One of the reasons I’ve neglected the blog is that I have been working on understanding better. I’m still not entirely there but I want to share my thoughts so far and ask readers for their experiences. I’ll tell you at the end about my other reasons for being scarce. (Image by Billy Pasco)
The explanation I have given so far for intense attachment to the therapist and related issues, is to picture a small child, whose main job in life is to make sure that the grownups do what they are supposed to do to provide the love and attention necessary for life. I have pictured a sort of grieving process, whereby the inner child gradually comes to accept the reality that some of the primary love that was missed will never be fulfilled, while other parts, like having an empathically connected witness can be fulfilled.
In this scenario, the therapist’s job is to provide empathy without seeming to promise the full primary love that is not possible. The empathy creates a positive context with which to face the pain of not having what can’t be.
But I’m not sure that is the whole story. Too often, my proposal has felt inadequate. Many of you have questioned when the yearning will lessen and how the emptiness can end.
The other possible issue
For a long time, I have held the idea that, under good conditions, people internalize a sense of connectedness to the primary caregiver which then gives them a permanent feeling of everything being ok and not being alone. This sense is so deep and nonverbal that it is taken for granted and not even noticed by those who have it. There is something that has been called “basic trust.” I think that is the the same thing, the result of internalizing primal love. It is also what makes for “object constancy,” the sense that the other can be relied upon to return if absent, and that relatedness exists regardless of physical presence.
Margaret Mahler, who introduced the concept of object constancy, pointed out that in children, this sense of connectedness and safety, even if acquired, is vulnerable to disruption under conditions of stress. It can be lost, then regained. So what about the many people whose early experience has been so disrupted that whatever sense of connectedness they internalized was shaky or nonexistent?
I have often wondered about that, and here I’ll propose some answers. First, a caveat. As you can imagine, there is an active nodding of heads by those whose inner child is hoping to use this explanation as a reason for insisting all the more vehemently on having the parental love they have been waiting for. To make matters more difficult, I don’t know a sure way to tell which mechanism might be operating. So anyway, here I go…
So what can we do?
I have known a certain number of people for whom I really think object constancy has never been sure. Some I have worked with long enough to see it appear where it was not before. What they have in common is that in between sessions, they really don’t have a sense of being connected. They experience a deep and genuine sense of being alone and disconnected from anyone. Their aloneness between sessions or during the night is profound and real, requiring some quite drastic measures to get through those times. By drastic measures, I mean psychological defenses and strategies of a primitive nature.
What has happened, is that over time, very slowly, perhaps even over decades of reliable and constant therapeutic relationship, I have seen a sense of being OK in spite of being alone, begin to appear. I think this represents an internalization of a reliable presence and relationship, coming and going, but always coming back.
All I know about Internalization
So let me tell you what I know about internalization. I think there is internalization fast and slow. The slow kind takes its time, and very gradually accrues. It is not hurried, but keeps getting stronger and more reliable under stress. That’s the simple and easy one, if only the conditions are met. Under good conditions, it happens over decades in development and is there to support the successful emancipation of young adulthood.
Then there is the other one. I first became interested in internalization when I realized that the low self-esteem experienced so regularly by trauma survivors is very hard to eliminate. I realized that what had happened, is that they had internalized the exact attitudes of their abusers, and those attitudes were exceedingly hard to get rid of. The fact that, even with successful therapy, a series of bad events could bring back all those bad feelings about the self told me that these internalizations were not only bad, but might be permanent. They were either deposited someplace where change isn’t possible, or they were guarded by some important mechanism.
Then I realized that there was a reason for their being kept unchanged. These attitudes are part of the conscience, which begins to function around 18 months. That’s when Schore says the prefrontal cortex is myelinated. Then the conscience starts to function around age three. So I began to put together that the conscience, which uses shame, and guilt as negative reinforcement and pride as positive reward, uses internalized values, attitudes, ideals and prohibitions, as measuring sticks to decide what to reward and punish. That very useful system, which, as best I can tell, animals don’t have, involves the cortex, not just the limbic system and gives humans a way to self-regulate, primarily towards the end of social cohesiveness (more on this in my new book, mentioned at the end of this post).
So when you really want something you are not supposed to have, if the internalized book of rules could easily be changed, then the conscience would be of no use at all. Therefore, it makes sense that the book of rules should be written in indelible ink.
Now, what about fast internalization? My search for answers took me to cult indoctrination. There I learned that under conditions of high stress, often helped by social pressure, music, ceremony, smoke, hunger, and lack of sleep, people who are ready, will internalize a whole new set of values and attitudes towards life. This works best when there is what I call “attachment anxiety.” Once people join a cult, it is very hard for them to be “de-programmed.” The story of Patty Hurst is, I think, illustrative. The more the person has a shaky sense of self and belonging, the more they are susceptible to this kind of indoctrination. Another classic example is the end of Shakespeare’s Taming of the Shrew, where sleep and food deprivation plus social rejection are used against the protagonist.
Internalization and Trauma
Learning about this has led me to examine other situations. Trauma is an example. Here, stress is at a maximum level, and I don’t know any situation where one might feel more alone, then as the object of an abuser who is intent on personal gratification and has no empathy or caring for the person being abused. I began to believe that these are exactly the conditions that promote rapid internalization.
What is the purpose of internalization? It is to maintain one’s connection with other humans. That is why people join cults, but it is a basic need we all have, that can be heightened at times of great stress. So it made sense that the reason behind the Stockholm syndrome, and the mechanism of “identification with the aggressor,” would be to preserve a sense of connection. And it made sense that victims of abuse would also internalize the attitudes of their abusers as a way of gaining a sense of connection, since adopting the point of view of the other is a way of securing a vulnerable connection.
From all this, I came to believe that bad internalizations happen as a result of terrible stress, where the need to be connected to someone leads to rapid, perhaps instantaneous, internalization of negative attitudes and values.
Undoing bad Internalization
Now we can talk about how this might heal. Given the general propensity to relapse, I don’t think that old internalizations can be “erased.” I could be wrong, but this is my belief so far. That means that even the amazing mechanism of memory reconsolidation, which allows for re-programming of erroneous beliefs, can’t undo this kind of mental content.
There are some who would disagree. Francine Shapiro, who invented EMDR, is one of the few, at least in her original book, who recognizes that core values are not the same as other mental contents and require different treatment. Most of the therapy community seems to have forgotten the superego and classified its values as the same as any other belief. I know that is incorrect. The way you can tell is if failure to live up to a belief leads to shame and success to pride, then it is a value. If not, it is a simple belief. Do you feel proud when you eat your favorite breakfast? Do you feel proud when a story has a happy ending? No. On the other hand, what do you feel when you exercise great self-control?
Unfortunately, even Francine Shapiro seemed to think that all you have to do is “install” a new value by waving a finger or making alternating clicks. It would be great if that was all it takes, but I remain skeptical. Please let me know if the EMDR community has learned otherwise. Meanwhile, the distinction between beliefs and values continues, in my view, to lead to a failure to adequately investigate what is special about values.
A closer version of what really happens is that we can establish a new internalization, capable of overriding the old, bad one, even if the old one is still imprinted somewhere in our neural networks.
Now, you may have noticed I am putting internalized values and object constancy in the same category. I think that is warranted, but object constancy goes so far back, that it is not a source of pride or shame. Otherwise, I have a feeling it operates using many of the same principles and mechanisms.
Now I’m getting far into conjecture, because the research has not been done, to the best of my knowledge. I’m guessing that internalization of the connection with the other, even though it is gradual, happens at moments of connection stress. In other words, I’m guessing that it is the pang of loneliness that happens at the moment of saying good bye, that allows a little bit of internalization to take place. I’m guessing that over decades, what has allowed some people to internalize a new sense of secure connection, who didn’t have it before, are the collected moments of angst at separating from the other, not so much the steady presence.
There is some relevant observation. Freud talked briefly about “identification with the lost object.” Also when kids are left alone by a parent at an appropriate age, say 10 or 12, then they often have a tendency to act more responsibly than when they are with the parents and feel safe about acting up and then being told to behave.
A Reader’s Experience
Recently a reader of this blog told me how she was abruptly dropped after over a year with a good therapist. Apparently the clinic where the therapist worked suddenly decided to crack down on good treatment and insisted that the client be thrown out of the facility and terminated without ceremony. She was devastated, and wondered if I had any ideas about what to do. Here was my thought.
Might it be possible for her to try to internalize the love and genuine caring that she had already received. Could she allow herself to notice that she had already received a good amount of what had been missing? I don’t know how much wanting to internalize makes a difference, but I now that children often want to internalize some attitude or value they consider to be good. So I thought it was not entirely unrealistic, that noticing the positive of what she had received might improve her ability to internalize a sense of mattering in the world and not being alone. Is that correct? I don’t know. I wonder if readers have any relevant observations?
For now, this is all I have to say. In the years I have held these beliefs, they have not bee contradicted, nor can I say they have been proven true. If research does not pick up this issue, then maybe we can collect experiences that do shed light.
What I’ve been up to recently
I said I would mention what else has been distracting me for a while. I have given some hints. It is that I want to develop a therapy training program, especially for psychiatrists, who often receive only minimal training in psychotherapy.
What worked for me was to develop an understanding of just how people change. Rather than following a method, I could then focus on trying to identify what change processes needed to happen, then work on supporting them. I want to give others that experience, which, by the way, naturally moves us away from the competing schools model where therapists must choose to be disciples of one particular camp.
Towards that end, I created a brief “info-graphic” to simplify the common infrastructure of psychotherapy. This is in no way a challenge to existing theories and methods, just filling in the part that couldn’t be filled in before. Having done the info-graphic, I thought there was a need for something to give away free to anyone who would give me their e-mail address, so I just finished a new e-book. The Common Infrastructure of Psychotherapy is a short (75 page) introduction to the material covered in my other books. Here is the link to the info-graphic: “I want the free info-graphic showing The Common Infrastructure of Psychotherapy!” From there you will be able to get the new book, also free, but please join my email list or go to the page even if you are on the list. (I won’t ever sell or give your info to anyone. It will be kept on Mail Chimp for now, or, if I have to change, some other platform that cares about protecting you.)