Whole Therapist, Whole Patient
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Whole Therapist, Whole Patient

Integrating Reich, Masterson, and Jung in Modern Psychotherapy

Patricia R. Frisch

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eBook - ePub

Whole Therapist, Whole Patient

Integrating Reich, Masterson, and Jung in Modern Psychotherapy

Patricia R. Frisch

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About This Book

Integrating the work of Reich, Masterson, and Jung, Whole Therapist, Whole Patient is a step-by-step guidebook for professionals to learn about the psychology of their patients and conduct treatment in a dynamic way. This text combines Reich's character analyses, Masterson's work on personality disorders, and Jung's dream analyses to create a clear typology of character types that therapists can use to understand themselves and their patients. Also included are case management techniques and guidance for working with difficult patients. In addition, readers can turn to the book's online resources to access a downloadable patient package, case presentation guide, and psychological history form.

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Information

Publisher
Routledge
Year
2018
ISBN
9781351334662

Part I

Reich’s Influence

Introduction

Purpose of My Guidebook

As a psychologist in private practice for over 40 years, I have the honor of being with people through their tumultuous conflicts, the steady ebb and flow of their feelings, memories, and experiences as they examine their lives and try to guide their own ship. There are intervals of accomplishment, satisfaction, resolution, and creativity in the therapeutic process. As well as times when my office is filled with jagged emotions of conflict, pain, fear, and grief for what was and what is. Psychotherapy is heartfelt and soulful work.
It can be extremely challenging when patients come in with their built-in, tried-and-true character styles that are no longer working for them. They haven’t had the opportunity or they haven’t been ready to look honestly at how they relate and behave. They do not know another way to be. Sometimes they lack an intention to actually change, although they do demand to feel better. As psychotherapists, we do our best to be the clearinghouse for their mind’s roiling perceptions and try to help make order out of chaotic thoughts, fears, and concerns.
We can feel a myriad of reactions to the process—anything from complacency about our skill level to disappointment that we can’t do more to insecurity when patients stop therapy on a dime after a few sessions or longer and we wonder what we did wrong that this patient ran out the door. We can experience boredom, impatience, and restlessness; we can feel strain if we feel devalued, insulted, or attacked. We may be kept up at night with fear for a patient in crisis, or unable to clear our own roiling mix up of images that bang around in the middle of the night.
It is a profession fraught with shadowy times as well as sweet successes that feel warmly satisfying. It is also a profession that grows us up from within as we hold the impossible while trying to metabolize unthinkable situations—the contorted distortions of human life. Relationships are created that dig as deep as the old, dank, gnarled roots of a tree. Our patients know us as they learn how to know themselves more and more. These therapeutic relationships develop over time and have their fair share of conflicts, disappointments, and potential ruptures that may bring the existence of the relationship to the edge of the abyss. Who knew, when the therapy began, where it would wind its way? Therapeutic relationships have a life of their own. The therapist, in the process of learning to be effective, matures, settles, and becomes whole in the process of good work. The patient also is demanded to grow, to stretch far beyond what he thought was possible—entering dark terrain and coming out the other side, he too becomes whole. Therapy moves beyond personal history and pathology to become an opportunity for transformation and individuation. Thus, therapy engenders the archetype of the mandala as both therapist and patient achieve wholeness through the rigors of the process.
The therapist needs a capacity for fierceness. Patients will trample us as they do others, and we are the ones who have to be clear, neutral, and intolerant of abusive attitudes and behaviors. We draw the line in the sand and patients learn not to cross it. Support is one aspect of treatment; fierceness and courage are other necessary qualities to be developed in the therapist.
I decided to write this guidebook as a way to speak directly to therapists and impart definitive trail posts to the unwieldy path of psychotherapy. I have supervised psychotherapists for many years in many contexts. I have taught interns to work with inmates and correctional officers at San Quentin State Prison. I have guided students at their practicum and intern placement sites. In 2000 I formed the Orgonomic Institute of Northern California (OINC) with Richard Blasband, MD, an original founding member of the College of Orgonomy (ACO) founded by Elsworth Baker, MD, at the request of Wilhelm Reich. OINC was established to teach the theories and mind/body approach of Wilhelm Reich, MD. As the training program evolved, I acquired the institute and expanded the model, integrating other theorists, which led to the creation of my own particular approach and method. Through the institute, I teach character analysis and biophysical interventions (Reich’s verbal and somatic therapy model), while expanding on specific elements that update the theory. I accredit therapists in this modality called Orgonomy. My live training program and independent study modules provide a comprehensive method of doing therapy that is applicable to psychotherapists whether they are beginning students or mature professionals.

Why Wilhelm Reich

Why Wilhelm Reich? I came to psychology through the avenue of dance and philosophy. I was always interested in the realm of ideas, European and Asian philosophy, and religion. While inhabiting my philosophical head, I also lived in my body through dance. I danced early in my life in Los Angeles, learning jazz dance with some of the great master choreographers of Hollywood musicals. In college in San Francisco, I continued to dance in the plentiful modern dance venues, as well as African and jazz classes offered in the city. After I graduated from San Francisco State University, I returned to Hollywood and danced with a modern ballet troupe for more than five years, performing locally and in New York City. I lived and breathed physical/emotional expression through dance. Later I taught a variety of movement and dance classes and became interested in how we can live more in our bodies. That track, mixed with important spiritual seeking at that time, led me back to college to get my master’s degree in psychology. I later completed my PhD and sat for my psychologist license.
My experience as a dancer immersed me in an exquisite form of expression that merged body and mind into one. Then I took those skills to become a trainer in the holistic mind/body/spirit program of Arica. Conducting movement exercises with participants to introduce them to their bodies and psychic makeup was the beginning of my trajectory in psychology. Although the path of psychology captured me, I never lost my connection to the importance of physical expression. This deeply felt understanding of mind-body experience soon guided me to the founder of classical somatic therapy, Wilhelm Reich.
Reich’s contribution to the field of psychiatry, medicine, and science is panoramic. Trained as a psychoanalyst in the Freudian community in Austria in the late 19th century, he later formulated his own unique form of therapy. He rejected the analytic passive approach as ineffective when defenses are left intact. He engaged the patient’s defensive structure in a radically different way. This method was known as character analysis and is still a highly respected theory. As Reich’s thinking evolved, his investigations in science and medicine led him to include a biophysical aspect to his treatment protocol. He discovered an energetic component that he applied to psychotherapy years before the current acceptance of energetic concepts. He understood that mind and body are indivisible, one functional unit, and it was imperative to treat the whole person. He created a theoretical platform that resulted in an efficient, effective therapeutic approach that included direct biophysical interventions and expressive exercises.
Reich was a controversial figure in his time. He challenged the orthodoxy with his radical ideas in many areas beyond psychotherapy. Yet it was his rambunctious personality that infused his approach with a fearlessness that allowed for creativity and spontaneity in the room with patients. Out-of-the-box interventions that are methodical in relation to the system, yet inspire a freedom to speak honestly to the patient, come from Reich’s profound understanding of defensive structures and how they block aliveness and authentic access.

My Method—Additional Character Types

Wilhelm Reich’s theories have an overarching influence on my approach. Of course, as a mature therapist, I utilize many colors on my palette. As I worked with Reich’s character typology that developed within the Freudian analytic period in the history of psychiatry and psychoanalysis, Oedipal issues held central sway. Later, object relations theorists researched important earlier developmental passages and attachment issues were integrated into the developmental paradigm of health and psychopathy. I felt Reich’s typology of character types was incomplete as it relied almost exclusively on the Oedipal pathway. So I incorporated, with the help of the brilliant work of James Masterson, MD, and the Masterson Institute theorists, additional character types or personality disorders originating from earlier stages of developmental arrest. That filled out, updated, and made complete the system of character types.
As psychodynamic therapists we also need tools to investigate the unconscious.
Orgonomy includes dream analysis. Carl Jung, MD, was a master of that sphere and his dream theory is invaluable to the therapist. Dreams are a way we can enter the deepest world of the patient’s unconscious and hear the guidance the dream offers. Jung and his concept of the individuated self guide us in treating the final years of life; therapy makes possible a metamorphosis from small ego to spirit. Jung’s theories and specific instructions in dream analysis are discussed in the online resource section “Dream Analysis and Individuation.”
So the spectrum of my method spans in utero to death in the sense that there is a full tool chest within my method to handle the entire scope of a life.
One of the most important tenets of this guidebook is know and understand your patient. That does not mean know her story nor does it mean know her problematic symptoms. It means delineate the basic structure of how the patient is. Then you have a road map that can address that particular structure in a systematic way. You are not walking in the dark, but rather have clear light to see and effect change. That excites me and I want to impart this systematic approach to you.
Understanding the patient goes beyond the structure of the psyche to include understanding how the patient manifests that structure in his physical body. Reich called this body armor, the way energy moves or is held back in the physical structure. How that very immobility or stasis creates the personality or character armor. How blockage in the eyes, the ocular segment, affects the contact the patient makes in the world. How the longing in the mouth, the oral segment, creates habits of overeating, substance abuse, or overtalking and therefore driving potentially debilitating habits.
The system I teach gives you tools to see character and body armor, and gives you schematics to treat your patient. Then you have a map of the terrain and your interventions make sense. Ultimately, if you choose to add biophysical interventions to your tool kit you can learn that modality directly from my institute. That modality takes specific skill development. Understanding the biophysical segmental armoring patterns as defined here will allow biophysical interventions that are feasible within the context of verbal analysis.
This book is full of nuts-and-bolts suggestions, with clear, concise instructions and protocols to inspire therapists and challenge their style. I will give step-by-step guidelines from the first patient phone call, to stages of treatment, to the business of therapy. Most importantly I will teach you how to dismantle the patient’s defensive structure that is preliminarily in the way of deepening to the innermost feelings that need to be understood and released. I will utilize camouflaged patient examples as well as training vignettes to help illuminate our discussion. Working with trauma, abandonment depression, and termination are thoroughly covered in the online resource section “Progression into Trauma.”
After graduate school and internships and licensure, there is not, necessarily, a clear-cut path of how to actually do therapy and locate the effective strategies or dangerous pitfalls. There are treacherous inclines on this path. With this book you can come away with tools to help you begin.

1 History of Wilhelm Reich

The Approach in Practice

In my 36 years of practice as a psychologist, I have seen hundreds of patients transform their lives through mind-body therapy. Patients enter my practice sometimes at the end of the line, after trying multiple clinical approaches yet still feeling frustrated that their symptoms and difficulties remain. Involving the body alongside the verbal therapy makes the difference. We can understand our life stories, we can discuss events that led to our difficulties, we can explain our current challenges, but cognitive recognition and verbalization is not sufficient to effect change.
The body has an expression; it may want to cry deeply with abandon, kick vigorously as it expresses pent-up frustration, anger, and rage or weep and reach out with tender feelings. Nothing is more relieving than to thoroughly express what you actually feel in a safe setting. But we learn, depending on our personal history and culture, to stymie emotional expression, hold it back with gritted teeth, a rigid jaw, a squeezed throat, and a compressed chest resulting in a loss of capacity to breathe fully. Our habitual repression creates chronic pain, physical stress, and disease in our body and we can become physically ill as a form of unconscious expression. Authentic emotional expression with fluidity of movement is impossible due to our taut and tensely woven bodies. I fortunately found a system of therapeutic interventions that soften the body and the mind, making it pliable, healthy, and responsive—with the goal of teaching patients their lost art of self-expression and authentic living.
Wilhelm Reich, MD, defined health as the capacity to be flexible and nondefensive with ease of expression of authentic feeling both emotionally and sexually. His innovative thinking, still cutting edge in our time, offered me an approach that engendered a complete and whole pathway to mental health with a mind-body orientation.
I have worked with multitudes of men who were never allowed to cry, had constricted voices, stiff chests, and rigid personalities. Through our therapy, they learned to express long-held pain and grief that had been bound-up throughout their lifetimes. This allowed them to be emotionally vulnerable and available within their family relationships. I have worked with many women with traumatic histories, burdened with physical symptoms: irritable bowel, chronic headaches, and tight painful muscles. They became comfortable expressing pent-up feelings of anger and fear as they unlocked painful memories and relieved their sore bodies of its chronic pain.
Most psychotherapists are not trained to work with the body. Reich taught a comprehensive method that addressed the personality structure and how it manifests in body type. With an organized and systematic approach, the clinician can treat the body along with the character problems that result in serious challenges. I had found my niche and have been developing Reich’s platform into my own method since graduate school.
In this book I will invite you into my method and my therapy practice and help you discover my Whole Therapist/Whole Patient process. This process incorporates the work of Wilhelm Reich, James Masterson, Carl Jung, and my own unique experience as a therapist, teacher, mother, wife, and human.

History of Reich and Development of His Theories

Wilhelm Reich’s clinical approach laid critical groundwork for my method. Throughout his life he pursued a broad spectrum of scientific inquiry and wrote on a wealth of topics, including biology, family practices, weather patterns, politics, and society, but we will address only his relevant clinical ideas. I will explain his history and how his life and theoretical development progressed.
The vast majority of Reich’s lines of inquiry, research results, and contributions are quite relevant and applicable to today’s scientific conversations and therapeutic formulations. Here I will bring aspects of Reich’s clinical theoretical conceptualization into contemporary psychological application. And I will simplify Reich’s vast clinical theoretical bounty so that specific aspects are accessible and useful to the contemporary therapist.
Reich was a product of his times. It is the context of the times, and the initial influence of his mentor Sigmund Freud, that oriented his view and defined for him the driving forces and critical phases of human development. I have altered that orientation to be compatible with my clinical experience. In my opinion, Reich overemphasized the Oedipal complex and childhood development seen solely through the lens of sexual development. This emphasis, with its strict gender roles and binary gender assumptions, precluded an understanding of flexible family models that include shifts in gender identity and expression. I have added this viewpoint to the conversation. I have eliminated some assumptions from his model, kept others, and added the earliest attachment developmental phases that are clinically and pragmatically relevant to my understanding of our patients. In other words, I picked and chose elements of Reich’s theories that make sense to me while keeping the integrity of his contribution.
In-depth research has continued into the causes of psychological difficulties. The complex interplay of forces that influence our psychological condition include genetic contributions, family systems, and external circumstances. There is also extensive research on attachment theory, which is a strong factor. I have expanded on Reich’s character types by utilizing attachment theory to delineate earlier developmental passages that mark specific additional character types. These earlier development phases are critical and expand on Reich’s emphasis that was singularly focused on Oedipal phases and development of sexuality. I give these details so you can understand the historical context and the etiology of Reich’s thinking and to shed light on why I expanded on that paradigm to include significant additions to his character typology, an expanded perspective on nontraditional family systems including gender fluidity, and added Carl Jung’s quintessential contribution to dream analysis.
I will explain Reich’s mind-body formulation without much change in the basics although I add my own twist. The model of adding bodywork to analysis is as applicable and innovative today as it was when he created it. To this day, and to our detriment, the mind is separated from the body in the vast majority of psychiatric and psychological therapeutic approaches (excepting the use of drugs). The medical establishment’s emphasis on psychogenic drugs is the standard traditional approach to mental illness. I have been consistently able to titrate patients off medications using the biophysical work along with character analysis. The whole modality has strong ameliorative impacts on patients’ physiological symptoms.
Wilhelm Reich developed Orgonomy in the 1930s. He was born in 1897, in Galicia, now the Ukraine, then included in the Austro-Hungarian ...

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