Enactment is when the dynamics of a primary wound become replayed in the dynamics of the therapeutic relationship. This is often understood by the therapist as an error, a mistake made, a transference unseen or poorly contained; but for me that misses the point.

It was once assumed that transference and countertransference were likewise unfortunate intrusions in the analytic process, whereas we now see them both as inevitable and as valuable sources of information regarding the client's relational patterns. Transferential dynamics can take us beyond knowledge of a client's dynamic symptoms into a here-and-now experience of their actual relational presence; including how they construct us through transference into versions of their own primary storylines, how we construct them through countertransference into versions of our own; and, crucially, how it is that our respective stories might collide or merge - enactments usually become apparent when the working-alliance ruptures in some form of collision, or when it remains impassive and undisturbed in some form of collusion.

Enactment dynamics can only be understood as simply a mistake if we assume that we would be better off if the whole disturbance had been avoided, and that a strident stability in the working-alliance is always therapeutically preferable.

If, however, we acknowledge that ‘the mistake’ emanated from a largely unconscious, co-organised relational-psychological field, incorporating the psyches and developmental wounds of both participants, then we might imagine that ‘the mistake’ is significant in their underlying dynamic relationship.

If we now conceptualise that these underlying enactment dynamics are a mimesis of a primary developmental wound, dissociated from awareness, we can see that we have been given an extraordinary access to the wound itself, not in the relative abstraction of past or external relationships, but in the here-and-now of the therapeutic encounter.

It is therefore not mainly the client, but the therapeutic relationship that needs to be experienced and healed; though this can be problematic, as it requires me to step beyond the relative detachment of my therapeutic position into the necessary conflict within me, between my professional persona and my real self.

Martha Stark's 'two-person-psychology’ points us towards this uncertain and challenging territory, whereby it might just be necessary to resolve something within ourselves in order for the therapeutic relationship to resolve something within itself, and thereby for the client to resolve something within himself. If we wish our clients to risk navigating the path that might lead to the razor's edge of transformation, surely we should be willing to do so too.

The more I approach enactment as the vehicle by which dissociated relational dynamics come into the foreground of the therapeutic process, the more accepting I become of the idea that my own flawed being and subjective process are at least as alive in the therapeutic process as any training, knowledge, structures, and capacity for analytic positioning that I might employ; and that this is to be embraced as an exquisite, excruciating potential for mutual growth.

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As we are just planning and thinking about Morit’s forthcoming CPD workshops on integrative trauma therapy, this topic is currently at the forefront of our minds, so I'm sharing it with you.

There is a wide spectrum of opinion as to what role working with the transference plays in trauma work. I believe that the therapist’s awareness of the transferential dynamics is essential. As in all therapeutic work, the question is how my therapeutic awareness might most usefully and appropriately translate into my presence (whether that is silence or an intervention), and in this respect traumatised clients present special difficulties, requirements and conditions.

In simple terms, as traumatised clients have learnt to avoid relational intensity for fear of being invaded or overwhelmed, for the therapist to impose attention to the intensity of transferential dynamics can often be pre-mature and re-traumatising. The fragility of the client’s bodymind system may require that the therapist hold their countertransference reactions internally, frequently for a long time, without ‘letting on’. The therapist, therefore, may need to stay and stick with being aware of and bearing feelings which the client cannot (yet) be expected to engage with.

The client, without necessarily being able to ask for this, needs the therapist to be a protective ally who puts the integrity of the client’s recovering system above their own needs for relating or mutuality. In the meantime, the therapist needs to hold unbearable feelings internally, transmuting them quietly rather then sharing or expressing them, even as a foundation for formulating an interpretation.

However, the fact that the client may need to see and experience the therapist as a wholly good and benign object, does not automatically mean that the therapist has to restrict her own experience to this idealised expectation, or has to positively define and construct her role in terms of precisely that protector figure who was by definition absent in the original trauma. Such an exclusively positive self-understanding on the part of the therapist numbs her to the complexities of the bodymind process involved in addressing the frozen reality of trauma in the here & now of the therapeutic relationship.

Messler-Davies’ work with trauma (Messler Davies, J. & Frawley, M.G. (1994) Treating The Adult Survivor Of Childhood Sexual Abuse: A Psychoanalytic Perspective) reveals how far into the relational dynamics a client and therapist may fruitfully go when both therapist and therapy itself may be experienced as a re-enactment of the abusive object, or when the client’s internalised abuser may be constellated in relation to the therapist.

This degree of working-through may not be required or appropriate (or not yet possible at a given point in time), but the dynamics addressed by such work are ever-present in the relationship with traumatised clients.

In my opinion, therefore, the question is not whether to work with the transference or not – unless we ignore or deny it and override it, the only question is whether to work with it implicitly or explicitly. In either case, the therapist’s handling of her countertransferential responses constitutes the relational container which the client subliminally experiences and which profoundly affects the work and the space she is able to provide for the process of recovery.

The post What is the role of transference in trauma work? appeared first on INTEGRA CPD.

The bullet points are not yet answering the question, they are just laying the ground work, attempting to remove some of the confusion and dogmatism around the question, and opening out the complexity of what we might mean by "it works".

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Look out for my upcoming series of 100 daily tweets on this long-standing conundrum in psychotherapy: HOW DOES IT WORK?

• Whether & how therapy works seems to me to be surrounded by lots of categorical & absolutist opinions, traditional dogma & blinkered theory.
• Can we find an integrative perspective that can embrace psycho-education, coaching, counselling & psychotherapy as ALL working in some way?
• How can regular meetings of two people sitting in a room, apparently having a chat together, be expected to have deep & helpful effects?
• The various therapeutic traditions have tried to address that question with their particular ‘theory of therapeutic action’, in jargon terms.
• There are profound divergences & paradigm clashes between the traditions regarding that apparently innocuous question of therapeutic action.
• With the general public considering psychotherapy supposedly as ONE recognisable profession,how can there be such fundamental disagreements?
• How can the profession have so many versions of what makes therapy work? How can they all claim to be doing the same psychotherapeutic work?
• Apparently, ALL psychotherapy works – across ALL therapeutic approaches, this is the most robust finding of decades of outcome research
• Research has established over and over again the so-called 'Dodo-bird Verdict': "all are winners and all must have prizes" – all therapies WORK – somewhat!
• However, the research statement ‘it works’ is based on averages, without any idea ‘WHY it works’ in a particular therapeutic relationship.
• Therapy-as we know it-DOES work,but in haphazard, elusive and unpredictable ways, subject to the vagaries of the two subjectivities involved.
• It DOES work, but that ignores and denies a) how damaging it can be, b) and the huge differences in effectiveness - see: http://bit.ly/1kPMvuI
• The contested and heated debate about WHETHER therapy works or not occludes the more fundamental question: What do we MEAN by ‘it works’?
• An embracing, non-partisan view of how therapy works would need to recognise that different people find a multitude of things helpful.
• When people say ‘it works’ they mean they’re finding things helpful or therapeutic,without distinguishing levels of experience referred to.
• Usually they mean: “something has changed, and I feel better”, but that could result from a variety of profoundly different change processes
• One of the most quoted modern references for theories of therapeutic action: Boston Change Process Study Group http://www.changeprocess.org/
• What doesn’t become explicit usually is the idea that there are different KINDS of change/change processes at different depths of experience
• Wilber provides a good starting point by distinguishing change via ‘translation’ from change via ‘transformation’ – what does he mean by that?
• ‘Translation’ means ‘change WITHIN an established structure’, whereas ‘transformation’ means ‘change OF the established structure’.
• That’s a useful distinction, but I find more helpful the following three-way distinction: ‘translation’, ‘contradiction’, ‘transformation’.
• Over the longer term, as Wilber proposed, every development goes through phases of translation alternating with phases of transformation.
• Once a new structure has established itself, change proceeds via translation WITHIN that new structure; but eventually that reaches a limit.
• At its structural,developmental limit, change via translation STOPS working, and a deeper transformation of the underlying structure occurs.
• Tracking -as we do in therapy- our subjective, experiential reality, that breakdown of the existing structure involves an internal struggle.
• That struggle usually involves –before the emergence/creation of a new structure- the destruction of the old: what I call: ‘contradiction’.
• I call it ‘contradiction’ because on the level of psychological reality, the person finds themselves – or is consciously – opposing the old.
• For example: in order to escape a negative addictive pattern, the person would decide to contradict and counteract the addictive impulse.
• However, simply contradicting the old, established pattern, as necessary a stage as it is in the change process, often does not work & last.
• In order to find a sustainable new structure, beyond fighting & contradicting the old structure, a more fundamental transformation is needed
• That’s because the contradiction impulse is usually caught within the logic of the structure it is trying to escape,in a simplistic reversal
• As Einstein said: we cannot hope to solve problems with the same kind of consciousness that created them. Transformation is then needed.
• The question how therapy works has different answers in each of the 3 phases of the change process: translation,contradiction,transformation
• What ‘works’ in translation, stops ‘working’ in contradiction, & is opposite to what ‘works’ in transformation. Different principles apply.
• Same is true for transformation and translation: what ‘works’ in one is profoundly unhelpful, counterproductive or dangerous in the other.
• So unless we appreciate the complexity of these different kinds of change, ALL of which are valid and subjectively experienced as helpful…
• … we will not be able to formulate a comprehensive theory of therapeutic action that is capable of embracing the inherent paradoxes.
• These 3 different modes of change underlie the confusing complexity of why different things work at different times for different people.
• As a client,what I want my therapist to have is a comprehensive view that is not habitually biased towards one or the other of these 3 modes
• What we can’t expect as client/therapists is lasting structural change when we’re applying only principles of translation and contradiction.
• What we mustn’t demand as clients and mustn’t promise as therapists is the expected results of one mode by the principles of the other.
• The deeper the change that is longed for, the higher the stakes, the less predictable the outcome and the more dangerous the procedure.
• Psycho-education, coaching, counselling and psychotherapy all offer themselves to be helpful and they all ‘work’ to some extent some times.
• They all need to work WITH and WITHIN the client’s existing personality structure in order to (Rule No 1) ‘meet the client where they are’.
• But the various disciplines differ & struggle when what is needed is to CONTRADICT or TRANSFORM the client’s existing personality structure.
• more to follow ...

Some of your COMMENTS and my REPLIES:

• In response to: How can regular meetings of two people sitting in a room, apparently having a chat together, be expected to have deep & helpful effects? I suggest you look at "Essential Research Findings ... The Facts are Friendly" by Mick Cooper - or was that a rhetorical question?
  MS: It WAS a rhetorical question from the viewpoint of the public, as part of my series of tweets on how therapy works. Mick's research shows that therapy DOES work, confirming the famous Dodo-bird verdict, but does not answer the question HOW. There are MANY ideas of HOW therapy works, but clients rightly ask: how come these ideas are so varied and contradictory?

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The post How does psychotherapy work? – laying the groundwork in 100 daily tweets! appeared first on INTEGRA CPD.

It’s not surprising that mindfulness has turned into another fad & can’t possibly live up to people’s desperate expectations & idealisations.

Westerners are in grave danger of misreading the Eastern teachings on mindfulness through the legacies of our dualistic, religious heritage.

Mindfulness can plug into our established dissociation between mind & body, exacerbating the crippling dominance of the mind over the body.

In our entrancement with the supposedly superior mind we miss the fact that the Eastern aim of mindfulness is to TRANSCEND the mind.

Mindless-ness is considered deeper than mindfulness. It is this effortless state which gives the effort of mindfulness practice its purpose.

In a culture rampant with addictive mindlessness, it is difficult to get our heads around the possible benefits of mindless-ness.

The dissociative mis-uses of mindfulness techniques exacerbate delusions of mental control which fortunately/unfortunately always backfire.

A potentially deeper and more challenging, but infinitely more satisfying version of mindfulness can occur only within ‘bodymind fullness’.

What kind of psychology (un-psychology) will help to establish that ‘bodymind fullness’ without which mindfulness cannot flower?

What kind of techniques (un-techniques) are effective in walking the knife-edge between mindfulness and mindlessness?

Want to participate in a workshop that experientially explores ‘mindfulness’ versus ‘mindlessness’ versus ‘bodymind fullness’?

Read the full blog post or Get in touch to register your interest!

The post 12 tweet summary: Mindfulness – Mindlessness – Bodymind Fullness appeared first on INTEGRA CPD.