from Clinical/Therapeutic Issues
By Joseph Nicolosi, Ph.D.
Healing moments occur when the client feels seemingly "unbearable" affect, while at the same moment, experiencing the support of the therapist.
Recent advances in psychotherapy have focused on the central importance of affect in the therapeutic process.
Evidence is mounting for our understanding the therapeutic alliance as an "affective correcting experience" (Schore, 1991). Affects--the neurotransmitters of human relations -- connect the person with his emotional environment. Affect-Focused Therapy (AFT) is about the way we attach, detach, and re-attach. Treatment focuses on the removal of blocks that disconnect the client from his core feelings.
The particular meeting place of reparative therapy and Affect-Focused Therapy lies in our view that homosexuality is fundamentally an attachment problem. For many of our clients, same-sex behavior appears to be an attempt to repair an insecure attachment to the father. Emotional disregulation, most often in the form of shame blocking masculine assertion, drives many of our same-sex attracted (SSA) clients toward unwanted homosexual enactment. Homosexual activity, fantasy and ideation serve as temporary compensation for failure of the attachment bond.
But we do not reduce SSA solely to father-son attachment failure; in fact, we believe that some homosexual development may well have begun with problems in mother-son attunement. Indeed, the effectiveness of reparative therapy is increased by use of techniques that also explore early mother-son attachment problems. Because the mother-child bond shapes and refines our earliest sense of self, therapy must also revisit that attachment.
Interpersonal rapport is, in the final analysis, what characterizes our deepest humanity and determines our internal equilibrium. Thus our treatment process has moved away from more traditional attempts at resolving intra-psychic conflict, and more in the direction of affect regulation, with the therapist as affect-regulation facilitator.
The quintessential model of affective contact is the Double Loop, a powerful therapeutic achievement between client and therapist.
A Radical Therapeutic Resonance
The flow of affect is determined by attachment. Traditional psychodynamic concepts such as "internalized objects" are metaphors for this biologically based phenomenon of neurological transmission. What we call "internalization of the object," for example, is actually a body-held memory--a conditioned affective response.
AFT requires the therapist to exert a level of emotional engagement and empathy that is far beyond, even contradictory to, the traditional psychotherapeutic approach. AFT concentrates upon the fine details of the effective intersubjective therapeutic exchange. The therapist must be fully emotionally "present" in order to elicit, and deeply share, the client's visceral experience.
Affective expansion has been shown to occur when there is a radical level of client-therapist resonance. Utilizing AFT techniques, the reparative therapist attempts to evoke the client's expression of core affects and to expand his somatic awareness. As trust and confidence build within their exchange, the client begins to feel confident enough to experience an authentic exchange with other men. Later, he can begin to more authentically engage women.
Attunement Changes Brain Structure
Each person's neurological structure is designed to be synchronized with other neurological structures. As Stern reminds us, "Our brains were designed to lock in with other brains" (2002). But human attachments can break down (as illustrated by the Double Bind) and then reconnect (through the Double Loop). Interruptions of affect--through anxiety, shame, and other inhibitors--disconnect the person from his emotional environment, causing a shutdown.
Personal identity development is the cumulative result of years of attunement with others. Our level of attunement with others, determines our inner relationship with ourselves. Traumatic malattunement--the inevitable consequence of Double Bind communication--creates shame, and shame creates intrapsychic detachment. In contrast, attunement with the therapist in the Working Alliance (a consequence of the Double Loop experience) resolves this barrier of shame and fosters self-reattachment.
Thus, an affective "turning on," or openness, is the goal of reparative therapy. In AFT, the therapist maintains empathic attunement in the Working Alliance to facilitate unification of the left brain and right brain hemispheres. In so doing, the he metaphorically "embeds" himself between the client's right brain and his left brain.
It is through this connectedness with the therapist that the client allows himself to feel the bodily sensations that are associated with his painful early experiences. Healing moments occur when the client can feel what seems to be unbearable core feeling, while at the same moment, experiencing the care and support of the therapist. Thus, in a process of interactive repair, their attuned relationship actually changes the neurological structure of the brain.
For the client who grew up in the narcissistic family, the early trauma of the parental Double Bind has created an attunement split. Through reattunement, the Double Loop unifies the client with himself, then unifies the self with others. Attunement with another leads back to greater attunement with self.
From Anxiety to Spontaneity
Affect-Focused Therapy rapidly accelerates the client's encounter with his fear-filled affective life. The therapist encourages him to feel and express his anxiety-provoking bodily feelings and sensations, while at the same time, supporting him in maintaining their interpersonal contact. Toleration of this previously unbearable affect is possible because of their mutual emotional rapport.
Through that Double Loop experience, the client learns that painful emotions are not intolerable in themselves-- but rather, it was the early sense of parental abandonment associated with those emotions that actually rendered them intolerable.
The goal of therapy, therefore, is the integration of conflicting affects. When the client experiences the reintegration of these once negative-seeming affects, he experiences a surprising eruption of spontaneity, authenticity, vitality, and a feeling of self-integrity--all of which is prompted by the restructuring of the True Self. This restructuring is expressed as a greater outflow of energy in relating to others, and less preoccupation with oneself.
With the emergence of the True Self, we gradually see the establishment of new friendships and the strengthening of old and long-neglected family ties.
A Subtle Synchronicity
When Affect-Focused Therapy functions at its best, we see a corrective experience of sublime attunement with subtle, highly nuanced human communication. Therapist and client share an implicit knowledge--that non-verbal, pre-explicit experience that can occur between two people in the recognition that "I know that you know that I know."
In many hours of analyzing audio- and videotape recordings of actual psychotherapy sessions at my clinic, I have seen how this subtle synchronicity emerges, with each person in the therapeutic dyad eventually having the sense of what the other is trying to express. Stern offers the example of two people kissing: the speed, direction, angle of approach--all perfectly coordinated for a "soft landing" (without crashing teeth)--is a miracle of psychic intimacy with "maximal complexity" of thinking, intending and then doing. Stern says it simply:
"Our minds are not created alone; they are co-created. Our nervous system is ready to be taught by other peoples' nervous systems, which transforms us."
Psychotherapy is the second opportunity to integrate one's emotional life. In attempting to explain how this therapeutic second opportunity works through the model of sublime attunement, Stern speaks of the importance of setting the correct tempo for "moving along"--the unspoken regulation of the rhythm and intensity of the back-and-forth between two people. He also notes the importance of "field regulation," which is the assessment of the other's receptivity with questions such as "Do you really like me?" and "What's actually happening between us right now?" He is particularly interested in what he calls "'now' moments," when the entire frame of the picture alters to zoom in on two people as they are pulled into the present moment, while experiencing an intense "existential presentness."
These "now moments" contain a heightened anxiety and the sense that somehow, "this moment is important," either for good or ill in the relationship. Personal exposure and vulnerability are a basic part of these moments; we see an excitement, a recognition of each other on a deeper level, and perhaps a slight, embarrassed smile that recognizes this sometimes-awkward vulnerability and personal exposure. Such moments, which Martin Buber calls "moments of meeting," cannot be forced; but as therapists, we can certainly, as Stern says, "be ready to coax such opportunities into existence."
Stern's description of the textured aspects of these central moments constitutes our Double Loop.
Two Binary Affects: Assertion vs. Shame
AFT helps us distinguish the basic "on" (attaching) affects versus the "off" (detaching) affects. Common detaching affects include anxiety, fear, and shame. Attaching affects are trust, empathy, and love. This fundamental "open/closed" distinction, described by Fosha as the "green signal" versus the "red signal," is equivalent to the sympathetic versus the parasympathetic neurological response.
Making the same distinction but in different words, Schore identifies affective openness and attunement, in contrast to a "freeze" response. This freeze response is much like reparative therapy's "shame" response--the consequence of the boy's feeling humiliated for his masculine gestures.
Clients have expressed this experience of the affective shift as the difference between--
exploding - imploding
heart open - heart closed
inflated - deflated
expansive - constrictive
These vitality affects versus inhibitory affects are illustrated by the Pike Phenomenon (Wolverton, 2005). In an experiment, a pike fish is placed in a tank with live minnows. The pike immediately begins eating all the minnows it sees. Then an invisible glass cylinder is placed over the pike, separating it from the minnows. Attempts to eat the minnows result in the pike hitting its nose on the glass cylinder, causing it pain. The cylinder is then removed, but the pike, anticipating pain, makes no more attempt to eat the minnows. The vitality response has been lost and the inhibitory response is substituted.
The Pike Phenomenon illustrates a conditioned response that inhibits healthy assertion. For our clients, there is an anticipation of shame for their gendered assertion.
Anticipatory shame represents a somatic "flashback" which switches the body into a defensive, shut-down mode.
Emotional Shutdown on a Biological Level
It is sometimes helpful to explain to the client that his shutdown is a physiological, bodily reaction. This explanation helps him observe his own bodily shifts as they occur in the moment. Developing a self-observant stance can increase the client's ego strength as he observes his body (not "himself," but "his body") shift to the shut-down mode. The facilitation of the client's observation of his own bodily response is similar to Eye-Movement Desensitization Therapy's repeated instruction to the client to "go back to" and then "let go of" the traumatic image.
Another term for the Shame Moment is the "freeze response," in which the person loses his somatic vitality and the body becomes rigid and stiff. This is similar to the Freudian concept of dissociation, the earliest phenomenon of study in the history of psychoanalysis, which is triggered when the person anticipates a recurrence in the present of some past trauma. In dissociation there is a "segmentation of minds," each possessing its own "cluster of thoughts, feelings and memories" (Jung) which are held in the body. When someone is "in one mind" (a cluster of embodied memories), it is hard for him to recall the other "mind," and if the other mind is recalled--i.e., felt in the body--then it has already left the first mind.
For example, when a person walks into a restaurant feeling hungry and smelling good food, he is in one "mind"; two hours later, when he has eaten his dinner and walks out, he is in a very different "mind," and it is virtually impossible for him to recapture the totality of that earlier mindset of hunger and anticipation.
A client reported going on a weekend trip where he was camping and shooting with his friends. This experience put him into the Assertion state, where couldn't recall the other "mind" of homosexual temptation. A week later, when he was back into the shame zone, the opposite had occurred: he couldn't recall the mindset of Assertion.
Shame Posture vs. the Assertive State
Reparative therapy carefully examines the self-states, especially regarding the scenario preceding homosexual enactment. The simultaneous experience of feeling shame in the body, and at the same time experiencing the acceptance and understanding of the attuned therapist, works to diminish the physiological "charge" of shame.
When clients are in the Assertive Stance, they can vaguely recall, but cannot intensely feel, their homoerotic attractions. When they shift into the Shame Posture, they cannot recall what it was like not to have compelling homoerotic feelings.
Shame, as we have noted, has, like all other the self-states, an evolutionary survival function. It is a powerful controlling tool used by the "pack" for socialization that aids survival of the group--and thus the individual. (Shame, it should be noted, is not the same as guilt--guilt results from a negative judgment of one's own behavior, while shame is a basic physiological response.) A child will be shamed--which is to say, threatened by expulsion from the pack--for behaviors that risk the stability and survival of the group. (Some researchers posit that this autonomic response of shame may be the biological basis for conscience.)
The self-state of shame brings to mind the work of Freud's mentor, Pierre Janet, known as the father of dissociation. Janet laid the foundation for Freud's later work on hysteria-- where past events, when held outside of consciousness, still retain an influence on present behavior. Dissociation represents the mind's attempt to block out traumatic childhood memories which still, on an unconscious level, feel overwhelmingly threatening.
Somatic Shift Leads to New Meaning
Reparative therapy focuses on Body Work because we understand the unconscious mind to hold a buried "body memory" that operates without cognitive awareness. The body does not deceive us, but the mind can do so. Freud said the goal of psychoanalysis was that "Where 'id' was, there ego shall be"(1933). He meant that psychoanalysis replaces unconscious, irrational impulses with self-awareness and rationality. We may revise this dictum to propose that "Where the somatic shift is, there new meaning shall be," because the mind can give new understanding to body memories as they are reexperienced.
For example, the gay-identified man sees an attractive male and experiences a sexual arousal. His self-understanding is "I'm sexually attracted to him because I'm gay. Such attractions are normal and natural for me." For this man, an attractive male is associated with sexual gratification, and he comes to believe that such feelings authentically define him.
However, the non-gay homosexual has the same somatic reaction to the same attractive man, but his internal narrative is quite different. He says: "I'm attracted to that man because he possesses qualities of masculinity that I feel are lacking right now within myself. And what can I do to change that?"
This is the essential difference between the gay-identified man and the non-gay homosexual--the way they interpret their body responses.
What the gay-identified man takes at face value, the non-gay homosexually oriented man instead, chooses to question. The gay man believes this attraction is "out there," reflecting his true self-identity.
But the "non-gay" SSA man sees the same feeling as a catalyst for asking himself, "It's not about the other guy's attractiveness. What is going on 'in here' right now to generate these feelings that contradict my true, designed nature?'"
Fosha, Diana (2000). The Transforming Power of Affect: A Model for Accelerated Change. N.Y.: Basic Books.
Freud, S. (1933). New introductory lectures on psychoanalysis. S.E., volume 22, p. 80.
Schore, A. (1991) "Early Superego development: The emergence of shame and narcissistic affect regulation in the practicing period," Psychoanalysis and Contemporary Thought, 14, 187-205.
Stern, D. (2002). "Why Do People Change in Psychotherapy?" Presentation. University of California at Los Angeles, March 9, 2002; Continuing Education Seminars, 1023 Westholme Ave., Los Angeles, CA 90024.
Wolverton Mountain Enterprises, 2005, www.wolverton-mountain.com/articles/pike.htm.
For more information see: Joseph Nicolosi.com.