This unpublished paper was given
in Sydney in November 2004 at the annual conference of the Australian
Association of Somatic Psychotherapists (AASP).
“I Want My Mummy.” By Alison Ball
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Introduction
Last year I was really thrilled to hear Brenda Rowlandson’s
excellent paper regarding her personal experience of how she has helped
herself deal with her lifelong headaches. As you probably know, Brenda’s
paper was published last February in the journal “Psychotherapy
in Australia” (Rowlandson 2004). Brenda was influenced by Henry
Krystal’s ideas in his 1988 book called Integration and Self
Healing: Affect, Trauma, Alexithymia and I think I can take some credit
for having introduced her and others to Krystal’s book because
I was so extremely impressed when I had read it.
The major concept that struck me in Krystal’s book was the
notion that beneath almost all addictions, psycho-somatic illnesses
and a host of other conditions lies the one issue. That is, the inability
or the unwillingness at a deep unconscious level to take on the mothering
function for oneself on behalf of oneself. This issue, Krystal says,
is relevant in some way or at some level for all of us. I believe
too that the relative presence or absence, the intensity, the degree
and the way this phenomenon manifests itself can be a useful perspective
on what goes on with many clients. And let me stress that the most
insidious problems presented by this phenomenon are those that are
almost wired into unconscious survival decisions or organizing principles.
I intend no blame here. The way we do life is the way we do it until
or unless we feel safe enough to do otherwise and can bring our unconscious
conflicts into awareness.
Krystal is talking about the mothering function being experienced
as virtually the inviolable property of the mother. This can occur
because the original mother was not willing to allow the child to
gradually take over or into him or herself that mothering function.
The mother may not be able to allow this natural maturation because
of her own needs and/or because she falls into what Juliet Hopkins
described as the “too good mother”. In other cases the
maturation does not occur because for reasons to do with various degrees
of deprivation, cruelty, trauma or neglect, the child was not able
to take in enough of a good-enough mother so as to be able to incorporate
it into himself toward himself. In some people the internalised mothering
function may be experienced as an adult voice that is narcissistic,
rationalising or dismissive of the needs of the child. In others the
only internal mother or parent is extremely cruel, critical and denigrating.
I think this phenomenon is similar in some ways to the propositions
put forward by Symington in his book “A Pattern of Madness.”
As many of you may know Symington has formulated a pattern that he
believes underlies all psychopathology. If I may put it in shorthand
terms one aspect of Symington’s proposition is about the various
degrees to which we all lean toward playing one side or the other
of the “worm” or the “god” to someone else’s
“worm” or “god”. That “God” may
be an individual, a group or perhaps some cause. Krystal, sometimes
uses “mother” and “God” interchangeably which
adds to my thought that he and Symington have something similar in
mind in this inability or reluctance we all have at some level or
in some way to take on our power as adults and/or to grow up and take
responsibility for ourselves, our own thoughts and ideas and our own
well being.
Personal Examples
To briefly illustrate this phenomenon before I go any further I
will give you three personal examples of how I have experienced it
in myself. And I have used myself deliberately so as to emphasise
that this is an issue for almost everyone of us in some way and also
to minimise the references to client material, though later I will
give some generalized client examples. So, I think I was representative
of how someone could present as a client when the phenomenon has become
part of the character structure and is being lived out as an unrecognized
and deflected facet of the personality. When I came into therapy I
was one of those who almost literally threw myself on the floor in
front of my therapist and though I could not have verbalised it then,
it was as if I opened my arms and cried, “Take me, I’m
yours. Do with me what you will.” And implied in that was, “Love
me, let me love you; take care of me but don’t seduce me and
make sure that you can bear all my fury and rage when you fail me
and when you don’t succumb to all my needs and seductions.”
Well, it took a lot of years to work through all that until I was
forced to grow up somewhat, but the process of doing so is what years
of therapy for some people is primarily all about. My experience over
8 plus years meant that I discovered that the infantile “Me”
was an Ok starting point and that with my therapist’s help I
would find an “I”, a real grown up within myself who could
take charge; as opposed to the largely pseudo grown-up who had given
birth to and raised three children. At least I did start with a consciousness
of some sort of “Me” but some of our clients do not even
seem to have that “Me” at all or one that is solid enough
to work with. Others have had to totally suppress all evidence of
a “Me” or they have had to dissociate from it.
Another two examples from my own experience which some people may
have heard before. I think of it as like the remnants of the refusal
on my part to grow up and take on the mothering function for my self
toward myself. The first I think of is that until a few years ago,
whenever I would come home and look at my front garden and see say,
that there was some paper blown onto the garden then I would most
frequently want to just ignore it. Funny thing is that, since I live
alone, it was still there the next time I went outside. In my mind,
rather like with any sort of house work I had some sort of fantasy
that “a good fairy” would or should come and do it. These
days it is much more possible for me to be my own good fairy or, if
I really don’t want to do some particular job then that adult
executive “I” inside me can make a decision to pay someone
else to do it.
And the final personal example is of how difficult it was for me
to regularly do the exercise that for years I knew I must do in order
to keep myself fit now that I led such a sedentary life. Although
I had a lot of understanding of where this all came from it took the
shock of instant confrontation with my own mortality by fracturing
two bones in my body in one year to force me to take the literal step
toward being willing and able to look after myself enough to walk
regularly. My overwhelming feeling was, “I can’t be bothered”.
And this I think is a sign of the wish to stay infantile as are the
cries of “It’s not worth the effort” or the “I’m
too tired” statements we hear around us all the time. For me
it was as if I was saying to myself, “Mummy carry me! Carry
me!”, as my daughter used to say when she was about 2&1/2.
“Mummy please carry me; my legs are tired and I am too little
to walk all that way.”
Other examples
Now for some other examples. My guess is that each one of you can
come up with several of your own where over the years you have resisted
being an adult who can and will take care of yourself. There are of
course all of those who express their dependency needs through illness,
or addictions around food, alcohol, cigarettes, prescription drugs,
illegal drugs, gambling, computers or even, dare I say, SMS’ing.
Theodore Dalymple has written a book called Life at the Bottom which
discusses another similar category of those people who live life as
if the world owes them totally or at least owes them a living or look
for someone else to blame for everything. They live out an assumption
that their parents owe them, their housemates owe them and “the
government” owes them. The dole or other government handout
is referred to as their “pay” and many don’t actually
believe that it is incumbent upon them to earn their own living. In
share houses they don’t pull their weight, while in partnerships
they fall into childhood roles treating their partners as either they
were treated as a youngster or they expect that their partners will
look after them just as Mum and Dad did. All this rather than take
on equal adult responsibility which includes the mothering function
for themselves.
Others live at home with Mum and Dad until well into adulthood hoping
forever that Mum and or Dad will finally be for them the good enough
parents they are still so craving. Or maybe the parents have not allowed
them to take on the “mothering function” for themselves
and have actively encouraged the son or daughter to stay at home forever
taking care of the parents who themselves have never grown up. Then
there is the group who may not live at home and may even have their
own partner and children but who spend their therapy with almost endless
resentment and complaints about all the ways in which their often
now quite elderly parents are still not giving them what they need
and want.
“Meet my Needs” or be an Adult
A sub-category of the above grouping we can hear in the constant
complaints in this “new age” era of the person who gets
so hurt and upset because “my partner does not meet my needs.”
The hackles on the back of my neck rise each time I hear this one
and I can get very judgemental. In my view an infant has an inherent
necessity for someone else to meet their needs because that is the
state into which the human infant is born and they will not survive
otherwise. Not many of us would argue that they do not also have an
inalienable right for those needs to be met. The degree to which those
rights are conferred on older children, the elderly, the sick and
the disabled is one measure of a civilized society. But there are
always limits.
And, in my opinion, outside these special circumstances, for all
of us who are ostensibly functioning adults, then the possibility
that someone else will meet our needs is, simply a bonus. A bonus
of what can be the best in hopefully mutually supportive relationships
with our friends and our nearest and dearest and if we are lucky,
a bonus that can extend to the wider community and enrich that community.
Taking care of the other is one of the ways we can show our love,
care and concern for the other and enhance the richness of our lives
and the lives of the other. BUT…again in my opinion, there is
no inherent right for the other to take care of me. In the big wide
world, I believe that it is primarily my responsibility to take care
of myself and to meet my own needs.
Implications for Psychotherapy
However, for us as psychotherapists maybe this whole issue is a
chicken and egg problem. What does come first? Is it the lack of a
mothering function within us or constitutional and attachment problems
that may include trauma, neglect or deprivation and which then lead
to dependency or denial of dependency and the inability to take on
the mothering function for and on behalf of ourselves. In any event
the special province of long term intensive psychotherapy is primarily
about addressing dependency and attachment needs. I know of no other
way to work with these needs in a way that ultimately helps the person
to grow up and take that mothering function into themselves.
When clients do present with the above issues there is a whole range
both in intensity and degree. At an extreme, some may be living their
lives almost totally regressed so that they are literally acting out
a life where the adult in them presides in very limited areas of their
life if at all. Toward this end as well, are those who are dissociated
from or may suppress the infantile parts of themselves, maybe grow
up precociously then come to therapy stuck in some sort of pseudo-adult
state where their inner needs are not known about, split off or denied.
Others will not be so debilitated and their dependency needs only
manifest themselves in particular areas of their lives.
In summary the above constitutes the genesis of the idea that I had
for this paper. I simply wanted to draw your attention to this phenomenon
as I see it and leave you to think about whether or not it can give
some frame of reference for thinking about what is going on at times
in the therapeutic relationship. The rest of this paper is where my
thinking then took me about particular groups of clients, a framework
for thinking about how we work with some of them and also some of
the difficulties presented for ourselves in working with such clients
who present with serious damage or deficits in this area.
Finding a Therapist
To go on, and if you will pardon the pun, Krystal’s book simply
crystallized something for me. It touched into an old interest of
mine which is to do with how to work with some particular groups of
clients who have these deep dependency and attachment issues. These
are the ones I want to think about in the rest of this paper. There
are of course many people who never get into therapy and are quite
literally much sicker than those we see. But the ones who do come
are often quite desperate. Going through life only half grown up has
its own pain and leads lots of people to seek therapy. They may not
know exactly what it is they need but they are desperate to find a
therapist who will sense and meet their deeply seated turmoil and
their drive for wholeness. The infantile part of themselves has to
sort of catch up with the rest of them that has grown up.
Many of these clients would be considered to be borderline. They
are also often people who have managed to get by quite well in life
and have, in the eyes of the world achieved many common life goals
such as marriage, family and even perhaps a satisfying career. But
they do this in spite of carrying along that very infantile part of
themselves. There is often a huge disparity between the self who operates
or is seen to operate in the world and how they feel inside themselves.
That is how it was for me before I came to therapy. Others are quite
split off from that infantile self but they may have coped in adult
life by attaching to and merging with a partner, a family or some
organization like say, a church organization, a cult or perhaps a
political group who or which has, in some important respects, been
a substitute parent for them.
I want to suggest to you one way of thinking about how to work with
some of these clients. Then I will present three examples of what
I think of as different groupings of clients in the way they present
or respond to therapy. These groupings are by no means exhaustive.
I had to stop myself giving you other groupings. Neither are the groupings
totally discrete and there are overlaps. After these examples I then
want to finish with some of the pitfalls for both the client and us
as therapists when we work with such clients in the way or ways I
am suggesting.
A way of working or thinking about what is needed
for some of these clients
In recent years I have had much interest in the theoretical discussion
in psychoanalysis and psychotherapy regarding the continuum that is
therapy and this links with my old interest I mentioned. When I first
became a social worker in the ‘70’s I often had not a
clue how I could work with some of the clients I was seeing. Then
I came across a book called “All My Children” by Jacqui
Schiff. In case you do not know this book, it is the story of two
psychiatric nurses who worked in mental hospitals in the days before
medication was available to treat schizophrenics. These two nurses
were totally frustrated by the lack of any hope for the most chronic
and seriously ill patients some of whom were relatively young but
had been given up on by the doctors. The two nurses resigned and began
taking some of these patients into their own home and quite literally
re-parented them including bottle feeding, cots, nappies and leading
them through crawling stages as necessary. Numbers of these patients
were able to regain a functioning life. A more recent account of re-parenting
is given in The Flock written by Joan Frances Casey with Lynn Wilson.
Given that I myself was in great need of re-parenting at the time,
it is not surprising that this book made sense to me and gave me a
helpful framework for thinking about what was needed for some clients
even if they did not require such an extreme form of re-parenting.
Even after all I have learned since then this notion of re-parenting
still frequently seems relevant to me. I also realise now that this
notion can be included in a whole discourse in psychotherapy and psychoanalysis
about the goals and aims of the work and the methods to be used. I
do not intend going into that discourse any further here today because
I want to concentrate on using this notion of re-parenting as a useful
framework for thinking about what may be going on for us and some
of our clients who lack this internalized mothering function.
I should say that I understand that this notion of re-parenting
is not very fashionable these days and sometimes it is regarded as
demeaning, patronising and infantalizing. However, I want you to consider
it because I think it fits almost exactly with what some people need
from us as therapists and is particularly relevant for these groups
of clients of whom I am speaking. I do not want to be patronising
because this was also me when I came into therapy and it is true that
nowadays I can look back on that infantile half grown up me and feel
a bit sheepish or even a bit ashamed about how needy I was. On the
other hand I still, to this day stand in awe and wonder at the depth
of the process, the courage it took and the gratefulness I feel that
I found a therapist who could see me through the process. Then I have
that same sense of awe and wonder when a client wants me to be involved
with them in a similar process.
Clients Needing Re-parenting
The first group are those people who come closest to my idea of
re-parenting when they are driven to regress immediately they attach
themselves without question to a therapist who they sense as able
to take on their neediness. It is like they are saying, “You
are IT for me”. That is, this person has been searching for
someone who will allow them to deal with their deepest, most regressed
dependency and attachment needs. Some may have first done the rounds
of many therapists who have shied away from their neediness. These
people can sometimes do significant work in the surface layers with
some therapists but the dependency layers which sometimes verge on
the psychotic will only be touched when they have found the therapist
who fits the bill for them and can offer long term, very intensive
and patient psychotherapy. Mostly they are people who have been deeply
traumatised, neglected or suffered great deprivation in their childhood.
These clients are often highly emotional, often very regressed and
sometimes quite uncontained. They frequently only learn through action
and the concrete and especially by us being very concrete in our care
and concern for them. They idealize us at first. They demand or wish
that we love them as much or more than anyone else in our world. Many
profit by being held and nurtured in a very baby like way. But, can
they then get up at the end of a session and go out into the world?
Are they safe? Will they have a car crash on the way home? We worry
about them. They occupy our minds constantly rather like the mother
keeping the baby in mind.
As far as they are concerned it is not transference where they experience
us as if we are their mother. In their mind we ARE their mother; a
mother that they never experienced before. Therapy with this group
can be very torrid at times and even gruelling as the idealization
turns on its head when we somehow and inevitably betray them and we
become hated and denigrated. During this time we can only hope that
in the good times we have built up enough of a good enough presence
in their minds and heart. If we have, then they may be able to stay
with us, refrain from suicide or otherwise harming themselves and
hopefully find new strength and a different sort of relationship from
the stance of an adult.
A second group are those who to all appearances do have an
adult functioning self. They often have a very good job and have provided
very well for themselves financially and materially. They seem to
have taken on for themselves the mothering function in day to day
terms. It is mainly in the context of an intimate or therapy relationship
where the problems become manifest and we find that the adult, rationalising,
functioning self is built on a largely denied precarious house of
cards. These people may completely deny the degree of their dependence
and their desperate need of the other to meet their infantile self-object
needs even though all their behaviour make it clear that they want
a true and perfect mirror for themselves and someone who will idolize
them. In the face of any real or perceived rejection by the substitute
external mother /partner/ therapist they are in danger of total collapse
or suicide.
They predictably come into therapy at the point of a relationship
break-up. Both partners and therapists find them almost unbearably
controlling. They have grown up precociously and their adult self
seems built on a disavowal or repudiation of the capabilities of the
actual parents and other authority figures. This will now include
the therapist who is soon perceived as inadequate and useless. Some
of these clients will only stay in therapy long enough for their “out-in
the- world” functioning self to be restored and/or for an intimate
relationship to be regained. Their attachment to their functioning
self may be so strong and their fear of feeling their own “littleness”,
inadequacy and vulnerability so unbearable that they reject any possibility
of regressing in therapy. They want to intellectualise everything.
They often won’t let themselves cry in therapy though if they
do they can be like a tantrum throwing toddler. They only want support
for their adult-in-the-world self. They would probably be scornful
of any notion of therapy as re-parenting or else they have a very
particular idea of how you, the therapist, should do it; eg. It is
not, “Let me be a baby”, but “Give me the sort of
support I did not get as a teenager”. These people become totally
enraged and very often leave the therapist who offers the blank screen
analytic approach or the challenge of a more Kleinian based perspective.
However they may stay with the therapist who is willing to offer years
of the mirroring and validation inherent in a self-psychological approach
although there may be underlying contempt when they think they are
in control of the therapy. This self-psychological approach though
is, in my mind, another form of re-parenting.
The third group I am thinking of and the one I want to talk
about in some detail, are those who spend their lives being the nurturing
mother to lots of babies or say, serving in the helping professions.
They thus give out to others what it is they need for themselves.
But over time they become enraged and resentful about all the giving
out they do and can come to feel they get nothing back. Sometimes
they find that they actually hate people even while they sacrifice
themselves. An example of this category and of what it may take to
work with them might be someone who may have been totally traumatised
from or before birth through physical and/or sexual abuse. This category
of person may very closely resemble Krystal’s description of
Alexithymic (ie. Unable to use emotions as signals to oneself) and
may have a similar problem to the holocaust survivors he describes
(p.234). In them he says, “The process of making peace with
oneself becomes impossible when it brings back the helplessness and
shame of the past” and they “experience self-healing as
‘granting Hitler a posthumous victory’.” That is,
“If I get better they (the parents) will be let off the hook.”
This is a common dynamic seen in varying degrees in many clients.
At first such a client may be completely overwhelmed and overcome
by feelings so my first job would be containment and shoring up the
dam walls which somehow had broken. This person may be utterly convinced
that she/he chooses nothing in life; rather things “just happen”.
Then later we may discover that his/her capacity to blank out or numb
is a way to block out all knowledge of thought, words or feelings.
Now we will have to concentrate on building safety and validating
his/her way of being and the necessity for being however she/he is.
Later we may discover the fears of being crazy which disguises the
wish that all that abuse did not actually really happen. Better to
be mad than really believe that your parents hated you or how much
you hate yourself and everyone else. Along the way I will at times
have to teach such a client that all physical contact is not abusive
and help them gradually find that touch and holding can be nurturing
and affectionate. However this is dangerous because then they are
really put in touch with the need of me and with this the pictures
of the abuse can re-surface as a warning that it does not pay to want
anything or anybody. And underneath is usually massive rage which
cannot be gone near. Months of silence can ensue at times and when
it becomes at all possible now I must maintain a stance of just letting
it be. Hopefully now the silence can be tolerated without inducing
feelings of total isolation, or terror because old feelings can arise
of having to produce something for the other, even if it only be thoughts
and words. There needs to grow in them some internal sense of when
they themselves might actually choose to talk or want to talk and
convey to an interested other what they might feel and think. And
so they begin to understand at an organismic level that they do have
choices in life about what they give of themselves.
And all the time with such a client we walk a line on either side
of which they maybe continue to feel they’d be better off dead.
The major fear for some is that there may be no self at all. Or it
may be a continual balancing act between fears that they will not
be able to cope at all (ie.say, go to work) if they were to get in
touch with feelings or on the other side the dilemma of terrible feelings
of isolation and alienation; of being cut off from themselves, the
world and those who love them if they maintain the wall around their
feelings. None of this is a linear process but rather one that cycles
continually while the various facets become more and more clearly
defined and differentiated and we must battle constantly with the
hopelessness we both feel at times. It is crucial to foster and validate
the self-in-the-world which is frequently felt as not real and at
the same time encourage the adult self to be in charge in the therapy
room. In that way, when feeling and emotion break through the walls
they can gradually learn to self-regulate and make conscious decisions
about whether or not they can dare to allow themselves to go into
those feelings or decide to block them off.
With some of these clients, because the child self may have been
so humiliated abused, damaged and abased I do not think it wise or
even possible for them to regress to a child like state in therapy.
Rather, most of the time it is important to align with the adult even
though that adult may be frequently overwhelmed with enormous pain.
In this case there may not be the obvious drive to have me re-parent
them but nevertheless they may gradually get in touch with massive
longing, and may at times allow themselves to be nurtured so they
can slowly internalises a new experience of a parental/ authority
figure.
The Pitfalls
Those are examples of only three of a number of possible groups
of patients at this extreme end of my continuum where, attachment
and dependency needs must be attended to so that they can take on
the mothering function for themselves on behalf of themselves. Now
I want to finish off with some pitfalls for both clients and therapists
regarding this whole notion of re-parenting.
An on-going question for me in relation to these clients is, how
much can I realistically offer them? Sometimes what they need is quite
extreme and very, very demanding of us. Sometimes their demands stretch
us to our limits. They frequently need much more than once weekly
sessions, they might need extra time on the telephone and sometimes
would profit best from longer sessions. Can they afford our full fees
for all they need and if not do we reduce our fees, often substantially?
Frequently they want to merge with us, want to idealize us and have
us be precisely as they want us to be. We have to be very sure that
we do not seem to offer something which we cannot continue to give
or give to the extent that may be needed.
I emphasise this point because first and foremost we must look after
ourselves as therapists. How much and what we give will vary greatly
with each therapist. Clients ultimately self select their therapist
according to what they need at the time and what they sense we can
give. The reality is we cannot always give what is needed and some
of the above clients may have to leave some therapists without that
infantile part of themselves attended to adequately.
I think a lot about what makes it possible for each of us to work
better with some clients than with others. Each one of us can stand
certain sorts of demands on us and not be able to tolerate other sorts
of demands. For instance I gave up formal massage years ago. Massage
takes too much out of me. I cannot give so much that way. I also notice
that, with the second client group I spoke of, I only go to the constant
mirroring and validating when all else fails. Others may find that
sort of therapy easy. I don’t or at least not with this group
of clients. I find that I most easily can give a lot to the sort of
client who falls into the first group I described. So I have wondered
why that is. And the conclusion I have come to is that the first group
actually give a great deal to the therapist, or at least I feel given
to by them. They really enter wholeheartedly into the therapy process;
they can’t help themselves in that, as they are driven to do
it. They are highly charged and they give of their emotions. And they
give their trust.
With the second group I feel frustrated by their rationality and
their resentfulness. They don’t want to give of their feelings
and emotions but they want me to admire them even when they continually
intellectualize and are often objectionable and attacking. They invoke
in me a wish to be rid of them. And, as my supervisor has frequently
said to me, unconsciously, they know they are disliked and she has
a view that if we do not acknowledge that but continue to only mirror
and validate, then the likes of myself are in danger of using that
method as a way to defend against my own sadism and/or of inappropriately
acting it out with them. I might say, close family who know me best
(and probably some of my clients too) might say that I don’t
always defend against my sadism but definitely let it out at times.
And that leads me to think about a similarity to Winnicott’s
(p.201, 1992 (1958)) thoughts on all the reasons why mothers may hate
their babies. Myself and other therapists who work with people with
high dependency needs must give much thought to the degree to which
we might actually hate those we love and particularly those who are
dependant on us.
However, of one thing I am certain. That is, that no matter how much
we give or how much we do as therapist in our conscious or unconscious
attempts at re-parenting, we can never and I stress never, make up
for all that was lost to the child in our client. Ultimately we cannot
be the actual idealized mother/ parent that they so longed for and
arguably had a right to expect as an infant At least to that extent
they will feel betrayed by what we either did promise them or they
felt we had promised them. And we will have to bear their fury with
us over that.
Sooner or later they will, if we are doing our job, and no matter
how much or what we give to them, have to confront the fact of all
that has been lost to them. They will have to mourn and grieve the
loss of the parents they ideally wanted, their potential to be more
than they are or might have been, the wasted years and the terrible
sadness that there was neglect, abandonment, trauma in their life
and that that has affected them in the here and now. This grieving
and mourning is an absolutely crucial aspect of good therapy. Without
the mourning there is no chance of real engagement with their life
now and all that they do have in the here and now. Then with a bit
of luck, because of the good that has been built and our willingness
to stay with them through thick and thin even when they have hated
us, they will gradually be able to take into themselves on behalf
of themselves that mothering function. Hopefully they will have built
up the capacity to self regulate, to love and care for themselves
and to comfort themselves in their pain. And hopefully too, they become
assertive enough and loving enough that they can build mutually supportive
relationships in their lives so that their on-going adult needs can
be met and they can be that person for others. I think this growth
is the outcome of good enough therapy.
There are a couple of other dangers with these most deprived clients.
When people regress to the level needed for some at this extreme end
in therapy there is always the possibility of suicide or so called
accidental death. Clients die either because they cannot bear the
feeling that they have wasted their lives, or when they feel they
have lost the good therapist/parent they had found or when they turn
their hate and rage against themselves. When such violence and rage
is connected to the edge of psychosis then the risk is mammoth and
for the therapist to contain that risk is extremely problematic
This last issue was written about by Michael Balint, following Ferenczi
and a further aspect explicated by Bettleheim. Balint described two
forms of regression. One was a benign regression and the other was
a malignant regression. He believed that with some people when they
regressed there was no possibility of containing it. The more that
the therapist gave the more the client regressed, wanting more and
more and more. They were unfillable. Perhaps we know a lot more now
than was known to Balint and Ferenczi in the form of containment and
regulation of affect but this issue must be thought about.
That being said, I want to put in Bettleheim’s proviso. I have
an enormous trust which I think I learned from Jeff Barlow, in the
capacity of the human spirit to know what they need to do in therapy.
But sometimes a client might have something in mind about some way
they would like me to be with them that stretches my usual limits
eg. What if I was not one who was usually open to the possibility
of lying on the floor cuddled up to the client and that was what they
wanted or needed. Well usually I must tune into myself and check with
myself about my willingness or capacity to go in that direction. If
I can’t or don’t want to then as far as I am concerned,
this becomes simply one more issue to be thought about and discussed
with the client. We all have our limits. That’s life and that’s
reality.
But when someone is extremely regressed in therapy I rely very heavily
on this trust in the capacity of the human being to move in the direction
of growth and gradually move forward and toward growing up. I have
generally thought that it is innate. However Bettleheim has a warning
for us. He says that of course the force of the movement toward growth
and growing up is biologically determined in the infant and young
child. It is just nature’s way. But for the adult there is not
this biological imperative. We have actually already done it. And
this might mean that the satisfactions gained from being regressed
and getting needs met in therapy that have never been met before may
be so seductive that the gain of being grown up pales into insignificance
and is not something to be welcomed.
Growing up, taking on responsibility for oneself and living with
reality is a horrible outcome of therapy for many people. They wish
they could get back all their mechanisms they had used all their life
to escape from reality or to get others to take care of them. Often
we must deal with their anger that we have taken away from them their
habitual ways of coping. They forget how bad they used to feel. Now
they just resent the fact that I will not be their Mummy for ever.
As a therapist told me a client had said to them recently, “Growing
up sucks!”
REFERENCES
Balint, M. (1968) The Basic Fault. Therapeutic Aspects of
Regression. Northwestern University Press, Evanston, Illinois.
Bettleheim, B. (Sorry can’t locate this reference as I have
loaned the book)
Casey, J. F. & Wilson, L. 1991 The Flock. The Autobiography of
a Multiple Personality. Fawcett Columbine New York.
Hopkins, J. (1996) The Dangers and Deprivations of Too-Good Mothering
in Journal of Child Psychotherapy Vol.22, No.3 1996. Ps. 407-422
Krystal, H. (1988) Integration and Self Healing: Affect, Trauma, Alexithymia
Rowlandson, B. (2004) Therapist Heal Thyself: Touching into the Pain
of Migraine in Psychotherapy in Australia, Vol.10, No.2 February 2004,
Ps 54-58 .
Schiff, J. ( ) All My Children (Sorry I have also loaned this book
so no more details)
Symington, N. (2002) A Pattern of Madness. Karnac Books, London
Winnicott, D.W. 1992 (1958) Hate in the Countertransference in “From
Paediatrics to Psychoanalysis: Collected Papers.
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