Uncovering the Resilient Core

A Workbook on the Treatment of Narcissistic Defenses, Shame, and Emerging Authenticity

Patricia Gianotti, Jack Danielian

• Éditeur: Routledge
• Année: 2017
• ISBN:
  9781317293460
• Édition: 1
• Sujet: Psychology
• Sous-sujet: Psychotherapy Counselling

Uncovering the Resilient Core provides a comprehensive and inclusive methodology that guides the therapist into the nuances and complexities of the therapeutic relationship throughout the entire course of treatment. With its psychodynamic/relational orientation, this Workbook is unique in that it begins with character pathology in its widest spectrum and moves in depth to understanding and treating corrosive shame, dissociation, trauma and narcissism, including narcissism's many hidden cultural and dynamic manifestations. The applied nature of this text draws from a wide variety of case examples as well as progressive therapeutic techniques designed to help deepen therapeutic listening skills. Training concepts are organically linked to videotaped treatment examples, with ample discussion questions and case analyses that can be used in your own supervision groups. These videos can be found on www.routledge.com/9781138183285 and serve as companion illustrations closely following the learning points in the text itself.

1

Resilience

An Overview and Introduction

Be a provenance of something gathered, a summation of previous intuitions, let your vulnerabilities walking on the cracked, sliding limestone, be this time, not a weakness, but a faculty for understanding what’s about to happen.

—David Whyte, excerpt from “The Seven Streams,”
from River Flow: New and Selected Poems
©Many Rivers Press, Langley, WA, USA.
Printed with permission from Many Rivers.

David Whyte’s poetic words serve as an introduction to this text, an invitation to explore the often complex and variable nuances of the therapeutic process. Our goal for this Workbook is to explore and revisit basic, fundamental principles that answer the question, “What makes for a good psychotherapy experience?” Using a relational paradigm, we might also ask, “What are the essential elements of a therapeutic holding environment? How do we co-create a relational incubator for healing, recovery, and development throughout the life span?”

The process of psychotherapy is much like an invisible current that surfaces and resonates between patient and therapist. Following the various currents or self-states that branch and connect back toward the “real” or authentic self is a process that requires courage and trust, introspection and memory, grieving and letting go, in addition to adjusting expectations of self and other. Attending to these various components of the therapeutic journey ultimately leads to integration and growth. As the title of our book, Uncovering the Resilient Core, suggests, we will weave the concept of resilience (itself also an underground river current) throughout the various themes and learning points covered in each chapter.

The textbook understanding of the term “resilience” highlights the concrete physical parameters of resilience, defining it as “the physical property of a material that can return to its original shape or position after deformation that does not exceed its elastic limit.” The psychological, medical, or emotional interpretation of resilience refers to it as one’s ability to recover from illness, depression, and adversity and the measure of one’s strength, toughness, adaptability, hardiness, and the capacity to withstand stress.

Based on the principles of physical science, one could extrapolate that psychotherapy is, in fact, in the service of resilience. The fundamental aim of successful psychotherapy is to help the patient regain his or her natural ability to return to “one’s original shape,” that is, return to one’s authentic nature.

Resilience deepens and becomes more accessible as modulation and regulation of emotional states occur and as cognitive capacities develop. Suffering can build or uncover resilience, but only if there is a safe haven of supportive relationships as well as cultural beliefs and traditions that maintain hope and perseverance.

In terms of the healing power of a therapeutic relationship, there is a direct correlation between vulnerability and resilience. Uncovering the resilient core within our patients is both a retrieval process as well as a co-creative discovery process, one that requires the exposure of the patient’s vulnerability in order to heal old wounds and feelings of shame. Understanding the interconnections between shame and vulnerability, and vulnerability and resilience are key theoretical touchstones of this book.

As each patient embarks on his or her therapeutic journey, there is no formulaic or theoretical framework that can claim superiority over others. Rather, good therapy is an increasing amalgamation of skills and relational honesty. It is fraught with risk and uncertainty, where painful memories and tender surprises are uncovered as the bond of the imperfect therapeutic relationship strengthens and allows for more of the real self to be revealed.

Initially, the therapist holds the optimism, determination, patience, and confidence that change is possible. The belief that change is possible relies on a belief in resilience, notwithstanding negative circumstances, early attachment failures, trauma, or neglect. The resilience of the real self becomes stronger and more sure-footed through the mirroring, patience, safety, and trust in the bond created through the therapeutic relationship. As David Whyte reminds us, “Let your vulnerabilities be this time not a weakness but a faculty for understanding what’s about to happen.”

Our Theoretical Approach to Resilience and the Therapeutic Change Process

The recent appearance of the concept of resilience in dynamic treatment is a significant metapsychological advance in our understanding of the complex nature of inner change. The complexity of change is made a little less complex when we recognize growth as a dialectic outcome of the therapeutic encounter between our core real selves and our idealized protective selves, that is to say, the encounter between the authentic self and the false self.

The metapsychological advance involves the idea that from the very beginning of life, the mind (like the body) is in a continuing process of working to actualize itself. The process is inherent. It is not just a wish to get well but a built-in need we all share to get well. The process is seldom easy and often very challenging, especially as defensive structures are more heavily entrenched. But the crucial shift in thinking is in the awareness that the real self is always present no matter how submerged, disconnected, or discounted it may be. As Russell (2015) expresses it, “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us” (p. 3).

This metapsychological appreciation compels us more and more to be attuned to the patient’s therapeutic moment, as patients desperately deal with unintegrated splits, which have historically robbed them of their vitality, resourcefulness, and sense of being. As we learn to stay with the patient in the immediate moment, we subjectively experience the vulnerability of despair and hopelessness. This is the intersubjective posture linked to the therapeutic alliance to which we will continually refer.

Lest this sound like a formula for therapeutic overload, it is this very change in posture that liberates us to monitor and process moment-to-moment information as the patient shifts from self-state to self-state. Since we are working every moment monitoring disconnected or dissociated states, we stay more alive in our ability to sustain ourselves in both the short and long run. Both patient and therapist benefit from this aliveness, which is our best therapeutic ally to productive work and our best insurance against “burnout.”

Just how can we protect ourselves from burnout and compassion fatigue? The protection comes from how we see change. Throughout this Workbook, therapeutic change is seen as the result of a resurrection of the patient’s authentic (real) self. This is true no matter what level of pathology we encounter. Our moment-to-moment resonance with even the most bedeviled real self keeps us in touch with what is possible. Optimism for our patients and for the work we do is the result.

It is inevitable that we have joined the emerging focus among practitioners of patient resilience. This is not a Pollyanna-ish blindness to tragedy, nor is it a blindness to increasing levels of narcissistic pathology in our society. Rather it is a description of an approach to treatment (and especially treatment of character pathology) that is both more promising and more sustaining than previous attempts, either short-term or long-term.

However, we must be careful not to see resilience as a brand new approach we are just discovering. In her otherwise highly instructive book, Russell (2015) writes that because of denial in the field, we have “not had a word” for resilience capacity or resilient potential. This assumption of newness is not warranted. It may feel like a new approach to treatment from the view of classical thinking. However, the work of Karen Horney, in particular, identified just this very approach to treating character pathology and associated disorders of the self. Horney’s psychoanalytic institute has been recommending and refining just this experience-near empathic understanding of treatment for well over the last half century. She explicitly focused on the alienation from the real self as the origin of most psychic distress and described real self as the “ ‘original’ force toward individual growth and fulfillment” (Horney, 1950, p. 158).

Resilience has not been well-accepted in therapeutic circles until recently. It is not a novel idea, but it has been marginalized because of political struggles and entrenched biases in the field. The current work of Fosha, Russell, and others may help to overcome these historic internecine conflicts.

An Introduction to the Structure of this Workbook

This text is designed as a follow-up Workbook directly amplifying teaching and training concepts from our text Listening with Purpose: Entry Points into Shame and Narcissistic Vulnerability (2012). The Workbook provides detailed case examples to clarify theoretical concepts and techniques. Our aim is to enable therapists to sort through difficult clinical issues, finding anew further efficacy of treatment. We provide an extensive sampling of videotaped case vignettes and study/discussion questions throughout each chapter. As a stand-alone document, this Workbook does not replace supervision but is meant to capture as closely as possible the unfolding experiential reality and challenges of the treatment process as conveyed through the medium of the printed page. We believe our constructivist approach is readily adaptable to a variety of treatment approaches and will be of benefit to trainees and early career clinicians, as well as seasoned practitioners.

Goals of the Workbook

Our goals in developing this Workbook are to provide clinicians with tools to:

• Improve clinical assessment and intervention techniques.
• Enhance therapeutic listening skills.
• Develop greater confidence around the “timing” of interventions.
• Maximize growth opportunities through deepening the therapeutic relationship.
• Leverage both positive and negative transference to repair insecure or traumatic attachments.
• Identify micro-dissociations as blocking mechanisms that dampen down awareness in moments of stress.
• Assist patients in the consolidation of gains and the identification of resilience throughout the treatment process.

The bulleted items capture aspects of what it means to attend to the entire scope of clinical practice. Each element constitutes a critical aspect of treatment, a “part” of a larger whole. As such, our constructivist approach to psychotherapy requires a systemic-relational framework, one that draws the therapists’ attention to various components of listening and moment-to-moment tracking as the treatment unfolds.

The Workbook draws from here-and-now experiential illustrations of theoretical concepts and process techniques that come from a modern, broad-based psychodynamic-relational orientation. However, cognitive-behavioral therapists and other practitioners who have used our approach to treatment have reported that the process grid and the foundational techniques underlying it have immediate applicability to their work as well. Treatment goals and intervention techniques can be easily modified to the therapist’s background and training. The process-oriented model presented in this m...