EMDR and Psychoanalytic Psychotherapy

EMDR and Psychoanalytic Psychotherapy

I thought I might share this: an abstract for a paper at an EMDR conference. It’s a bit glib but I think it says something about how I work, and why.

As EMDR becomes more popular and its application becomes more diverse practitioners may find it helpful to consider some of the ways psychoanalytic therapists have explored therapeutic relationships. Freud’s work with trauma in the 1890s, enthused by his interest in mesmerism, in some ways bore a closer relationship to contemporary EMDR practice than to contemporary psychoanalytic psychotherapy. The metapsychology he developed, although at first-sight complex and sometimes arcane, offers EMDR practitioners a wealth of ways of thinking about their work without departing from the usual protocols.

Perhaps one of Freud’s most interesting discoveries was that the ways therapists think about their work inevitably affects the therapeutic relationship. From cognitive interweaves to decisions about treatment planning, the timing of interventions, the depth of preparation required and how a client should be oriented post-treatment, a psychoanalytic attitude can expand awareness and foster confidence. Freud wrote about ‘wild psychoanalysis’: psychoanalytically informed interventions by doctors, nurses and others who may not have been trained in the full psychoanalytic method.

I will explore the implications of EMDR with a psychoanalytic attitude and look closely at three distinct ways of drawing on psychoanalysis: a form of history taking based on free association which I have found extremely helpful; EMDR as applied to dreams; and considering how our interventions may sometimes be less rational than we imagine.

 

Creepy Rationalism: The New Sophists

The creepy rationalism of many psychotherapists, or therapists as they often call themselves, continues to disturb me.  They’re like newsreaders: a strange sense of authority (absurd in any other context) that sounds so rational. What they are saying is usually built on a very thin but compelling layer of understanding, like someone who’s been to the moon and can describe what the earth looks like from the stars … but I wouldn’t trust an astronaut to tell me about life on earth. These New Sophists may sound rational, but endowing someone with reason will have more to do with how I listen than the presence of any intrinsic good sense.

Rational means endowed with reason. Logical means reasoning correctly. We can argue over what’s correct, but there’s no arguing with sophistry. Sophistry’s a drug that demands withdrawal and one of the best ways to do that is to listen for logic and then ask questions.

 

Trauma Work and Scenes

Trauma work and scenes
Don’t get stuck looking for meaning. Let your client tell you what’s going on.

Heidi from Finland asked me if I could give another example of noticing a scene playing out,  and how I worked with that. ‘What’s the relationship between trauma work and scenes?’ she asks. Perhaps I can answer her question and at the same time say something about how I regard working in the transference, why I believe it is so important to work in the present as much as possible, and something about why I find theory helpful.

Imagine a child growing up with a number of siblings. She develops a relationship with her parents where they come to depend on her helping them communicate. She has a difficult relationship with her siblings, who find her controlling,  secretive and somehow, as one of them put it when they spoke as adults, ‘in a different place’.

Thirty years later, when I first worked with Christina, it wasn’t hard to find traces of these early relational dynamics playing out in her life. The work we did underlined for me the important relationship between trauma work and scenes.

What would you do? Let’s forget about trauma work and scenes for a moment and think about what your job as a therapist might be.

Part of your job as a therapist , if you come to work with a person like Christina, is to be as sensitive as possible to the dynamics you might get to know through you relationship with her, which might tell you about what she experienced in her early life. Thinking psychoanalytically that would involve considering the transference, and you own countertransference feelings (although I tend to conflate the two into the transference relationship). Other therapeutic modalities will have their own ways of doing something similar.

Using your intuition, rooted in your emotional relationship with your client, you will then need to help her identify the situations where the traces of her early life seem to be playing out, and to get to the conflicts and emotional struggles she is facing.  The behaviour represented by the ‘scene’ you discover is symptomatic of the way she tried to cope in her early life, and how this affected her.

Don’t be seduced by the obvious scenes. She may well, as Christina was, be a manager at a large company and have developed separate relationships with two senior figures, and be distrusted by the people she manages, who also find her distant. I’ve found various scenes active in people’s lives.

We need to locate the scenes with the most affect – the ones that lie most directly upon the fault-line of her early life trauma (to use a phrase I would like to think about in great detail somewhere else), rather than ‘satellite scenes’, which have something in common with Freud’s ‘screen memories’.

In her relationships your client may also, as Christine was, be very close two two of her children and her husband might end up occupying originally played by her siblings. Scenes can be played in so many different ways. Take these two, with Tom Hiddlestone and Laurence Olivier.

Your job is then to hold in mind the early life behaviour while you explore the current scene with your client, reacting and acting out of all your imagined familiarity with the woman’s past even if you don’t take her there. Try to stay in the present and see what presents itself: where do her associations take you both? What do her feelings suggest? You could ask her, for example, what the sensation she notices inside her, when she describes the current scene in her life you are exploring, seems to say about her.

If that’s difficult try finding a creative way of getting to what a client’s beliefs about themselves, held in their feelings might be.

I remember asking Christine what it would be like to imagine her feelings, the sensation she had noticed, as an animal. What would it be like? It turned out to be an imaginary animal, the nature of what helped Christine subtly describe how she felt. We imagined what would happen if someone else was given the animal: what would it bring with it as a magical spell to cast upon its owner? What would that owner say about themselves once the spell took hold? ‘I am too overbearing,’ she said – and Christine found herself describing, very emotionally, how she felt she was too overbearing, and what she did to cope with this.

I never mentioned Christine’s childhood. She made a number of connections herself, most of which would have been beyond me; or if I had made them they would have horribly over-simplified the situation.

A conscious awareness of the past, even if it was a reconstruction of the kind of tableaux I used to love seeing as a child at the British museum, resided in me throughout this work. The anchor to the present resided in the client. Between us we found a way of working through something that connected the two.

I intended this as a short note, so I shall end it here. Almost.

Trauma work and scenes … something isn’t finished.

A thought that comes to me having written this relates to the need for a psychotherapist to understand something about theory even if they never talk theoretically with their client or their colleagues. The best psychotherapists and counsellors I know talk about the theory I know only as much as they would their favourite novels or films.

I’m thinking of a printing engineer I used to know who, when called to the site of a problem, would spend some time listening to the machine that seemed to be malfunctioning. This man knew how the machines worked in extraordinary detail. Not only that, he understood the process of printing inside out; and even of publishing. If you spoke to him he could give you a history of a book (from its life as a part of a tree to its place on a shelf in a bookshop) that was so entertaining, and so particular, taking into account the subject of the book, the place in the world it was made, the time it was written, the political circumstances, the kind of transport systems available … and so on. The engineer loved his work.

My point is that when he arrived to mend a machine, all the engineer had to do was listen and he usually had the problem solved quickly. Sometimes he didn’t even have to take the machine apart: the problem lay in the way it was being operated. He knew his theory, and he loved his work, and he could fix a printing machine without once looking at  a circuitry diagram, an operating manual or a service history.

I prefer to work with people like him. Trauma work and scenes: think of yourself as an actor trying to convey the trauma in a play. How would you play a scene? The best actors seem to know a lot about how theatre or cinema work … and if as a psychotherapist you can’t conceive of yourself as playing a part in your client’s dramas, the scene of the psychotherapy, you may be missing a lot. You may even be playing your part without realising it (although I have to say there’s some of this in every psychotherapy I can remember, which I have only been able to get in touch with after the event; and probably some I will never know about).

Trauma work and scenes: I wonder sometimes about my need for repetition.

Why are the Stock Markets Crashing?

Stock market ‘carnage’ is an effect of addiction. Addiction affects all areas of life. In many ways it is life: unavoidable, like colds, getting old, and death. All we can do is understand it better and learn to live with it; and if we do we will be less anxious. If we are less anxious we will better be ourselves without trying to draw on things outside ourselves to make us feel better.

If you borrow to invest you are effectively drawing off nothing, and with low interest rates investors have been doing exactly that. Now there is a fear of interest rates rising investors are scrambling to deal with their debt-chains.

The stock market crash: it’s an emotional thing. Don’t get caught up in being rational if you want to make sense of it. It doesn’t make sense: it makes chaos, which is what addiction does. Addiction is a drive towards extinction, to non-presence. Freud called it the death drive. It’s overwhelming. It’s what’s happen if you are eaten up by anxiety.

Giacometti, Fear and Hatred

I went to see the Giacometti show at the Tate yesterday and found all the fear of the world in most of the things he made. I recognised, in my own unease as I walked through the gallery, the soul-substance of TV and the Internet. The many special forms of fear that drive viewers or users: jealousy, envy, competitiveness, loneliness and misogyny, each with their awful textures, like kinds of intention I could almost separate into different painful, hateful senses of space, time, distance and intensity.  I saw the actual forms of television sets and computers in his sculptures. There were also his tiny figures, framed so much like we are these days, in no broader context than a screen, and sometimes a very small screen. Not the Silver Screen but the greasy, smudged thing on a phone. I’m glad I didn’t go on my own.

Narcissistic Feed

I’ve been thinking about narcissism lately and ended up watching Now, Voyager yesterday and selected excerpts form the Alien films this morning. None of this ran together in the way I have just written it until I began writing the words ‘narcissistic feed’, but there we go.
       Narcissism isn’t necessarily a bad thing: thinking about what you like to eat, wear, say and do; if I didn’t I would, in an awful sense, disappear. There’d be nothing of me on show and no return from that in the world to give me a sense of having a life that’s mine. Of course narcissism can be overdone and, from time to time, most of us overdo it – unless we underdo it, which I might come to at another time: underdo as in written our of life or written over someone else, no doubt a particularly egregious narcissist.  We forget that we don’t actually know better than other people, or that we know them half as well as we might imagine. All kinds of narcissism rely on a feed from the outside world, from the kind of ‘that’s a nice hat’ comment to the more disturbing ‘you’re mine’ behaviour which characterises those egregious types I mentioned.
       If you want to see what happens when narcissism becomes a difficult thing watch what happens to Charlotte Vale, or the crew of the Nostromo in Alien. Narcissists take a dim view of those around them trying to assert themselves: it interrupts the feed. Charlotte or Kane could have stayed in their cabins, but instead they went looking for adventure.
       Differentiation, the move from a ‘we’ to an ‘I’, recognising the other, will always in some way be worrying (not being comfortable as an ‘I’ leaves you feeling anxious). You know you’ve got a problem when someone insists on ‘we’, not necessarily if they get worried about the ‘I’ … we all do that.
       The ‘I’ demands a leap into the unknown unless I believe, secretly, we really are always a we, inseparable and conjoined. Wilfred Bion wrote about Experiences in Groups, not ‘experiences of groups’. Groups are an experience rather than an entity – as  The Three Musketeers would have done well to remember.
       I got worried about something like this yesterday. When I was a boy hooked on watching Sunday afternoon matinee films Now, Voyager had only existed for thirty years … rather like the relationship between now and another film I love: Withnail and I. And so I was reminded that I am 50 again. The ‘we’ of Tom Tomaszewski, me in all of my incarnations, still hasn’t quite become used to this ‘I’, the 50-year old one.

 

Limits of Psychotherapy

I love reading but I find it very hard to read most psychotherapy journals, especially the ones circulated by accrediting bodies such as UKCP. What could be an opportunity for me to engage with  other people wondering what it is that constrains them, or affects them  and exploring how they proceed from there … often ends up with me feeling like I’ve arrived at Checkpoint Charlie with the wrong papers.
       If I’m going to think about the limits of psychotherapy I have to begin by looking at the limiting effects of psychotherapists, whenever they get together. It doesn’t have to be that way, but generally that’s how I have found it. Psychotherapy seems to be a refuge for numbers of people who might have imagined themselves, in another life, as an artist, a doctor, a philosopher, a scientist or perhaps (if they’ve had enough therapy) a prison guard or a better parent.
       But reading, for example, the latest edition of the UKCP gazette I remain unsure how aware its writers are of the negative effect of their … professionalism. There’s so much attempted mastery: attempts to inflict expertise on the reader that remind me of a scene from Nicholas Monsarrat’s The Cruel Sea in which gulls pick over the dead floating on the ocean surface after a horrible incident with depth charges.
       Mastery is a force to be resisted. If I want philosophy I will turn to someone who can at least tell me deconstruction isn’t about taking things apart; or that the preface to Hegel’s Phenomenology of Spirit might be a good thing to read before putting pen to paper for the UKCP gazette. If I want to know about creativity I’d like to speak with someone who’s made something that a lot of people find exciting. If I want to understand neuroscience I’d like to meet with someone who has more than a fleeting acquaintance with Niels Bohr.
       If I feel I am in the domain of psychotherapy I’d like to look outward and see these expert categories approaching to greet me. They might have arrived here, in psychotherapyland, but they came from somewhere else. And I might go and pay them a visit at home some time, too … even if I end up realising we live in the same place … but that’s getting a little more complicated than I intended here, when I just wanted to write something about what seems to be happening to a profession I love being part of, but forever seems in search of a soul.
       Psychotherapists can be experts in the unknown, but we need to understand that some people have spent most of their time thinking about the things this particular category of expertise is likely to conjure up.   And I’d like an introduction to those things: never to be a told a psychotherapist knows best.

#Psychoanalysis: infatuating & infuriating

I love psychoanalytic thinking. It’s imaginative, it can take me and other people to surprising places, and it’s somehow at one with the world in ways that other kinds of thinking don’t seem to be. Psychoanalysis seems on the side of poetry and mystery, ever the best ways of trying to get a feel for life, whereas other forms seem, at least to me, catastrophically limiting.
       Unfortunately it’s also a ready defence for half-wits and clowns. It’s easy to mistake psychoanalysts for intellectuals. Some intellectuals enjoy psychoanalysis, but very few of them are psychoanalysts. Psychoanalytic thinking offers a kind of quick-sand for the insecure, sucking them in to a world where nothing is at it seems and there’s always an opportunity to state the obverse rather than the obvious.
       Psychoanalysis can offer security as long as you don’t need it.
       Possibly the problem is in the word ‘thinking’. Psychoanalytic practice involves being in a ways that don’t dissociate thinking from feeling. They become something else.

 

Acronyms: Small Forms of Resistance #1

Once upon a time acronyms perhaps seemed exciting, of the future, nothing to do with stuffy formalised conversations or over-long names. I dread them. Every one I see seems dissociated from what it represents … schools and colleges whose names are reduced to admissions friendly  locator scripts; medical interventions and psychiatric conditions that do nothing to help me remember they concern lives. ADHD as like a chemical compound, a thing in itself, rather than a way of describing manic levels of activity. Acronyms take the sting out of death without even the awful dissonance of a euphemism: PAS, DAS, VE, AS, ASFRA, or EDAS. They root me to whichever institution holds the upper hand in deciding what needs to be done in response to some form of human activity. If you want to know about ADHD look in the DSM. Abandon acronyms. They’re on the side of death and tyranny.

On Being 50

I wanted to write something about becoming fifty when it actually happened, back at the beginning of October. But October’s been like  a berth on a clipper crossing the Pacific sometime around when my grandfather was born (1857). October, an uncomfortable bunk in the year 2016, one of the ships sailing me through time. Years can be like boats. There are many non-scientific ways of thinking about time travel: friendships, lives, things which have happened and the echoes or ripples that carry forward.
        Afterwardsness … I’m not particularly fond of Freud as a psychologist, not in the prescriptive sense of x + y = neurosis z, as some might have him,  but as someone who thought about life I find him irresistible. His notion of nachträglichkeit, often translated as ‘afterwardsness’ might be one of the best boats of all.
        Sailing on, I’d like to mention a discovery I made today. I was reading about the wonderful Jean Laplanche (who appears, incidentally, in Agnes Varda’s film ‘The Gleaners and I’ talking about winemaking and psychoanalysis), whose thoughts about the enigmatic signifier I may owe much of a career to, when I cam upon a startling reference to a seminar he gave in Kent in 1990. I was startled because as far as anyone connected to my training at the University of Kent was concerned, Laplanche was a non-person, not even a mystery, but one of those figures teachers and trainers seem never to have heard of. I shrugged, inwardly and outwardly, but always felt this unawareness was a little like the kind of unawareness we each sometimes cultivate in relation to a kind of tricky problem. Laplanche was joint editor of what’s become the standard encyclopaedia of psychoanalysis and,  internationally, a figure something like The Pet Shop Boys might be to anyone with an interest in music (Orthodox Psychoanalysis, for all of its all its apparent esotericism, has something of the spirit of  Take That).
        And there, as I read about Jean Laplanche, was a reference to a paper, ‘Psychoanalysis, Time and Translation’ delivered in 1990 to the first year of students completing my then newly established training. Laplanche wrote a book called ‘New Foundations of Psychoanalysis’ and there he was, in at the start, the foundations, of a training that later seemed incapable of recognising him.
        There’s a story in all this, if I ever get the time to look into it.
        I mention it here in relation to my becoming 50 not specifically out of pique but to show maybe something of what I mean by echoes and ripples from the past. I find something out and it seems to be an intersecting, me and Laplanche catching up somehow … somehow.
        If you read me much you’ll know I tend to think a lot of things come to us indirectly, rather like the ball in a pinball machine. I used to play one of those at a caravan park near Newhaven where the ball even went down a hole later to appear randomly from one of many other holes in the machine. In life we don’t see the paddles or the curves of pins; or the strange electronic mushrooms or the jump pads (I imagine there are more correct technical terms). Sometimes we can’t even see the arc or the angle of something as it approaches: it simply lands.
        I began by saying I wanted to write something about being 50, but it seems that’s still on its way.