In the first part of this series, I discussed Allan Schore’s video about early neurological damage resulting from failures in the attachment relationship between mother and baby. In the second part, I used Schore’s research to help explain why our defense mechanisms are so tenacious, and why authentic change is difficult and rare. I’d now like to conclude with my personal, somewhat idiosyncratic view on how real change occurs, how that early damage can to some degree be healed, and what conditions are necessary to do so. I don’t have the science to back it up; all I can offer is my experience, both as a client on the couch for 14 years, and in working with my own clients for the last three decades.
My thesis is simple: if failures in early attachment damage the brain as it develops, the way to repair that damage (to the extent possible) is through another “attachment” relationship that somewhat resembles but also differs in major ways from that early bond: the psychotherapy relationship. I suppose I mean that in therapy, something like a “corrective emotional experience” occurs, as long as we don’t idealize that experience and we understand that therapy doesn’t fully correct for all those early emotional failures. The corrective emotional experience in therapy is not a replacement for a mother who truly loved and cared for you. It’s the closest to such an experience that many people ever get but it’s a distant “second best.”
Broadly speaking, there are several different aspects to the successful (and healing) psychotherapy relationship. The first of these involves the therapist’s ability to enter into the client’s emotional world, bear with the pain and confusion long enough to make sense of it, and then to present his or her insights in such a way that the client feels understood. That one sentence condenses many elements. To begin with, you need a therapist who can tolerate a wide range of emotions, who isn’t afraid of anger, envy or hatred, and who can bear with the client’s often profound pain.
Especially in working with serious difficulties such as borderline personality disorder, the therapist needs the emotional/psychological strength to bear with and not feel overwhelmed by a significant amount of terror, rage and overall chaos. The therapist must have had extensive psychotherapy him- or herself. Then the therapist needs the skills necessary to understand what it all means and to communicate it. Those skills come from good training, supervision and years of experience as a therapist. I understood quite a lot when I was 30 but I when I made my interpretations, I often came across a bit stilted; I was trying too hard to maintain that ideal psychoanalytic posture, and rather than feeling understood, my clients sometimes felt “analyzed”. It took me a while to learn how to speak in a more empathic way.
Empathy (and not sympathy) lies at the heart of the healing interpretation (see my post on empathy vs sympathy to understand the difference). I’ve always been good at detecting unconscious rage and envy; it was years before I developed an emotional appreciation for just how agonizing those feelings can be. Especially as the transference develops, you can find yourself the target of painfully destructive attacks, enraged and unjust accusations, possessive angry “love”, etc. In the heat of the moment when we’re under siege, it can be difficult to recall just how agonizingly painful it is for the client to feel that way. If the therapist can’t bear those feelings within him- or herself, it will be hard to make the client feel understood, safe and accepted. But if we are able to bear with those painful emotions and offer to our clients empathic insights, we will gradually — bit by bit, over time — help them learn to tolerate those feelings in themselves.
In this way, the therapist provides a kind emotional support analogous to what a good mother provides. As I discussed in an earlier post about the development of mind and meaning, it is the mother’s role to accept the infant’s projected feelings — all the terror, anger, etc. that it doesn’t understand and can’t tolerate. In a “good enough” attachment relationship, the mother responds appropriately to those projections and thereby helps her baby learn how to bear them. In Schore’s terms, the brain then develops more or less “normally”, making many complex neural interconnections and building structure so that the child grows a capacity to understand and contain its own experience. Years later, a therapist can try to make up for a failed attachment relationship. He or she can bear with a client’s projections, try to understand what they mean and respond appropriately. Bit by bit, over time, we can help our clients develop the mental capacity to understand and bear with their own experience. It’s not the same as having had a good enough mother. It won’t restore the brains of our clients to some pre-damage state, but it can make a very large difference.
Most of my colleagues would probably agree with what I’ve had to say so far. This view is based upon the psychoanalytic theory I read during my training, the excellent supervision I received and my years on the couch with an analyst who never shrank from my pain, rage and envy, who had a profound ability to bear with me through my depression. Without his help, I never would have developed the mind and emotional capacity I have today. I was extremely fortunate to have found him when I did; I’d never be where I am today without his help. I know he cared deeply about my welfare and gave emotionally to me in ways that meant a lot to him, too. It was within the context of this relationship — this new attachment relationship — that the healing occurred.
Where I think I might diverge a bit from my colleagues — at least in what we’re willing to discuss in public — is that the truly healing relationship involves a kind of love and commitment on both sides. When I accept a new client, especially someone with grave difficulties, I take it seriously; the relationship may last for many years and the emotional demands will be large. If our work “takes hold,” my clients will attach to me in powerful ways. While the psychotherapy relationship means something different for each of the participants — it is, to a significant degree, about the client’s life and not mine — we both must care about it. And over time, we will come to love each other. It scares me to put those words down — I feel extremely vulnerable saying it.
While it’s not the same thing as the love between mother and baby, though it can never replace what was lacking, it is important and powerful. I would say that in many ways, it is this love that offers the greatest chance for healing. The brain may not have developed normally because the child lacked what it needed at a critical period, but love and understanding within a later therapy relationship can do quite a lot to repair the damage. Maybe my clients and I will never be “native speakers”, as it were, because, as infants, we didn’t get what we needed, but that doesn’t mean we can’t become proficient at the language.
Merry Christmas, everyone!