Tuesday, July 24, 2012

Margaret Wilkinson - Transference, Neuroscience, and Integration


"Perhaps as yet speculative, nevertheless it may be inferred that the analytic process, and the evolving symbolizations associated with it, can develop new neural pathways in the brain, and in particular can develop the fibre tract known as the corpus callosum that is the major highway between the two hemispheres, shown to be reduced through the effects of trauma (Teicher 2000). Such integration is facilitated as, through the experience of the transference, past is linked with present and emotional experience revisited and reworked. Through the analytic process, new entities are added to pre-existing connections, in the transformative way that is the outcome of appropriate and well-timed interpretation. Schore comments that affectively focused treatment can ‘literally alter the orbito-frontal system of the brain’ and suggests that ‘non-verbal transference-countertransference interactions that take place at preconscious-unconscious levels represent right hemisphere to right hemisphere communications of … emotional states between patient and therapist’ (Schore 2001b, p. ).

At the beginning of therapy the greatest need may be for containment with the therapist as the container of uncontainable affect of unbearable experience, and also as the one who can process the rapidly changing dynamics of the transference and countertransference in order that what feels like ‘now’ may settle into ‘then’. There will be a need for meaning making, for naming that which was previously known only in the body, unavailable to the mind. Early relational trauma may give rise to vertical splits within the personality, experienced as alternating subjectivities, at the very least there will be the frightened, angry child whose development was stopped by the experience of overwhelming trauma and whose emergence in the consulting room will mark the first tentative steps towards trust. One might say that part of successful therapy will be the recognition of the threesome in the consulting room, that is the analyst, the patient who manages the day to day more or less successfully whether adult or child, and the inner hurt part of the patient that is often characterized as the traumatized child within The skill of the analyst is to relate to both without favouring one or the other so that the two may become more able to interact in a caring way one with the other, eventually becoming more wholly integrated into one, allowing a new experience of the self.

The questions surrounding the recall of memory and accuracy of memories that surface in the consulting-room have been widely discussed; however we should also be aware of the way in which the changing of emotional memory may actually be a benign aspect of analytic work, in that the re-telling (from explicit) or re-experiencing (from implicit) of memories in the presence of the therapist may lead to a modulation in the quality of the affect associated with the memory, thus modifying the memory. Siegel notes that recent studies of flashback conditions suggest an intense activation of the right-hemisphere visual cortex and an inhibition of left hemisphere speech areas’ (2003, p 15) At such moments much will depend on the calm that the therapist is able to sustain within in the face of much that urges consciously and unconsciously towards just the opposite. A lowering of tone and slowing of speech, speaking in what Williams (2004) has termed ‘pastel rather than primary colours’ may help to counteract the responses triggered in the patient. It may be possible to help the patient to modify their experience by use of a simple phrase such as ‘it was then, not now’. Cozolino (2002) suggests that this is effective because it stimulates Broca's area and encourages the functioning of right and left hemispheres in a more integrated way.

This process of cure is not only that of making unconscious conscious, with interpretation, but also the interactive experiencing within the therapeutic dyad. It is the combination of the two that enables change. The development of regulated of affect within the patient brings with it the capacity to reflect, that then makes more possible the interpretative moment, in turn bringing with it the possibility of more integrated hemispheric functioning and the development of coherent narrative. Fonagy argues that ‘the ability to represent the idea of an affect is crucial in the achievement of control over overwhelming affect’ (Fonagy 1991, p. 641). For this to occur successfully interpretation; must be grounded in the emotional experiencing that occurs within the therapeutic dyad rather than being merely cognitive engaging primarily the left hemisphere alone. Beebe and Lachmann describe the analytic process as ‘a co-constructed interactive process’ in which ‘the narrative dynamic issues and the moment by moment negotiation of relatedness fluctuate between foreground and background’ (Beebe & Lachmann 2002, p. 17).

The work in the consulting room, with its focus on the transference, calls forth emotional responses that come from implicit, emotional, amygdaloidal memory traces that affect profoundly the individual's way of experiencing and relating to others. The more traumatic the early experience of the patient, the more necessary it is for the analyst to keep this firmly in mind. The therapist's way of working, of containing and moderating the affect evoked, will determine whether an experience ‘kindles’, that is, activates an emergency response where no emergency is, releasing a toxic soup of chemicals in the brain and retraumatizing the patient, or whether it facilitates the ‘quenching’ process which then permits analysis of the transference. Such work enables the later left brain analytic processing, that ‘allows for the structural expansion of the patient's orbito-frontal system and its cortical and subcortical connections’ (Schore 2001a, p. 72) and strengthens cortical control over the amygdala (LeDoux 2002)."
(pp. 490-492)

Margaret Wilkinson (2005). Undoing dissociation. Affective neuroscience. Journal of Analytical Psychology, Vol. 50, pp. 483-501

2 comments:

  1. I heard Margaret Wilkinson speak at the Interpersonal Neurobiology Conference at UCLA this morning, March 10, 2013. She was brilliant, thought provoking and oh so validating of the human aspect of healing. She combined the best of psychoanalysis, neuroscience and relationship therapy to describe where the power rests in psychotherapeutic healing. I feel privileged to have been there to hear her.

    Joanna Poppink, MFT
    http://www.eatingdisorderrecovery.com

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    1. Thanks for the comment Joanna. It is wonderful when someone like Margaret can appreciate and incorporate the insights offered by neuroscience without losing the warmth of the human spirit that is reflected in psychoanalysis at its best.

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