Frame Breakage to the Rescue
Some time ago, with perhaps a combination of inspiration and trepidation from Freud’s work, I felt liberated enough to introduce a frowned-upon practice into my psychotherapy room. While Freud did write about his observations of his dogs in the room, he did so without really exploring their role in terms of his own theoretical paradigm. It was with my limited knowledge of this history that I furthered my own daring on the subject.
It is Freud’s love of his dogs and the power and status he attributed to them that lead Anna Freud to famously claim that her father had, ‘transferred his whole interest in her on to [Anna’s dog] Wolf’, (Young-Bruehl, 1988, p. 217) and his own comment that ‘our Wolf almost replaces the lost Heinerle’ (Freud’s six-year-old grandson who died of tuberculosis in 1928) (Molnar, 1996, p. 275) that reveals how his dog became a surrogate family member and helped him deal with painful grief. Freud’s introduction of his pets into his clinical practice, however, was met with varying degrees of tolerance by his patients. Hilda Doolittle, for example, was somewhat displeased: ‘Jofi would ‘wander about’ at the end of the session and ‘the Professor was more interested in Jofi than he was in my story’ (Doolittle, 1956, p. 162). Furthermore, Freud’s experience of owning a dog would precipitate his decision to end his life. It is documented (Edmundson, 2007; Schur, 1972) that shortly after his beloved dog Lun began howling, repulsed by the smell, and turned away from Freud’s necrotic mouth cancer, on 23 September 1939, Freud died from two hypodermic injections, of between 15 and 25 mg of morphine, administered twelve hours apart (Schur, 1972).
Perhaps such accounts speak to Freud’s devotion to his pets and may help us understand his decision to bring both the company and the love of his dogs into his practice room. If so, then what is discussed in this chapter will not be such a surprise.
As a result of having learnt something of Freud’s accounts of the effect of his dogs on his patients, the psychoanalytic process and his practice, and when the vet insisted that I could not let my own dog, following a serious illness, out of my sight for several weeks, I knew managing this would be a
Frame breakage to the rescue 123 challenge. One never makes a decision to change anything in the therapeutic space without knowing there will be a substantial impact on the therapeutic relationship. 1 became preoccupied with whether to do so.
1 have two practice locations, one in the Sydney Central Business District and another in my home in suburbia. Working from home often interferes with practice routines and as a result, I am frequently challenged with how to manage a frame affected by domestic issues which make working in that environment, not such an ideal option. Occurrences such as garbage day, the mail - or any other - deliveries, the lawn mowing man, and visitors arriving early all create contaminations of the frame - although these events, which 1 might not otherwise have wished upon psychotherapy patients, do habitually provoke important - and often therapeutically useful - conversations.
My study and my development of the relational model in my practice slowly precipitated significant changes in my thinking and working style. Relational theory fashioned ways in which to discuss such frame disturbances with the patient and offered ways to consider how that rupture inevitably unleashes latent anger, frustrations, or unspoken feelings and experiences. Such conversations helped to create a more solid relational platform from which the patient could work and develop by allowing opportunities that would not have occurred within a more stringent psychoanalytic frame, for discussing relational nuances. Stern (in Aron, Grand, Slochower, 2018, p. 28) writes, ‘there is no sense in addressing someone about a sensitive subject unless you communicate in a way that really speaks to that person’.
And now I was to be challenged in my home practice by yet another external factor - the arrival of a highly traumatised, now unwell, rescue dog. I was about to traverse territory that Freud had shone a dim light on, although without having provided us with any clear theoretical direction. 1 became preoccupied with how bringing Saydee into the therapeutic space might impede my usual way of working and also affect the frame. Such is the importance of the frame that Casement (1990) reminds us that when the analytic space is kept free from influences that could distort or disable it, the process then unfolds and can be trusted and followed. Could 1 make that quantum leap by bringing a dog into in the therapeutic setting, and still work in a way that was consistent with my psychoanalytic practice, a framework which informed my work for many years? Could I hold that frame, which could be partly devoured by the inclusion of an unpredictable third? Occasionally 1 had heard my own internal critic’s alarm in response to stepping outside the very clear boundary of that psychoanalytic space as Casement outlines. Early on I had been disapproving of the ‘unnecessary’ inclusion by other practitioners of such things as family snaps and collectibles into the psychotherapeutic space. Was I about to consider a similar faux pas? My question to my peer group as to whether I bring Saydee into my own clinical room was met with scepticism, alarm, and concern. As a result, 1 was reticent to discuss in much detail with colleagues my experimentally and intentionally breaking the frame by bringing Saydee into the room, fearing that 1 might suffer similar criticism 1 had dispensed towards others.
The relational psychotherapy principle of the third, however, provided an alternative perspective for me to consider the introduction of Saydee into my clinical practice. Aron (2006) discusses the flexibility of the relational structure of thirdness in our move away from subject/object, us/them, and moving into thinking about working within a frame that supports the development of clinical work. Benjamin’s (2018) notion of rupture to repair allows us to think about working with vulnerability and imperfections towards a more collaborative approach between the patient and psychotherapist. The patient’s contribution, she argues, enables repair even though repair might occur via their protests. It was this idea that liberated me from my concerns and authorised my bringing Saydee into the room. No matter the protest of the patient, a relational approach provided me with a way of thinking and working with the possible rupture of Saydee’s inclusion, and furthermore, it was even likely to benefit the patient - or so I told myself.
Part of the decision to bring Saydee into the therapeutic space was fostered by her first arrival in my home when 1 had left her in the outer rooms of the house; her separation anxiety was such that she would become persistently noisy if she knew I was within close proximity. She would scratch at the closed-door closest to her, and, in her attempt to remind me of her existence, would bark intermittently. I felt frustration and irritation at this new addition to my world, which complicated and affected all areas of my life. 1 had become exceedingly aware of, and concerned about, my own agitation while working. I was concerned about how my unexpressed distraction and agitation would unavoidably find its way into the room and be felt unconsciously or otherwise by the patient. In knowing Saydee was nearby and distressed, what would I be affecting and stimulating in the room? Could 1 be momentarily distracted to the detriment of the patient?
After several sessions with Saydee outside the room, it was evident this arrangement was not working and proved distressing for us both. 1 began to feel that it would be more unfavourable for the patient to have this traumatised, anxious object outside the room than inside. It fast became apparent that I would need to begin considering more seriously the implications of bringing this damaged little dog into sessions.
I had had two colleagues who had successfully managed to introduce a dog into the clinical environment and as this would not be the first time I had worked with a dog in the therapeutic room, this was somewhat familiar, yet slightly different terrain. Many years earlier, at the beginning of my work as a psychotherapist, my previous dog, Doogie, was already with me in the room when I began to work with my patients - my then patients already knew me with a dog. Doogie developed relationships with certain patients, which is discussed later in this chapter, but Doogie’s presence in sessions felt different to what was about to unfold with Saydee; the experience of
Frame breakage to the rescue 125 bringing a new, and traumatised, object in the form of Saydee into an existing relationship felt considerably different.
Also, at the time that 1 was thinking about introducing Saydee into my practice, I was not taking new patients and each existing patient was long term. Much of my practice was made up of patients who had been diagnosed with varying degrees of attachment disorders. My main therapeutic considerations about bringing Saydee into the room were whether, in spite of my fears and concerns, the likelihood of the protest Benjamin (2018) discusses and the issues the dog might trigger for the patient, I could allow a positive process and outcome to occur.
1 felt cautious. I was concerned, in particular, about my borderline patients. With a persistent instability of interpersonal relationships for the borderline personality, which developed through early infant rupture, the internal structures of patients with this type of attachment disorder are inevitably affected by interactions with the psychotherapist. Impulsive reactions are common. Such reactions may emerge in the form of an enactment where the patient moves into a dissociative space reflective of their early traumatic experience and responses. These early experiences have affected the patient’s ability to self-regulate thereby compromising their ability to work relationally with the psychotherapist (Bromberg, 2011).
In the occasional caring and nurturing from the borderline or attachment disordered patient towards the psychotherapist, there is a covert, unarticulated agreement lurking. This covert message is a sort-of quid-pro-quo expectation on the part of the patient that the same care and nurturing, or more, will be reciprocated, by the psychotherapist. If the psychotherapist fails to reciprocate in the way the patient desires, rage-fuelled punitive action will invariably follow. With this type of internal processing, and the common associated features of fallacious self-image and acute impulsivity, I knew a dog’s presence would likely be a deeply provocative trigger. Fear of rejection, abandonment and separation has an incalculable impact on the self-image, thinking, feelings and behaviour of these patients. The borderline patient has the ability to idealise the psychotherapist in one moment and engage in severe animosity in the next. The exertion of this power is a formidable, often discombobulating experience, even for any veteran practitioner. I feared, though, that it would be much worse for a dog, and a highly traumatised dog at that. This can be a savage attack and I did not want the dog to have a traumatic experience as a result of a decision I had made bringing her into an environment with a patient with borderline features.
The question was not if Saydee would impact the relationship, but how she would impact the therapeutic relationship, and how I might manage that impact. While I was aware, of course, that Saydee’s presence might trigger the patient’s archaic wounds which in turn would evoke a plethora of feelings, and that this may offer valuable therapeutic opportunities for us, I was also juggling other feelings of protection towards Saydee - perhaps a three-way countertransferential process: me projecting onto Saydee myconcerns for myself and for the fragile relationship with my patients. 1 also felt concerned about how I might manage the dog’s experience when that happened. It brings to light the work of Benjamin (2018), where she relieves the stressors of fearing the rupture of thirdness by considering that we can use this potential power struggle as an opportunity to explore together, with the patient, a mutually beneficial affective outcome.
In spite, or perhaps in view of all of the above, I forged ahead with what I hoped was my well-monitored and well-researched experiment. As a practitioner who works predominantly with transference and countertransference, I felt that I could manage the responses that would predictably find their way into the therapeutic space and that these responses might even allow rich material, as Benjamin (ibid) suggests, to surface, material that otherwise may take years to arrive in the room. Furthermore, I could reverse the decision to have Saydee in the sessions if it became too much for the patients.
So, in many unexpected ways, we began the journey of healing.
N usually attends the home practice where the dog is now firmly ensconced, but on this occasion, she sailed into the practice room in the CBD, where Saydee had not yet been introduced and says, ‘How’s that dog version of me?’ To which I reply, ‘She is well thank you’. She sinks into her favourite position on the couch and I ask, ‘I wonder what parallels you draw between Saydee and yourself?’ Quick as a flash she retorts, ‘we both wag our tails when we see you’. I deliberate over this statement a moment, then say, ‘I’m not sure you always wag your tail when you see me’.
Pause. Silence. Nothing forthcoming from the patient.
I wait, then turn the covert overt and say, ‘Last week you threw a cushion at me in anger. Can I assume today you are pleased to be here?’ Disliking the reminder of her outburst from last week’s session she says, ‘Yeah, I’m sorry about last week. Sometimes I hate you and could spit at you; this week I love you’. She beautifully articulates the classic borderline struggle with whether to hate or love the object and how this can vary dramatically from session to session, or even moment to moment.
We discuss how painful this road has been. Her life since thirteen has been an ever-increasing series of deep cuts, cuts with a blade, cuts sometimes requiring anything up to twenty stiches, cuts which she vividly describes as turning ‘white, then red, then orange, then yellow’ as she slices through her own flesh. She wears scars ‘from hate’, a hatred directed towards herself, on every limb of her body, barring her right arm. After six years of psychotherapy, she is only just beginning to understand that her self-hatred comes from an interpretation she made as an infant of her experience of an unavailable, violent, angry mother with a mental illness. She has never been able to traverse the topic of ‘hate’, other than by her overt, self-cutting, though she is
Frame breakage to the rescue 127 slowly beginning to understand that she is enacting what her own mother might have felt towards her.
A wandering mind
A breakthrough came when K attended a third weekly session of her eight years of psychotherapy.
Saydee had begun coughing violently and while 1 knew enough not to take my attention from the patient, I did want to be sure the dog was not choking to death in the corner of the room. I momentarily diverted my eyes to see what the dog was doing. In that split second of distraction I was condemned and seriously chastised with vehement vitriol. K’s tirade pervaded the room. ‘I knew you’d be more focused on the fucking dog ... 1 know you don’t even know I’m in the room when the fucking dog is here ... I don’t want her here ... get her the fuck out... 1 hate you ... 1 hate that fucking dog’.
There it was. All 1 had been anticipating from Saydee’s entry into the room. Florid. Palpable. Yes, I could have immediately got up and removed the dog from the space. In doing so, however, I would not only have prevented the rich transferential material from being processed but I would also have prevented the regressed and triggered Child ego state (Berne, 1964) from her early developmental thoughts, feelings, and behaviours, from expressing all that was being generated by my attention to Saydee. Had I gratified her demands and removed Saydee at that point, 1 might have foreclosed on a significant therapeutic opportunity to provide for the patient a space safe enough to effectively renegotiate previously unchartered developmental challenges. The dynamic might have been similar to parents gratifying the unreasonable demands of an uncontrollable two-year-old.
While K’s family - mother, father, brother, and grandparents - all tried to kill each other in her young presence, she did what she needed to survive. With that same skill she was going to manage Saydee and 1. Somewhere in her archaic experience she knew she had to manage me to protect herself. I knew that for her to recover and lead a full life, it would not be useful for her to be managing every person she encountered. She would need to learn that 1 am potent enough to manage all that goes on in the room - no matter how much she wanted to push those boundaries. And I would do that with her assistance, rather than her control.
Once the onslaught abated, I waited for quite some time to pass before 1 responded. 1 did not break eye contact with her. Finally, I asked, ‘Perhaps you fear Saydee will steal my love from you?’ Staring back, also maintaining contact with me, her eyes filled. Tears rolled down her cheeks. She nodded. After a few more minutes of silence I added, ‘I’m gathering Saydee feels to you like a threat right now.’ With her mascara streaming down her face, creating black trails like those seen after the fury of a bushfire and seeping onto the white cushion she was hugging close to her chest, she nodded again. In that moment I saw her in the rubble of her early life, the carnage pulpable. She appeared likethe crumpled doll someone had tossed in the corner, limp, hair adrift, a mask of black rivers running down her face. I imagine this might have been how she felt on those dark nights, watching, waiting, hearing them trying to kill each other. It would take only a severe slash into her own flesh to drown that out.
In cases of self-injury, 1 note that the rate of the recurrence of cutting is always high, when tumultuous feelings reappear. While this might generate fear for the psychotherapist and thus tempt the psychotherapist to intervene to stop the behaviour, 1 have found it more useful to locate the historical source of the cutting. This patient speaks of killing herself, often. In recent months it has escalated. 1 also know that if her belief is that 1 have embedded Saydee into my life, and with a resurgence of those painful feelings of terror, abandonment, and aloneness, death might be the only option she could envisage. Knowing she lacks language when regressed in trauma, more quietly I share my image asking, ‘Are you feeling discarded, abandoned?’ As if hearing my thinking, she adds, ‘Yes, like when they fought.’ She shuffled. I wondered if she might speak again. She does, almost inaudibly at first. Tve been feeling like 1 finally found someone to see and hear me, somewhere I feel safe and 1 bet Saydee will take that from me. So I hate her.’ Now, finally, we can talk about the hate, not pretend it does not exist.
She finally articulates intense feelings, moving through an impasse, no longer using the defences recruited to avoid the ridicule, rejection and the feelings of insignificance of an earlier stage when her existence and feelings were not validated. Now, if I am thoughtful about the impact that Saydee as a third has in the room she may have the chance to understand and be understood. By giving voice to the protest (Benjamin, 2018) and by using Saydee as her object she is able to say she loves me, following hating me. It is also the first time the patient has been able to overtly express both love and hate. When K understands that I see her, from both my description of her being discarded and asking if she fears loosing me to Saydee, she is able to relive the feeling she had in the room and link them back to a time in her family, now knowing these are not the same in that moment but that they are a stimulation of a dissociated experience (Bromberg, 2011). Bromberg (ibid) asserts that the activation of the dissociated experience in this way is essential for the process to develop and progress. By diverting my eyes onto the dog and my attention away from the patient I had triggered an archaic experience of abandonment and aloneness. After she was able to challenge me about my alliance with Saydee, and after my articulation of her concerns, eventually she was able to understand that my thinking and feeling towards her was not as she experienced in her family.
The dog has facilitated, language, love and hate in the room.
On reflection I have wondered if the advent of Saydee’s integration into the psychotherapy room was as a result of my previous love, Doogie. Doogie
Frame breakage to the rescue 129
was often described as ‘that animal from The Never-Ending Story’ or ‘an Ewok from Star Wars’; self-declared dog-haters loved Doogie. His warm, loving nature made it easy to integrate him into the space, though Doogie’s foray into the therapeutic room was perhaps more by default than as a result of a considered process such as Saydee’s introduction was.
A friend had given me a tiny handmade garden post that read One spoilt dog lives here. Some family member had randomly stuck it in the garden without thought about its message to any unsuspecting passer-by - quite acceptable unless the homeowner is psychotherapist, working from home.
For some time, I had been working with S who could barely speak due to trauma, which, together with her experience of having been inappropriately patented, compromised her ability to parent her own baby. The combination of her depressive state and her traumatic background also limited our work options. CBT seemed to be the best modality in helping her to develop her life and parenting skills. One day she came into the room with much more vigour than her usual malaise - perhaps even animated, asking ‘You have a dog?’. I was so surprised I did not even manage to do the famous psychotherapeutic line, ‘What is it that makes you think I have a dog?’ Or even more feebly, ‘How do you feel about knowing I have a dog?’ I just spontaneously, and in hindsight intuitively, said, ‘Yes I do.’ She had seen the sign in the garden. Shyly she said, ‘I love dogs’. Then, as if I did not hear, or did not hear the importance of what she was saying, she said, in an almost childlike manner,
very, very, much. I walk and look after a dog now and again for this old man who lives near me. He struggles to walk, so I help him with things. 1 love walking his dog the best. Can I meet your dog?
Mild alarm coursed through my body, plagued by the caution ‘the frame, do not break the frame’. My tentativeness in that moment might have appeared to be matched by her own tentativeness. In my case, however, my response related to my fear of a frame breakage, though it could have been interpreted by the patient as a well-considered and thoughtful; in hindsight a sort of mirroring of this patient’s usual mood.
The therapeutic space being invaded by something other than the patient and the psychotherapist or the effect of a frame breakage, is always a concern. While it might appear to be a good idea in the moment, mostly it is not. Usually we are left to mop up a gory, emotional mess with the patient at some later stage. A patient once accused me (in that tone) of fearing a frame breakage to protect myself, not her. Perhaps there is some truth in that. Those gory, messy sessions are hard work and the repercussions can reverberate for years. However, the words ‘do no harm’ are also in our charter, and I felt a dog visit fell into that category for this patient. This day, therefore, I heard myself say, with more calm that 1 actually felt, ‘Yes of course you can meet my dog. His name is Doogie.’
1 went to the door of the consulting room, which opens off into the main part of the house and called his name, knowing he would be close by. He knew these people who visited his home. He had been familiar with their voices, their stories, their smell, their distress, their footsteps and probably much more which only a dog might know, as is in keeping with dog responsibilities. As I called his name this day, he was there at the door, in a flash, though initially he would go no further than the threshold; to date he had only been allowed in this space when it was patient-free. Briefly I wondered if he was even more reticent than S or 1. Because she wanted to meet him, 1 forged on, giving him the go-ahead nod. He went straight to her and lay at her feet, not mine - as if this was a normal thing to do, as if this was something he did every day, something they shared regularly. 1 was surprised to observe her slide off the couch onto the floor near him, wriggling into a position as close to him as possible without disturbing his selected space. She immediately began stroking him. This would be the position they remained in for the rest of that session, and the position they assumed in her sessions from that day forward. Looking at them together, it appeared that this had been prearranged between them, so natural was their bond.
The remarkable thing about the change in the room was how her session content transformed from that day forward. Henceforth, each session began with a greeting to Doogie, and a question about how he was and what he had been up to. Sometimes S would give him a little rendition of her week, which was ever-so informative to the psychotherapist. This was more than I had ever been able to extract from those lips. Woollams and Brown (1979) use the carom as a metaphor to describe an attempt, conscious or unconscious, at communication, where one person’s intention (S, in this instance) is to impel a message off to the second person (Doogie) onto a third (me), which is for whom the real transmission of information was intended, as happens with the balls in the game of billiards. A carom in billiards, when used at the right time, is an important, formidable shot, whereby the cue ball ricochets into another ball, using the second ball to shoot another (the intended) ball into the pocket. There may be some parallels between the notion of the carom and the relational concept of the third. Benjamin (in Mitchell and Aron, 1999) refers to the two experiences that the patient has: that of recognising the psychotherapist as a part of their own inner world and also as a part of another - in a way the intrapsychic and intersubjec-tive aspects of relating. This allows not only the opportunity for relating where that has been difficult, but also at another level allows that exploration of both feelings and relating without the threat of direct engagement. The psychological significance here is that as this patient had used mutism as a defence; it had become too difficult for her to communicate directly to another human, or adult. A canine, however, was less threatening and allowed that communication without risk. Whether conscious or unconscious in this case, S was so engrossed in her dialogue with Doogie it was almost as if my role was superfluous. Thereafter I began to hear all sorts of
Frame breakage to the rescue 131 things offered as information to Doogie, which would drive our work forward into uncharted territory.
In breaking the frame, and allowing a third into the therapeutic space, the patient was able to liberate her voice, then her story, into a non-threatening third allowing us to work within that space, so as to progress something greater than the two of us had been able to achieve.
1 This chapter has been adapted from Delving Deeper: Understanding Diverse Approaches While Exploring Psychotherapy by Jo Frasca, self-published in 2016.
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