How We Change Volume II: The Process of Change

How We Change

Volume II:

The Process of Change

Richard L. Gilbert, PhD

Published by Richard L. Gilbert at Smashwords

Copyright 2013 Richard L. Gilbert

This ebook is licensed for your personal enjoyment only and may not be re-sold or given away to other people. If you would like others to read this book, please purchase an additional copy for each person or encourage them to purchase it for their use. Thank you for respecting the copyright of this work.

All is change; all yields it place and goes.

Euripides

And so we beat on, boats against the current, borne back ceaselessly into the past.

F. Scott Fitzgerald

The Great Gatsby

Contents

Preface to Volume II

Chapter 1:The Stages of Identity Change

Chapter 2: Impediments to Identity Change

Chapter 3: Resistance and The Forces of Continuity

Chapter 4: The Retreat from Shame

Chapter 5: The Retreat from Debilitating Regression

Chapter 6: The Retreat from Responsibility

Chapter 7: The Retreat from Identitylessness

Chapter 8: The Psychology of Water

References

About the Author

Preface to Volume II

A few years ago I was assigned to teach an introductory course in psychotherapy to a group of graduate students. Unfortunately, the day before the semester was to begin, I came down with laryngitis, a terrible disability for someone who lives by transferring language. It’s often said that necessity is the mother of invention and so, out of necessity, I condensed my lecture, which was slated to be two hours long, into a single four-word question: How Do People Change? After raising this question I remained quiet for the duration of the class and, after withstanding a period of awkward silence, I had the privilege to listen to a wonderful discussion among these students beginning their training in psychotherapy about the nature and dynamics of personality change. Since this day, even if I don’t have laryngitis, I have always started any course in psychotherapy with the same question.

The reason I begin with this question, and the reason I believe that discussions following this question generally prove so fruitful, is that is arguably the most important and basic question a therapist -- new or old -- can ask. It is a question that is central to all major models of personality and approaches to psychological treatment. It is unfortunate that, in most graduate programs in mental health, students are taught approaches to treatment and specific intervention techniques without first thoroughly examining the fundamental question of how people change. They are taught how psychoanalysts treat clients, how behaviorists intervene, and the methods of gestalt therapy. And these are valuable things to learn. The potential drawback of this approach, however, is that therapists will come to mediate their reality and actions through the lens of a theoretical model rather than to more directly face the client’s struggle with change. Sometimes I wish that we would convene a conference on the process of psychological change. At this conference, we would wipe the slate clean, throw out all theoretical models and prior conceptions, and build a method of intervention from a careful examination of the change process. This would be in contrast to the current practice of clinical education where students primarily learn theories of mind and derive models of change from these conceptual frameworks.

Ideally, before therapists are schooled and directed in a specific model of intervention, they should explore the question of change in a very personal manner. They should honestly ask themselves:

"In my life, have I changed in any significant ways? If I have changed, how

have these changes come about? Have I seen other people who I know well

-- friends, lovers, family members -- change? How have they changed? Is it

the same or different from the process that I went through?"

Out of this in-depth and honest reflection about their life, and the lives of those around them, will come an answer. We can’t say that this answer is true in an absolute sense or that it will never be revised, only that it currently rings true given a careful examination of their experience. That is, we cannot say that it is a true position, only that it is an authentic position. What can be said with assurance, however, is that the model of psychotherapy that therapists practice should be consistent with their beliefs about the process of psychological change. If it is not, then they are more of a technician than a therapist and there will inevitably be a degree of inauthenticity to the work that they do. Specifically, if they believe that people change primarily through acquiring new skills, or by altering the environments in which they live, then they are best suited to behavioral work. If they believe that people change primarily by thinking in a less biased, more rational manner, then they are suited to cognitive therapy. If they feel that people change primarily by revising their life stories, then they are suited to the practice of narrative therapy.

The reason that the authenticity and belief of the therapist is so crucial in the selection of a model of therapy is precisely because all approaches to treatment are models, systems of metaphors that guide thinking and practice, rather than statements of truth. There are those who have spent their life trying to empirically demonstrate the differential efficacy of one model of treatment as opposed to another. These efforts have failed, and will inevitably continue to fail in the future, because the complexity of the process overwhelms the tools of empiricism. Thus, if the choice of a model of treatment cannot be made on the basis of the differential truth of its propositions or the differential efficacy of its practice, then at least the choice can be made on the basis of the therapist’s sense of authenticity and genuineness in working within a particular set of metaphors.

In the course of this book, I will attempt to broadly address the question of change; that is, to address it in a manner that is less tied to a particular theory of personality or model of psychotherapy than is typically the case in the field. I say less tied, rather than completely independent, because it is not possible to fully liberate oneself from the theoretical models one has learned and applied over years of training and practice. Given this reality, perhaps the best one can do is to consciously attempt to address the topic of psychological change as a general issue that transcends any specific model of mind, and to identify one’s predispositions toward particular theoretical perspectives that will inevitably influence one’s observations and reasoning.

As will become apparent (especially in Volume II when I advance my personal views on psychological change) the broad theoretical tradition in psychology with which I am most closely aligned is Object Relations Therapy and Self-Psychology -- the most contemporary and popular of the great revisionist models of Classical (Freudian) Psychoanalysis. My affinity with these neo-analytic models is based upon three considerations. First of all, as with all analytic conceptions, these models strongly emphasize the formative role of early childhood experiences in the structure and dynamics of adult personality. Thus, there is a strong developmental emphasis in this school of psychological theory and practice. Similarly, in Volume II, an effort will be made to draw upon issues and processes in general human development as a foundation for understanding the progression of change in psychotherapy.

A second reason that I am most sympathetic to Object Relations and Self-Psychology as a theoretical perspective is because, more than any other conception of personality and change, this approach is relational. It places the action of significant emotional relationships at the center of the process of development and change. Change is conceived of within a two-person psychology, within a social context, rather than as primarily a personal or intra-psychic struggle. Consistent with this perspective, out of my own personal experiences, reflections, and observations, I have concluded that, while people can benefit substantially by being taught new skills, thinking more rationally, and revising the narrative of their life, I believe that the most significant and enduring changes that people make occur as a result of experiences within important, emotionally-meaningful relationships. After all, it is in these kinds of relationships where central personality dynamics are created. It stands to reason that these kinds of relationships will offer the greatest possibility for change. In essence, I am suggesting that there should be a parallelism between the context of psychodynamic development and the context of psychodynamic change. This belief in a relationally based parallelism between psychological development and psychological change is most closely aligned with the perspective of Object Relations Therapy and Self Psychology and thus, in the interests of authenticity, I have pursued this approach to treatment. Throughout this work, the advancement of a relational view of change, as well as the rooting of issues of change in the broad context of human development, will be underlying and unifying themes.

Finally, my affinity with Object Relations and Self-Psychology is based upon emotional and philosophical considerations as well. In order to convey this point, I will contrast the typical reasons given in the field for the prominence of Object Relations and Self-Psychology with my belief in the essential, emotional basis of this popularity.

Traditionally the appeal of Object Relations Therapy and Self-Psychology is linked to the fact that it introduced a method of working effectively with individuals with character disorders – individuals who, because of profound disturbances in the pre-Oedipal social environment (i.e., the first 3 years of life), demonstrate severe borderline, narcissistic, or schizoid disorders. Prior to Object Relations Therapy and Self-Psychology, the prevailing wisdom within psychoanalysis, expressed by Freud, was that individuals with pre-Oedipal disturbances were not amenable to analytic therapy. In this context, Object Relations Therapy and Self-Psychology is often credited with broadening the types of clients that are appropriate for psychodynamic therapy. In my view, however, this traditional view does not fully or accurately capture the basis of the popularity of Object Relations Therapy and Self-Psychology. First of all, a method of psychotherapy that is primarily applicable to the long-term individual psychotherapy of character disorders would be too inflexible and narrow to achieve broad popularity. In truth, Object Relations Therapy and Self-Psychology are based upon a broad set of skills and methods of understanding that are not duration or format specific. That is, they can be flexibly applied to briefer forms of intervention and interventions that involve systems (couples, families, and groups) as well as individuals of varying levels of disturbance.

In contrast to this traditional perspective, it is my view that the popularity of Object Relations Therapy and Self-Psychology has more to do with its emotional impact on the therapist than on the strength of its particular theoretical propositions and applicability to specific clinical disorders. To understand the basis of this point, it is important to recognize that all approaches to psychotherapy can be classified according to their theoretical depth and the degree of warmth in the stance of the therapist. Classical psychoanalysis, for example, is based upon a profound and conceptually sophisticated model of personality that is intellectually stimulating for the therapist and which seems well matched to the complexity of human experience. At the same time, many classical analysts seem cool and detached in their neutral stance toward their clients and they often appear paralyzed by their own heightened consciousness and introspection. Conversely, behaviorally oriented therapists or Rogerian humanists may have a benign or warm stance toward their clients, but their underlying conceptual model seems naïve and fails to address the richness of our internal lives. All other models of psychotherapy – narrative therapy, gestalt therapy, strategic therapy, etc. – can also be discussed in terms of this fundamental split between depth and warmth.

It is in this regard that Object Relations Therapy and Self-Psychology offers something unique and integrative for the therapist. The greatest achievement of Kohut was not the introduction of a theoretical construct; it was the introduction of empathy into the psychoanalytic arena. The greatest achievement of Bowlby was to talk about the role of attachment and human connection, not only as important developmental milestones, but also as foundational processes in successful psychotherapy as well. The introduction of issues of empathy and connection into analytic therapy offered the clinician, for the first time, a methodology that contained central elements of both depth and warmth. In my view, the fundamental reason for the enduring interest and prominence of Object Relations Therapy and Self-Psychology is that, in addition to its strong developmental and relational conceptions, it offers the clinician a viable solution to the central split between depth and warmth that has characterized the field of psychotherapy. Stated more generally, by introducing issues of empathy and emotional connection into the analytic environment, Object Relations Therapy and Self-Psychology linked the conceptual brilliance demonstrated by Freud and the emotional warmth captured by Rogers. That is, it created a bridge between the previously divided worlds of analysis and humanism.

In sum, while I will attempt to address the issue of psychological change outside the strict confines of a particular theory of personality and psychotherapy, this discussion will consistently be influenced by approaches which are strongly rooted in processes of human development, explicitly relational in focus, and which seek an integration of analytic depth and humanistic warmth. Because Object Relations Therapy and Self-Psychology has elements of each of these themes, I will inevitably draw upon its conceptions somewhat more than other central perspectives on personality and psychotherapy.

In Volume I, I noted various types of psychological change, discussed potential sources of significant change, and reviewed existing models of clinical change. Now, in Volume II, I will attempt to convey a model of how individuals change in the course of relationally oriented psychotherapy that draws upon principles of human development and seeks to link analytic and humanistic perspectives on change.

Chapter 1: The Stages of Identity Change:

To Join, To Know, To Do, To Be

Based upon my observations and prior research and theory on the psychological change, I propose that identity change occurs in four broad stages (Attachment and the Frame, Insight or Consciousness, Action and Will, and Identity Consolidation) with transition periods preceding each of these stages.

In this chapter, I will provide an overview of each stage of identity change and consider whether these stages involve an invariant sequence. I will then discuss the relationship of this model to the progression of change in normal human development. Subsequently, in Chapter 2 I will discuss a number of impediments to the process of identity change and, in Chapter 3, I will address the issue of transition periods in the process of change. Recognizing and understanding the dynamics of these transition periods is very important because one of the key impediments to substantive change, the client’s resistance, is heightened during these times. Consequently, these are the times when most clients drop out of therapy, thus foreclosing on the possibility of change occurring at the level of identity.

In discussing transitional resistances, an effort will be made to avoid viewing these processes in pejorative or pathological terms. Instead, they will be conceptualized as normal, constructive forces of continuity in personality, – analogous to the homeostatic mechanisms that typically operate in advanced biological systems. In this way, the conflict between change and non-change will be expanded from a relatively narrow, intra-psychic sphere (e.g., focusing on conflicts between desire and inhibition in classical analysis, or conflicts between attachment and emotional protection in object relations therapy and self-psychology) to a more basic struggle between forces of change inherent in human development and forces of continuity found in advanced biological systems. This reconceptualization is not intended to diminish the importance of the specific conflicts addressed in analytic models. It merely seeks to embed them within, or link them to, broader, more encompassing, human issues and conflicts.

Similarly, in Chapters 4 through 7, when specific resistances or forces of continuity are discussed in detail, it will be evident that these processes are often expressed in broad, humanistic terms such as the retreat from shame, responsibility or identitylessness. Once again, while the notion of conflict is preserved from analytic models, the nature of this conflict is re-conceptualized and expressed in broad, humanistic terms reflecting the current effort to bridge analytic and humanistic conceptions of personality and change.

The Four Stages of Identity Change

1. Attachment and The Frame

The first stage of identity change is unique in that it is the only stage where two major objectives must be accomplished simultaneously. First of all, an attachment from the client to the therapist must begin to develop. By an attachment I mean that clients must come to experience their relationship with the therapist as important, meaningful, as having emotional value. Put another way, for identity change to be a possibility, the therapist must become an object of identification for the client, someone who embodies qualities that the client values and who represents the process of growth and change in a positive manner. In the absence of this attachment -- this experience of identification -- specific, defined changes are possible in psychotherapy, but not changes at the level of identity. If there are any immutable laws in psychotherapy, this may be one of them: No attachment, no identity change.

One way to more concretely grasp the importance of an attachment relationship in the process of internal change, is to consider this situation: Imagine that two people bring to your attention certain problems in the way you conduct yourself in the world. In both cases they address the same problems and use the same words to provide their feedback. However, there is one crucial difference: In the first case, the person who talks to you is someone who you do not respect, or with whom you have a neutral or inconsequential relationship. In the other instance, however, someone who is very important to you and for whom you have high regard delivers the feedback; that is, someone with whom there is an attachment or meaningful emotional bond. It is self-evident that the input of the former person is far less likely to be taken in, to penetrate, to be reflected upon, to serve as a catalyst for change. In other words, the impact of therapeutic communication cannot be understood merely by analyzing the content of what is said and done. The relational context of this communication is crucial as well. Put another way, we spend far too much time considering what therapists do and say with their clients (the level of intervention) and far too little time considering who therapists are to their clients (the level of attachment).

Certainly, one can understand the emotional basis for this excessive focus on intervention. It