by Kjell Standal-Bergen-Norway
ON SELF-REGULATED BASED AND EXPERIENCE ORIENTED VEGETOTHERAPY.
On Self-regulated and experience oriented vegetotherapy.
I have been working together with Prof. Dr. med. Victor Linden for nine years, until his death in december 1993. Through these years I have learned his method of vegetotherapy. Dr. Lindens work is based on Freud, Reich, Bolwby and Raknes. This article is an attempt to summerice and give a teoretical frame to the practical an intuital knowlegde Dr. Linden has achived during his 40 years as an active dayly working vegetotherapist, and which he willingly has sheared with me during these nine years. The approch to this method of working I have desided to call: Self-regulated and experience oriented vegetotherapy. Three components, and an overall principle of this approach will be discussed. These components are: The position of the body in the therapeutic session, to move with the pasients experiences and sensations, and the principle of moving from the peripherical to the central in the therapeutic process, and the selfregulating capasity of the organism, based on Reich consept. Bolwby’s attachment theory will be discussed in the frame of the terapeutic relationship.
About Self-regulated and Experience Oriented Vegetotherapy.
This paper systematizes and places in a theoretical context the practical and intuitive knowledge that Prof. Dr. med. Victor Lindèn has given me in our more than nine years long collaboration about vegetotherapy. The paper describes methods, places them in a frame of dialectic thinking and connects them to modern infant research. Some ideas of sexuality viewed in light of the vegetotherapeutic tradition are introduced, and reflections on the therapeutic relationship according to Bowlbys attachment theory.
The approach can be regarded as holistical, and regards all forms of appearances in the organism as an expression of different sides of the same entirety. Central in this entirety is the vegetative system and its functional ability, which is regarded as one of the fundamental principles in the adaption of the organism, and will be decisive as to how the organism is able to utilize its growth promoting potentials of selfreguation.
I have chosen to call this approach:
Selfregulated and Experience Oriented Vegetotherapy.SOV
Prof. Lindèn met Reich, worked under Braatøy, collaborated with Nic Wall and went through self-analysis by Raknes. He did work with vegetotherapy dayly for nearly 40 years, until his death in 1993.
His methods are based on the works of Freud, Reich, Bowlby and Raknes. Lindèns profound somatic comprehension and experience, acquired in his work as a doctor of medicine without too many remedies, his insight into and comprehension of connec- tions in the organismic and his well developed intuitive intelligence, and also his willingness to share his experience with me, has been an invaluable reservoir in enabling me to build up my organismic comprehension and my intellectual apparatus of conception around this way of working – or perhaps more correctly – this working tool.
For my part I started with patients in vegetotherapy in1985, passed on to full time private practise January 1987, and have since then consequently worked with vegeto- therapy five days a week.
My patient group is most often referred from the primary medical doctor, and the symptomes range from psychotic states, states of grave anxiety, fibromyalgi, emotional disturbances to lighter anxiety states.
A clarification of my point of view on vegetotherapy, the way I learn it from Victor Lindèn. By vegetotherapy I mean : Working directly with the veqetative system aiming to restor the normal vegetatative processes in the organism. This leads me to the follwing position : All disturbances – psychic or somatic – are also disturbances in the vegetative system. This disturbance is in reality an contradiction in the vegetative system, that could not be solved in a satisfying way for the individual.
This again leads me to take the following position: With psychic and somatic disturbances in the organism, restoring of the normal vegetative function will lead to an optimal strengthening of the specific organism’s level of function. If this argument is followed right through, it leads me to the following final reasoning for my position:
The healing power of the organism derives from the vegetative system at the same time as it is also working through this system at all other biochemical, physiological, somatic,emotional and cognitive processes. Changes are occurring centrally from and are spread peripherally in the organism.
The organism enters into a dialectical interaction with the environment and itself as an organism. This means that the organism within certain limits, not only forms its cognitive, emotional and behavioural sequences of action – but also directly through it- self and its environmental forms its somatic behaviour an physiological appearance.
To place this in an understandable context, I will, before passing on to the methodical, say some words on Contradictions. Dialectics and dialectical thinking are the basic elements in my comprehension and approach to the functions and processes of the vegetative system. The assumption of many of the statements now following would not have been possible to formulate without the insight which the reading or Havemann (1964) has given me.
All conflict can be regarded as unsolved contradictions, and a condition for growth and development on all levels is that these contradictions become solved and that they are solved by being united on a higher level of acknowledgement. The following will be formulated briefly.
A condition for things to be a contradiction is that they have something in common. Combining contradictions is a condition for all growth and development. If contradictions cease in becoming united, stagnation and decline ensue.
The function of the vegetative system is based on the combination of contradictions (parasympathetic/sympathetic/hormone axis/the immune system). Disturbances in the vegetative system are unsolved contradictions in the same system. These contradictions in the vegetative system are mirrored in the organism.
Because the vegetative system’s level of function is prevented from optimal function through this contradiction, this will penetrate the organizing of the organism on all levels. The vegetative system is in a dialectical relation to the whole organism, also to itself. This entails that the mirroring of the contradiction in the organism is distinguished partly by the organisms compensation of this contradiction, but also by the vegetative systems own compensatory initiative.
This view will maintain that every psychological phenomenon has its somatic correlate, in such a way that every occurrence in the organism affects all parts of the organism, simultaneously as these too are forming and changing all parts in the organism, also their mutual relations. This has consequences for the organism’s relation to the environment, which in its turn influence the organism’s conduct and way of behaviour. Regarded this way, the organism is created – not only emotionally and cognitively – but also somatically by its environment, simultaneously as it itself is creator of itself and of certain parts of its milieu.
This leads to the manifestations in the organism (biochemical, physiological, somatic, emotional, cognitive and behavioural) mirroring this contradiction which is based on this unique organism’s genetic and social disposition and also its history. Within our cultural heritage certain social and genetic factors will be a collective reservoir from which the generations collect their techniques of adjustment. These techniques of adjustment will influence the individual solutions that the organism enters into, in the
sense that they form certain more or less rigid frameworks within which the solutions are to be found. At the same time the individual and the generations try to change these frameworks in order to adjust them to new ways of living. Direct access to popular frameworks of understanding around this, we find in the folk tales, proverbs, meta consumption, legends, popular medicine etc.
Now to the methodical.
Placing of the body in Time and Space.
We regard the infant. Laying on its back it has its legs drawn up, it knees are resting towards the stomach and its pelvis is in free motion. During inhalation the chest is expanding outwards as well as upwards in its longitudinal direction, the shoulders are pressed upwards and the pelvis is falling down. During expiration the chest flattens and contracts in its length, the shoulders fall down, the muscles of the the stomach contract and the pelvis is raised. In the infant we regard the pelvic reflex in free display. You may to a certain degree claim that this is the basic position of the human being “before evil entered the world.” I ask the patient – with some few exceptions – to undress the upper part of the body, lay down on his back, and raise the legs in inverted V position in order to let the foot soles rest on the bench.
This is the therapeutic basic position in all consultations in the therapy.
The placing of the body in time and space in the therapeutic situation is standardised, and to a certain degree ritualized. My view is that this standardised situation maxi- mizes the patient’s possibility of inner exploring and minimizes outer disturbances/ changes. Through what you may call a ritual, a confidence and certainty is established in the patient about how the therapeutically framework will be, and also that the patient need not speculate as to which features or happenings could be brought into the frame- work of therapy. This strengthens the patient’s state of readiness to turn his attention towards his inner life and his bodily reactions. At the same time -this situation gives the therapist a good opportunity to study the patient’s bodily reactions, emotional changes and cognitive adaptations. This standardized situation gives the therapist a good opportunity for a systematic evaluating of the actual therapy process, if he so chooses. It is not only that the patient lies down on his back and stays there.
The first instruction most often is to ask the patient to empty his head of thoughts and to breathe as usual. When the patient is placed in this position and is breathing in his usual way, he shows his vegetative disturbances, for instance through his respiration and in stiffened muscular regions for instance in his head, throat, thorax, diaphragma, thighs and legs, and his pelvis may have locked itself.
Sometimes you may get spontaneous reactions where the patient himself spon- taneously becomes aware of the anomalies in his respiration or tightness in different
muscle regions. Other times you have to encourage the patient to notice how his respiration is by asking him questions, and to make him aware of the muscle regions which are contracted or tense.
Questions as: Can you feel that you are barely breathing? Do you agree with my saying that you are breathing by fits and starts? Can you feel your breath shivering when you respire? Is it as if your breath has become stuck in the upper part of your chest?
The intervention is determined by how the patient is breathing, and how tense the patient is. It may be enough that the patient is allowed to relax, find his own breath as it really is, and through this, an inner exploring may start spontaneously. It often happens that in the patient there are accessible movements which in their rudimentary form are identical to the infant’s way of breathing. I do encourage the strengthening of these movements, so that the patient lifts his shoulders when respiring, and lowers his shoulders and lifts his pelvis when expiring. In my opinion, it is imperfect/lacking contact with these basic and spontaneous biologically determined movements that characterize the patients. This contact may be more or less disturbed, but it is always disturbed.
By bringing the patient from a vertical to a horizontal position the activity of the vegetative system immediately changes, the blood pressure, for instance, is changed. When you ask the patient to move his shoulders and pelvis, you start a physical activity. This involves among other things that the heart spontaneously precipitates hormones, and the vegetative system is activated. The disturbed regions in the vegetative system are also activated. (for instance increased swallowing, ticks, blushing, muscular spasms, trembling etc.) These vegetative reactions are unconscious.
Depending on how the patient introduces himself through how he lies down on the bench – I thoroughly investigate the body language, the form of the body and his behaviour from the moment the patient enters the room till he lies down on the bench – trough this I form a hypothesis about how I am going to intervene. This will be through observation of mimicry, bearing, the distribution of fat, his voice, his way of walking, the colour of his skin and so on. Sometimes I ask the patient to imagine a picture of himself as a small boy. Usually such a picture will protrude in the patient’s mind, and very often this picture is connected with a conflict situation. I call this a situation- memory. Such situation-memories we all, nearly without exception, can recall. This may become a starting point, usually by letting the patient describe the picture, where the patient is, how old he is and what atmosphere there may be connected with the picture, if other persons are present, what persons they may be etc.
I hope that this may give an insight as to how the initial stage takes place.
The Self-regulating Capacity of the body.
One of Reich’s (1371,1976) basic theories was that the organism possesses a selfregu- lating mechanism which pervades it on all levels, and that this is functioning indepen- dently of whether it may develop freely or not. lt is the biological life of the organism. A great deal of this self-regulating capacity/ability is, as it seems confirmed in newer infant research, Stern (1985) and Trevarten (1987), show that the child’s self-regulating ability is very well developed already from birth. This is true not only for the ability to take the initiative in, and to enter into communicative relations on the emotional level, but also in the capability to say stop if it goes too far. (Turning away, closing the eyes, writhing, crying etc.) This capability to say stop if things become too difficult has not disappeared in the patients, but it must have the opportunity to work and develop. Precisely this ability to speak up, bodily, emotionally and verbally is in my opinion, basicly the self regulation of the organism. Development of this ability tells us that the therapy is on the right road.
This involves among other things, the capacity of setting limits for others in relation to oneself as an individual, but also for oneself in relation to others, something which can only occur if the individual has developed its own limits.
It seems to me that this self regulating ability/capacity is always intact in man, even if it occurs in a stunted adaptation to life, severe somatic dysfunctions, psychic tragedies and similar things. First and foremost, we notice this in the child who tries to survive in the way which is for him the best possible, and that he makes use of the existing resources in the best possible way. That this may lead to withdrawal, denial, dysfunc- tion etc., can only be regarded as what was then the best solution to life crisis’s, and a way to go on living.
In my view, this self-regulating capacity is present in the most damaged, and always accessible as a healing force. This does not mean that any individual without help can make use of the potentials which this self-regulating force has, but it is there. It is the patients biological vitality and therefore unconscious in its function.
Then: Self-regulation is working, even in the organism’s dysfunction.
Reich (1971) attached this selfregulating ability to libido, which to him was an expres- sion of both the sexual vigour and vitality together. Libido, by virtue of its nature, is seeking towards pleasure, and if this is being frustrated, man will react with anger and aggression.
If we follow Reich in this, anger and aggression are initially growth creating forces. They can, however, function as growth promoting only when they are aimed directly towards him/that which is preventing natural conduct of life, normal freedom and growth.
This does not mean that the child necessary is given a right, but that the child has a right to show and develop its emotions. If this does not happen it may lead to ill health. (For instance inwards directed aggression).
The therapeutic consequences of this is very important. The aggressive forces must be activated in their whole appearance emotionally, bodily and cognitively – and then be directed against him/it/those which initially activated these forces and prevented the free developing of these forces. It will often be the primary persons with whom the emotions are being associated to and against whom they are also being directed. It is important that the patient is then given the opportunity to symbolical1y, through use of pictures and bodily activity to “attack” these persons. On the bench this may manifest itself as scratching, spitting, kicking, crying and convulsive sobbing.
My experience is that this is absolutely necessary in order to solve the vegetative antagonisms due to a lacking possibility to utilise these powers in their original form created in the system. That all emotionality and all experience mainly must be connected with the real situation in which they appeared and must be solved directly in that connection is a basic principle in my form of vegetotherapy.
It will be too extensive in this presentation to go into such things as for instance sub- liminal solutions and solutions by metaphorical modes of expressions, which in my opinion also happens.
When the body is placed in the position earlier described the vegetative system is activated. This is a good starting point for experiences (cognitive, emotional, visual, psychological and somatic) which activates the body’s ability to remember what became locked, which injustices were executed, which bodily and emotional reactions this created, how the individual had to overcome and live with these, how the chance to protest against these injustices was cut off, and which direction the protest then had to take.
Re-living these situations again in the register of the whole body is to me a condition for working out the contradictions in the vegetative system created by these incidents. When this occurs, it leads to spontaneous recovery of the vegetative system’s functions. Spasms in the musculature loosen, spontaneous recovering of breathing occurs, the skin changes colour, the patient gets better sight and as some say, it is easier to think clearly.
I belive that the main task of the therapeut is partly to help the patient to recall ECOSORS: Emotional, COgnitive and SOmatic Reconstructions which have been decisive for how the patients own self-regulating growth possibilities have been disturbed and entered the vegetative system as an unsolved contradiction, thereafter to be congruently present in the patient’s emotional condition, a co-wanderer in the land- scape which the patient must seek to be able to construct, or rather recreate his history.
The vegetative system “are emotions” and can best be reached through the affects. Through calling attention to the bodily, emotional and cognitive changes in the patient which the change in the activity of the vegetative system is starting. the chances to call forth the excitements connected with these disturbances will be rather good. This may be passions as grief, anger, fear, rage and disappointment and sexual feelings.
From the primary theory through which contradictions in the vegetative system are being worked out through the passions, it is a condition that this is happening in order to let the body get in touch with its own self-regulating capacity, and to let it re- establish its growth promoting capacity of self-regulating. Regarding the body’s self- regulating capacity, touching/manipulating of the patient’s body by the therapist will be contra-indicated. The patient himself will return to his own growth promoting self- regulating capacity if he is permitted to do this in his own tempo.
This also implies a consistent attitude to the fact that the patient if allowed to develop freely in the therapeutic relationship, “does not take on more than he can carry”. In my opinion you may risk disturbing, eliminating or hampering this growth-promoting self-regulating capacity in the patient if you interfere with the organisms bodily boundaries. There may as well be danger afoot that a sort of opinion about and a demand for how the patient should function may develop. This can happen through transference of a scope of understanding which the therapeut has, and may be implanted in the patient through unconscious bodily demands from the therapeut. A struggle also may arise between the therapeut and the patient about what is “right” , and the patient may again be exposed to demands about “what is right” and “how he ought to behave”, and may be at worst, the demand that the patient’s body must be accessible to the therapeut.
To be in harmony with the patient.
The backbone of Lindèn’s approximation, is the idea of “being in harmony with the patient”. This holds good on all levels – cognitive, emotional, physiological and somatic. To be in harmony with the patient is a treatment of resistance at the same time as it is an acceptance of the resistance. Resistance can hardly become useful for the therapy if it is not dialectically regarded as a resource as well as an explanation and a measure of the individuals ability to learn, and how comprehensive and thorough this learning has been.
One way of describing this is to say that you are agreeing with what the body, the thoughts, the emotions spontaneously offer. This may be verbal statements of emotio- nal experiences or bodily phenomenons, and also non-verbal signals. This means that one must catch “the most vivid” in the organism. Bodily seen what is most vivid can be hypo tonic as well as hyper tonic. The most important is to train oneself to see which parts of the body are most “prepared” to respond when called attention to.
This also holds good for all levels (cognitive, physiologic, somatic, psychological) where the patient shows readiness to react. Practically this may manifest itself in such a way, that an individual who has taught himself to master his convulsive sobbing by clearing his throat/swallowing frequently, will increase this clearing/swallowing when he lies on the bench. This means that first he is made aware of the clearing/swallowing, then he is encouraged to clear/swallow still more.
Such forms of clearing/swallowing is without exception unconscious. It is a vegetative inverted response whose task it is to prevent an unsolved contradiction in the vegetative system from coming into full bloom and thus reach the patient’s conscious life. By encouraging an increased clearing/swallowing this unsolved antagonism is being activated and the patient becomes aware of either having a lump in his throat or that his eyes start burning. Sometimes they can feel how the breast is contracting, that there is a pressure/itching in his eyes or a pressure on his chest.
The next step will then be to change the focus from the clearing/swallowing over to the other sensations which have arisen. The patient is thus gradually lead towards the underlying affect that had to be suppressed as it could not be expressed at the moment the actual affect reaction appeared. When the affect then breaks through it most often is connected with a situation or an emotional climate, against which the patient himself was powerless to react, or to influence. I willingly stick to this simple example because the recall process itself and the therapeutic intervention itself vary as much within these limits as there are patients.
Here I will only sketch some simple rules for how one proceeds in principle. Most important in this is respect for the history of each individual, how this has been constructed in the mind of the individual, brought into the somatic activity and the form of the body. How this history forms the individual’s encounter with the world around him, and how all this is decisive for our encounter with these individuals. This implies that the therapist is always aware of the process occurring , that the therapist is favourably inclined towards the patient’s state of mind, that the therapist the whole time attentively follows what the patient says and experiences and how he acts.
It is important to emphasize that I here mean what the patient is already prepared to be able to reconstruct and acknowledge.
To move from the peripheral to the central.
By this I mean grasping what is most distinct, what is “offering itself.” This may be modes of expressions, unconscious movements or bearings of the body, mimicry and so on. What the patient in some way or other is showing/telling, lies as an acknowledging state of readiness in the patient, a readiness to perceive and
comprehend, reconsider. To go from the peripheral to the central means to approach what is difficult/the conflict in the patient through indirectly or by gradually circling in more central emotional blockages/traumas. From the principle that healing comes centrally from within the organism (has its origin in the vegetative system) and is being spread to the peripheral, then to go from the peripheral to the central means to uncover deeper and deeper levels of conflicts.
While these are being solved, the conditions are laid to solve the the primary conflicts/ antagonisms in the vegetative system. When these primary conflicts are solved, a process is started, the origin of which has its starting point in this solving, and this is spread centrally from and to the peripheral in the organism on all functional levels.
An example: By asking the patient to recall a picture of himself as a little boy (a remembrance of a situation) I usually make him describe this picture. Some times it may be helpful to ask the patient to describe what clothes he is wearing or where he is. If for instance he answers that he stands outside the house where he lived as a child I may ask if it is possible to enter this house. What is the door like, is it possible to open it? And if so, what are things like indoors? Which room would he fancy entering? What is this room like? Are there people in it? Which persons are these, whether it is possible to feel the atmosphere of this room? Can you look closer at who these persons are? Can you hold one of the persons, can you see his face, can you see his eyes?
This means to go from a relatively neutral field of experience to a more emotionally loaded field, where the affects most often are being built up the more the patient is nearing the emotional centre in the experience of the picture as well as in his own emotional life.
This is a small part of an abundance of possibilities to move the patient from a peripheral mode of experience to more emotional loaded and emotional connected conflicts. This, of course, also concerns bodily, emotionally as well as cognitive experiences. On the whole it is a matter of combining the bodily, emotional and cognitive experience ability together in such a way that the patient acknowledges, the conflicts as an organic whole and that they are solved as an organic whole.
Something about Sexuality.
It is not unusual to regard vegetotherapy as a sort of sexual therapy. In this I deeply disagree. It could therefore be appropriate to say something about my conception of the role of sexuality in the individual, and my view on sexuality in children. Reich(1971) says:…. “The sexual-economic theory may be expressed in some few sentences. The psychic health depends upon the orgastic potency, i.e. the ability of giving oneself in the natural sexual act. Psychic illness is a result of a disturbance in the natural ability for love. The healing of psychic disturbances primarily is dependent on the establishing of the natural capability of love. Under natural conditions the energy of life is regulating itself without forced duty or forced moral. Antisocial
behaviour emerges from sexual urge which exist because the natural sexuality has been suppressed. People who are being brought up in an atmosphere of life-and sex denial acquire an anxiety for pleasure, which is physiologically deeply rooted in chronic muscle tensions.”(.16/17).
The formulation in this section of Reich is in itself not so difficult to follow. His statement that the healing of psychic disturbances demands the establishing of tbe capability of love is also not especially difficult to accept, if we by love mean the capability of establishing deep and binding relationships to other people on the bodily as well as on the emotional/cognitive level.
If one masters this and enters such relationships in devotion, respect and with joint growth on all levels as a starting point, then this is directly antagonistic to a neurotic relationship. It is also not difficult to accept that people brought up in an atmosphere of sexual renunciation acquire a pleasure anxiety. The child’s sexuality is just a matter of the childs ability to experience pleasure in his own body. Stern (1985) says:…The infant is thus seen as an excellent reality tester. Reality at this stage is never distorted for defensive reasons” (s. 11).
The consequence of what Stern says is great. It tells us – if it is so – that the child has not developed defence mechanisms which can cope with the strain that the child is exposed to. This must mean that the child’s experiences are a bodily totality, the pleasure as well as the sanctions.
Orgasm in children is common, but this orgasm is directly connected with the total bodily experience and to the child itself as its bodily being. Sanctions and punishment in this area interfere directly with the childs body, this because the child’s acknowledging main category is his body.
This leads to the punishment’s interfering with the acknowledging-categories and is not diminished by a developed defence. This may have negative consequences for the child’s ability to experience pleasure and its ability to acknowledge the physical side of life. This may lead to desire reactivating such a traumatic happening on an unconscious level, and the individual reacts to pleasure impulses with experienced anxiety, without knowing what created it to begin with, as this is repressed.
It is more difficult to follow Reich (1971) when he says: The degree of seriousness of every psychic illness is directly connected with th the grade of seriousness of the genital disturbance. The prospect of cure depends directly upon the possibility of establishing tbe the ability of genital satisfaction. (p.100,) Likewise his continuation on this: The genital disturbance is not, as earlier assumed, one symptom among many others, it is the symptom of the neurosis itself. (p.100)
There are several reasons why I can’t accept this. The one is the empiric, what we can also call clinical experience. Here I lean towards Schelderup (1988) who to a large degree expresses the experience I have myself and also those of Lindèn. Schelderup says: ” I have more and more come to the conclusion that the theory about the sexual causation of the neurosis solely or at least principally, is in reality due to a misunderstanding of the presenting facts.” (p.92.) He continues “…. a conflict of non sexual character has created a seclusion and thereby a general hampering of the active and self-assertion tendencies.” (p.96). It becomes meaningfully related to my clinical practice when he says :”….The child has been given too strong a task of adjustment or exposed to heavy stress or a traumatic situation,to which he has been powerless, and unable to work through.” (p.97) Further :”….The child has staked all his forces, all his emotional life on something, then encounters an overpowering resistance and suffers defeat. All roads to usual outlets of emotions are closed. The child is completely powerless and becomes overwhelmed by his impressions. Such an overwhelming of impressions towards which one is powerless, creates anxiety. The child will then also later react with anxiety and quite instinctively try to avoid things which in any way might lead to a similar helpless situation. But as a consequence of this he will be more or less paralysed in his ability to once more enter into anything wholeheartedly. Many impulses and emotions are automatically restrained and cut off. (p. 97,).
The importance of this to which Schelderup calls attention, is that traumatic experiences of non sexual character can also interfere and disturb/limit the organisms total development of life. This lacking capability of life development will of course interfere with the individuals ability of full sexual devotion, and disturb or twist this.
The other thing is the structural level. By structural I mean the organism’s structure biologically as well as intra psychically during the very first years of life. I lean towards Trevarten (87) and Stern (85).
If it is so, as modern infant research seems to show, that the child already from birth experiences as well as seeks out states of pleasure, as for instance mutual communicating creates in the child, as emotional synchronization also seems to generate pleasure, and last but not least, that this experience is associated with bodily activity, stimulation and excitation and experienced as pleasurable by the child. If all pleasure in its starting point is bodily, then it must be the childs experience of the body as a category of acknowledgement, which is placed under pressure by frustrations of the natural extroverted seeking and exploring activities of the child. It is the body’s actual acting that is attacked, and it can therefore not be difficult to imagine that full devotion to the body may be re-established as a secondary effect when a primary contradiction is solved.
The pelvis reflex can be looked upon as such a primary capacity in the body that was present originally, and that it re-appears as an indicator that the patient again is able to
experience pleasure as a bodily totality. Sexuality then becomes a possible potential of knowledge for man, on the same footing as other bodily, thought and emotional states. The movement of the pelvis tells something about establishing the ability of using, having access to, a broader spectre of acknowledgement potentials.
Something about the Conditions for the Development of Harmony.
I will say something about the conditions for the development of harmony, and about forms of attachment, because both phenomenons are important for the therapeutic relationship and for the development of the therapy.
Modern child research (Trevarten, 87, Stern, 85) shows that infants actively take part in the framing of the interaction between itself and its nearest relations. It also seems likely to suppose that the infant distinguishes between and perceives the intentions of the caring persons, i.e. their emotional attitude towards the child. During the childs first three months it seems to be beyond any doubt that persons are the most important objects of orientation, towards which it direct its attention. It seems reasonable – according to this research tradition – able to maintain that the child is developing its coping ability during the first months of life by interacting through emotions. This rudimentary understanding of other people’s emotions/intentions, that takes place already at birth, creates the foundation for coordination of ones own intentions with those of others. This is the basis for all development. From this, the mutual dialogue arises which must be present for the development of deep emotional ties, which form the basis of security.
In my opinion man has from birth on an understanding of other people’s intentions, he seeks cooperation and nearness, he has a need for discovery and is full of inquisitiveness and spirit of inquiry. This permeates the child’s activity and is in its “raw” form the very hallmark of Homo Ludens -the playful, alive, creating, searching and interactive man.
This must – in my view – mean that this ability to understand the intentions and emotions of others and to be in congruence with the emotional life of other people, is an important condition for meaningful interaction with other people.
This must have strong therapeutic implications if we take it seriously. It is vital that the therapeut is deeply accepting and in tune with the patients emotional life, because it was there it “turned wrong”. (in the interaction with other people’s emotions.)
On can say that the therapist must be an emotional reservoir, from which the patient can expect acceptability when he is playing out his feelings directly against the persons in question and where the therapist must recognize these emotions and be in tune with them.
A Little about the Therapist.
. The therapeut is always facing the patient so that the patient can obtain eye contact with the therapeut, if necessary for the patient. In some situations, for instance during a fit of anxiety, it is – in my opinion – rather necessary that the therapist establishes eye contact and that this look from the therapist gives two messages:
I do not fear your anxiety.
I am present and with you in your anxiety.
It is important to emphasize that the therapist can only obtain this attitude if the therapist himself is relatively free from anxiety, or at least able to separate his own anxiety from others, and have very good control of his own. It is probably unlikely that the therapist can master this if he himself has not experienced how it feels to lie on the bench, as well as has been forced to fight his own fears. This demands a quite comprehensive training.
Attachment – Bowlby.
I will give an extract from Bowlby’s (1984, 85, 86) theories because this will form the foundation for some views later on, about the therapeutic relationship and what presents itself there.
Bowlby believes that the child’s ability to establish relationships, develop ties of love, are present from birth on. This is an independent, strongly developed ability, not tied to satisfaction of physiological urge and need. According to Bowlby the satisfying of the child’s strong inborn need for and state of readiness to enter into dialogues with its surroundings, is as important for the childs development as the satisfying of the need for food, safety and care. In other words: The satisfaction of the child’s need for a dialogue with its surroundings is as important for the child’s psychological development as food is for the child’s physical development.
If the child is to develop favourably, psychically as well as physically, the psychological as well as the physical needs must be satisfied from the very beginning. Psychological needs are primarily satisfied by entering into an emotional dialogue and interaction with others. Bowlby regards attachment as a biologically determined capacity, as a result of evolutionary historical development. What is required for a child to be attached to an adult is that the adult is available for the child over time. Incorporated in this view is that all children will become attached to available caring persons, independent of the treatment they get from them. Using Bowlby’s theory as a starting point, and that unsolved emotional conflicts created in the attach ment
relationship, between the patient and the care taking person, plus other traumas, are what are presented to the therapist in the therapy, then also the quality and the contents in this early attachment are presented. This biologically determined and unconscious phenomenon will present itself during the therapy hour independent of the will of the therapist and the patient, just by virtue of their regular meetings. One of the main conditions for how the quality of the child’s attachment develops is, according to Bowlby, the child’s experience of the accessibility, and the responsiveness of the care taking persons. If we regard the conditions – that attachment will always develop after a time, and that the quality is dependent upon accessibility and responsiveness – this will be a rather important therapeutically effective relationship. The relationships the patient developed towards the primary persons in childhood, will be the basis of the emotional climate in which the patient is encounters the therapist in the starting phase of therapy.
This must – in my view – mean that the therapist must endure attachment, he must be aware that such attachment will happen in any case.
The relationship that develops between the therapist and the patient will present itself on at least three levels.
The patient becomes conscious of his own earlier relationships by reliving the emotional,bodily and cognitive aspects which were the contents of the relationships. This means that the patient partly tries to loosen the ties to the actual primary persons, and at the same time establish a more functional attachment towards these persons, which reflects a better developed and more realistic approach to them, whether they are alive or not. Dealing with the grief over what did not occur.
At the same time/simultaneously an attachment to the therapist is developing and this attachment is a condition for the earlier attachment becoming conscious and transformed. In this phase of development the therapist rnust endure the patient’s attachment to him, and have insight into the nature of this attachment, and understand that it is unavoidable and necessary. This must not be mistaken with transference.
The same development of the attachment-history will also occur on the therapeutic plane. Attachment – Independence – Detachment. The therapist must also accept and agree that the therapeutic attachment must also become untied.
This area might have been discussed more thoroughly. But I leave it as a string thoughts and as my attitude to the therapeutic process, and, and to some basic elements in this.
We have now taken a walk in some fields of the therapeutic landscape which I regard as my own. I have left out a lot. I have for instance not spoken of traumatic 15
experiences such as: times spent in hospital, unconsciousness in connection with accidents, separations of different forms, and other experiences which made such lasting impressions that they had to be banished to the unconscious,but are at the same time remembered through what we call anxiety, bodily behaviour, somatic forms of reaction and ways of encountering the world.
REFERANCES BOLWBY J: (1984): Attachment and loss: Volume 1, ATTACHMENT.
Middlesex: Penguin Books Ltd.
BOLWBY J: (1985): Attachment and loss: Volume 2, SEPARATION. Anxiety and Anger. Middelsex: Penguin Books Ltd.
BOLWBY J: (1986): Attachment and loss: Volume 3, LOSS. Sadness and Depression. Middelsex: Penguin Books Ltd.
HAVEMAN R: (1964): Dialektikk uten dogmer? Naturvitenskap og filosofi. Universitetsforlaget A/S.
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SCHELDERUP H: (1988): Nevrosene og den nevrotiske karakter. (2.utg.) Universitetsforlaget A/S.
STERN DANIEL N: (1985): The interpersonal world of the infant. A View from Psychoanalysis and Developmental Psychology. New York: Basic Books,Inc., Publishers.
TREVARTHEN C: (1987): Universal cooperative Motives: How infants begin to know and learn language and culture of their parents. I.G. Jahoda and T. Lewis (eds.): Aquiring culture: Cross-cultural studies in child development.
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