The treatment of Samantha

In Chapter 1 we hypothesized and cited considerable evidence in support of how seeking fundamentally provides the spark to activate the various intentions and goals framed in our seven motivational systems. Seeking begins in utero, expands more fully within the neonate, and continues in increasing complexity throughout life. Without the spark of seeking we would become inert, lifeless, without desire or intention. A sense of agency, a sense of a doer doing, would be undermined and the affective tone would be predominantly depressed.

How does seeking become strengthened or undermined in one’s life? Positive, successful experience reinforces and strengthens the spark of seeking more generally as well as, more specifically, activating particular motivation(s). Successful experience establishes positive expectancies that, in turn, reinforce seeking and enhance vitality. In contrast, negative, failing or unsuccessful experiences undermine seeking as well as the specific activated motivation, and establish or reinforce negative expectancies.

In this chapter we highlight clinical material that involves the three broad developmental pathways delineated in Chapter 1: 1) the pathway for human relatedness and intimacy; 2) the pathway for mastering the environment; and 3) the pathway for a healthy body, physiological regulation, and a good mind-body connection. In addition, we described in Chapter 1 how particular underlying generalized affect tones become established, beginning early in life, on the basis of lived intersubjective or relational experience.

When a person makes a call for psychoanalytic treatment, it is a resilient, hopeful spark to seek once again the needed ingredients for connection, self-esteem, a sense of agency, and hope that we can achieve our intentions and goals. Each of the protagonists in the analytic relationshipenter with his/her respective subjectivities and underlying generalized affect tones, co-creating specific ambiances in the patient/analyst process. These ambiances at times can be worked on explicitly, expanding reflective awareness of the underlying affect tones and their current and past relational experiential origins - a gradual transformative process. In addition, psychoanalytic change requires new relational experience within and outside of the analytic relationship that occurs both at explicit and implicit levels, to establish more positive affect tones and vitalizing expectancies.

In our book. Enlivening the Self (2016), I (JLF) presented the psychoanalytic story of Samantha in chapter 2, “Clinical Guidelines.” We illustrated the developmental processes that occurred over the course of a 15-year psychoanalysis. We now represent the clinical material to highlight change processes occurring more specifically along the three developmental pathways described in Chapter 1: that is, human relatedness and intimacy, mastering the environment, and physiological regulation. We will feature how these change processes are brought about through expanding empathically based reflective awareness (i.e., the explicit reflective/exploratory/understanding) and through cocreating other new implicit and explicit relational processes. We highlight, in particular, the change in Samantha’s underlying generalized affect tones and change in the patient/analyst’s cocreated analytic ambiances. We point out the dominant, as well as changes in, affect tones as Samantha in her waking life and in her dream-life attempts to overcome the considerable trauma that had been so disruptive for her.

As the therapy unfolds, we will attempt to recognize and evaluate progress in understanding the problematic organizing themes and their origins, enhancing current successful adaptive patterns, and forming new capacities emerging out of new lived experience. Has the patient become more resilient in responding to a disruption? Has the therapist become more able to recognize disruptions and better able to discern their source, in terms of both the patient’s and his contribution? Do therapist and patient feel increasingly known by each other, especially as each relates to the other in their interactions? Is there an increased understanding of the activation of various problematic self-states with corresponding affect tones and capacity to deactivate these states? Has a new interactive pattern emerged with a new, more adaptive authenticity of each, enhancing a sense of doers doing? Has the dyad been able to engage within a social context that has become more flexible and enlivened? Does a favorable old pattern or a newly formed one open patient and therapist to increased experiences of feeling deeply touched? Are there moments of admiration of the sensibility and exploratory skills of one another and both together? Have negative attributions become replaced by new attributions more accurately reflecting the essential strivings of each and of their joint efforts?

As we present a psychoanalytic case study, we address each of the developmental processes for their relevance in understanding and facilitating therapeutic change. While the case was treated by one of us (JLF), discussions of it in the “comments” attached to the narrative reflect our common understanding.

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