Clinical Practice and the Architecture of the Mind

Robert Langs

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9781855750883
• eBook ISBN:
  9780429911972
• Topic: Psicologia
• Subtopic: Storia e teoria della psicologia

This book draws upon analytically oriented settings for almost all our clinical observations. It provides an excellent introduction to the theory and technique of communicative psychoanalysis and links it with the growing field of evolutionary psychoanalysis.

PART I

OBSERVATION AND ARCHITECTURE

CHAPTER ONE

The fundamentals of psychotherapy

There is, I believe, a measure of dissatisfaction and a wish for more effective forms of psychotherapy lurking in the mind of every mental health practitioner. There have been many definitions of the unsolved mysteries and the ills that have befallen the psychotherapeutic realm and many prescriptions for their cure. Yet the plethora of diagnoses and amelioratives speaks more as symptoms of the disease rather than their solutions.

Virtually every book written about the theory and practice of dynamic psychotherapy and psychoanalysis (in this book, I do not distinguish between the two) carries with it the implied message: “These are the unresolved problems besetting our field, and here are some proposed solutions.” With so many volumes written each year, is it possible to develop an overarching viewpoint that would bring order and sensibility to this maze of confusion and uncertainty? The belief that this quest can be fulfilled is the backbone of this book.

There seems little to be gained by trying to resolve this predicament by turning to one or another of the many current versions of psychoanalytic theory and invoking the seeming clinical insights it would offer. No single theory has gained primacy over its competitors or proven itself as a generally acceptable guide to clinical practice. My own efforts to use the communicative approach to psychotherapy to clarify the treatment experience have met with considerable success, yet they stand without the full support of the therapeutic community (Langs, 1982, 1988, 1992a, 1993a). Another kind of strategy is called for, and it appears to lie in one direction alone—turning at long last to basics, the heretofore undefined fundamentals of psychotherapy.

To move in this direction, I propose that we deconstruct the process of psychotherapy into its cardinal elements and use these fundamentals as a new context for comprehending the transactions and dynamics of the clinical situation. An effort of this kind would be in keeping with recent work designed to develop a bottom-up science and theory of psychoanalysis that could supplement the top-down theory of Freud and his followers, with its stress on high-level, general concepts and broad generalizations (Langs, 1992c; Langs & Badalamenti, 1992).

Virtually all present-day psychoanalytic theories stress three elements:

1. Individuality—the uniqueness of each patient and therapist, and the therapeutic unfolding they create conjointly; the distinctiveness of each patient’s genetic make-up and life history; and the special attributes of and basis for his or her psychopathology.

2. Psychodynamics—the role of interpersonal and intrapsychic conflict; issues of affect, self-image, and tension regulation and the like, as they pertain to both therapy and a patient’s emotional dysfunctions.

3. Broadly stated universals—ill-defined attributes shared by all patients (and therapists) and their life histories, as well as all treatment interactions; generalizations that are formulated in dynamic terms, such as the Oedipus complex, transference, and resistance, which are broadly defined empirically and difficult to specify.

The shift to basics involves complementing these individually oriented perspectives with two additional considerations:

1. Specific universals—well-defined aspects of human nature that apply to all humans, patients and therapists alike, as well as to all therapeutic interactions.

2. In particular, for our purposes, the fundamental structure and functions of the human mind—the evolved general design and capacities of the human psyche that shape, constrain, and provide the resources for individual adaptations to emotionally charged impingements and for the processing of psychodynamically charged inputs.

In developing the interplay between the basic structure and universal attributes of the human mind on the one hand, and the individuality of patients and therapists on the other, we are adopting a new way of observing and thinking about the therapeutic process and its curative powers. It is within this integrated context that the clinical explorations of the present volume will unfold.

For some time now, evolutionary-oriented psychotherapists have been attempting to investigate the evolved nature of human emotional functioning (for details, see Tooby & Cosmides, 1990, 1992; Slavin & Kriegman, 1992). In so doing, they embarked on a quest for universal evolutionary trends and their effects on given individuals with particular genetic make-ups and life histories. However, their work suffers considerably because they have been attempting to formulate evolutionary scenarios for the aforementioned highly complex entities like transference and resistance, without defining the more basic elements of the mind on which natural selection inevitably acts (Gould & Lewontin, 1979). They have thereby placed themselves in a position similar to trying to understand human language without a science of linguistics, or the human brain without any knowledge of its neuronal structure. Research of this kind requires the identification of basic components; so, too, with investigations of the human mind.

The search for fundamental components—irreducible structures and functions—typifies the pursuit of virtually all current forms of science, from physics and chemistry to anthropology and archaeology. Physics without a quest for the essential building blocks of matter is unthinkable, much as anthropology without the pursuit of the earliest forms of life and of the hominid line—and the essential features with which they are distinguished—would be incomprehensible. In practical terms, engineers could hardly think of building efficient and safe power plants without an understanding of basic physics. And despite all protests, the same principles apply to psychotherapy—we need to grasp our own essentials if we are going to forge effective and safe forms of treatment.

The need for a fundamental science of psychoanalysis has been recognized for some time, though there is considerable debate as to its feasibility (see Kuhn, 1962; Edelson, 1984; Grunbaum, 1984; Langs & Badalamenti, 1992). Recently, however, almost unnoticed, there has been a series of empirical efforts to shape psychoanalytic research and theory in ways that would qualify the field as a true part of science and biology (Langs, 1992c; Langs & Badalamenti, 1992, 1994). These endeavours range from formal research studies that have brought statistical and, more recently, stochastic and mathematical methods to psychoanalytic data, to important developments in human psychology shaped by evolutionary-oriented psychotherapists and psychologists (Tooby & Cosmides, 1990, 1992; Slavin & Kriegman, 1992).

While still in their infancy, these efforts at formal science and at identifying the genetic basis of emotional functioning, psychopathology, and the factors that influence the process of psychotherapy serve to remind us that human beings are very much a part of nature and that they can—and must—be understood deeply as such. Movement towards science inevitably brings with it the realization that basic mental structures and functions must exist—and that the promise held by identifying their design and operations should be pursued.

What, then, are the fundamentals of the therapeutic experience and the process of cure—of psychotherapeutic clinical practice? At first glance, this appears to be a surprisingly difficult question to answer. After all, we are dealing with an extremely complex aspect of nature, a multidimensional situation within which two individuals, each a complex entity, interact and strive to “cure” an equally complex dysfunction in one of them. Unfortunately, we do not have the “luxury” of investigating a single, readily defined—however complicated—identifiable structure or set of functions like vision or language, or even the brain. Instead, we are trying to study two minds in interaction, at a time when the investigation of the interplay between two more easily delimited brains barely exists.

Where, then, should we locate these mental basics? Within the patient, the therapist, or the system they create together? Or less broadly, do they reside in the respective psyches of one or both of these participants in treatment, or in their respective behaviours and communications, or in what each experiences subjectively and consciously, or in the nature of their respective unconscious experiences—whatever they may be? Or should we instead turn to the therapeutic setting, or to the ground rules and framework of the treatment experience, as our fundamentals? There appears to be a wide variety of basic entities that pertain to the therapeutic experience, ranging from aspects of each person to their systemic interplay with the setting in which the treatment transpires.

Each of these interacting domains has clinical relevance and impact, and each deserves intensive study. The immediate issue becomes one of deciding where to begin this examination of basics—which entity seems most promising? Because psychotherapy is essentially a human endeavour, we are likely to be inclined to concentrate our efforts on the patient and/or therapist—doing so as they experience and respond to each other’s communications and to the conditions under which they are conveyed.

This option leads us to our next problem: patients and therapists are very complex individuals. We must therefore select some basic aspect of their structure and functions as a specific starting point for our sojourn into fundamentals. The choice that I have made is reflected in this book. For many reasons, I have elected to study what I term the emotion-processing mind—the complex configuration of mental (as distinguished from brain) structures and processes through which humans adapt to emotionally charged stimuli or impingements. Given that the adapting mind is central to human existence—and to psychopathology and its cure—the architecture or design of this mental configuration seems to be a logical and promising entity for first study.

How then can we develop a blueprint for the design of the emotion-processing mind*—and a delineation of its ramifications for clinical practice? Clearly, our definition of this structure and its functions will depend heavily on what we choose to observe, how we organize those observations, and the formulations we derive from these efforts. Both observation and interpretation will be necessary.

The field of observation that I have chosen to concentrate on is the therapeutic interaction and, more specifically, the communicative exchanges between patients and therapists. I make use of two clinical paradigms or settings in developing these studies: (1) communicative psychotherapy, and (2) its more recent off-shoot, empowered psychotherapy, which involves a basic, well-defined adaptive task for both the patient and the therapist (Langs, 1992a, 1993a). Furthermore, given that the patient free-associates and thereby reveals far more about the adaptive dynamics and structures of the mind than the therapist, who speaks only intermittently, I will be especially focused on the patient’s contributions to the therapeutic dialogue—and only secondarily, though without neglect, on those of the therapist.

It is on this basis that I here derive a contemporaneous blueprint or model of the architecture of the mind, which, in turn, is used freshly to explore and comprehend the therapeutic experience and the process of cure. The interplay between model-making, on the one hand, and clinical practice, on the other, is at the heart of this book.

Join me now in an exploration of the design of the mind. I think you will be quite surprised at where this journey takes you and how it affects your understanding of psychotherapy and its methods. I, myself, as I pursued this path, was rather astonished by the realizations I was making and the directions they pointed to with respect to clinical practice (Langs, 1986, 1987a, 1987b, 1992c). It is my hope that this book aptly conveys the excitement of discovery that characterized these pursuits and, at the same time, gives vitality to the new clinical techniques and perspectives they speak for.

NOTE

*The human mind appears to be organized into two basic systems—the cognitive mind, which is responsible for all adaptations that are relatively emotion- or conflict-free, and the emotion-processing mind, which is responsible for adaptations that involve emotionally charged inputs or stimuli. For ease of writing, I use the term “mind” in this book to refer to the emotion-processing mind, unless otherwise indicated.

CHAPTER TWO

Some basic tenets

Ms Allen is a young woman in once-weekly psychotherapy with Dr Barton, a clinical psychologist. She entered therapy mainly because she was repeatedly attracted to very hurtful and destructive men and had not been able to forge a satisfying and lasting relationship with any of them.*

In the tenth month of her treatment, the patient began a session with a dream in which her father’s brother, Martin, forces her to get into his car and drives her to a secluded place where he forces himself on her sexually. She went on to recall that Martin was an erratic man. At times he was kind and helpful, but he had a violent temper and could be assaultive both verbally and physically to anyone in range of his wrath. Ms Allen remembered an incident in which he appeared unexpectedly at her home when she was a teenager. No one else was there at the time, and he made obscene remarks and seductive overtures towards her. Although quite frightened, she was able to get him to leave by pushing him out the door before anything more untoward occurred.

The uncle was a car mechanic who worked endless hours, even Sundays and holidays, a habit his wife and children strongly objected to and openly resented. He seemed more concerned about earning money—he had a morbid and unrealistic fear of poverty—than he was about his family and their needs. He really should have spent more time with his family, Ms Allen lamented. His daughter has had major problems with drugs, and these must have stemmed from his being away from home so often. There was also a suspicion in the family that he had been seductive with her and that perhaps they had had incestuous sexual contacts.

Ms Allen continued: The dream must have been prompted by a family gathering the previous weekend at which the uncle appeared and behaved provocatively. She kept out of his way and was glad she did; avoiding him was the only way to prevent something awful from happening with him.

Enough of him, Ms Allen commented, and she went on to say that she had done a very strange thing at work [she was an editor at a publishing firm]. She had made an appointment with an important author she was working with, and had said she’d see him on the fifteenth—not mentioning the day. It turned out that the fifteenth was a Sunday and that the author had come to her office on that day, thinking it odd but romantic. When he found her firm’s offices closed, he became quite enraged, and Ms Allen had to endure a lot of flack when he called that Monday to complain about what had happened.

Ms Allen had meant to see him on Monday rather than Sunday, and she wondered if she was being unconsciously seductive in inadvertently proposing the Sunday meeting. It was a rather destructive thing to do—hurtful for both the author and herself. She wondered if she was threatened by the man’s attractiveness; maybe she was sending him a mixed signal of ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• FOREWORD
• Part I Observation and architecture
• Part II Pursuing the design of the mind
• Part III Consequences of the architecture of the mind
• REFERENCES
• INDEX