessment?
How do we establish a working alliance, when the client is both demanding to be judged as well as afraid of it or resistant to it?

On the level of the words and explicit communication, the client may be asking whether they are indeed a borderline, or a manic-depressive or whatever label they are fishing for, and these are - of course - legitimate questions. But implicitly, there may be other questions which would simultaneously be asked and answered: "am I hopeless case?" "is it all my own fault?' "is my pain real?" "did I bring this upon myself?" "am I just being a bit lazy or stupid, when really I should pull my socks up?" Whose questions are these? Whose opinions and perceptions are we confirming or opposing?
The presupposition of such questions is that the problem rests in one individual (usually presumed to originate in some genetic disposition or biochemical given) - there is very little room for exploration of the possibility that 'the problem' may be co-created, that a family's biochemistry is interwoven with each other and that the symptom may be systemic and not reducable to one pathological individual. These kinds of considerations are already ruled out by the way the questions get asked, creating dilemmas for the therapist who rightly finds it impossible to give straight 'yes' or 'no' answers to them.
Therefore, what is omitted in this assessment set-up is the recognition that the question lies in the eye of the beholder - and not just the therapist, but also the client's internal and external beholders, observers, judges who constitute the intersubjective context in which the client is being pathologised. This intersubjective field exists long before the therapist is asked to step into it and perform the assessment, which can therefore never be 'objective' and 'neutral'. A good therapist doing an assessment perceives, responds to, takes into account this pre-existing field of opinions and judgements and identifies with or against them, creating an intersubjective entanglement which underpins any attempt at 'objectivity'.

The therapeutic professions have not entirely emancipated themselves from the idea that impersonal objective assessments - in and of themselves - are either possible or useful. However, our therapeutic principles and understanding tell us that “it is the relationship that matters”. Therefore, the heart of our work depends on our subjectivity – the only tool we have at our disposal is our self; that is all we can work with, for better or for worse. If – in pursuit of exclusive objectivity, academic uniformity and quasi-medical accountability – we try to eradicate the vagaries of our subjectivity from our practice, we destroy the essential foundations upon which our work depends.
Any supposedly 'objective' assessment is situated within and contextualised by the intersubjective relationship in which it occurs - whether the supposedly 'objective' facts or 'truths' are helpful or not does not mainly depend on the information that gets imparted in the assessment: the effect of the assessment depends on the relational dynamic within which it is delivered.

The same thing is true, of course, in our training as practitioners: many students who enter counselling or therapy training of some form or another regress back to school, assuming that success depends on similar principles and therefore take refuge in similar roles and survival mechanisms (becoming good, cooperative pupils or delinquent, protesting renegades, or anything in between).
This kind of transference which a student brings to their training is not dissimilar from the kind of transference that occurs in therapy: the same schemas, scripts and adaptations which we developed in school become reactivated in training. And to some extent the success of any therapeutic training depends upon the degree to which the student’s ‘habitual position’ (with its characteristic defences, anxieties and underlying impulses) can be addressed and worked through during the training, in therapy, in experiential groups but also in the training itself.
It was Carl Rogers who recognised that counselling training is likely to be more effective and productive if it encourages students’ self-directed learning, i.e. if the means and the ends of the training are congruent and coherent: if we are aiming for a profession of practitioners capable of independent reflective practice, then a traditional educational paradigm with its hierarchical and ‘other-directed’, pre-defined and imposed curriculum, format and structures is likely to create more problems than it solves. However, since the early 1990’s most counselling and therapy training has shifted significantly towards a standard academic paradigms, even if that does include some experiential process and practice.
What we notice in supervision is that many therapists arrive in their practice as supposedly independent reflective practitioners with ingrained ‘super-ego’ projections onto the profession and its organisations: many supervisees come out of training carrying fairly linear assumptions about ‘correct’ practice, and the supposed ‘rights’ and ‘wrongs’ of how to be a good therapist. These kinds of assumptions and habitual patterns effectively undermine the therapist’s sense of therapeutic authority and therefore the therapeutic space they are able to provide for their clients: in very immediate, nitty-gritty terms, these unresolved transferences (to the supposed authorities of their training and their profession, manifesting in compliant, inhibiting and deferential attitudes) interfere with the therapist’s responsiveness, spontaneity and creativity in relation to their client. The therapist does not feel free to follow their intuitions, lest they are in danger of being sued and struck off the register.
This kind of defensive practice in an increasingly litigious culture is well-recognised in medical circles – in the end, it does not serve anybody: it fails the client, and it fails the vocational passion of the practitioner, who resigns themselves to going through the motions.
These kinds of tendencies in ourselves, in our colleagues and in the profession at large are inimical to the depth of relational practice which we want to pursue (and which attracts us to the profession in the first place). The more we explore the depths of the relational encounter at the heart of the therapeutic process, the more we recognise that the traditional models of therapy do not do justice to the vicissitudes and dilemmas which the therapist experiences.
Following Petruska Clarkson (1994), we recognise that the therapeutic space consists of diverse, distinct and mutually contradictory relational modalities, which each have their validity, but are in constant tension with each other. As a therapist, I cannot hope to do justice to the client and to their psychological conflicts if I short-circuit the inherent relational complexity by imposing simplistic, linear instructions upon myself. The psyche is not linear, the therapeutic process cannot be linear, so my relational response must not be linear, so ideally my training and supervision and professional community does not model, uphold or insist upon linear ideals, borrowed and imposed from other scientific disciplines and educational paradigms.
As many of the elders of our profession have expressed: uncertainty, ‘negative capability’ and a capacity for sustaining helplessness are more important qualities and faculties for a therapist than knowledge, skill and competence. We want to be as open as we can to a multitude of relational configurations and relational spaces. Conversely, we want to impose as little dogmatism and habitual fixity on the therapeutic position and how we construct the therapeutic space (in order to maximise our capacity to be sensitive to how the client’s unconscious constructs the space).
Whether we use Martha Stark’s seminal distinction between ‘one-person’, ‘one-and-a-half-person’ and ‘two-person psychology’, or Clarkson’s distinction between working alliance, reparative, authentic and transference/countertransference modalities, ideally the therapeutic space I provide allows for all of these possibilities, unimpeded by linear ideas of the ‘rights’ and ‘wrongs’ of what should happen. This then allows me to notice that these different modalities are in constant dynamic tension with each other, creating transformative rupture-and-repair cycles in the therapeutic relationship which therefore can become as developmental as a ‘good-enough’ early attachment relationship.
These ideas become relevant in any kind of assessment we conduct: from the first moment that a client (or a student) makes contact with us, we attend to the particular atmosphere of the relational space we are transported to and co-create. Even when our task includes and requires an explicit assessment and the application of a set of standard criteria, we can notice the particular meaning and function these idea acquire in this particular relationship, knowing full well that these same ideas can have a completely different relational effect and meaning with somebody else.
One client is convinced that the rudimentary fixed points of the therapeutic framework apparently imposed on her necessarily put her into an inferior, compliant position; the next one is as convinced that therapy is an un-holding, wishy-washy useless environment, which fails to give him direction and security.
One client is convinced that the therapist treats her as one more miserable burden in an assembly line of rote, clinical cases treated according to the same manual; the next one is as convinced that the therapist’s attention to the way the two of them are making contact with each other in the room is a pointless, distracting irrelevance.
One client is convinced that the therapist’s empathic attitude is an invitation into a friendship which is supposedly the only place where this kind of warmth and acceptance can happen as by definition it is impossible in the cold clinical context of a consulting room; the next one is as convinced that the therapist’s boundaried and apparently cold clinical presence is a sign and conclusive evidence of a personal dislike.
In all of these situations, the therapist is the same personal-professional presence, but it gets perceived and experienced and constructed in very diverse and contradictory ways by different clients, who bring their wounds – their woundedness and their protection mechanisms against it – into the room and into the relationship.
In conducting an assessment, we recognise that this process is well under way by the time the client picks up the phone or enters the room. What kind of working alliance is available to be established depends upon how we navigate these pre-existing perceptions and assumptions: how do we engage with the client’s unconscious construction of the therapeutic space and our therapeutic presence?
Inevitably, as the therapist I am floating in a sea of contradictory currents, and it is understandable that I have the impulse to seek refuge in some guideline, some fix point, some standard procedure. As Bion said, there should be two frightened people in every consulting room. However, in attempting to assure my composure and portray a semblance of therapeutic authority by imitating some mould of ‘correct’ procedure, or reaching for some linear policy of how to be a good therapist, I lose access to the rich, paradoxical quicksilver complexity of the relational moment (in Ehrenberg’s felicitous phrase: “the intimate edge”).
The client can legitimately expect at least three aspects from an assessment:
– the therapist’s expert judgement as to whether therapy would be suitable, productive and a good investment, and if so, what kind of therapy – this is the equivalent of a medical examination, diagnosis and proposed treatment
– some negotiation of the business realities of therapy, i.e. mainly the financial deal
– but in order to make an informed, emotional decision about therapy, the client also needs a relational experience of what therapy would actually be like, and how the therapist engages in the relational multi-verse that has already been co-constructed

In offering a training day on “First Sessions and Initial Assessments”, these are some of the ideas and dilemmas we want to explore.

The therapist's habitual position

Morit Heitzler will soon be running a workshop in Oxford on the topic of "The therapist's habitual position".

Traditionally, when we describe a therapist's way of working, we think about theory and technique:
• what kind of concepts, models and theoretical framework underpins the approach?
• and what kind of interventions and therapeutic responses flow from this?

In simple terms: the theory is what I THINK about as a therapist, and technique is what I DO in response to the client.

However, this way of thinking about our work does not do justice to the roots and the essence of our work. It is a way of thinking borrowed from science and the ‘medical model’: it is not different from a doctor, who uses their scientific medical knowledge to examine, diagnose and administer a treatment to a patient.

The more we think about therapy as an intersubjective two-person encounter in which the quality of relationship is what matters, the more we recognise that the therapist's being - their underlying relational presence and stance - is a third significant factor alongside theory and technique.

What determines the therapist's implicit relational stance is a complex mixture of the therapist's own wounds, biography and background as well as their therapeutic training(s) and their own therapeutic process.

Just as people in general have habitual relational styles and patterns, therapists have habitual therapeutic positions (which we can think of as 'habitual countertransference' - attitudes on the part of the therapist which they take on as soon as they enter the therapeutic position, irrespective of the particular client in front of them). It is the therapist's habitual position which generates a particular therapeutic space - an atmosphere which may be more or less conducive, more or less transformative, depending on the client's character.

We can think about the therapist's habitual position in terms of certain stereotypes (the fairy godmother, the wise man, the stern interpreter, the challenger, the witness, the advocate, the doctor, etc), or in terms of the basic relational modalities or different kinds of therapeutic relatedness.

Most impasses in therapy and most breakdowns in the working alliance involve the therapist's habitual position somehow, and it is therefore an important and worthwhile focus for exploration for every reflective practitioner.

Thursday, 6 November 2014

Does my consulting room offer an integral embrace?

Applying Terentius’ (180 BC) 'Let nothing human be alien to me!' to the therapeutic space, I can ask myself: how much of human diversity does my consulting room invite, exclude or ignore? How much is structured out by default?
What are the assumptions I take for granted – about myself, about therapy, about the client, about reality – and which ‘unknown unknowns’ are kept outside the door without me even knowing that I exclude them?

How wholesome or comprehensive is the therapeutic space that I can provide? How does my own identity or bias, how do my own belief systems and habitual assumptions restrict the therapeutic space that I can offer?
How do my own wounds incline me towards creating a partial, limited and conditional space? How much of human experience, how much of each client’s whole self do I invite and welcome into our therapeutic space?

This question is, of course, especially relevant in terms of the multitude of therapeutic approaches. Even many ‘integrative’ psychotherapists restrict themselves to just a couple of – often contradictory – approaches. How many voices of the ‘pluralogue’ (a phrase coined by my colleague Doron Levene) are heard in my consulting room?

We want to approximate a comprehensive embracing stance towards the whole spectrum of therapeutic approaches. I have previously used the term ‘broad-spectrum integration’ to indicate the recognition that ALL therapeutic approaches not only work, but have their unique gems (as well as shadow aspects, of course). We could also use the term ‘integral psychology’ (after Ken Wilber’s book) as a finger to point at that particular moon.

An integral approach (in any field or discipline) attempts to minimise any areas that are left out by default: no obvious established 'truth' is to be side-lined or ignored.
In the great, but relatively young tree that is modern psychology, the three main branches which need to integrated are the psychoanalytic, behavioural and humanistic (not excluding the systemic and constructivist which don’t easily fit any of those 3). 20 years ago I suggested that in terms of body, mind and spirit we might need to include as a minimum Reich, Freud and Jung (which form a triangle where each of the three points is needed as a reference point to help integrate the other two). But there are, of course, many other ways in which we can slice the whole cake; or many other lenses through which we look at all the facets of the diamond that makes up the whole field.

Footnote 1: Publius Terentius Afer (195/185–159 BC), better known in English as Terence, was a playwright of the Roman Republic, of North African descent. His comedies were performed for the first time around 170–160 BC. Terentius Lucanus, a Roman senator, brought Terence to Rome as a slave, educated him and later on, impressed by his abilities, freed him. Terence apparently died young, probably in Greece or on his way back to Rome. All of the six plays Terence wrote have survived.
One famous quotation by Terence reads: "Homo sum, humani nihil a me alienum puto", or "I am a human being, I consider nothing that is human alien to me." This appeared in his play Heauton Timorumenos.

Monday, 26 May 2014

The Shadow Aspects of Body Psychotherapy - Summary

This is a brief and incomplete summary, in response to a current project by Courtenay Young, long-standing president of the European Association of Body Psychotherapy (EABP), co-editor with Michael of the English version of the 'Handbook of Body Psychotherapy' alongside the original editors of the German original (Halko Weiss & Gustl Marlock), to be published next year, and currently writing a series of papers on the shadow aspects of the Body Psychotherapy tradition (published in the International Journal of Body Psychotherapy). Courtenay had asked me for a summary of my current ideas on the subject, which I jotted down quickly, based on more detailed previous writings on the topic (see references below - Soth 1999, 2000, 2004, 2005, 2010).

Michael Soth has also published several articles that address some of the 'shadow aspects' of Body Psychotherapy, where he tries to work through some of the inherited 'wounds' of the tradition - thinking about this in very similar terms to how we inherit 'wounds' from our family ancestors, by applying the notion of character formation to ourselves as a tradition and a community of practitioners. What is the character of our tradition? What are the dynamics of its origin and early development which we inherit? What are the wounds of our therapeutic ancestors and how do we still carry them today in our theory and practice?

He suggests that unless we attend to these shadow aspects, it is possible for Body Psychotherapists to actually end up perpetuating the body-mind split, rather than helping to integrate or transcend it (which is the declared intention and aim).

In order to offer a process of characterological transformation - which is indeed what most Body Psychotherapists think they are doing - a particular kind of relational space is required to contain the deconstructions, transformations and re-integrations of the client's existing sense of self and personality structure. Soth argues that for several reasons most traditional Body Psychotherapy is not managing to generate the relational space needed to truly achieve its promised objectives. In order to access the unconscious dimensions of the client's characterological reality, the therapist needs to be capable of 'allowing themselves to be constructed as an object' by the client's unconscious, i.e. via the transference. This is different from observing, interpreting and even exploring the transference somatically, as these interventions are only possible once the therapist has already recognized and articulated what the transference actually is. However, we cannot presume such a nonchalant grasp of what are after all deeply unconscious processes - in both client and therapist - without compromising our notion of the unconscious, its reach and depth and extent, and what the processes are by which we may become aware of it. We can become aware of the depths of the client's unconscious only by processing our countertransferential responses in such a way that the relational unconscious manifests in the therapeutic relationship in the first place.

The relational space needed for characterological work starts with un-knowing on the part of both client and therapist. The therapist then needs to take a stance which allows the transference to manifest, via 'allowing themselves to be constructed as an object' (taking into account that there are a multitude of ways of interfering with such unfolding of the transference). Only when these conditions are met, can a relational process emerge and deepen to the point where therapist (and client) slowly become aware of unconscious processes through getting caught in co-created enactments. Character transformation occurs via enactment - the therapist needs to be able to surrender to the enactment and respond from within it (rather then presuming to be able to operate on it from outside, as was traditionally assumed). This 'theory of therapeutic action' requires the therapist not only to be attuned, but to survive being - and being experienced - as the 'wounding object'.

The relational space needed for characterological work needs to include the therapist's flexibility between all the relational modalities (Petruska Clarkson - working alliance, authentic, reparative, transference countertransference, transpersonal; plus - as added by Soth - the therapeutically inescapable 'medical model') and kinds of therapeutic relatedness (Martha Stark - one-person, one-and-a-half person and two-person psychology). The relational space needed for characterological work also needs to include what Bollas calls the 'transformative object'; this implies the relational capacity on the part of the therapist to move along the full spectrum between the extremes of one-sided, power-over dynamics (what Jessica Benjamin calls 'doer' and 'done-to' dynamics of 'complementarity') on the one hand and intersubjective mutual recognition on the other (in humanistic language: the extremes of I-it and I-I relating).

Traditional Body Psychotherapy does not meet these criteria, for several reasons and inherited tendencies which constitute its habitual position: • A general obliviousness regarding countertransference as a parallel process (as understood in modern psychoanalysis, i.e. since the 'countertransference revolution in object relations') and therefore a systematic unawareness of the enactments of the 'wounding relationship' between therapist and client (i.e. how the client's 'wound' - as body-mind split - enters the therapy room and how the therapist and the therapeutic process enact, replicate and exacerbate the wound - whether or not the therapist's own wound enters or not, which it frequently does in significant ways). • The many disavowed and hidden 'medical model' assumptions that come down to us across the Body Psychotherapy generations, which tend to objectify the client, using body-mind terms and values: - this particular shadow aspect can be traced all the way back to Reich's (as well as Lowen & Pierrakos') medical training, Reich's own narcissism and thus the objectification of others; • A strong 'humanistic' bias against psychoanalysis, and also the cognitive-behavioural tradition, because they are largely - and correctly seen by Body Psychotherapists - as disavowing the body altogether (until recently) and failing to deeply understand somatic process in a body-mind-psyche context; • Therefore, what follows is a body psychotherapeutic idealisation of the body, that makes it significantly unlikely that therapists attend to the actual phenomenology of the body-mind relationship: the whole approach and movement could be seen to be defended against the depressive position, for instance, by holding on to a merger of the symbiotic/narcissistic aspects, thus avoiding a differentiation of the body and mind (Jung's opus contra naturam); what we need instead is a paradoxical understanding of embodiment, which is not polarized against its opposite pole of disembodiment, but embraces it as a dialectical (and therefore dynamic and evolutionary) antithesis. • A lack of differentiated and detailed understanding of cognitive (and imaginative) processes, as they are all being lumped together as defensive 'head' manoeuvres; • Some of the defensive aspects of character typology, where insufficient attention is paid to embodied object relations and internalisation processes; •An over-emphasis of the reparative aspects of the modality of Body Psychotherapy.

To be continued ...


Relating to and with the Objectified Body (1999)
The Integrated BodyMind's View on 'Body/Mind Integration' (2000)
What Therapeutic Hope for a Subjective Mind in an Objectified Body? (2004)
Current Body Psychotherapy - a Relational Approach for the 21st Century? (2005)
The Return of the Repressed Body - Not a Smooth Affair (2010)

Saturday, 15 February 2014

Evaluation & feedback from recent workshop in Brighton

What are therapists looking for in their CPD training? I think I'll try and organise a mini-survey soon, once my new website is up and running. Just had some properly evaluated feedback collated from recent workshop in Brighton - have a look here:

Tuesday, 17 December 2013

A critique of Martha Stark’s model

[this is still a draft ... so far written for Body Psychotherapy audience]

Stark’s groundbreaking work addresses several issues – all of great significance in the historical development of psychotherapy: the therapist’s phenomenological stance; the therapist’s relational stance (not quite the same thing); the mind-over-body dualism; the systemic perspective; the post-modern, pluralistic shift generally and psychotherapy integration specifically.

On all these dimensions, tectonic paradigm shifts have occurred over the last 100 years; assumptions that were taken for granted a century ago have been questioned and a diversity of positions and theories has evolved around each one of them.

The problem with Stark’s contribution is that she conflates the different dimensions (and how they interact with each other) into one - too simplistic - narrative. This creates problems, especially for Body Psychotherapy, which need to be addressed.

Stark structures her argument around one main line of development: from what she calls ‘one-person psychology’ to a modern intersubjective ‘two-person psychology’, with a middle position which she – half-tongue-in-cheek, but on the basis of a serious, valid and helpful distinction – calls ‘one-and-half-person psychology’. This is a valid and significant line of development. It’s essentially a phenomenological-philosophical argument, which refuses to reduce humans to objects and establishes a fundamental and qualitative difference between the epistemology of natural versus human sciences: rocks do not talk back and they do not have a mind of their own. We can treat people as research objects (from what philosophy calls a ‘third-person’ perspective), but that research in and of itself will never arrive at valid truth claims regarding the human meeting of minds, or intersubjectivity. Between humans we need to admit the always already present subjective perspectives and therefore cannot get around interpretation, i.e. hermeneutics (see Habermas) which gives rise to an entirely different category of truth claims when it comes to intrapsychic or interpersonal phenomena. This anti-reductionist position postulates that in human affairs we need to recognize the other in an unpredictable and open dialogue (Gadamer) from a ‘first-and-second-person’ perspective.

In the world of psychotherapy, Buber’s famous phrase ‘I-Thou’ is well-known as capturing these ideas and attitudes. This begs the question of its opposite and what role ‘I-it’ relating may have in therapy. Here Stark comes to a surprising – for somebody who describes a linear historical development – and helpful, integrative position: she gives validity to all three possibilities and states that they all have their uses at different times with different clients.
This integrative attitude is neatly expressed by Ken Wilber’s phrase ‘transcend and include’ (Wilber’s four quadrants, by the way, are a very useful contribution to the distinction between ‘I-Thou’ and ‘I-it’, introducing a whole new level of sophistication, which Stark’s model does not include).

The problem for Body Psychotherapy is that in addition to describing these shifts – across the whole field, including psychodynamic and humanistic traditions – from one-, to one-and-a-half to two-person psychology, she also sees a development in bodymind and relational terms: from a classical psychoanalytic emphasis on knowledge, insight and mental understanding, towards the importance of felt, embodied experience towards intersubjective relating. But this is conflating several distinct dimensions – and in all of them changes have indeed occurred simultaneously over the last century – but to superimpose them on one line of development is a category error, mixing apples and oranges.

The various ways in which different traditions actually take changes in all these dimensions on board, and whether they dismiss earlier positions or do indeed ‘transcend and include’ them, creates a very confusing, pluralistic field, that is not neatly captured by Stark’s outline. Different traditions combine the various dimensions in entirely different - and contradictory – ways. So the only way to capture this and gain clarity would be to create a multi-dimensional space of historical development, along several separate axes, each with their own continuum:

1. between ‘I-it’ and ‘I-Thou’ stances
2. between ‘exclusively mental’ and ‘holistic’ approaches
3. between ‘working alongside’ the client as an ally and ‘working opposite’ the client as a relational other (which is not the same as ‘I-it’ versus ‘I-Thou’, and not reducible to it – see Gomez, Lavinia)
4. between ‘challenging’ and ‘supportive’ stances
5. between ‘individualistic’ and ‘systemic’ perspectives
6. between ‘pure approaches’ and ‘integrative hybrids’

This may create some more clarity, but only up to a point. There are further axes we can think of, and the closer we look at them, most of them are not actually linear axes along a polarized continuum in the first place.

For Body Psychotherapy, the most pressing distinction is the recognition that - whatever the constellated bodymind phenomenology the therapist focuses on – it is always possible to either take an ‘I-it’ or an ‘I-Thou’ stance. It is perfectly possible to be intersubjectively engaged with the other’s mind via insight and knowledge. Equally, it is perfectly possible to take an objectifying stance towards the other’s body and experience. These two dimensions – the phenomenological one (from one-, to one-and-a-half to two-person psychology) and the bodymind one (from knowledge to experience to holistic relational experience) – need to be kept distinct, if we want to gain an overview over the variety of approaches actually being practiced within the field.

Some of these problems in Stark’s contribution can be usefully addressed by complementing it with an integrative model which has gained popularity over the last 20 years in the UK as well as globally. Petruska Clarkson’s model (1994) tries to establish a comprehensive spectrum of relational modalities between client and therapist, comparing these to kinship bonds, thus validating an integrative multiplicity of therapeutic relating. But it falls short of grasping the paradoxical essence of the dynamic whole which is the body-mind system of the therapeutic relationship (Soth ).

Thus, a holistic and phenomenological two-person psychology as body-mind process (possibly extending into many-persons psychology) still awaits formulation (Stark, xxxx), but a starting point is the integral-relational notion of the ‘Fractal Self’ I have suggested elsewhere (Soth xxxx), by extending the concept of parallel process to include bodymind (Reich’s functionalism) and inter-subjective dynamics and unconscious process (Soth, 2007).

Improving on Freud ...

or: What does Freud mean ‘by projection of a surface onto a surface’?

[this is still a draft ...]
About 35 years ago I stumbled across an expression in reading Freud, which intuitively made a deep impression on me: “the ego is a projection of a surface onto a surface”. I have not forgotten about it, and it has been engraved in my mind since then, although I have never been able to locate it since then (if you can help me find the citation, I would be very grateful – actually I have now found a reference in Boadella, which I need to pursue – see bottom of doc!!).
I remember having a sense that here Freud was onto some deep, precious recognition. But my mind could not get its head around it at all. In those days it constituted a defeat if my mind could not understand something. But on this occasion, I gracefully admitted defeat: this thing was just beyond me. I just knew that a powerful, educated, disciplined mind had here formulated a stroke of genius. I cannot even be sure that I correctly remember the actual phrase, in its word-for-word detail, so in writing about it I am aware that I am pushing the boat out.
It has taken me about 25 years or more to get anywhere close, but over the last 10 years I think I have begun to understand it. And not only to understand it, but - in my ever humble way – to even improve on it, or so I fancy.
Freud was a child of his times, and a mental and psychological giant, but it is also true to say that in those heady fin-de-siecle days and the decades that followed, he - and those around him - were taking baby steps in their thinking about the phenomena of the psyche. They were severely hampered by thinking within, as well as struggling against, the dominant zeitgeist of their time. So much of their thought – the distinctions they made, the categories they formulated, leading right into their conceptualisations and models – much of this has stood the test of time and shaped the 20th century and its consciousness and thus human evolution, but it also led to all kinds of intellectual contortions and misleading complications, many of which are to some extent unnecessary.
Of course, they were trying to do justice to the complexity of the psyche, and so there is a level of reality where our models do need to match that intricate, quick-changing mercurial complexity. But the problem is not that the models are complicated – no, something much more vexing is going on: in trying to make sense of our perceptions of ourselves (and the human mind and psyche in general), our own internal conflicts and our ambivalent reactions towards the intensity of emotional and psychological experience – between the ever-present spectrum of pain and pleasure - enter our thought process and skew it. So it’s not surprising that our minds come up with ambivalent and confusing ideas – this is true for you and me, as well as great minds like Freud’s.
In pursuit of the noble adage "Know Thyself", and in directing our gaze towards our subjective experience, the conflictedness of that experience affects our capacity to see and to think. Therefore, as a consequence, our thoughts, ideas and models tend to reflect the conflicts that they are embedded in and arise from - rather than constituting any clear, let alone objective, perception or interpretation of the psychological facts.
In other words: our mental processes are parallel to our psychological reality. Fritz Perls was polemic about it in saying: all reasons are lies. But he was onto something: our thinking is not as clear and realistic and objective as it fancies itself. Our thought process is subtly influenced and subverted by the emotional agendas and avoidances which it fancies itself to be devoid of. Thinking is often born out of emotional defensiveness; or at the very least, it can acquire emotionally defensive functions. Our thoughts move in characterological grooves, on tracks which we take for granted and therefore don’t take into account and don’t factor in. Not one of our thoughts can be presumed to be free of such defensive functions – the defensiveness does not announce itself through the content of the thought. The thought itself – more likely than not – is valid and true, or at least has a truth content. The defensive function is visible only through the context and the emotional/psychological effect of the thought – the bodymind state that results from the thought; or the relational effects, both internal and external, that are precipitated by the thought.
The history of psychology and psychotherapy is full of models that are pervaded by - and are manifestations of - a fundamental emotional ambivalence: on the one hand, we want to, need to, are desperate to recognise and understand ourselves, right down into the depths of our psyche; to get some insight into those irrational forces beyond our awareness and control that drive our thoughts, feelings and behaviour - apparently like Greek gods, constantly and invisibly interfering in human destinies, but without human rhyme or reason. Such understanding can only flower when it is based on radical openness and acceptance: an agenda-free phenomenological enquiry into ‘what is’ – attending to ‘the body in the body’, ‘the feelings in the feelings’ – in the felicitous phrase of the Buddha’s sutra on mindfulness. Freud’s main focus was not ‘healing’ of the psyche, but a scientific version of ‘know thyself’ (a courageous enquiry not suited to the faint-hearted, weak-willed or woolly-minded which would then have anxiety-reducing and healing side-effects).

On the other hand, we're desperate to overcome those forces we are at the mercy of – to gain control over these irrational forces of the psyche and appropriate them and turn them to our ego’s advantage, and so edge closer to establishing a delusional stability and identity and maintaining an apparently secure, fixed and invulnerable self.
Our thinking and our models are therefore to a significant degree compelled by the impulse not to understand ourselves, deeply and truly, in a spirit of acceptance and surrender, but : to eradicate the pain, conquer the vulnerability, transcend the helplessness to overcome of vulnerability, our sense of feeling at the mercy of the irrational forces, emotional pain.
In short, our ego is conflicted: our conscious efforts are pervaded and guided and compelled and underpinned by a fundamental ambivalence in relation to psychological reality. The ego is compelled to find its roots and connect to them, to pursue the cracks down to their roots, to root out its limitations, heal the splits, cover up the cracks, and ultimately to transcend the prison of itself - at the same time as being compelled to perpetuate its existence into immortality. That ambivalence underpins and underlies all of our Western thinking, and therefore hampers our grasp not only of our internal world, but - of course - reality altogether.

So what was that statement by Freud that had left that lasting impression on me?
When talking about the relationship between the Ego and the Id, he said something to the effect of: the ego is a projection of a surface onto a surface.
Taking into account that we are here at the beginning of the 20th century, in an age of imperialism before the First World War, with the vacuum that Nietzsche’s death of God had created still haunting the Western mind, and at the height of positivism and materialism, with science about to take over as the new God, Freud is very much thinking in terms of physics – models of material reality that were taken as understood.
Making sense of psychological process by taking recourse to supposedly equivalent physical processes, on the one hand using physics as metaphor, but thereby treating them as much more analogous than they are. The metaphors become concepts which in turn become frames – Freud’s topographical model reflecting assumptions of archaeology and geology. Sometimes those analogies were made explicit – like Freud’s vision that some day all psychology might be reduced to neurology. With the photographic camera holding sway as one of the brave new advances of modernity, he’s taking recourse to a process of projection: the Id as the driving force of psychological process, ever energetic, it is like a light source projecting its energy onto the mind as a receptive and passive screen; with the animal-Id driving and radiating its instinctiveness; and consciousness as the apprehension of that energy and the mental manifestation and image and thought translation of it. 
So Freud implies that the surface of the Id is like the screen, onto which the film - moving images of the drives - are being projected. Remembering that Freud was deeply committed to neurology, and finding ways of rooting psychological process in the nervous system, he is trying to find a model for the mechanism by which basic unconscious physiological processes in the body are linked with and can manifest as psychological and mental and conscious processes and consciousness. He understands the body as a homeostatic system that goes through cycles of excitation, which arise in the Id, as instinctual processes. How do these unconscious, physiological processes become conscious? How does the human mind become aware of them?
Remembering also that at this point Freud is very much embedded in his topological model where the Id, the Ego and Superego are like geological layers - making therapy a bit like archaeology - it is easy to see why he thinks of the interface between the Id and the Ego as a surface: the forces within the Id are manifesting as arousal at that surface; this excitation is then available to be perceived by mental consciousness, and translated into images, thoughts and self-reflection. So whilst it is not difficult to see why Freud thinks of the Id as having a surface which the ego is watching, a bit like a film on a screen, what is more difficult to grasp is why he is speaking of the projection of that surface onto a surface. How does the second surface come in and what is it?
Here we come to an interesting point, where a whole paradigm clash manifests. On the one hand, Freud is deeply committed and embedded in the project of modernity, where mental observation is objective and thoughts are a direct objective reflection of what's out there. The Enlightenment, with its worshipping of reason, manifests in the belief (or we might say: the delusion), that the human mind has evolved to the point (with Western males at the pinnacle of that evolution, closest to a male God at the top of the pyramid), where they can see, think about, understand and ultimately control the movement of the universe. But whilst Freud cannot help being part of that compulsion and project, in everything he does he also undermines it. Along with Einstein and others, Freud is instrumental in puncturing the delusions of modernity and helping Western consciousness to its knees and to crumble (Freud's work effected a profound revolution in man's attitude towards, and comprehension of, his mental processes, constituting after Copernicus and Darwin, a third blow to man's self-esteem - See Stephen Jay Gould's “An Urchin in the Storm”, p. 214, for a development of Freud's "three great discontinuities”). Freud himself believed that his theories had struck but the latest blow against human vanity, the first being Copernican cosmology, which had displaced humankind from the centre of the astronomical universe, and the second, Darwinian evolutionary theory, which had removed it from the centre of the biological universe. By proposing that humans had evolved from animal species, Darwinism denied the biological uniqueness of humankind and asserted that human beings were but one of many species of animals. Just as Darwin destroyed the basic opposition between human and animal by placing human beings within a biological continuum, Freud similarly destroyed the traditional basic opposition between sanity and madness by locating normality on a continuum. (Anthropologists, as Levi-Straus then proposed, similarly replaced a traditional western opposition of civilized and primitive humanity with a conception of culture that places all social organisations upon or within continua).

The surface of the second surface he is talking about is the intuition that the mind is not an objective perceiver and reflector – not simply an accurate and reliable mirror - of what is ‘out there’ (or ‘in here’). Freud's key insight is that the supposedly rational mind is at the mercy of unconscious feelings and thoughts, and driven and directed by them all the more, the more it fancies itself above it. Already in his early theorising, Freud consequently does justice to this in his own thinking. He never fully succumbs to the promises and delusions of the Western mind. In himself or in others, he has a healthy, fundamental suspicion of every thought, including his own. In this regard, he is the father of post-modernity. He does not think of the mind as a single, perceiving point, like a mirror or an accurate radio receiver. No, he thinks of the mind as a surface: yes, as a screen, on which the unconscious conflicts are being played out; but as a screen which is affected by what it reflects, a screen that morphs under pressure of what it perceives and portrays.
He does not think of the mind as outside of the bodymind process, he does not succumb to an idea of the mind as the Archimedean lever which from its outside, dissociated, separated vantage point can leverage the whole of reality according to its whim. No, he thinks of the mind as a receptive surface, subject to the pressures of what it is perceiving, and therefore inexorably connected with it, and responsive as well as reactive to it.
On a deep level we can say that Freud has an intuition that transcends the subject/object split (this is not to deny the many aspects in which Freud is caught in perpetuating that very split). There is a long tradition of people trying to make up their minds as to whether Freud belongs in the first or second camp. The crux and the genius of Freud is that he, of course, simultaneously belongs into both camps, being deeply conflicted, but beginning to notice, attend to and formulate the conflict he experiences and recognises himself as caught in. The paradigm clash runs right through him, but his genius is that he is beginning to cotton onto it, recognise it, inhabit it reflectively.
On the one hand, he is the ultimate perpetrator of modernity; on the other hand he is the beginning of the end of it, its undoing and deconstruction. 
Freud's formulation of the relationship between the Id and the Ego, as a projection of a surface onto a surface, manifests this paradigm clash in a nutshell. He formulates, and his formulations are circumscribed by, a way of thinking in terms of projectors and screens that is very much trapped in the subject object/split; and in terms of the relationship between physiology, nervous system and the soma on the one hand and the mind, consciousness and psyche on the other, in the body/mind split. But what he's formulating at the same time is an intuition not exactly of their mutuality, but their intricate interconnectedness. He is speaking, thinking and formulating it from within the dissociated disembodied mind that is beginning to intuit its own limitations and turning towards the embodied roots of its own disembodiment.

In the language and formulations that have evolved in my mind over the last 15 years, having the benefit of complexity theory and 20 years of living with the idea of parallel process, I prefer to formulate Freud’s idea through the notion of the ‘fractal self’.
The idea of the fractal self combines integral thinking with parallel process. It draws on Wilber’s integral theory, especially as it applies to the body/mind and subject/object split, but goes beyond it in a significant way: by drawing on the idea of parallel process, we can make much more precise and meaningful statements about how the different levels and layers which integral theory describes in evolutionary terms, are actually related and linked in the complexity of the human bodymind. We can make much more useful statements both about the pathologies and contortions of the human bodymind, as well as about the paradoxical and often self-defeating process towards integration and wholeness. For a description and mapping of the overall spiritual individuation process, Wilber’s distinction of the various layers and states and lines may be sufficient, and integral theory does a good job of it (probably the best we have currently available, when we include its interested critics and detractors).
However, the more we get into the nitty-gritty of the individual human and how they are trapped in self-replicating contortions, the more we get down to the complexities of the individual subjective human psyche, as therapists do, the more we need an experience-near understanding of these vicissitudes. We then need to understand the detail of how the various layers of body and mind are linked and how patterns conspire to maintain the status quo within characterological fixations. How are old wounds and traumas embodied, carried from the past into the present into the future and – most importantly – just how do they replicate themselves? How come the mind is helpless, even when having understood the origins and manifestations of a characterological pattern, to actually change that pattern? Why is the mind helpless to change those patterns? Why is understanding usually not enough?
Many, if not most, modes and modalities of therapy are still built upon the mind as the supposed agent of change. Most talking therapies inherit the legacy of the 19th century, and that half of Freud's work which was caught in modernity. Many, if not most, modes and models of therapy are not suspicious enough of their own thinking, concepts and theories, both in general as well is in the nitty-gritty of a particular client-therapist relationship. We need to understand more the other half of Freud, who did recognise the mind as a parallel process, as the reflection of a surface onto a surface.
The more we can recognise, and more importantly, surrender to parallel process, the more the notion of enactment, being caught in patterns, whether we have any awareness or understanding of them or not, becomes significant. The notion of enactment, as parallel process like infinite dominoes replicating a pattern, regardless of the mind’s understanding or interference, is much closer to the reality of our vulnerability and susceptibility to these patterns.

Lifestreams: An Introduction to Boadella - 1987 - ‎Psychology
This enables us to comprehend Freud's statement that the ego is a projection of a surface onto a surface.5 Not only is the ego a function of the cortex, the outer ...

Tuesday, 5 November 2013

The tensions and contradictions between authentic and reparative modalities of therapeutic relating

I am currently writing a chapter for a book, which addresses some questions I frequently hear, regarding the relational modalities:

The crucial inspiration for authentic relating, however - pre-dating the explicit formulation of  intersubjectivity by several decades - came from Martin Buber’s dialogic philosophy (1947), which had a fundamental impact on Rogers, Perls, and the humanistic movement, captured in the phrase ‘I-Thou’ relating.
Already during the 1960’s and 1970’s humanistic writers had begun to question the psychoanalytic tendency to absolutize the transference as the be-all and end-all of the therapeutic relationship. Many of them had come through psychoanalysis and understood that the transference was helpful in understanding the vicissitudes of the therapeutic working alliance. But they also recognized that much of psychoanalysis had ossified into a one-sided and fixed relational stance which more often than not  was liable to undermine and destroy the working alliance, by a punitive attitude against ‘acting-out’ and the analyst’s habit of reducing everything that happens between therapist and client to transference.
The humanistic movement was inspired by an intuition – years later to be articulated by Petruska Clarkson (1994) - that the therapeutic space is and needs to be relationally complex, with the therapist capable of flexibility and fluidity between all the modalities of therapeutic relatedness, rather than dogmatically as fixed in their relational position as the client is in their characterological position.

In pursuit of the unfolding of the client’s full potential, humanistic therapists were willing to experiment (as analysts as Ferenczi, Reich, Sullivan and others had done) and found that both authentic and reparative modalities held therapeutic possibilities which psychoanalysis was categorically ruling out and excluding. There was some understanding that many psychoanalytic ‘rules’ instituted by Freud had grown out of his reaction against his traumatic experiences with the intensity of the erotic transference in his early practice, and that these principles and guidelines of practice needed revising, especially in the light of the new cultural context of sexual liberation, then 60 years on from Freud.

However, in its evolving anti-reaction against the objectifying, patriarchal and power-over paradigm of classical psychoanalysis, humanistic therapists often tended to swing from one extreme into the opposite. With the precious discovery of anti-hierarchical modes of relating often turning into an egalitarian ideology, rather than habitually enacting a fundamental relational inequality as psychoanalysis had done, humanistic therapists now started habitually avoiding any trace of inequality. Throughout the humanistic approaches, this resulted in a relational stance designed to systematically side-step and short-circuit the intensity of the transference – one reason why Body Psychotherapy has been criticized for neglecting the relational dimension of therapy.

Whilst often based on psychoanalysis merely re-stating the rigidity of its classical paradigm as well as prejudice, its critique of relational obliviousness in the humanistic field is substantially valid: by conflating reparative and authentic modes of relating into a confused blend, the subculture of humanistic psychotherapy has long managed to avoid an inconvenient feature of reparative relating: it is by definition inherently and necessarily unequal, and in its extreme is positively infantilizing. By wrapping the reparative stance within a philosophy of authentic, dialogical relating (which is by definition inherently and necessarily equal), the unpalatable aspects of reparative relating can be denied and rationalized. Repair of the client’s maturational deficiencies and provision of the developmentally needed responses – as valid and necessary as they are to the fullness of the therapeutic endeavour – inevitably involves the client experiencing – from within their subjective experience of the deficiency (i.e. from within the regressed state at the root of the deficiency) – a sense of need and inequality, even helplessness and feeling at the mercy of the other.

But even worse than that: contrary to the humanistic principles of I-Thou relating, a reparative stance inevitably involves a perception, not to say: a diagnosis of the wound and the deficiency. The reparative mode is inseparable from a sense of objectification – with a benign, motherly, nurturing attitude, but objectification nonetheless. The developmental deficiency – or more precisely: the client’s unawareness and defence against the wounding inherent in the deficiency - interferes with the client’s capacity for mutual intersubjective recognition: reparative relating cannot get around some kind of ‘medical model’ implications. There is a fundamental tension and opposition between reparative and authentic modalities of relating – a tension which can be navigated and worked with, but it should not be denied and collapsed. One of the shadow aspects of the humanistic tradition, therefore, are hidden and denied ‘medical model’ assumptions which pervade both theory and practice (Soth 2005, 2008).

Humanistic therapists and writers have developed a host of ways to fudge this issue: by re-formulating the repair not as an unequal interpersonal dynamic, but as the client’s self-healing process; by claiming – quite rightly – that the equality of authentic relating is reparative of the wounds inflicted by a history of unequal relating.
But none of these manoeuvres get around the conundrum: the experience of developmental repair implies the experience of the wounding, in a context of inequality; without the client actually feeling the deficiency which we are supposedly repairing, and therefore feeling unequal, we are colluding with an avoidance of the wound. This is the inescapable logic of the Kleinian opposition to any kind of gratification of the client’s needs and demands, any kind of fudging of the wound and the inherent helplessness, as well as frustration, anguish, envy and fury.