Is Verbal Symbolization A Necessary Requirement of Analytic Change?

This paper considers the potential of bidirectional, nonverbal (procedural) enactments for effecting therapeutic change. Whether such nonverbal enactments need to be symbolized for clinical change to occur is discussed. Clinical and conceptual material is presented which indicates that changes in self-representations can and do occur without the need for verbal symbolization.     

Relational treatment of a borderline analysand

Abstract

This paper, in case material, examines the role of the analyst is co-creating the sado-masochistic enactments so common in the transference/countertransference with borderline analysands. Emphasis is placed on how to resolve the enactments so that a new paradigm is created based on trust and cooperation.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Myth,Memory, and Meaning: Understanding and Treating Adolescents Experiencing Forced Migration

ABSTRACT

Refugee adolescents present a unique challenge to treatment. In their desire to be part of their new country, they often split off the formative years of their development. This includes both the person that they were in the past, their relations with peers and what made them “cool,” along with the officially documented political story that brought them asylum. This can lead them to feel disconnected and disoriented, but also as though their world is in fact built on lies.

They often come to treatment following enactments that make them appear tough, hardened and hard to reach, and which continue in the consulting room. When they are met with an official “trauma” narrative that explains their experience in political and psycho-educational terms they often find the experience alienating. They need to connect the world that they left, the world that live in now, and their own private experiences of love and hate in order to form an integrated identity.

This discussion explores aspects of the refugee narrative of psychoanalysis to help to illuminate the tasks necessary to co-create a meaningful narrative with refugee adolescent patients. It suggests ways to connect to the refugee experience and hear the young patients as they move between the political and the personal, the official and the familial, to understand themselves and return to the developmental task of creating an adult identity.     

Effects of Monitoring and Social Reprimands on Instruction-Following in Undergraduate Students

The effects of the magnitude of nonverbal consequences, monitoring, and social consequences on instruction-following were evaluated. Twenty-four undergraduates were exposed to a matching-to-sample procedure. The undergraduates underwent four experimental phases that differed regarding the presence or absence of the observer and the correspondence or non-correspondence of the instructions with the nonverbal contingency. In Experiments 1 and 2, the magnitudes of the nonverbal consequences were manipulated, and in Experiment 3, the effects of verbal reprimands on instruction-following were evaluated. The results revealed that alterations in the magnitudes of nonverbal consequences did not influenced the performances of the participants and that monitoring increased the probability that the participants would follow the instructions but not to an extent sufficient to maintain performance when the consequences did not correspond to the nonverbal contingency. The inclusion of verbal reprimands was necessary to achieve this effect. These results support the proposition that social control is important for maintaining instruction-following.

     

Psychodynamic Group Therapy with Hispanic Migrants: Interpersonal,Relational Constructs in Treating Complex Trauma,Dissociation, and Enactments

ABSTRACT

This article introduces an interpersonal, relational approach to group therapy for Hispanic migrants with significant histories of violence, abuse, multiple losses, and recurrent trauma. Psychodynamic group psychotherapy may help to address trauma symptoms, insecure/disorganized attachment, grief, and isolation with newly arrived migrants. How the relational paradigm in group psychotherapy is contributing to current theories of complex trauma and dissociation is reviewed. Using this modality conveys the importance of examining trauma-driven enactments, dissociation and symbolization involving the members of the group, the group-as-a-whole, and the group leader. Clinical examples and group therapy interventions used to address powerful dissociative enactments are discussed.     

Commentary on Paper by Ellen F. Fries

In Perchance to Sleep: Minding the Unworded Body in Psychoanalysis, Ellen F. Fries masterfully articulates the complexities of right-brain to right-brain, body-to-body interactions between herself and her patient. Her work highlights the dominance of the nonverbal implicit self over the verbal, explicit self and provides an excellent example of clinical work in which she thoughtfully attends to the unspoken, bodily based communication that takes place within the therapeutic dyad. In this discussion, I offer perspectives from Sensorimotor Psychotherapy on the impact of early attachment on the procedural organization of action sequences that reflect and sustain the implicit self, and embody unconscious relational expectations. The following topics are addressed: (a) Physical actions that provide avenues of exploration into the implicit self, especially actions such as reaching out, making eye contact, or maintaining an upright posture that are abandoned or distorted when they are ineffective in eliciting the desired response from attachment figures; (b) Body-oriented interventions that target the involuntary physical spasms that Fries' patient experiences, which are associated with unresolved physiological arousal originally stimulated in the face of trauma; and (c) The nonverbal manifestation and negotiation of enactments that emerge from the body-to-body dialogue between the implicit selves of patient and therapist.     

Relational Message Interpretations of Nonverbal Matching Behavior: An Application of the Social Meaning Model

Abstract

The social meaning model asserts that some nonverbal behaviors have consensually recognized relational meanings within a given social community. According to this perspective, the interpretations made by encoders, decoders, and 3rd-party observers of the same nonverbal behavior should be congruent. The authors applied the model to the identification of relational message interpretations of nonverbal matching behavior. Confederates either matched or did not match the nonverbal behaviors of conversational participants while being watched by nonparticipant observers. All three nonconfederate participants provided interpretations of the confederates' relational messages. As the authors had expected, there were moderate correlations between the 3 perspectives, with observers usually providing less favorable assessments than the conversational participants. The authors also examined the influence of positive and negative stimulus behavior on relational message interpretations.     

Classroom Behavior and the Ability to Decode Nonverbal Cues in Boys With Severe Emotional Disturbance

Abstract

Nonverbal decoding skills are important for successful social functioning, particularly for emotionally disturbed children. Boys with severe emotional disturbance (n = 25) and a control group of boys (n = 22) were compared regarding the relationship between ratings of classroom social behaviors and nonverbal decoding skills. Participants were predominantly African American. The Diagnostic Analysis of Nonverbal Accuracy (Nowicki, 2001; Nowicki & Duke, 1994) was administered individually to the boys while teachers completed ratings of their social behavior in the classroom. The 2 groups of boys did not differ in nonverbal skills. However, aggressive classroom behaviors were associated with specific nonverbal skills only for the boys with severe emotional disturbance. These findings suggest that nonverbal abilities may have a greater impact on the social behavior of emotionally disturbed boys. Future research is needed to better understand the social difficulties of boys with severe emotional disturbance.     

Communication comforting strategies and social bereavement: Verbal and nonverbal planning and appropriateness

Abstract

Based on Applegate's (1980) hierarchy of comforting strategies, this study assessed the effects of verbal planning (e.g., Berger & Bell, 1988; Infante, 1980) and nonverbal planning on the perceived appropriateness of comforting communication. Participants indicated their verbal and nonverbal communication strategies in response to a hypothetical bereavement scenario, and these strategies were coded into Apple-gate's (1980) hierarchy. Bereavement counselors also rated the appropriateness of each respondent's comforting message strategies. Results are discussed in terms of reflection-enhancing relational strategies and the bereavement counselors' perspectives of the effects on surviving family members.     

The play of transference: some reflections on enactment in the psychoanalytic situation

The incessant play of nonverbal activity between patient and analyst actualizes and amplifies the primary verbal data of the psychoanalytic dialogue. Both parties must inevitably register this kinesic level of communication, and react with capacities acquired in and elaborated from earliest childhood. The analyst's apperceptive (unfocused) looking, as part of his freely hovering attentiveness, utilizes these capabilities gradually to perceive and organize patterns combining the verbal and nonverbal data. It is through the recognizing and eventual understanding of these gestalts that the analyst builds up his knowledge of his patients. In these patterns can be identified: (a) conspicuous behaviors, idiosyncratic for the individual, which often yield to psychoanalytic inquiry to reveal their dynamic-historical antecedents; and (b) inconspicuous background kinesics, habitual to the individual, which ordinarily are opaque to analytic exploration, yet hold rich meaning. Observing these small behaviors in relation to verbal content provides evidence of their linkage to, and enactment of, pregenital- and genital-level conflicts over diadic and triadic object relations, even in highly structured personalities. These enactments combine elements of play, miming, and drama to constitute an experiential dimension that actualizes and externalizes the patients' inner life of conflict and relation to objects.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

Empty Depth,Empty Breadth,and the Forging of a Therapeutic Alliance

This paper describes a case in which analyst and analysand became interlocked in battles that drew out the 'mad' parts of each other. It explores how the extreme conflict may have actually been an integral part of what has become a truly therapeutic process for both. Theoretically, the dialectical movement of becoming through contradiction is used to help explicate how mutually destructive enactments were necessary building blocks of genuine intimacy.     

Effects of the Acquisition of Prerequisite Behavior on the Learning of Nonvocal Verbal Behavior and Vocal Imitation in Children With Severe Retardation

The effects of acquisition and maintenance of prerequisite interactions, such as attending behavior, nonverbal imitative behavior, and disruptive behavior, on the learning of nonvocal verbal behavior and vocal imitation were evaluated. Four severely retarded children were selected on the basis of low level or absence of the target behaviors (nonvocal verbal behavior and vocal imitation) and failure to reach the acquisition criterion on prerequisite behavior. The results were evaluated visually and by time series analysis. Findings indicated that the acquisition of prerequisite interactions led to superior performance and fewer trials to reach criteria in this language intervention.

     

Interpretive acting-out: Unavoidable and sometimes useful

Abstract

Using one detailed case presentation, this paper examines the clinical hardship of making accurate and helpful interpretations that do not become part of the patient's defensive system. The author argues that interpretive acting-out is inevitable in the psychoanalytic process. But, if properly monitored, understood, and contained, these interpretive enactments can sometimes actually be a profit to the overall treatment. Issues of projective identification, countertransference, and the importance of realizing our transference role in the patient's changing phantasies are discussed throughout the case material.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

The Role of Background Behavior in Televised Debates: Does Displaying Nonverbal Agreement and/or Disagreement Benefit Either Debater?

ABSTRACT

This study examined the effects of background nonverbal behavior displayed with the purpose of undermining one's opponent in televised debates. Students watched one of four versions of a televised debate. In each, while the speaking debater appeared on the main screen, subscreens displayed her nonspeaking opponent's background nonverbal behavior. In one version, the non-speaking debater remained “stone faced” during her opponent's speech, while in the other three she nonverbally displayed occasional disagreement, nearly constant disagreement, or both agreement and disagreement. After viewing the debates, students rated the debaters' credibility, appropriateness, objectivity, and debate skills, in addition to judging who won the debate. Analysis indicated that background nonverbal behavior influenced audience perceptions of debaters' credibility, appropriateness, objectivity, debate skill, and the extent to which the debate was won. These results suggest that adding nonverbal agreement to expressions of nonverbal disagreement do not reduce the negative impacts of communicating disagreement nonverbally during an opponent's speech and may in fact further decrease the audiences' perception of a debater's credibility and overall performance.     

Honoring Protective Responses: Reframing Resistance in Therapy Using Polyvagal Theory

Therapists often conceptualize resistance as client behaviors that impede progress; this perspective threatens the therapeutic alliance, especially in couple and family therapy where increased resistance and multiple alliances are present. Polyvagal theory reframes and normalizes resistant behaviors as preconscious, protective responses emerging from our autonomic nervous system. The theory also explains how humans reciprocate safety cues to connect with each other; therapists can use concepts of polyvagal theory to manage their own emotional regulation and foster safety and connection in therapy. Polyvagal concepts deepen our understanding of protective behaviors presenting in couple and family therapy; therapists can help couple and family clients to recognize protective behaviors in their own relationships and facilitate safer connection and engagement. Clinical implications are presented: psychoeducation can help clients normalize and understand their protective processes; therapist presence and immediacy acknowledges and normalizes protective behaviors as they arise; therapist and client self-regulation skills support connection; therapist genuineness is a precondition to client safety; and understanding of polyvagal theory enhances assessment of conflict and enactments in couple and family therapy.

     

Enacting Actuarial Fairness in Insurance: From Fair Discrimination to Behaviour-based Fairness

ABSTRACT

In line with developments in the personalisation of risk, the idea that insurance products should above all be ‘fair’ to the policyholders is increasingly voiced by commentators. The performativity thesis in Science and Technology Studies usually used to study economic markets can be used to investigate different enactments of ‘actuarial fairness’ in insurance practice. Actuarial fairness functions as a technical economic concept and was coined by the neoclassical micro-economist Kenneth Arrow (1921–2017). Faced with anti-discrimination legislation, the insurance industry has, since the 1980s, advanced the principle of actuarial fairness to legitimise their medico-actuarial technologies to discriminate between risk groups. In the absence of this actuarial fairness, it is assumed that dynamics of adverse selection—derived from neoclassical assumptions about economic actors— will result in the bankruptcy of insurance providers. The paradigmatic case of Fairzekering, a showcase of contemporary behaviour-based personalisation in car insurance, demonstrates an important shift in how actuarial fairness is enacted through behaviour-based calculative devices. Here, policyholders are enacted as being personally in control of their driving style while an interactive discount-infrastructure is set up to provide real-time feedback to incentivize policyholders towards ‘good behaviour.’ This enactment of behaviour-based fairness simultaneously implies a shift in the enactment of the economic actors involved, constitutive of the making of new economic ideas in behavioural economics.