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PART I
AFFECT REGULATION AND CLINICAL PROCESS
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1
Shrinking the Tsunami1
I begin with something personal—my mother’s favorite story about me—a one-liner that took place when I was 4 years old. Even back then I was given to reverie states and while I was sitting next to her, silently lost in thought, I suddenly “woke up” and asked, “Mommy, when I was born how did you know my name was Philip?”
I’m still trying to figure it out. At 4, the concept of nonexistence had begun to interest me but I was still young enough to not worry about it. I simply knew I existed before I was born and I was trying to learn the details. There was no such thing as “nonbeing” much less the shadow of an abyss or a thing that grownups called “death.” It was unthinkable; nonbeing had no personal meaning for me. Where was I before I was born? Wherever I was, Mommy must have been with me. There was no discontinuity in self-experience. For me, self-continuity had not yet been subjected to developmental trauma serious enough to tamper with it. Is that possible? Sure, but only to a degree, and only if we look at trauma not as a special situation but as a continuum that commands our attention only when it disrupts or threatens to disrupt the continuity of self-experience.
There are, however, certainly people for whom my little tale can have no meaning, people who in one way or another have had experiences, often terrifying experiences, of nonbeing. Even at the age of 4. Or earlier. For such people my question to my mother touches on a topic that is never to be touched on. Something inside them tells them that nonbeing is a real threat, that a powerful and terrible tsunami of chaotic and disintegrating affect lurks within.
If we accept that developmental trauma is a core phenomenon in the shaping of personality then we also accept that it exists for everyone and is always a matter of degree. If that is so, then the stability achieved by even secure attachment is also a matter of degree. That is to say, everyone is vulnerable to the experience of having to face something that is more than his mind can deal with, and the differences between people in how much is unbearable is what we work with in the large grey area we call “developmental trauma” or “relational trauma.”
The “Giftie”
Robert Burns (1786), the Scottish poet, wrote, “Oh wad some Power the giftie gie us/To see oursels as ithers see us” (p. 44), but it is not all that easy to accept an image of yourself as seen through the eyes of an “ither,” and it is especially hard when the other’s image of you is based on what for you is a dissociated part of self—a “not-me.” So whenever I hear that line of poetry, there is a part of me that feels like telling Burns to do you-know-what with his “giftie” and to be careful what he prays for.
Nevertheless, the giftie to which Burns refers is undeniably a developmental achievement even though using it involves a lifelong internal struggle, a struggle that includes those times you would like to return the giftie to the store for an exchange. But, irony aside, it may be the most valuable gift that any human being will ever receive—the gift of intersubjectivity.
When you are able to see yourself as others see you, while not dissociating from the experience of how you see yourself, you are relating intersubjectively. The problem is that a human being’s ability to relate intersubjectively is variable, uneven, and sometimes requires what feels like having to stare at sunspots. For anyone, seeing oneself through another’s eyes can become too stressful. Why? Because the other’s view may feel too starkly discrepant with one’s ongoing self-experience at the moment for both views to be held in mind simultaneously. When such is the case, the mind is geared to ease such stress by the defensive use of a normal brain process—dissociation. We are accustomed to thinking of dissociation as triggered by internal cues, but in fact the signal initiating the process typically comes from an “other,” no matter whether the other is another person or another part of self. Regardless, overly disjunctive self-experiences are then adaptationally held in separate self-states that do not communicate with each other, at least for a while.
For some people, “for a while” means briefly; for others it means a very long while or even permanently. For people in the latter group, dissociation is not just a mental process to deal with the routine stress of a given moment but a structure that rules life itself by narrowing the range in which it can be lived. The mind/brain organizes its self-states as an anticipatory protective system that tries, proactively, to shut down experiential access to self-states that are disjunctive with the dissociatively limited range of the state that is experienced as “me” at a given moment. This rigid sequestering of self-states by means of dissociative mental structure is so central to the personality of some people that it shapes virtually all mental functioning, while for others its range is more limited. But regardless of degree or range, its evolutionary function is to assure survival of self-continuity by limiting reflective function to a minor role, if any. The mind/brain, by severely limiting the participation of reflective cognitive judgment, leaves the limbic system more or less free to use itself as a “dedicated line” that functions as what van der Kolk (1995) calls a “smoke detector.” It is designed to “detect” potentially unanticipated events that could trigger affect dysregulation.
Because it is a proactive solution, the diminished capacity for cognitive self-reflection in favor of an automatized emphasis on safety comes with a price. It requires the person to, at best, “smuggle in” a life that is secondary to a process of constant vigilance—a vigilance that, ironically, mostly produces what information theory calls “false positives.” It might seem that, if such is the case, the person would sooner or later figure out that there is a connection between something being wrong with his life and the fact that he spends most of it waiting for something bad to happen. The reason a person tends not to make that connection is that the dissociative structure is itself designed to operate out of cognitive awareness. Each state holds a relatively non-negotiable affective “truth” that is supported by its self-selected array of “evidence” designed to bolster its own insulated version of reality. If the person tries to reflect on the question, “Why am I living my life this way?” the potential for an internally destabilizing affective collision between incompatible versions of personal reality is triggered. Even to formulate such a question is a threat to the integrity of the dissociative mental structure that, to the mind/brain, is the only reliable safeguard against affective chaos. Nevertheless, the question is asked at least indirectly, often out of desperation. Sometimes it leads the person to seek out a therapist, albeit with certain parts of the self denouncing the idea so ferociously that, by the time he arrives at your office, he may not be able to tell you why he is there.
Once in treatment, the fact that he or she is “of more than one mind” about being there leads to the enacted emergence of another question—and the ongoing struggle over allowing it to be put into words might be said to shape the entire course of the therapy. Implicitly, this second question might be seen as: To what extent is the protection against potential trauma worth the price paid for it? Initially, the question is played out in the form of an internal dispute among a patient’s panoply of self-states, some championing affective safety, others endorsing what is life-enhancing even if it involves risk. This self-state war pulls the therapist/patient relationship into it, thus giving them a chance to participate enactively in a here-and-now externalization of the patient’s fraught relationship with his own internal objects.
Shrinking the Tsunami
Enactment is a shared dissociative event. It is an unconscious communication process that reflects those areas of the patient’s self-experience where trauma (whether developmental or adult-onset) has to one degree or another compromised the capacity for affect regulation in a relational context and thus compromised self-development at the level of symbolic processing by thought and language.2 Therefore, a core dimension of using enactment therapeutically is to increase competency in regulating affective states. Increasing competency requires that the analytic relationship become a place that supports risk and safety simultaneously—a relationship that allows the painful reliving of early trauma, without the reliving being just a blind repetition of the past. It is, optimally, a relationship that I have described as “safe but not too safe” (Bromberg, 2006a, pp. 153–202), by which I mean that the analyst is communicating both his ongoing concern for his patient’s affective safety and his commitment to the value of the inevitably painful process of reliving.
Fine phrases, but I am not the patient. For a trauma survivor, “safe but not too safe” initially has no meaning because relative safety as an experience has no meaning as subjective reality. For the trauma survivor, the shadow of the tsunami looms. Indeed, when I speak of “safe but not too safe” I am aware of a part of me that holds an unspoken sense of apology that is not dissimilar to what I felt when I came up with the title “Shrinking the Tsunami.” I am pretty sure that if I had personally experienced an actual tsunami, close up, I would not have been able to use that word figuratively in my title. It would have hit too close to home. For a trauma survivor, language holds the potential to trigger an affective reliving of dissociated traumatic experience. By contrast, I was as free to play with the word tsunami as I was to play with the word shrink. In therapy, the growing ability to play safely with something that has so far existed only as a dissociated shadow of past trauma is what I mean by “shrinking the tsunami” and is what the rest of this book is mainly about.
I shall describe how, through interactions that constitute “safe surprises” (Bromberg, 2003b), a patient’s ability to emotionally distinguish nontraumatic spontaneity from potential trauma (the shadow of the flood) is increased. I shall address here the transformation in analytic treatment of unthinkable “not-me” self-states into enacted here-and-now events that, in the form of safe surprises, can be played with interpersonally, compared with the analyst’s subjective experience of the same event, and become part of the patient’s overarching configuration of “me.”
I offer the view that the transformative process of shrinking the tsunami not only leads to a greater capacity for affect regulation, but also is fundamental to the core of the growth process in psychotherapy, which for me has never been better described than by Ronald Laing (1967) in his phrase, “an obstinate attempt of two people to recover the wholeness of being human through the relationship between them” (p. 53).
The foundation of this growth process is an analytic situation that permits collisions between subjectivities to be negotiated. The negotiation takes place through the creation of a shared mental state— a channel of implicit communication that supports what Buck (1994) calls a conversation between limbic systems (cited in Schore, 2003a, p. 276)—amounting to nothing less than the cocreation of a relational unconscious that belongs to both persons but to neither alone. The patient/analyst relationship becomes a therapeutic environment to the extent that the boundary between self and other becomes increasingly permeable.3
When I speak of the traumatic past of the patient being played out, the concept of play, as I use it here, is similar to what Philip Ringstrom (2001, 2007a) calls improvisation. It is a form of play in which the mutual recognition of each other’s subjectivity is, in Ringstrom’s terms, more implicitly played with than explicitly enunciated. His point overlaps with my concept of collision and negotiation (Bromberg, 2006a, pp. 85–150) and with Schore’s (2003a) concept of state-sharing (pp. 94–97), but Ringstrom (2007b) underlines something additional that is worth repeating: “Improvisation often entails playing with the other as an object [because] when the two parties can play with one another as objects they intrinsically reveal something about themselves as subjects.” This is especially important because the collision part of what I call the process of collision and negotiation is, indeed, all about the developing capacity of patient and analyst to move from experiencing the other as an object to control or be controlled by, to being able to play with each other (although at first as objects). I believe it is this meaning of play that makes possible the negotiation that then leads to intersubjectivity—experiencing each other as subject.
For instance: I am committed to the value of the analyst’s sharing with his patient his subjective experience of the relationship itself— including the details of his states of mind and his awareness of the shifts in mind/body experience that take place during a session. In my writing I have made a point of the importance of communicating to the patient one’s personal concern with the effect on her of what one is doing, including the effect of the sharing, so that your patient knows you are thinking about her affective safety while you are “doing your job.” Do I always remember to do that? No. Do I hear about it when I don’t? Frequently! Do I like hearing about it? Not especially. But the more I can accept my patient’s “giftie” of seeing myself through her eyes (especially those aspects of self I had been dissociating), the easier it becomes for my patient to negotiate the transition from experiencing me as an object to control or be controlled by, to experiencing me as a person who is committed to recognizing her subjectivity even though I am doing it badly at a given moment.
Alicia
Let me tell you about a session in which such a moment of transition was particularly vivid. Alicia was a woman who had achieved fame, financial success, and critical acclaim as a novelist but lived as a recluse. At the time she became my patient I had been a fan of Alicia’s writing for many years and was also familiar with her well-known reputation for social isolation. What I was still to find out, however, was that her reclusiveness hid a shocking inability to engage in authentic discourse with another human being, a truly bewildering incapacity for authentic interpersonal communication. As an author, Alicia described social interactions with penetrating wit, sophistication, and a flair for the deliciously unexpected. The characters in her novels were clearly crafted by a mind that understood the complexity of human relationships, but, as I was to find out both from her and with her, in the few social interactions she could not escape (she of course refused book tours), it was an open secret that the very qualities that made reading her books such a delight, existed in face-to-face encounters only in their opposite form.
The early phase of our work was not easy for me. It was confusing and frustrating, and, because I had eagerly anticipated being with the stimulating person I knew through her writing, I also lived with a partly dissociated experience of disappointment—almost as if someone else had written Alicia’s novels and I would never get to know her. In our relationship her personality was characterized by an unimaginative concreteness that informed everything she said, although she did not come across as unintelligent, nor did her literalness appear to stem from depression. The one-dimensional quality of her thinking and mode of relatedness was, as she herself put it, “just the way I am around people.” It was not too difficult to recognize that her self-state as a writer was dramatically dissociated from her self-state “around people,” though early on there was no clear route to addressing the discrepancy without both making her self-conscious and heightening her concreteness. Which is to say, early on there was no clear route to free ourselves from what was being enacted.
Over time, the processing of enactment began to play an increasingly greater role in our work, and slowly the dissociative gap between her disparate self-states lessened. It became easier to recognize the presence of the “writer” in the way Alicia talked about herself in sessions even though the qualities of wit and playfulness that were so evident in her writing remained minimal in our direct interactions. Nevertheless, I found the change that was taking place so heartening that I told myself that the increase in coherence across her self-states was more stable than it was—and I got lazy.
In the session I describe here—a “moment of transition”—Alicia and I were once again participating in our enactment. As I had often done in the past, I shared with her my experience that something was feeling affectively “off”—something felt discrepant with what was being spoken in words. But unlike similar moments in which I had been careful to inquire about the impact of sharing my state of mind, this time I did not attempt to find out from each of Alicia’s separate self-states what effect my act of self-revelation had on each. Even in the moment, I was slightly aware that part of the reason for my laziness was that I had been yearning for a chance to have a stimulating conversation with one of my favorite authors, and I was hoping to create the occasion by unilaterally deciding that she no longer needed me to treat her as if she was “just” a patient. As I ended my self-disclosure and readied myself for the hoped-for pleasure of a creative negotiation of our respective experiences, she replied with just a single sentence—a “one-liner” that was more than I could ever have hoped for. Alicia looked at me with a twinkle in one eye and a glare in the other and said, “I think you are starting to have delusions of candor.” I broke up in laughter and so did she. There it was—spontaneity, wit, and feisty playfulness—emerging in a way that belonged to neither of us alone. It belonged to the joint creation of a relational unconscious that became infused with a life of its own—a joint creation that allowed my concept of “standing in the spaces” to become embodied as a physical (see Ogden et al., 2006) and interpersonal reality, a conjunction that invited us to play together with what was in both of her eyes, her twinkling eye and her glaring eye.
There is little doubt that this transition out of enactment, or rather through it, facilitated a power...
