Integrating Body Self & Psychological Self

David W. Krueger

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415763363
• eBook ISBN:
  9781135454524
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

David W. Krueger illustrates a novel synthesis of fundamental psychodynamic principles with evolving advances in developmental, self, neuropsychological, and attachment theories. Focusing on action symptoms, self object experiences, gender issues, embodiment, somatic symptoms, affect regulation, and ego states, the theoretical innovations are illustrated by vivid case material. He introduces treatment inroads enabling clinicians to hear and articulate arcane messages spoken in metaphor, actualized in symptoms, and encrypted in the body. A fresh conceptualization from an original thinker, Integrating Body Self and Psychological Self broadens our understanding of the mind and body interplay in the clinical exchange.

Part I
Body Self and Psychological
Self Development

But first the notion that man has a body distinct from his soul is to be expunged.

William Blake, 1790

Emotions are no more and no less than the readout of internal body states.

William James, 1884

The ego is first a body ego.

Sigmund Freud, 1923

Primary emotions are always the result of body states.

Antonio Damasio, 1994

There is nothing that falls within the purview of psychoanalysis as a science of the human phenomenon that does not involve a bodily reference—explicitly or implicitly.

William Meissner, 1998

1
Body Self in Psychological
Self Development

The body as represented in the brain may constitute an indispensable frame of reference for the neuroprocesses that we experience as the mind.

Our most refined thoughts and best actions, our greatest joys and deepest sorrows use the body as a yardstick.

The mind had to be first about the body or it couid have not been.

Antonio Damasio
Descartes' Error

The infant searches swirling, formless surroundings for a knowing touch, a lock with parents' eyes, affirming a fortifying form and confirming a grounding presence, the quintessence of human attachment. This hope is relational, linked with soothing flesh and satisfied mouth, to become the building block of the psychological regulation of physiological needs and the foundation of trust; later, from this foundation of affiliation and effectiveness, excursions of exploration and assertive curiosity occur (Lichtenberg, 1989), allowing separation with affirming rapprochement.

The gentle whisperings and soft, murmuring echoes of sensation are outlined and contained as the infant's body is held in total suspension by the strong hands of another who knows that safety and passion are no paradox. To be wrapped m an encompassing cocoon of gentle vitality is simultaneously intense and calm. These felt sensory experiences, or their unmet yearning, are reactivated throughout life; there is never a time that the desire evaporates.

Significant caretakers define the infant's body by interactive attachment, mirroring, outlining, and resonance with both interior and surface. This relational matrix organizes and gives meaning to body self. From before birth, there is an intersubjective dialogue, interaction, real (and later fantasied) relationship unfolding between the child and parents that fashions self development, including gender. The child and his or her body effects, shapes, and coauthors the relationship with parents, and vice versa.

Attachment Patterns

Attachment needs are, first and foremost, body-based needs. John Bowlby (1969, 1973) described a system of emotional and behavioral response patterns in the caretaker and infant that he termed the attachment system. Bowlby and Siegel (1999) described the attachment system as an inborn motivational system that organizes experiences, emotions, and memory processes of the infant in terms of attachment to, and innate communication with the mother.

The initial attachments are formed by the age of 7 months, are selective to only a very few persons, and lead to specific changes in an infant's brain function and behavior (Main, 1995). The attachment interactions and patterns with primary caretakers may be the initial and central foundation from which body self and psychological self develops and integrates.

Four categories of attachment have been defined by Main and Soloman (1991). Mothers secure in their attachments develop secure, consistent attachments in the infants; dismissive attachment styles create infants with avoidant patterns; mothers preoccupied with attachment demonstrate ambivalent styles of attachment. The fourth style of disorganized-disoriented attachment is a result of maladaptation from insecure attachment: The mothers diagnosed as chronically depressed or alcoholic are either unattuned to the infants or maltreat them, and children develop their own depressive patterns, difficulty in concentrating, and disorganized attachment behavior. Empathically unattuned parenting leads to one of two types of attachment: anxious-avoidant attachment, in which the individual curbs or buffers the overstimulating situation by avoidant or distancing behavior, or an anxious-resistant pattern in which the individual denies signals of overstimulation, and resists being comforted. Attachment disorganization pattern is exemplified by unresolved trauma in the parent resulting in parental fear in response to the child's distress. The child perceives that fear, reads it as an accurate mirror of danger, and the anxiety becomes manageable by external and internal detachment. These expectations and experiences grow into an entire representational system of attachment, of what it takes to maintain attachment, and the possibilities of attachment regarding regulation of affect, esteem, and tension states (Main, 1995).

These models based on procedural memory govern how other attachments/relationships will be approached in the future. The security of the child in the primary attachments determines how environmentally assertive and exploratory the child will be. The secure, avoidant, and resistant categories of infants evolve in these consistent ways: the secure stays secure, the avoidant becomes dismissive; the resistant, crying infant becomes preoccupied (Main, 1995). Infants and children must first develop a secure attachment to parents before they can venture into new territory. If this secure attachment is compromised or pathological, various adaptive efforts and accommodative maneuvers will be used to establish that attachment, or to reestablish it. These compensatory efforts to fill in what is missing developmentally, are perhaps used later in a more generalized defense against a variety of painful feelings.

While the attachment archetype with the primary caretaker forms the first template of interaction, the configuration is mutually determined: the way the infant behaves toward the mother exerts a powerful influence on the mother's behavior (Kandell, 1999). Similarly in treatment, the way in which the patient interacts powerfully shapes the analyst's response.

The regulation and alignment of states is dependent on accurate parental attunement to the child's signals and sensitivities well before words or verbal language are available. This attunement and engagement at a preverbal-nonverbal level is a foundation for internal connectedness of mind and body, and of human relatedness, with significant implications for what is most fundamental in an analytic relationship. The internalization of these attachment patterns creates the procedural (implicit) memory of self, self-states, and self-in-relation to another.

Secure attachments provide a sense of safety and containment in an environment that might otherwise evoke fear. Sensitive and empathically attuned caregiving create the experience and expectation that comfort and reduction of anxiety can take place through the attachment, later to be internalized as one's own. The child does not have to be possessive of the mother if he already truly possesses her. He only becomes possessive when he recognizes that he, indeed, does not possess her, and she does not respond as if he is entitled to her. Ownership, entitlement, and a sense of belonging cannot then be taken for granted and metabolized as internal security based on a secure attachment.

Attachment and attachment patterns are not synonymous with intimacy or dependency, but reference a particular, repetitive interactive style with corresponding internal organization. Attachment theories are explanations of how significant caregiver interactions affect the child's inner world, of the replication of parents' own attachment behavior when they were children, and of the continuity of attachment patterns and corresponding internal organization over time (Main, 1995; Fonagy & Target, 1995)

The attachment system of the physical and psychological tie to a primary caretaker and the exploratory motivation, pool curiosities to explore the environment; ideally, these two systems are complementary and not at odds with one another. It is up to the primary caregiver half of this attachment scenario, to make it acceptable to explore without losing the primary bond, to have emotional connection both ways (Stern, 1990). Attunement includes the matching of vocal responses with feeling, allowing the developing infant to translate from one sensory modality to another (Stern, 1990). Boundaries of the shared experience expand, the universe of feelings broadens, intensity deepens.

The compass of recognizable feelings assumes their developmental recognition and differentiation; later, for feelings undifferentiated and conflicted, the entire image of a feeling may have to be defined in outlining its shadow by obsession, or illuminating its reverse image by denial.

Fonagy (1999) demonstrated that there is a transgenerational transmission of these traits, and that the characteristics of the child could be predicted prior to birth based on studying the parents. The nature of the relationship that the mother and the father would develop with the child could be predicted essentially 80% of the time by knowing the attachment pattern history of each parent. There is a strong relationship between the particular patterns of attachment of a child by one year of age and their attachment patterns as an adult, as well as the pattern with the children that adult will parent (Levy & Blatt, 1999). Attachment theory offers an additional perspective from other views including unconscious motivation and unconscious fantasy. For example, the small child experiences terror in her panic state, wants to approach her mother for security, yet knows that her mother likely will not provide comfort, but a shaming response. This internal dilemma emphasizes lived experience rather than drive distortion.

Developmental Origins of the Body Self

Freud (1923/1961) said that "the ego is first and foremost a bodily ego" (p. 27). Since Freud used the term ego interchangeably with self, his indication was that one's sense of self, later evolving to a psychological self, first begins with a body self, established fundamentally through sensory input. The integration of this body self becomes a fundamental aspect of self representation, including body image.

The body self is a developmental hierarchy of experience and intellectual mechanisms progressing from images, to words, to organizing patterns, to superordinate abstractions and inferences that regulate the entire self-experience (Krueger, 1988a).

The close and careful attunement to all the sensory and motor contacts with the child forms an accurate and attuned body self in the child. These relational experiences, initially in development of bodily experiences, that form the initial experience of unity of mind and body, predicated on the initial establishment of the body self as container for the evolving psychological self. Both Winnicott (1965) and Stolorow and Atwood (1992) have emphasized how the caregivers' affect attunement is conveyed through initial, consistent, and accurate sensorimotor interaction with the infant's body. It is the accuracy and continuity of this sustained contact that allows the evolution of the psychological self: that we reside inside our bodies, that there is a unity of mind and body with evolving cohesion of body self and image, that psychological self evolves with the use of symbols and language to communicate internal experiences.

The earliest imprint of mother on the child is through the bodily sensations and feelings, the earliest body contact and reciprocity and attunement to body fluids, sensations, sensory matching, and secure holding emerges from a time before there were words or a language. In an elegant and innovative work, Wrye and Welles (1994) reconstruct this narration of desire from the powerful preverbal, inchoate yet very real, body experiences and memories emerging in transference and countertransference experiences in adult analytic patients. They suggest that these remnants of earliest body contacts may be expressed in the sensory, bodily experience mutually evoked that may link itself to the earliest care of the mother's attunement to body processes and body fluids of the child to form early maternal erotic transferences and countertransferences. Their focus on the preverbal origins of erotic transference, regarded at times by both patient and analyst as a psychotic core experience or an "erotic terror," can be understood and integrated, to provide the creation of the first true intimacy that some patients have ever experienced. Dramatic developments in infant research, newer understandings of early development, and expanding awareness of neurobiological and intersubjective experience all inform this appreciation.

The body and its evolving mental representation are the foundation of a sense of self, Since Freud's notion of the body ego, the consensus of most developmentalists is that the body self refers to the full range of kinesthetic experiences on the body's surface and in its interior, and the body's functions (Faber, 1985: Lichtenberg, 1978).

Lichtenberg (1978,1985) describes the concept of the body self as a combination of the psychic experience of body sensation, body functioning, and body image. He hypothesizes that reality testing occurs in a definite developmental sequence of increasing awareness and integration of body self.

Stages of the Development of the Body Self

The development of a body self can be conceptualized as a continuum of three stages, the first of which is the early psychic experience of the body. The second stage is the early awareness of a body image, with an integration of inner and outer experience. This process forms body surface boundaries and internal state definition. The final stage is the integration of the body self as a container of the psychological self, the point at which the two merge to form a cohesive sense of identity (Krueger, 1989; Lichtenberg, 1978, 1985).

The Early Psychic Experience of the Body

Mahler and Furer (1968) have indicated that the earliest sense of "self" is experienced through sensations from within one's body, especially proprioception. These sensoriperceptive stimuli enable the infant to discriminate the body self-schema from its surroundings (Mahler &c Furer, 1968); tactile sensations, the primary body experience during the first weeks and months of life, may be the first developmental experience of the body self (Kestenberg, 1975). Spitz (1965) observed the baby's inclination to concentrate on the mother's face, and particularly on the eyes during periods of feeding.

The mother's hands outhne and define the original boundary of the body's surface; definition and delineation are provided to the infant's otherwise shapeless and boundless space. There is evidence that body experience during the first weeks and months of life is mostly tactile, and only somewhat auditory and visual (Shevrin & Toussieng, 1965). The awareness of the body based upon tactile sensations is the first developmental experience of the body self. The sense of body is the first sense of self, awakened by the mother's touch, the initial form of communication. The mother's hands establish the first body boundary; auditory and visual stimuli have an important role as early development proceeds.

The mother's empathic resonance with the infant's internal experience provides the infant with a mirroring and reciprocity that not only reinforces and affirms, but forms (Winnicott, 1971). If the mother is empathically aligned with the baby, this is the baby's first experience of effectiveness: Affect produces a reciprocal response in the mother. Mutually and reciprocally, the infant's internal state is also given form and definition by the accuracy of this empathic attunement. Kestenberg (1985) emphasizes the rhythmic movement between mother and child and the match in movement styles as a foundation in the bond between them and as a catalyst for the infant's development.

The accuracy of the einpathic attunement is crucial, because it is the initial linking of mind and body experiences. If the mother is not accurately and consistently attuned to the infant, the basis for a mind-body division (nonintegration) is formed, inhibiting one's ability to develop emotional literacy. This awareness and language for feelings and internal experiences is initially established by accurate labeling by essential caretakers, developing road maps of internal and external experience through this interaction. This core sense of self-orbiting around body self and caretaker interaction defines this essential awareness and literacy.

This empathic attunement by primary caretakers is so essential that we see in some of our patients the absence of this awareness, with the reliance on external referents, the persistent search for mirroring responses, and for tangible representations of deficient internal affir...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• Introduction
• Part I Body Self and Psychological Self Development
• Part II Developmental and Clinical Integration
• Part III Clinical Applications
• References
• Index