Countertransferential? Counter-Therapeutic? Counter-Intuitive? Some Concluding Thoughts

Jo Silbert and Jo Frasca

The abundance of material on animal-assisted therapy together with our anecdotal experiences and the increasing scientific evidence (see, in this volume, Chapters 3, 4 and 5 by Rachmani, Meggeson and Roitman, respectively) attesting to the remedial, relational and empathic qualities of animals offer us a valuable opportunity to develop a framework for thinking about how animals may be considered legitimate partners in the practice of contemporary relational psychoanalysis and psychotherapy.

As some of the contributors to this volume have suggested, discussion about the impact of animals on the practice of contemporary relational psychoanalytic psychotherapy is scant. The authors of the foregoing chapters have thus begun to address this omission in the literature by collectively considering how an animal in the clinical space may offer opportunities for the examination of the human psyche within a triadic - or group - relational matrix of which an animal is a part. By exploring, in the context of an animal’s presence, principles fundamental to relational psychoanalysis, such as the analytic relationship, frame, enactments and the third, the authors demonstrate how animals may be seen as subjective others, trigger unconscious conflicts and act as a bridge connecting the various dominions of intra- and interpersonal experience.

By way of elaboration, the contributors of these chapters have shared case material and clinical thoughts emanating from their practices, often including challenges presented by working with an animal in the treatment arena. Indeed, some have shared their struggles, processes and clinical reflections behind their introduction of the animal into their treatment spaces, thereby alerting us to the myriad of factors to be thoughtfully engaged with, prior to doing so.

Along these lines, we believe that there is another matter which invites our judicious consideration. In this final chapter, we have decided to introduce into the conversation some thoughts about the sporadic inclination on the part of some animals to involuntarily mute affective expression and perhaps even banish affective experience by their propensity - surely neurobio-logically designed, intuitively informed and perhaps countertransferentially driven - to comfort or soothe humans in distress. This chapter questions whether animal empathy and care thus demonstrated, in arresting affect expression, undermines the transformative potential of the psychotherapy process (Fosha, 2000,2003) and is thus counter-therapeutic, or whether such intuitive behaviour on the part of the animal presents a unique opportunity for understanding the intrapsychic and relational worlds of the patient, and thereby facilitates the analytic work (Grossmark, 2012a, b).

The power of affect: traumatic beginnings

Trauma in early development, as a primary agent of dissociation, will impede the brain’s capability to regulate in social and therapeutic settings (Schore, 2011; Bromberg, 2006, 1989). In response to traumatic circumstances, Fosha (2003) reminds us that in an attempt to restore a tenuous attachment bond, children will resort to ‘defensive exclusion’ (p. 228) of whatever emotions result in the volatility or reactive withdrawal of an emotionally under-resourced parent, thus undermining the development of self, self-with-other and optimal functioning in the world (Fosha, 2000).

The power of affect expression: ‘charting a new course’

Difficulties acquired through experience should be transformed through experience (Fosha, 2000; Gill, in Kahn, 1991). By the psychotherapist’s commitment to activities dedicated to promoting the patient’s sense of safety, to actively share in the challenges of the emotional work (Grossmark, 2012b; Fosha, 2003) and to her belief in human beings’ capacity to tolerate ‘risk and trust.... [alongside]... suffering and despair’ (Fosha, 2000, p. 6), the analytic dyad’s regulatory capabilities (Grossmark, 2012b; Shane et al., 1997) and interactive process are enhanced and the patient is supported by the analytic relationship in ‘charting a new course’ (Fosha, ibid, p. 6).

Fosha’s (2000) work on affect offers a persuasive exploration of affective experience and expression as integral to psychological transformation. She conceives of affect as an adaptive and complex phenomenon which reveals an individual’s experiences of self, other and the intricacies of their relational patterns and affective experience (2003) as being integral to resourcefulness in relationships and in the world. In a conducive relational and affective milieu, patients are able to risk both expression and experience of previously disavowed traumatic, frightening and intimate emotions, paving the way for trauma recovery and the patient’s emergence more fully into being and more fully in connection with an other (Fosha, 2000).

We acknowledge that not all affective expression is transformative. Fosha (2000) encourages us to distinguish between ‘affective phenomena that activate deep transformational processes and other affectively-laden experiences that are not mutative’ (p. 2). Rothschild (2000) alerts the psychotherapist, when the patient is in a heightened state of arousal and at risk of re-traumatisation, to the importance of titrating emotional experience

Some concluding thoughts 181

and expression by ‘putting on the brakes’, a considered, clinically informed intervention based on attuned assessment within the context of an empathic psychotherapy relationship.

Canine countertransference

Patients may, of course, communicate defensive affects, which mask unmet longings for attachment and connection (Fosha, 2000) or unspeakable experiences, by ‘impact’ (Casement, 1985), potentially inducing in the psychotherapist a range of somatic, affective and/or cognitive reactions.

Saydee had learned that a person’s cry is an indication of distress. At times of expression of distress during therapy, Saydee would approach some patients, one of whom we shall call K, and tap gently, repeatedly, persistently on K’s foot with her paw, until K stopped crying. Be it Saydee’s response to her distress at another’s pain, an inability to bear her distress or a reflection of how she historically needed to protect and take care of her little owner, her gesture would have the desired effect: K seemed to excise his distress, just as he had always done.

As with Fosha’s explanation above of the process of ‘defensive exclusion’, thus it is in the clinical space; the overt and unconscious communications between psychotherapist and patient generate an emotional environment -made no less compelling by a dog’s contribution - which sanctions and vetoes certain responses and behaviours. When the therapeutic environment cannot support patients to feel safe in their affective experience and expression, they are susceptible to the defensive exclusion of the very agent -affect - which Fosha repeatedly argues is vital to their psychological growth.

K’s distress clearly induced a reaction in Saydee (but it could as easily have been in the psychotherapist) that precipitated her (Saydee’s, in this case) response and the patient-canine interaction that followed, apparently reinstated K’s armour. Indeed, if such gestures on the part of the dog are experienced by the patient as soothing rather than intrapsychically dangerous, it must be profoundly affirming to have one’s distress so deeply witnessed and attended to by a dog making deliberate physical contact. On the other hand, while, in such moments, it may be tempting for us to believe that a ‘cute’ intervention such as Saydee’s could be comforting for a patient and that this could generate a helpful piece of cognitive work, such left brain reasoning could also bypass crucial latent material (Schore, 2011). Indeed, it could reflect a collusion with the patient’s dissociative tendencies, which are designed to protect him from traumatic feelings. A sanctioning of an adaptation or a deferral to the animal’s intervention may appear to be a humane act of caring, but such gestures can be a masquerade for rescuing, and as such, could hinder the psychotherapeutic process.

Fosha (2000) alerts us to the possibility that assumptions about the fragility of patients may be rationalisations for ineffective techniques and suggests that fragility should not be used to hinder clinical interventions. Weare reminded here (Shane et al., 1997; Kahn, 1991) of Kohut’s assertion of the therapeutic value of optimal frustration. Rather than gratification by caretaking behaviour, it may be the simultaneous experience of optimal frustration and empathy which is more likely to motivate change and growth. Notwithstanding Shane et al.’s (1997) recognition that there are some authors who believe that optimal frustration does not adequately explain development, a triadic psychotherapist/patient/dog dynamic, triggered by the dog’s attempt to soothe the patient, may preclude opportunities not only for any advantages that optimal frustration might have yielded but for the intrapsychic and relational opportunities embedded in the patient’s affective expression. While such caring/rescuing behaviour by an animal may be directed to the patient and appear to be an animal-patient collaboration, the psychotherapist herself - when she is unbearably impacted by the affective intensity in the room - may unconsciously recruit the dog as her proxy. She may thus also become a beneficiary of the dog’s intuitive intervention - with trauma recovery, a casualty. Or would it be?

Counter-therapeutic caretaking vs clinical choice

A collision of somato-affective experience between patient and psychotherapist or between the psychotherapist’s personal and professional selves may catalyse a cascade of adjunctive reactions, beginning with the removal by the psychotherapist of ‘“potentially objectionable” parts of [her] countertransference repertoire’ (Leigh, 2011, p. 328) causing her to intervene by reactively withholding from the patient. Leigh (ibid) proposes an alternative response; that in these ‘edge moments’ of activation, the psychotherapist recognises that she has been impacted, applies a metaphorical ‘pause button’ and thus creates a space to listen deeply to the patient’s coded information and process his disguised communications from within the relational matrix.

At what point, though, is the pause button to be applied? And to whom? At the moment of the dog’s revelation of her intention to approach the patient? Or when the psychotherapist notices her own reaction to the dog’s behaviour?

Central to contemporary relational psychoanalysis is the notion of the analytic field, an idiosyncratic analytic entity with a life of its own, both architect and artefact of the analytic encounter, which patient and analyst co-create and are organised by, and which brings the analytic couple into being. The field is distinguished by its own unconscious (Grossmark, 2012a) which does not reside inside the mind of either individual, but both crafts and emerges through dyadic interaction. The treatment itself is best served by the psychotherapist’s understanding of the process as being informed by communication from the unconscious of the dyad as to the state of the relationship and by the recognition of his or her role in the emerging field (ibid).

In the unfolding of the analytic dyad’s distinctive story, interactions that fully involve both psychotherapist and patient will also emerge. Such analytic

Some concluding thoughts 183 occurrences offer crucial information about the analytic relationship, its participants, about what is ‘un-knowable’ and about the trauma that resides in the field. Such information ‘can only come through “unmentalized” and “undreamable” (Ogden, 2009, p. 16) occurrences that involve patient, analyst, and the dyad’s unity, the field’ (Grossmark, 2012a, p. 291). Such happenings, which Grossmark refers to as ‘the flow of enactive engagement’ constitute therapeutic action which is to be welcomed, unobstructed, surrendered to (Grossmark, 2012b) and ‘lived with and through’ by the analyst (Grossmark, 2012a), thereby allowing the field to narrate its own story. Such engagements ‘foster the coming to life of the patient’ (Grossmark, 2012b, p. 638) and are ‘the key to the therapeutic action of a contemporary psychoanalysis’ (Grossmark, 2012a, p. 287).

With a dog in the room, the dyad becomes a triad and the field is accordingly authored. Patient, psychotherapist and dog now co-create and are organised by the field, the analytic relationship is expanded and “unmentalized” and “undreamable” enactment happenings now involve patient, psychotherapist, the dog and the triad. At that moment when K, placated by the Saydee’s concerned tapping, withholds his affective expression, it seems evident that Saydee most certainly intervened in the patient’s affective expression and experience, that she most certainly had something to do with the K’s affect inhibition and that K’s response was possibly a repetitive pattern. The denial to K of the opportunity to weep openly in the supportive, affirming presence of an other, may have precluded a therapeutic breakthrough. Is this, in fact, a moment of repetition? Or repair? Was a therapeutic opportunity forfeited? Or gained?

If affective experience and expression within the psychotherapy relationship are mutative and ‘affective competence is the capacity to feel and deal while relating’ (Fosha, 2000, p. 6), the inhibition of affect may well have been counter-therapeutic. By deciding to train the dog to apply the pause button so as not to intervene at such moments of affect dysrégulation, we would privilege the transformative power of affect.

If, however, the dog’s unimpeded intervention elicited the emergence of the patient’s primitive and regressed state by which his inner world, with its disavowal of affect, complex needs and disorganized states could be accessed (Grossmark, 2012b), and the psychotherapist, noticing her own reactivity to the dog, applies the metaphoric pause button to herself, thereby unobtrusively allowing the field to narrate its own story, another key to healing may emerge (ibid). In this case, we privilege the transformative potential of the triadic interaction.

What then would be our recommendations? Perhaps to remain alert to enactments amongst and between all sentient participants who constitute the analytic triad, as well as to developmental trauma, ‘the flow of enactive engagement’, and to the difference between reactive caretaking, rescuing and regulating. Defensive caretaking behaviour on the part of the animal, we have seen, may arrest the process of psychotherapy. And then again, it may not.

We conclude with our recognition of those who have grappled with and been rewarded by working from a relational perspective in the presence of an animal. We offer our appreciation to those who have been open to thinking about and sharing their experiences, struggles, thoughts, stories, cautions and reflections. We acknowledge their foresight in working creatively with the analytic frame and the framework of analytic language and we wish to express our indebtedness to the animals themselves for their fertile contributions.

References

Bromberg, P. M. (1989) Standing in the spaces: Essays on clinical process, trauma and dissociation. Hillsdale, NJ: The Analytic Press.

Bromberg, P. M. (2006) Awakening the dreamer: Clinicaljourneys. Mahwah, NJ: The Analytic Press.

Casement, P. (1985) On learning from the patient. Routledge: London.

Fosha, D. (2000) The transforming power of affect: A model for accelerated change. New York: Basic Books.

Fosha, D. (2003) Dynamic regulation and experiential work with emotion and relatedness in trauma and disorganised attachment. In M. F. Solomon and D. J. Siegel (Eds.), Healing trauma: Attachment, mind, body, and brain (pp. 221-281). New York: W.W. Norton & Company, Inc.

Grossmark, R. (2012a) The flow of enactive engagement. Contemporary Psychoanalysis. 48(3), pp. 287-300.

Grossmark, R. (2012b). The unobtrusive relational analyst. Psychoanalytic Dialogues. 22(6), pp. 629-646.

Kahn, M. (1991) Between therapist and client: The new relationship. New York: W.H. Freeman and Company.

Leigh, E. (2011) The censorship process: From distillation to essence—A relational methodology. In H. Fowlie and C. Sills (Eds.), Relational transactional analysis: Principles in practice (pp. 327-336). London: Karnac.

Rothschild, B. (2000) The body remembers: The psychophysiology of trauma and trauma treatment. New York: W.W. Norton and Company Inc.

Shane, M., Shane, E. and Gales, M. (1997) Intimate attachments: Toward a new self psychology. New York: The Guilford Press.

Schore, A. N. (2011) The right brain implicit self lies at the core of psychanalysis.

Psychoanalytic Dialogues. 21(1), pp. 75-100.

 
Source
< Prev   CONTENTS   Source