by Richard G. Erskine, Chapter Thirteen in Relational Patterns, Therapeutic Presence: Concepts and Practice of Integrative Psychotherapy,
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Early Affect-Confusion: The “Borderline” between Despair and Rage
Chapter Thirteen in Relational Patterns, Therapeutic Presence: Concepts and Practice of Integrative Psychotherapy,
Richard G. Erskine
CHAPTER THIRTEEN (Loc: 3893)
Early affect-confusion: the “borderline” between despair and rage (Loc: 3894)
First impressions and uncertainties (Loc: 3895)
The woman's voice on the phone was brusque. She launched into saying (Loc: 3896)
she was “depressed over relational difficulties” with her lover and she was searching for a new psychotherapist. (Loc: 3896)
told me that she had previously seen four psychotherapists; she shouted, “None of them were any good. They did not understand me.” (Loc: 3898)
I tried to slow down the rush of information by asking her name (Loc: 3899)
She was urgent to tell me more (Loc: 3900)
the “cold” male psychoanalyst (Loc: 3900)
other female psychotherapists who were always criticizing her (Loc: 3900)
she was unconsciously communicating the relational qualities she needed (Loc: 3901)
Theresa was going to require a sensitive and firm therapeutic relationship—a (Loc: 3909)
relationship would take a considerable amount of time to develop if I was going to be therapeutically effective. (Loc: 3910)
She described how each relationship ended because of “incompatibility.” (Loc: 3930)
she perceived the men in her life as not understanding her and/or not respecting her needs. (Loc: 3932)
she is often feeling depressed (Loc: 3935)
fearing abandonment; (Loc: 3935)
in emotional pain (Loc: 3935)
no one understands her; (Loc: 3935)
either self-critical or critical of others; (Loc: 3935)
destructive in most relationships; (Loc: 3936)
behavior oscillates between being extremely needy of others and hating them for failing her. (Loc: 3936)
My tasks would be to (Loc: 3937)
resolve (Loc: 3938)
her hyper-vulnerability and early affective confusion; (Loc: 3938)
relational needs that had been thwarted in the process of growing-up; (Loc: 3938)
her style of compensation and self-regulation (Loc: 3939)
The story of her relationship with Joan led Theresa into talking about other experiences of emotional abandonment. (Loc: 3969)
Each of these affairs ended in a “big fight” (Loc: 3971)
On several occasions we discussed how kindness, acceptance, or caring gestures stimulated her memories of painful, rejecting experiences. (Loc: 3976)
returned to these themes again and again until she clearly grasped how kindness and loving gestures were an integral part of intimate connection and belonging. (Loc: 3977)
the possibility of an intimate connection and belonging that stimulated a psychological “borderline” between terror and longing—terror (Loc: 3978)
She could not comprehend that the purpose in “fighting and pushing people away” was to avoid her emerging terror, pain, and grief. (Loc: 3980)
was more focused on the desperate emptiness (Loc: 3981)
She was suffering from affect-confusion. (Loc: 3982)
I kept bringing her focus to the reactions, conclusions, and decisions she may have made as a way to compensate for the relational loss. (Loc: 3988)
during her school age years she concluded, “No one is there for me.” (Loc: 3990)
telling herself, “I'm unlovable.” (Loc: 3991)
As Theresa became increasingly aware of the intense loneliness, she also began to feel a seething anger at her father that she had disavowed for years. (Loc: 3999)
asked Theresa to look me in the eye and tell me about the intensity of her anger. (Loc: 4000)
important that she look me in the eye so (Loc: 4000)
could see that I was taking her anger seriously. (Loc: 4001)
still lacked an internal sense of relational security so I avoided having her express her anger at a fantasized father in an empty chair. (Loc: 4001)
needed to see that she could make an impact on a man, an impact on me. (Loc: 4002)
Resolving confusion between behavior, feelings, and needs (Loc: 4031)
many sessions during these first several months (Loc: 4032)
behavior toward me alternated (Loc: 4032)
coquettish and aggressive, dependent and distrusting, self-sufficient and helpless. (Loc: 4032)
complain about being lonely, empty, and depressed and then would become elated about the future, (Loc: 4033)
Theresa frequently anticipated or perceived me as being critical of her when we talked about how she could modulate her accusations and anger (Loc: 4036)
work. I requested that we think together about the reasons underlying her own behaviors when she expressed despair, flirtatiousness, criticism, or aggression with me or other people. (Loc: 4038)
a behavioral pattern emerging: (Loc: 4058)
following an expression of vulnerability, (Loc: 4058)
find some reason to criticize me, (Loc: 4059)
announced that I was “not doing the therapy right.” (Loc: 4060)
I responded by calmly asking three important questions (Loc: 4061)
“How do you expect me to respond when you shout at me?”; “What were you feeling just before you shouted at me?”; “How do you need me to respond to you?” (Loc: 4062)
During this early phase of the therapy, Theresa was often angry at me. (Loc: 4077)
Theresa was engendering in me an aggressive and rejecting response similar to what her lovers and the women at work must have experienced. (Loc: 4082)
These transference/countertransference dynamics were an unconscious demonstration of Theresa's past, her developmental needs that had been thwarted, and her management in compensating and regulating herself. (Loc: 4084)
I too walk on a tightrope, the “borderline,” between my keeping the transference just active enough so her unconscious story could unfold within the healing responsiveness of our therapeutic relationship and, at the same time, take the responsibility to protect her from my becoming defensive or self-explanatory, a reactive countertransference, (Loc: 4086)
I explained to Theresa that, while being a competent, professional woman, she was also internally influenced by a confused, neglected, and angry little girl—a (Loc: 4102)
that little girl in Theresa who needed a consistent, dependable, and reliable therapeutic presence (Loc: 4104)
I explained to Theresa that she could bring her troubled inner child to the therapy sessions rather than having her “helpless crying spells” or getting into fights with her boyfriend. (Loc: 4106)
there was a tremendous amount of psychotherapy ahead of us if Theresa was going to get off the “borderline” of affect-confusion and have meaningful and satisfying relationships in her life. (Loc: 4116)
CHAPTER FOURTEEN (Location 4119)
Chapter Fourteen - Balancing on the “Borderline” of Early Affect-Confusion ()
Balancing on the “borderline” of early affect-confusion (Location 4135)
For many sessions (Location 4135)
reluctant (and at times unable) to talk about her childhood. (Location 4136)
As she told me of each current relational crisis, I helped Theresa trace her feelings to previous experiences in her life. (Location 4137)
was beginning to tolerate my phenomenological inquiry. Historical inquiry about her early life stimulated a lot of anxiety (Location 4138)
was now able to talk about her teenage years—years (Location 4153)
In response to my phenomenological inquiry she was having explicit memories in each session. (Location 4154)
was increasingly reporting feeling “empty,” “depressed,” (Location 4155)
She was worried about (Location 4155)
With each worry I inquired about how her mother would have treated her (Location 4156)
combination of both historical and phenomenological inquiry into the quality of her maternal relationship opened many new memories (Location 4159)
validating and normalizing her anger at her mother's criticisms and continually inquiring about her internal sensations, I provided a forum for Theresa to express her anger directly to me about her mother's ridiculing behavior. (Location 4162)
Deconfusing both the child and adult (Location 4163)
I regularly inquired about her body sensations and what she had been feeling just a second before the anger. (Location 4163)
these phenomenological inquiries, Theresa began to describe “penetrating body pains”—pains that we eventually identified as both sadness and shame (Location 4165)
experienced as body pains, I chose to focus on Theresa's shame before attending fully to her sadness. (Location 4166)
her sadness represented a much earlier, and perhaps more profound, grief. (Location 4179)
Inquiring about how she perceived the intricacies of our relationship was a practice that I continued to do at those potentially transforming points in almost every session. (Location 4195)
Early in our sessions she had said that she could not trust me when I said “something kind” to her. She added that I was probably “being seductive.” She could trust me more if I was criticizing her. (Location 4197)
we explored how these attempts to create a distance in our relationship, (Location 4198)
juxtaposition reactions, reflected an attempt to maintain both a sense of continuity and predictability in her life. (Location 4201)
I would say something in a caring way that both validated and normalized her needs-in-relationship and, in response, she would belittle my comment. (Location 4210)
Theresa often asked such explicit personal questions. (Location 4210)
some sessions I chose to give her a direct answer such as, “Yes, I mean what I just said.” (Location 4212)
In some sessions (Location 4212)
I would answer by asking her two questions. (Location 4213)
asked me if I believed her story. (Location 4213)
answered with a bifurcated question, “What does it mean if I don't believe your story about your mother hitting you, and what does it mean if I do believe you?” (Location 4218)
I would give a summarizing response similar to: “It seems that in either situation, if I do believe you or if I don't, in the end, you experience that you are ‘shit’ and that you will neither be understood nor will anyone really be there for you. That must hurt.” (Location 4231)
We were now able to talk together about Theresa's “borderline” between neediness and rage, despair and self-reliance, impulsivity and manipulation. (Location 4232)
psychotherapy was still not complete. (Location 4232)
relationship with her mother was still marked by Theresa's sense of “hate” and disavowal of a profound painful abandonment. (Location 4234)
so much in the life of that little girl that she had not yet remembered and resolved. ()
Chapter Fifteen - Relational Healing of Early Affect-Confusion ()
CHAPTER FIFTEEN (Loc: 4236)
Relational healing of early affect-confusion (Loc: 4237)
When Theresa would lead a session into complaints (Loc: 4243)
I would return to that neglected and emotionally abused little girl by inquiring about Theresa's physiological and affective reactions in living with an angry and confrontational mother. (Loc: 4244)
getting to her childhood experiences of feeling helpless and worthless. (Loc: 4248)
We talked at length about the difference in acting helpless in life today (her crying spells and demands on her boyfriend) and actually needing to depend on her parents when she was a child. (Loc: 4252)
We were no longer talking about crises or Theresa's self-destructive behaviors; we were talking about her needs as a child and her self-worth today. (Loc: 4254)
had two clear focal points for our continuing psychotherapy: (Loc: 4267)
important to address the relational needs and survival reactions of a neglected and verbally abused child; (Loc: 4268)
eventually be beneficial to therapeutically engage with the internalized mother who was influencing Theresa's current life. (Loc: 4269)
extremely useful to decommission the influence of the introjected other, but only after a secure therapeutic relationship with the distraught “child” is well established. (Loc: 4270)
continued to address the previously untold experiences of that little girl while also acknowledging and normalizing her aspirations. (Loc: 4272)
therapeutic dialogue included my frequent inquiry into how she coped and regulated herself when her mother was critical, aggressive, or rejecting. (Loc: 4275)
I continued to remember that she had said, “I am being just like my mother.” I started to impose myself between Theresa and her internalized mother by telling Theresa what I would have said to her mother if I had been visiting in their home (Loc: 4278)
It was too soon to provide actual therapy for the introjection of her mother's personality. (Loc: 4284)
Before (Loc: 4286)
any therapy with her parental introjects, more time was needed to support Theresa's self-definition, (Loc: 4286)
need to make an impact, (Loc: 4287)
need for security and validation. (Loc: 4287)
Acknowledging and normalizing these relational needs seemed to be essential to her psychological growth. (Loc: 4287)
was now depending on our therapeutic relationship for her internal support. (Loc: 4288)
Verbalizing implicit memory (Loc: 4290)
early childhood relational experiences—experiences (Loc: 4291)
now coming to consciousness because we had co-created a safe place to talk about her childhood feelings, desires, needs, and bodily sensations. (Loc: 4292)
phenomenological inquiry, curiosity, concerns, and personal presence stimulated Theresa's awareness of memories that she was unable to recall on her own. (Loc: 4294)
She could remember being criticized for getting dirty or being late but she was unable to recall any dialogue that acknowledged her experiences, feelings, or wishes. (Loc: 4301)
In several sessions I continued this type of historical inquiry with the focus of my inquiry shifting to the qualities of her maternal relationship at an ever-younger age. (Loc: 4303)
inquiring about her bedtime routine and the quality of possible conversations with her parents at that relationally crucial hour. (Loc: 4304)
As I focused my inquiry on bedtime for the preschool child, Theresa had no memory of being cuddled, read to, or having any pre-sleep conversations with either parent. Now I fully understood the cumulative neglect, over many years, that led to Theresa's conclusion: “No one is there for me.” (Loc: 4309)
these historical inquiries was followed by many phenomenological inquiries about her sensations, feelings, associations, thought processes, and desires. (Loc: 4312)
often led to an inquiry into how she survived, accommodated, and stabilized herself when no one was emotionally or conversationally there for her. (Loc: 4313)
inquiry was always focused on her inner experiences and subjective processes in response (Loc: 4315)
I continued to focus my inquiries on a younger and then even younger child. (Loc: 4319)
eventually asked what she knew about her infancy and toddler years. (Loc: 4320)
first answer to many of my questions was, “I don't know.” (Loc: 4322)
I would ask her to close her eyes and imagine herself as a preschool child. (Loc: 4323)
Much of this period of time was spent attending to Theresa's profound sense of loneliness—an (Loc: 4328)
She needed a consistent therapeutic presence and compassionate attunement to her loneliness and fear even though she sometimes angrily complained, “My loneliness and fears did not exist before this therapy.” (Loc: 4329)
I listened to Theresa's phenomenological experience of her early childhood, (Loc: 4333)
attended to my own sensations and impressions, my own affective pull to comfort and protect her, (Loc: 4334)
my knowledge of child development (Loc: 4335)
what any child needs in a parental relationship (Loc: 4335)
to form a secure attachment. (Loc: 4335)
all that I had learned (Loc: 4336)
became the data in forming many inferences about her affective/relational life. (Loc: 4336)
Although Theresa lacked a coherent narrative of her life's experiences, her sub-symbolic memories were expressed in body sensations, emotional reactions, and self-regulating patterns. (Loc: 4339)
unconscious attachment patterns were disorganized, often on an oscillating borderline between avoidant and anxious. Theresa lived on a “borderline” of intense neediness and rage, despair and self-reliance, impulsivity and manipulation. (Loc: 4341)
My attunement to her affect, rhythm, and developmental levels, as well as my physiological resonance, were essential in forming an involved connection that facilitated a communication of her sub-symbolic experiences and implicit memories. (Loc: 4344)
to make use of all of this information to create a healing relationship for this distressed infant and toddler. (Loc: 4347)
asked Theresa to imagine being a child about sixteen or eighteen months (Loc: 4348)
sitting in a high chair and being fed (Loc: 4349)
I inquired (Loc: 4349)
the look she imagined (Loc: 4349)
on her mother's face, (Loc: 4350)
how her mother would have reacted if she disliked the food, (Loc: 4350)
mother's tempo in feeding (Loc: 4350)
mother's joy or disapproval, (Loc: 4350)
all the body sensations that went with each inquiry. (Loc: 4351)
and provided both of us with a plethora of information about Theresa's early affect-confusion: (Loc: 4353)
Dispelling early affect-confusion (Loc: 4367)
Theresa now had less and less of an urge to regress to earlier periods of relational neglect. (Loc: 4371)
able to make many associations and connections to her adult life behaviors and emotional reactions. (Loc: 4372)
good understanding of her habit of pushing people away, her fear of intimacy, her rage (particularly at women), and her “tremendous longing for someone to be there for me.” (Loc: 4373)
In these previous two years, while I attended almost exclusively to Theresa's experience as an infant and very young child, I kept in mind her words, “I'm just like my mother.” (Loc: 4379)
Previously I had postponed doing any psychotherapy with her introjected mother; (Loc: 4380)
first two priorities had been (Loc: 4385)
establish a greater sense of relational security (Loc: 4385)
facilitate her expression of her own relational desires, (Loc: 4385)
I was primarily focused on the child's unrequited need for self-definition and the need to make an impact-in-relationship while always keeping in mind Theresa's needs for security and validation. (Loc: 4386)
For the past couple (Loc: 4408)
of years Theresa was no longer acting helpless (Loc: 4408)
was no longer getting into conflicts at home or work; (Loc: 4409)
self-regulated her affect-confusion (Loc: 4410)
she now had a satisfying sense of self-worth and aspirations. (Loc: 4411)
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