Self Experiences in Group, Revisited

Affective Attachments, Intersubjective Regulations, and Human Understanding

Irene Harwood, Walter Stone, Malcolm Pines, Irene Harwood, Walter Stone, Malcolm Pines

• Publisher: Routledge
• Year: 2012
• Print ISBN: 9780415899451
• eBook ISBN: 9781136314551
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Since the publication of Self Experiences in Group in 1998—the first book to apply self psychology and intersubjectivity to group work—there have been tremendous advancements in the areas of affect, attachment, infant research, intersubjective regulation, motivational theory, neurobiology, philosophy, somatic understanding, and trauma.

Carefully edited by Irene Harwood, Walter Stone, and Malcolm Pines, Self Experiences in Group, Revisited is a completely revised and updated application of self-psychological and intersubjective perspectives to couples, family, and group work, incorporating many of these recent findings and theories of the past decade. Divided into five sections, the contributors take an updated approach to the prenate and neonate in group; couples and the family in group; group theory, technique, and application; working with trauma; and group processes and artistic applications.

Throughout, the reader is engaged in affectively understanding what is experienced by individuals in the regulation and dysregulation of self as part of the interpersonal relating, learning, and change that can occur in groups.

Contributors: Mary Dluhy, Barbara Feld, Darryl Feldman, Vivian Gold, Irene Harwood, Gloria Batkin Kahn, Joseph Lichtenberg, Louisa Livingston, Marty Livingston, Jane van Loon, Judy McLaughlin-Ryan, Malcolm Pines, John Schlapobersky, Robert Schulte, Rosemary Segalla, Emanuel Shapiro, Walter Stone, Paula Thomson

Part I

The Prenate and Neonate in Group

1 Shared Experiences

The Prenatal Relational Model and Group Process

Paula Thomson

It is said that the present is pregnant with the future.

Voltaire

Self experiences are fundamentally experiences embedded within micro-and macro-cultural contexts (Pines, 1998). Many theoreticians have described the intersubjective existence of self (Beebe & Lachmann, 2002; Kohut, 1984, 1985; Stern, 2004; Stolorow, 1992, 2002; Winnicott, 1971), and all these theoreticians situate the self in a relational field that includes the earliest dyadic relationship of mother and infant and the healing relationship of analyst and analysand. Karterud (1998) moves beyond this notion of personal self; he describes a “group self,” one that is intertwined with a group and personal self. This group self contains the essential elements of self as described by Kohut (1984) (purpose and needs, “thrown” into a particular place and time, ambitions and ideals, and self-reflective). Harwood (1998a) elaborates on this group self and suggests that we view the self from a “wide angle lens which could focus on a wider panoramic view of the person within the larger environment” (p. 155). The understanding that self is embedded within a larger group and that the group participates in the intrapsychic structuring of self-objects are essential concepts for group self psychologists.

Attempts to define and understand the origins and structures of the self can be found in the earliest writings of philosophers and theologians, and now psychologists and neurobiologists. Typically, these explorations begin with the newborn—an unformed self that begins its journey in the dyadic interactions between mother and infant. What is commonly stated is that the neonate “is born with certain potentials that are his biological heritage. However, it is interactions with the environment that will evoke some of the potentials and bring them into development, whereas others are left to atrophy or may even be destroyed” (Wolf, 1988, p. 32). The examination of the intrapsychic structuring of the self starts the moment the newborn engages with selfobjects in the external world. Only recently have researchers turned to an earlier point of time in development. This new field of research examines a prenatal self that is shaped by the epigenetic interaction of genes and external intersubjective experiences. A growing body of research is now demonstrating the powerful effects of external events on intrauterine development (Barker, 2002; Barker & Lackland, 2003). During prenatal development you live in two worlds: the world of your mother and the world into which you are born (Hall, 2007). As a result, both mother and prenate (a term that includes embryonic and fetal development) share experiences of the maternal intra-and intersubjective worlds; the prenate self has already begun interacting with selfobjects that are structuring a self.

This concordant relationship between mother and prenate is the subject of this chapter and the bedrock for a prenatal relational therapeutic model (Thomson, 2007). It is posited that when pregnant mothers are guided towards greater self-regulation, the mother and her prenate will move towards greater emotional and physiological stability. With maternal regulatory stability, the prenate has an opportunity to develop optimally. According to Allan Schore (1994), the psychoneurobiological development of self-regulation facilitates the origin of the self. Further, the experience-dependent formation of the self not only begins from the moment of conception but is also the foundation of our intersubjectivity, our group self. Group therapy, especially group therapy that is psychoanalytically rooted in intersubjective and self psychology, may provide treatment opportunities that can enhance prenatal development and foster empathic awareness of prenatal lived experiences. Such an approach can build on the existing model of infant group therapy (Harwood, 1998b). It can situate the pregnant woman within a culture that is sensitive to her psychological and physical needs and can offer a shared experience with others, an experience that will be “felt” by her developing offspring. The first 9 months do shape the rest of our lives (Paul, 2010), and it is now time to include this phase of development into psychoanalytic awareness.

This chapter will outline how maternal–prenate shared experiences shape the trajectory of health and well-being in the life of the offspring. In this chapter, therapeutic focus will be given to prenatal maternal stress. Ultimately, clinicians treat, support, and provide therapeutic interventions for the mother and her developing offspring, since it is always a relational field during this formative gestational period (Field, 2001; Ponirakis, Susman, & Stifer, 1998). This in utero experience is the earliest form of a group self (Karterud, 1998); it moves beyond the traditional dyadic self of the infant and caregiver and incorporates the entire cultural ambience of the pregnant woman and her offspring. These prenatal experiences travel with us throughout our lives, and yet little psychoanalytic attention is given to these early self-structuring experiences, whether in individual or group treatment settings.

Prenatal Programming

Programming has been described as the physiological “setting” by an early stimulus or insult at a “sensitive period,” resulting in long-term consequences of function, a phenomenon referred to as critical period programming (Young, 2002). According to Davis and Norman (2002), the result of a positive or negative stimulus at a critical period sets in motion “the process of programming through the induction, deletion, or impaired development of a permanent somatic structure” (p. 386). Prenatal programming is now understood to be an epigenetic response that interacts with the external world of the mother, the mother’s responses to this world, and the prenate’s genetic inheritance; it prepares the prenate for psychophysiological survival during postnatal development (Miller, 2010). This programming shapes the self of the prenate so that postnatally it can mobilize needs, intentions, and ambitions that are congruent to its anticipated future self; it provides a psychobiological base for self-reflection, self-regulation, and self-cohesion.

Several theories have been developed to describe the early programming effects of in utero development. The Barker hypothesis (Barker, 2002; Barker & Lackland, 2003), originally called the thrifty phenotype hypothesis, is one of the most significant theories examined today. In this hypothesis, Barker proposed that if a growing fetus is malnourished, it will adopt several strategies to maximize its chance of postnatal survival. First, it selectively distributes nutrients to alter relative growth rates of different organs. For example, brain growth is preserved at the expense of other organs such as liver, pancreas, kidneys, and muscles. Second, metabolic programming is established during prenatal development. As a result, metabolic changes in the offspring take place to increase its chance of survival, especially in conditions of postnatal impoverishment, including a lack of nutritional resources or positive selfobject experiences. Despite the increased chances of postnatal survival, these adaptations are ultimately detrimental to the health of the offspring (in terms of compromised longevity and increased morbidity). For example, if the offspring is born into conditions that contradict the environmental deprivations of prenate life, the increased postnatal nutritional resources will move the offspring towards a lifetime of obesity since these conditions now contradict the prenatal programming that anticipated an environment of deprivation (Ozanne & Hales, 2002).

The predictive adaptive response (PAR) theory suggests that a “survival phenotype” acts to improve fitness in order to successfully achieve adulthood and reproductive life (Rickard & Lummaa, 2007). The PAR model posits that a developing prenate makes permanent changes to aspects of its physiology and anatomy that will prove advantageous in a predicted future environment. These developmental adaptations are a form of human plasticity; however, the adaptations are made on the basis of an anticipated future. But when the environmental future is substantially contrary to the prenatal environment, permanent accommodations may lead to profound alterations in morbidity and mortality. Consequently, the benefits of prenatal programming may become a severe cost to the adult individual. The gestational group self that formed may not be adequately prepared for a future that changed significantly from prenatal conditions. However, if the living conditions remain unchanged, then predicted adaptive responses of the offspring optimize species survival and these alterations will be transmitted to future generations (Cameron et al., 2005; Davis & Norman, 2002). The inherent constraints of the adaptive markers, such as increased mortality and morbidity, will not compromise sexual maturation and procreation; thus, the “group self” is fit to adaptively interact in the predicted future environment, and these adaptations guarantee that future offspring will be born and the cultural group will persist (Rickard & Lummaa, 2007).

Maternal Stress and Prenatal Stress-Response Programming

According to Luo et al. (2006), it is formidably difficult, if not impossible, to recover any birth defects in postnatal life. This awareness has been present since antiquity and yet it is only recently that a causal relationship between early prenatal life experiences and later risk of disease and psychopathology has come to light (p. 39). Multiple sources of maternal stress can negatively influence prenate development. For example, maternal physical illness, defined as an “interoceptive” stress response, and psychological stress (also known as neurotropic stress), defined as “exteroceptive” stress, threaten maternal and fetal dynamic homeostasis (Porges, 2001, 2004). Both maternal interoceptive and maternal exteroceptive stress shape the formation of prenate conditioned stress responses, since both activate the hypothalamic–pituitary–adrenal (HPA) axis, sensory cortex, prefrontal cortex, insula, hippocampus, amygdala, and autonomic nervous system of the prenate (McDougall, Widdop, & Lawrence, 2005). For example, if a pregnant woman is exposed to a hostile environment that requires increased vigilance, then the stress signal is transmitted to the fetus and programs a reduction in negative feedback in the fetal HPA stress axis (DiPietro, Hilton, Hawkins, Costigan, & Pressman, 2002c; Matthews, 2002). This stress axis engages threat-response behaviors in the prenate, and with repeated engagement of these defensive behaviors, heightened stress responses, including increased outwardly directed vigilance behavior, will be established in the prenate (Rickard & Lummaa, 2007; Thomson, 2004, 2007).

Chronic maternal and prenate stress has a cascading negative outcome, including placental insufficiency, gestational hypertension/pre-eclampsia, premature birth, and small size for gestational age in the fetus (Luo et al., 2006). Such stress conditions inevitably result in adult diseases such as metabolic and mitochondria-related pathologies, type 2 diabetes, and cardiovascular disease, diseases that may be related to prenatal programming of oxidative stress. Oxidative stress is linked to a modulation of gene expression; solid evidence demonstrates that maternal oxidative stress responses are transferred directly to the fetus (Luo et al., 2006). Oxidative stress is also related to increased programmed cell death (Plas & Thompson, 2002) and altered mitochondrial energy production. Without optimal mitochondrial functioning, the offspring will be vulnerable to multiple systems dysregulation and a failure to dynamically maintain homeostasis (Manoli et al., 2007). These multiple adaptations structure the prenate self; a psyche-soma self is constructed in preparation for a future that is fraught with challenges. Sadly, the prenate has already experienced self-fragmentation. The chronic stress of negative prenate selfobject experiences has shifted the prenate self-orientation towards a world of threat and stress. These early prenate metabolic demands have now compromised future metabolic energy resources in the developing self. The likelihood of postnatal developmental self-fragmentation experiences is now increased (Glynn, Wadhwa, & Sandman, 2000).

Chronic poverty is significantly linked to negative fetal and child development (National Institute of Child Health and Human Development, 2005). And depression increases with more adverse life circumstances, especially during pregnancy, and is associated with poorer fetal development (Field, 2001; Field et al., 2004). Further, maternal prenatal psychological stress has a greater negative influence on fetal development than does physical stress (Keenan, Sheffield, & Boeldt, 2007). Maternal anxiety, especially in high-risk pregnancies, increases risk for premature births or fetal growth retardation (Brisch et al., 2002), and maternal post-traumatic stress disorder (PTSD) has been linked to compromised fetal cortisol, increasing later risk for developing PTSD in the offspring (Yehuda et al., 2005). Prenatal exposure to cocaine increases infant dysregulation (Schuetze, Eiden, & Coles, 2007), and cumulative environmental risks (maternal psychopathology, poor nutrition, low socioeconomic status, overcrowding), coupled with substance exposure during fetal development, increase the offspring’s vulnerability for pathology later in life, especially poorer cognitive and emotional development (Yumoto, Jacobson, & Jacobson, 2008). Psychopharmacology during pregnancy (antipsychotic and antidepressants) increases the risk for poor fetal organ development (the liver may not be able to handle the toxicity; Casper et al., 2003), including maternal methadone administration (Jansson, DiPietro, & Elko, 2005). For some women, eating disorders increase during pregnancy (Thomson, 2007), which further compromises fetal development.

Maternal stress during pregnancy influences the offspring’s reproductive strategies including alterations in oxytocin production. In non-optimal environments the prenate will reach earlier sexual maturation and develop low caregiving behaviors that are shaped by oxytocin receptor levels located in the ventromedial nucleus of the hypothalamus (this directs reproductive strategies but not caregiving), whereas in optimal settings, later onset of puberty and high caregiving behavior will manifest as a result of increased oxytocin receptor levels in the medial preoptic area of the hypothalamus (Cameron et al., 2005). Increased reproductive disorders have also been related to prenatal programming, including increased infertility, ovarian and breast cancer, and polycystic ovarian syndrome (Davis & Norman, 2002).

Self-Regulation Systems and Prenatal Programming

During pregnancy, the prenate builds a physiological foundation of neuroendocrine, immune/inflammatory, and cardiovascular processes essential for stable self-regulati...

Table of contents

• Cover Page
• Half Title Page
• Series Page
• Title Page
• Copyright Page
• Contents
• List of Contributors
• Foreword
• Preface
• Acknowledgments
• Introduction
• Part I The Prenate and Neonate in Group
• Part II Couples and the Family in Group
• Part III Group Therapy, Technique, and Application
• Part IV Working with Trauma
• Part V Group Process and Artistic Applications
• Afterword
• Index