Breaking the Trauma-Bond Between Your Patient and Their Family
Recorded Friday 18 September 2020
An Object Relations Approach to Resistance in Treatment - Led by Dr David Celani - Chaired by Alice Waterfall
CPD Credits: 4 hours
This workshop will address one of the most frustrating and often repeated events in a psychotherapist’s daily practice, when a client, who seems to be making progress, suddenly begins to aggressively defend his family of origin and angrily abandons treatment. This sudden resistance to therapy is provoked when the patient realises that s/he is pulling away from their family of origin, both internal and external, and cannot imagine surviving alone.
W.R.D. Fairbairn recognised that “attachment to bad objects” was a formidable source of resistance to treatment: as the patient develops emotionally in relation to the therapist, their unconscious bond to the parents who neglected them in childhood is threatened by the new relationship, and by the discoveries inherent in the treatment.
READ MORE...The loss of their dysfunctional family appears to the patient to be catastrophic because they will have to confront the reality of their mistreatment in childhood. These unconscious loyalties are harboured in two mostly dissociated pairs of ego structures that developed from relational events between parent and child. These were (and are) intolerable for the child or even the adult to remember. Our speaker will demonstrate how to identify and respond to the two pairs of unconscious structures along with the patient’s developmental deficits, while minimising resistance and early termination.
Continuing Professional Development (CPD) credits for 4 hours are available as part of the course fee. You will need to fill out an evaluation form and pass a multiple choice questionnaire related to the content in order to receive your certificate.
Access to the Talks On Demand runs for 365 days from the date of purchase.
FULL PROGRAMME
The Extreme Dependency of the Child on Mother and the Consequences of Rejection
Fairbairn was one of the first analytic writers to recognise the devastating impact that maternal rejection has on the development of the child’s personality. He explained how the child’s absolute dependency on their mother makes rejection of their needs a traumatic event. The emotionally deprived child cannot continue to develop and explore the world because they would have to draw their attention away from their mother to whom they cling in the hope of love and protection that might be forthcoming. All other developmental tasks are thus put on hold, and they begin to fall behind their peers.
Q&A
The Development of the Unconscious, the Emergence of Sub-Egos, and the Hidden Attachments that Prevent Separation from Bad Objects
This session will focus on dissociated internalisations of the toxic relational events that repeatedly occurred in the child’s life. We will explore how such dissociated memories in relation to the rejecting parent create a sub-self that relates to memories of the rejecting parent in the child’s unconscious. A second pair of unconscious structures develop within the inner world that are designed to keep the child’s hope alive in the most rejecting and abusive families. This second split-off view of self and object is developed from the fantasy that the parent contains an untapped storehouse of love. This view of the parent gives the child hope for the future and this libidinal sub self is ferociously invested in discovering the path to this hidden love.
Q&A
A Fairbairnian Approach to Change: Minimising Patient Resistance, While Maximising the Therapist’s “Introjectability”
This section of the presentation will focus on identifying and responding to the split-off structures that will emerge during the treatment process. We will also examine the process of developing a clinical narrative that subtly focuses on early relational failures. Premature discussion of the many failures that the patient experienced can produce resistance, as the patient cannot yet accept them because they further separate him from his attachment objects. We will look at a clinical narrative is designed to help the central ego to grow, and to get used to relating to an external object that operates as a new and good object. Over time, the patient’s increasingly strong central ego will allow them to face the painful, neglectful and abandoning reality of childhood that has heretofore been successfully dissociated.
Q&A
Understanding and Tolerating Patient Resistance, and Repetition Compulsions
Fairbairn’s model is a powerful explanatory tool that sees resistance as a clinging to unconscious relationships in the unconscious structures. We will see how repetition compulsions are the acting-out of internalised relationships with new external objects (including the therapist) and how these offer a window of understanding to the patient’s unconscious. The calm and matter-of-fact discussions between the therapist as the good object and the patient’s central ego can accumulate in the patient’s central ego. In time, they can surpass the intense attachments between the split-off structures that have guided the patient’s life into repeated futile patterns. Typical clinical narratives between patient and therapist will be modelled to illustrate the surprising potency of this approach.
Q&A