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THE ART OF ATTENTIONCHRONICLES OF AN IMAGERY-ORIENTED PSYCHOTHERAPIST
By Jeanette Hogan Wright
Trafford PublishingCopyright © 2005 Jeanette Hogan Wright
All right reserved.
Chapter OneThe Capacity for Self-Analysis
When I put my feelings into a drawing then I can remember the picture when the feelings come and I don't have to ruminate so much. "Olivia"
An earlier working title for the Chronicles was "The Art of Attention: Self-Analysis and Symbolic Transformation." The title changed but its meaning remains and identifies the purpose of imagery-oriented psychotherapy: to assist individuals in the development of their capacity for self-analysis and to support symbolic transformation of affective intensities through the use of drawing within the structure of a therapeutic relationship.
Therapists sometimes ask what I "do" with those patients who lack awareness of themselves, who are very concrete in their thinking, or who, alas, won't draw. I respond that the capacity for self-analysis falls across a wide spectrum and that even alexithymians can become less alexithymic. When patients come to see me I attempt to assess their degree of access to an internal life, the range and quality of their imagination, and their ability to think metaphorically, areas ofaffective and cognitive life that I think can be traced back to the relationship between infant and caregiver. It is to these areas of developmental disruption or delay that I pay close attention. The therapist's task, as I see it, is to assist individuals in developing their awareness of internal states and to introduce tools that promote association, sustained interest in an internal life, individuation, and creative response.
The basic question I attempt to address is, How does the capacity for self-analysis develop? Demos provides invaluable understanding of infant processes in the study of self-awareness and describes parallels to the therapist-patient dyad.
I begin with Demos's findings from her research and their relationship to the affect and script psychology of Silvan S. Tomkins. In the "olden days" of Margaret Mahler the dominant clinical image was of infant and caretaker swimming along enmeshed in some kind of symbiotic soup until the infant was developed enough to separate and swim on its own. What Tomkins's theory of affect has shown us supports later infant research by Daniel Stern, Virginia Demos, Beatrice Beebe, and others, and changes our image of the infant and caretaker from an undifferentiated "soup" to two separate but unequal individuals from birth. This means that the infant is born with innate affects and distinct capacities for communication and problem-solving and relies on the caretaker for support and attention to each of these, a theory further applicable to the therapist-patient relationship.
As Demos illustrates, the task for the caregiver is to assist the infant in the toleration of optimal doses of negative affect, i.e. not too much nor too little so that the infant learns to sustain interest and persevere long enough to solve problems. For example: the infant sees a ball, reaches for it, and is distressed because the ball is too far away. The caregiver notices this and moves the ball within the baby's reach. Implicit in this simple interaction is the mother's ability to provide an optimal range of support. Caregivers and therapists strive to offer the right amount of help at the right time, but Solomon and Mother Teresa together can't always know what that is. Demos explains that if the caregiver gives comfort at the first sign of restlessness, the child doesn't have time to become aware of its distress or learn to trust its ability to manage the feelings; if the caregiver delays or withholds comfort too long or if the caregiver does not protect the child from traumatic experiences of negative affect, the infant's effort to persist is disrupted and a defensive retreat is set in motion.
Demos continues, "[B]oth too much and too little support will undermine the infant's efforts to achieve success in self-initiated goals and thus to be able to experience him or herself as effective...." In this regard, I sometimes hear adults say, "Nobody ever listens to me. It doesn't matter what I do, nothing ever works out." I understand these comments as telling me that developmental support for the modulation of negative affect was perhaps less than optimal and possibly even traumatic.
I believe that the therapist's attention to the adult's capacity to use inner awareness as a frame of reference for organizing behavior provides both therapist and patient with a compass for treatment. The therapist's awareness of the adult development of the capacity for self-analysis more effectively equips therapists to help individuals who feel like giving up because nothing seems to change. I address this dilemma more fully later in a visual vignette on an infant in distress.
Tomkins reminds us that people are unlikely to create in the throes of rage, anguish, humiliation, disgust, or terror. How, then, do individuals learn to become aware of affects when what they want is to simply get away from them? How do they develop tools to both modulate negative affect and continue positive affect and actually become more effective in the world?
Demos has formulated a process that identifies steps in the psychological unfolding of an infant's capacity for self-awareness, a process that also provides a map for those therapists interested in assisting adults in the development of their own capacity for self- analysis. In Demos's model, both infants and adults have the capacity to become "Aware of their distressed states, experience their Intention to end it, if negative, and, if positive, continue it, and Mobilize behaviors to achieve that goal." I find Demos's AIM (Awareness Intention Mobilization) model useful when I listen to a patient process experience. Is the individual aware of an internal state? What is it? Has she or he made a decision to end the negative state, and what steps can or have been taken to decrease the negative affect or continue the positive affect?
It is sometimes quite difficult for some to know how to end a negative state, particularly if they believe they would also have to end a relationship they desire. In addition, some artists with whom I work avoid doing art because it is a source of pleasure for them. For them, making a decision to continue a positive state is just as complicated (scripted) as making a decision to end the negative state.
Demos's work sparked the idea to develop a compass that would orient therapists to categories of emotional and mental experience intrinsic to adult developmental capacities for self-analysis. Borrowing from Nathanson's metaphor of a compass to organize emotional responses, I have arranged Demos's research on infant capacity for self-awareness on a compass of three poles, with an addition of my own in the fourth pole.
It takes practice and discipline to become aware of the cumulative and analogical force of loss, absence, and loneliness when these arise anew. When these matters emerge during the therapy hour an opportunity exists for therapists to help individuals grasp the source of complex feelings and connect the dots with their accompanying scripts for managing similar scenes throughout life.
Demos's research suggests that it is during infancy and early childhood that the capacity for self-awareness-and I would add the Winnicottian capacity to be alone-is laid down. These self experiences form patterns of response observable throughout the life cycle, if as therapists, we know where to look.
Chapter TwoA Visual Vignette on an Infant In Distress
What is bought, when attention is paid, is the self, the stamp of individuality. Mark Doty
It was a major discovery for Tomkins when he saw that certain affects matched certain scripts. In this visual vignette the reader can observe how distress was mapped onto a to a limitation-remediation script. In affect and script psychology the limitation-remediation script confronts difficult life situations through strategies of commitment and resignation in which damage is simply tolerated because it's a hard life and one must adapt. In this visual vignette I analyze a series of four drawings done by Olivia that show the descripting of a decontamination script and the attainment of a limitation-remediation script to manage distress. These drawings are further viewed through the lens of infant research and trace the development of this person's capacity for self-awareness.
Titled The Distressed Infant Series, the drawn images, bearing the names: "Alone in a Turbulent Ocean", "The Gaze", "Signals", and "Colicky Baby", appear to come from Olivia's implicit memory system and bring preverbal and nonverbal experience into view. From these drawings and the contexts in which they were drawn, I trace how these drawn images were generated and I present the patient's thinking process, along with my own.
When I write about patient work and find myself distressed that my comments might be repetitive to the reader, I try to remind myself that therapy itself is a repetitious enterprise and that it takes many rehearsals and duplications to attenuate painful experience and to integrate new learning. My hope is that each return yields new information and life becomes a bit more understandable.
Now, I invite readers to enter into the study of a six-week interval of time with Olivia. This period of visual-graphic accomplishment followed two years of preparation as material from the implicit memory system was accessed. Olivia's commentary is distinguished throughout the analysis in red ink.
Olivia, a forty-five-year old woman, is married with two children, is an artist and is employed as a science professor. She has come to see me during a period of vague loneliness, struggling with feelings of boredom and not knowing what interests her. One day I ask if she can express these feeling of loneliness in a drawing. What does loneliness look like? What does it feel like?
Alone in a Turbulent Ocean
She draws and describes "a small brown fish swimming all by itself in a turbulent ocean."
In a while, and mindful of the distance she feels from others, I ask if she can draw what it is like when there is an absence of tenderness in her life. Rare tears quickly surface and she says "There is no drawing for that. I have felt that way all my life. Couldn't my mother see that?"
She volunteers how "loathsome" she felt in seventh grade when her girlfriends were finding boyfriends and she wasn't. We discuss how her experiences of loneliness growing up were so difficult because there was an absence of support for things that interested and excited her. It seems that scenes such as these produced an overload of shame and self-disgust. Today she feels stuck because she has distanced herself so far from what interests her she doesn't even know anymore what it is she likes. We have had similar discussions at different times, and she says today, "I know all this, so what?" I ask, "But do you care about what you know?" Again, tears come to the eyes of this science professor and she says, "I can focus, learn, and then lose it. How do I re-care about what I know?"
Thus far, looking through the lens of Demos's AIM model, we can see that Olivia was aware of an internal state of distress but she could not form an intention to decrease the distress, nor did she know how to mobilize herself to achieve her goal to get rid of boredom. I think she is asking if she will ever feel better about herself. Can she exchange feelings of self-disgust for feelings of self-acceptance? Can she decide to decrease the self-disgust? Can she act upon what matters to her?
Then an amazing thing happened. Following this session, Olivia continued to reflect on the absence of tenderness in her life and returned for her next session with the second drawing in this series, "The Gaze." Her ensuing discussion of the picture revealed connections she has made between loneliness, self-disgust, and the strategy she uses for dealing with the disenchantments of life. Namely, don't deal with them, escape any way possible; a strategy understood as a decontamination script.
Following is a powerful and poignant image suggestive of unmodulated distress in infancy and a solitariness of life since. Infants gaze up at the world around them. If the mother's face doesn't appear or return this gaze, the basic need for nonverbal attunement may go unmet. The gaze in Olivia's drawn image is surrounded by brooding colors, looks strained, and suggests to me that there was something about the gazing between her and her mother that was "off."
Two eyes appear among bird- and leaflike shapes that fill the entire space. Olivia says, "My overall impression is that the eyes express the gaze of an eagle or a hawk. You always see them alone, up high, observing, as in intense observation from an up-high removed position. I see these birds more in winter and fall when the leaves are off the trees ... just watching. These birds are completely on their own. They are solitary. When they look it is not with emotion but it's utilitarian, they are looking for food. This connects to how I feel, not as a child, but now as an adult. Of being self-sufficient and not needing anyone. I feel I'm watching the world but am not a part of it. I can't depend on anyone else. Can't depend on people to give you love that is a kind of nourishment. It seems that other people don't have such separateness from others. I'm always aware of my separateness from others. In some ways, I like it, and other times it's just lonely.
"I think it was more painful as a child. I've compensated for the separateness by being arrogant. When you feel rejected from someone you can say you are superior to them. Then I think OK, maybe I deserve this humiliation. They're right. I can see how I developed a script to escape these feelings and overate, which then just confirmed my feelings of worthlessness. Then I ate because I wanted to feel worthless because it confirmed what I perceived other people thought of me. Then I felt crummy so I ate more to cover up that feeling."
When efforts to acquire the good scene repeatedly failed due to early disruptions in mother's attunement to a sensitive baby and later were magnified from lack of approval from father for her preferences, it was time for Olivia to enter junior high. Feelings of humiliation and disgust experienced in parental interactions were reinforced and magnified in scenes where she was unable to get her junior high friends to accept her for herself. By now she didn't much like the sensitive side of herself, either. Scenes developed into scripts to protect herself from feelings of self-disgust and alienation. The flawed strategy was to attempt escape from these intense feelings by overeating and behaving contemptuously toward school friends. She believed she could evade the hurt if she rejected friends before they rejected her. She characterizes the script something like this: "I'll give my friends something to really be disgusted about: I'll be fat." The distance between Olivia and other people grew and made for very lonely experiences.
Olivia continues, "When I think of an eagle or hawk sitting in the cold with no sounds, just the wind, it's like when I'm out in nature and it is cold that I feel most myself because I'm connected to the natural world and I feel whole. It's harder to connect with people. The eagle represents strength and something special; the hawk is just ordinary. I never felt special as a kid, didn't fit in, was told I was too sensitive. In the regular world you have to prove yourself, you can't just be yourself; but in nature it is different: everything just is.
"We are all basically alone. There is no perfect love, no perfect understanding. I just have to learn that."
Olivia's comments convey her intention to change (AIM). Conversations over the years about perfection led to an awareness that no one is ever loved or understood as much as they want to be. Able to act on her awareness, she began taking steps to descript her image of perfection as "perfect love and perfect understanding." Look again at the eyes in "The Gaze." One eye looks so sad and the other eye askew and cold. The word "gaze" immediately calls to mind the eyes of a mother and a child locked in a loving gaze, a very special experience. When developmental experiences of loneliness too often go unnoticed, a child may lose the ability to really look her mother in the eye if she no longer feels special in her mother's eye. For Olivia such experiences became magnified and resulted in the cold, detached, and severe degrees of separateness she has come to experience between herself and the world. Olivia tried to protect herself from an unbearable loneliness of being, in the only way she knew. Perceiving that her mother had detached from her, it appears that Olivia evaded loneliness and exchanged shame and self-disgust for arrogance toward school friends whom she considered just dumb. Future analogs developed; one analog played itself out in a decontamination script of overeating. These scripted responses bore similar ineffective solutions, until now, in therapy, I see evidence that she is beginning to claim her own goodness and move out of the failed strategy of disgust toward others and herself, a strategy she had hoped would protect her from the inequities and boredom of life.
Excerpted from THE ART OF ATTENTION by Jeanette Hogan Wright Copyright © 2005 by Jeanette Hogan Wright. Excerpted by permission.
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