No More Learning

Inevitably the influential events of an individu- al's first two or three years will either never have been registered in his memory or else cannot now be recalled. Here, of course, the best a therapist can do is to infer, on the basis of the transference situation and of such information as the patient has gleaned about his early years, combined with
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? ? ? such wider knowledge of personality develop- ment as the therapist has acquired, what the nature of those events may have been. In other words, he resorts to reconstruction; but in doing so he can in future draw on a much wider and more reliable knowledge of family influences on personality development than has traditionally been available to analytically trained psychotherapists.
THE THERAPIST'S STANCE
In this account of therapeutic principles, therap- ists will recognize much that has long been famil- iar, though often under a different name. The therapeutic alliance appears as a secure base, an internal object as a working, or representational, model of an attachment figure, reconstruction as exploring memories of the past, resistance (sometimes) as deep reluctance to disobey the past orders of parents not to tell or not to remem- ber. Among points of difference is the emphasis placed on the therapist's role as a companion for his patient in the latter's exploration of himself and his experiences, and less on the therapist in- terpreting things to the patient. Whilst some tra- ditional therapists might be described as
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? ? ? adopting the stance 'I know; I'll tell you', the stance I advocate is one of 'You know, you tell me'. Thus the patient is encouraged to believe that, with support and occasional guidance, he can discover for himself the true nature of the models that underlie his thoughts, feelings, and actions and that, by examining the nature of his earlier experiences with his parents, or parent substitutes, he will understand what has led him to build the models now active within him and thus be free to restructure them. Fortunately the human psyche, like human bones, is strongly in- clined towards self-healing. The psychotherap- ist's job, like that of the orthopaedic surgeon's, is to provide the conditions in which self-healing can best take place.
Amongst those who have recently given de- tailed accounts of the special value of adopting a modest and tentative approach are Peterfreund (1983) and Casement (1985).
In the foregoing description the therapist's role has been likened to that of a mother who provides her child with a secure base from which to explore. This means, first and foremost, that he accepts and respects his patient, warts and all, as a fellow human being in trouble and that his
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? ? ? over-riding concern is to promote his patient's welfare by all means at his disposal. To this end the therapist strives to be reliable, attentive, em- pathic, and sympathetically responsive, and also to encourage his patient to explore the world of his thoughts, feelings, and actions not only in the present but also in the past. Whilst always en- couraging his patient to take the initiative, the therapist is in no sense passive. On the one hand he tries to be attentive and sensitively responsive. On the other, he recognizes that there are times when he himself should take the initiative. For example, when a patient wastes time talking about everything and anything except his thoughts and feelings about people, it will be ne- cessary to draw his attention to his avoidance of the area, and perhaps also to his deep distrust of the therapist's efforts to be helpful or of his capa- city to keep confidences. With another patient, who perhaps is very willing to explore memories of childhood, there will be many occasions when a therapist can usefully ask for more detail or raise questions about situations of childhood that the patient has so far not referred to directly, but which seem plausible possibilities in the light of what he has been describing, and in the light also
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? ? ? of the particular problems from which the patient is suffering. In doing so, moreover, the therapist must never forget that his patient may still be strongly influenced by his parents' injunctions not to know about events he is not supposed to know about and not to experience feelings he is not supposed to experience.
An interruption to therapy probably always generates some reaction in a patient; sometimes it is conscious, at others unconscious, but non- etheless evident. When conscious, it may take the form of overt complaint or angry protest; when unconscious it may manifest itself by the patient disparaging therapy or missing a session or two before the break. How a therapist evaluates these reactions and responds to them will reflect his theoretical position. Someone who adopts attach- ment theory will respect his patient's distress or anger about the separation and will regard them as the natural responses of someone who has be- come attached to another--a respect that will be implicit in anything he says or does. At the same time he will give attention to the form his pa- tient's reaction takes. If openly expressed, he will be sympathetic and may be able to ease the pa- tient's distress by giving him information about
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? ? ? how he could communicate during the break. In addition, the therapist will consider how the pa- tient is construing the interruption and, should there be evidence of misconstruction, will at- tempt to discover how it may have originated. If, for example, the patient is apprehensive that the therapist will not return, the possibility of the pa- tient having been exposed to threats by a parent to abandon him might be explored. In cases where the interruption is due to the therapist be- ing unwell, he will be alert to the possibility that the patient may be apprehensive lest something he (the patient) has done or said is responsible. Were that to be so, the therapist would explore whether one of the patient's parents had sought to control him by claiming that the way he be- haved was making mother or father ill.
Similarly, should a patient react to an interrup- tion by disparaging therapy or missing a session, a therapist who adopts attachment theory would ask himself why his patient is afraid to express his feelings openly and what his childhood exper- iences may have been to account for his distrust.
It is not unlikely that the description just given of a therapist's mode of responding to his pa- tient's reactions to an interruption will contrast
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? ? ? with that of a therapist who adopts and applies one or another of the traditional psychoanalytic theories. For example, one such therapist might regard his patient's reactions as being rather childish, even infantile, and as indicating that the patient was fixated in an oral or a symbiotic phase. What the therapist then might say, and es- pecially the way he might say it, could well be ex- perienced by the patient as lacking in respect for his (the patient's) current feelings of attachment, distress, or anger. Here again there would be danger that the therapist might appear to be re- sponding in a cold unsympathetic way and all too like one or other of the patient's parents. Were that so the exchange would be anti-therapeutic.
How far a therapist can wisely go in meeting a patient's desire to keep in communication during breaks, e. g. by telephone, and for comforting when distressed during a session, turns on many personal factors in their relationship. On the one hand, there is danger of the therapist's appearing to lack sympathy for the patient's distress or even to seem rejecting. On the other is the risk of his appearing to offer more than he is prepared to give. There are occasions when it would be inhu- man not to allow a distressed patient to make
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? ? ? some form of physical contact: the roles are then explicitly comforter and comforted. Yet there is always danger that physical contact can elicit sexual feelings, especially when sexes are differ- ent. Depending on the situation each therapist must make his own decisions and draw his own lines. The more alive to such issues a therapist is the better will he be able to avoid the pitfalls.
EMOTIONAL COMMUNICATIONS AND THE RESTRUCTURING OF WORKING MODELS
When a therapist utilizes the kind of technique advocated here, it can sometimes happen that therapy gets into a rut in which the patient per- sists endlessly in describing what a terrible time he had as a child and how badly his parents treated him, without any progress being made. One cause of such perseveration, I suspect, is that the patient is convinced that his therapist does not accept the truth of what he is saying: hence his endless repetition of it. This may be due to the patient having always been scoffed at by those to whom he has told the story in the past or, and perhaps more commonly, to the therapist himself having indicated scepticism or disbelief. This can be done in a myriad of ways, by tone of voice, by
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? ? ? querying the details, by failing to attach any par- ticular weight to what the patient describes.
Evidently when the problem lies in the therap- ist's incredulity the way out is for him to make it plain that he knows all too well that such things do happen to children and has no reason to doubt the patient's account. Even so the impasse may continue: the story is told and retold in a flat cyn- ical way with no show of feeling whatever.
This situation has been discussed by Selma Fraiberg who, with colleagues, set out to help vul- nerable mothers at risk of either neglecting or ab- using their infants (Fraiberg, Adelson, and Sha- piro, 1975). They describe making visits to the homes of two such mothers and listening to the distressing tales these women had to tell. Each told a story of gross cruelty during child- hood--being subjected to violent beatings, being locked out in the cold, often deserted by mother, being shunted from one place to another, and of having no one to go to for help or comfort. Neither gave a hint of how they might have felt nor what they may have felt like doing. One, a girl of 16 who avoided touching or holding her baby (who screamed hopelessly), insisted: 'But what's the use of talking? I always kept things to myself.
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? ? ? I want to forget. I don't want to think. ' This was the point at which the therapist intervened--by herself expressing all the feelings that any and every child would be expected to have in the situ- ations described: how frightened, how angry, how hopeless one would feel, and also how one would long to go to someone who would understand and provide comfort and protection. In doing so the therapist not only showed an understanding of how the patient must have felt, but communic- ated in her manner that the expression of such feeling and desire would be met with a sympath- etic and comforting response. Only then was it possible for the young mother to express all the grief, the tears, 'and the unspeakable anguish for herself as a cast-off child' that she had always felt but had never dared express.
In this account of Fraiberg's methods of help- ing a patient express the emotions she dares not show I have deliberately emphasized the link between emotion and action. Failure to express emotion is due very largely to unconscious fear lest the action of which the emotion is a part will lead to a dreaded outcome. In many families an- ger with an adult leads to punishment which can sometimes be severe. Moreover a tearful appeal
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? ? ? for comfort and help can lead to rejection and hu- miliation. It is perhaps too often forgotten by clinicians that many children, when they become distressed and weepy and are looking for com- fort, are shooed off as intolerable little cry-babies. Instead of the comforting provided by an under- standing and affectionate parent, these children meet with an unsympathetic and critical rebuff. No wonder therefore if, should this pattern pre- vail during childhood, the child learns never to show distress or seek comfort and, should he un- dertake therapy, assumes that his therapist will be as intolerant of anger and tears as his parents always were.
Every therapist who adopts a psychoanalytic per- spective has long recognized that, to be effective, therapy requires that a patient not only talks about his memories, his ideas and dreams, his hopes and desires, but also expresses his feelings. The discussion of Fraiberg's technique for help- ing a cynical and frozen young woman to discover the depth of her feelings and to express them freely to her therapist is therefore a fitting note on which to end. In writing this lecture I have throughout been aware that, by using terms such as 'information', 'communication', and 'working
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? ? ? models', it would be easy for an unwary reader to suppose that these terms belong within a psycho- logy concerned only with cognition and one bereft of feeling and action. Although for many years it was all too common for cognitive psycho- logists to omit reference to emotion, it is now re- cognized that to do so is artificial and unfruitful (Hinde, Perret-Clermont, and Stevenson-Hinde, 1985). There are, in fact, no more important com- munications between one human being and an- other than those expressed emotionally, and no information more vital for constructing and re- constructing working models of self and other than information about how each feels towards the other. During the earliest years of our lives, indeed, emotional expression and its reception are the only means of communication we have, so that the foundations of our working models of self and attachment figure are perforce laid using information from that source alone. Small won- der therefore, if, in reviewing his attachment re- lationships during the course of psychotherapy and restructuring his working models, it is the emotional communications between a patient and his therapist that play the crucial part.
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? ? ? 1 Within traditional theory this shift of role by a pa- tient is likely to be termed a case of identification with the aggressor.
2 Since in previous publications I have given much at- tention to the ill effects on personality development of bereavements and prolonged separations, these themes are omitted from what follows.
3 For research purposes, however, criteria for accept- ing retrospective information as valid must be much stricter.
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