CNWL - December 4, 2015 - FINAL
A psychotherapist’s approach to Ms B: EMOTIONAL VALIDATION THROUGH
A RELATIONSHIP
Relationships
(To the audience) I am looking at you. You are looking at me. I am thinking
about you – how many of you there are, how old you are, are you bored and
tired by now? Maybe you are wondering when this all will be over. Maybe
you hate psychotherapists, hate Freud? Whatever ….. But we are in a
_(relationship)_______________________________, here, in this room, our
bodies and maybe even our minds are in this room now, together.
Psychotherapy has been around for over one hundred years and I have 10
minutes to give you some thoughts.
Today there are very many different ways of therapeutically thinking about
this young woman, Ms B. Viewing her through the psychoanalytical lense I will
give you one approach.
First to set the theoretical context for forensic psychotherapy:
- Never work in isolation, imp of teamwork, people helped by different
approaches at different states of their development. No magic bullet
- Each crime is a communication – means something, no such thing as a
senseless crime
Don’t forget Freud: We are not rational creatures. Importance of the
unconscious – that “which cannot be remembered gets repeated.”
EMOTIONAL VALIDATION: IMAGINE THE PATIENT AS A BABY
“Two traits are essential in the criminal: boundless egoism and a strong
destructive impulse. Common to both of these, and a necessary condition for
their expression is the absence of love, the lack of emotional validation of the
human.”
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In reading about Ms B, the first thing that comes across is to me in her struggle
with her body:
she wriggles in her chair, she self-harms, and she physically attacks others
using her own body.
She has sold her body in prostitution, she is also a mother. She discovered
the dead body of her own mother as a little girl. What does her body mean to
her – friend or foe?
Where do we get a sense of our own body? Many psychotherapists trace the
origins of our relationship with out body back to the relationship the mother
had with her baby. When does this start? During pregnancy the mother may
or may not develop an idea of her baby and begin to connect with the body
inside of her. In an ordinary, if there is such a thing, pregnancy, the mother
often has an idea, even before the baby is born, about her soon to be born
child. Boy or girl? A name, a hope for the baby’s future. Many mothers
stroke, sing and talk to the baby. The baby takes up a place in the mother, and
hopefully as well, father’s mind. Sadly for some babies this does not happen.
Pregnancy can be a time of domestic violence and enormous stress for the
pregnant women. The outcome for a baby born into this environment is not so
good. Many mothers are far too anxious and frightened to bond with the baby
before birth – which is what I see year after year in the weekly pregnancy
groups.
Often - once the baby is born to an anxious, angry to distant mother life gets
worse for both mother and child. The feeling that the baby may get from the
mother is that he or she is a disgusting little piece of shit, not the adoring,
perfect baby doll the mother was pinning her hopes of love on ….. In other
words the baby’s emotional needs are not met from the outset. The baby does
not receive emotional validation. We can infer this with Ms B. A mother who
goes not to take her own life is unlikely to have had enough love to give her
daughter.
As Joan Rapael-Leff puts it so well:” A pre-verbal infant absorbs not the words
but the implicit intentions of the communication…This register is conveyed
through PHYSICAL CONTACTS, facial expression, gesture and vocal tome.”
Although Freud’s technique, dubbed “the talking cure” by one of his early
female patients, PSYCHOTHERAPY is about much more than ONLY verbal
communication – the body speaks as well.
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The psychotherapist is attuned, as was the psychologist, to the way the “body
speaks” in the session.
The baby looks into the caregiver’s eyes seeking her gaze, hoping that the
mother make sense of the distress which is expressed though his body with
crying, flailing around, kicking.
The mother who has sufficient support, is able to take in the baby’s distress by
speaking calmly, soothingly, describing the baby’s experience to him. This
enables the baby, young child, therapy patient to experience another mind
which is able to think about his experience without acting out punitively. This
processes, which Bion termed REVERIE, helps and encourages the recipient to
see their experience as comprehendible and thus less terrifying.
If, on the other hand, the caregiver is freaked out by the baby, the baby will
then experience herself as horrible, dirty, and incapable of having any positive
meaning to anyone. This is seen time and time again in the mother and baby
groups. For Bion this early experience in the baby is the source of what he calls
“nameless dread”.
What I am getting at is that the gradual containment in the mother’s mind of
the baby’s distress has a physical outcome – the baby not only calms down but
also has the experience that their feelings have meaning, can be thought about
by the mother, and given back to the baby in a way that the baby experiences
as being understood.
I think this is what Freud means by emotional validation which initially takes
places between 2 people developmentally, the baby and the caregiver.
Without this fundamental developmental relationship is very difficult for the
baby/patient to move into wider functioning relationships which is one of the
reasons I think that women in prison say they “do not do groups”.
For the prisoner who has never been loved for her own sake, it is very difficult
to relate to well-meaning professionals. Prisoners who have been sexually
abused as children, are understandably wary of us professionals, many of
whom are about the same age or younger, better educated and better settled
in the world.
Technique:
So the psychotherapist seeks first to bring the body into the room, establishing
a safe and reliable time to meet. Great attention is spent on this as well as
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careful timing and exploring of any changes in the relationship such as breaks,
illness or appointment times. Through this careful reliability the therapist
strives to provide a relationship that will provide emotional validation for the
patient.
By giving words to the patient’s experiences the therapist often will note
an increase in the patient’s vocabulary. This means that the patient’s
capacity to think about her own experience increases, with the hope
that her behaviour will become more thoughtful with her emotions
expressed in words instead of acts. If her body can be accepted in the
room and her treatment of it talked about non-judgementally the
therapist hopes, over time (and it takes a lot of time) the patient’s
attacks on herself and others with decrease.
It is very important to remember that it takes a long time to learn a language
and the learning of a language depends on social relationships.
By providing an open mind, a reliable setting, words to describe experiences
and a curiosity about the patient eventually Ms B might be able to develop a
curiosity about her own experiences, a curiosity never nurtured by a mother
who later committed the ultimate attack on her own body – suicide.
Along with his emphasis on emotional validation there is another very useful
idea from Freud who, in his paper “Criminals from a Sense of Guilt (1917),
asserted that criminals seek punishment because of their deep sense of guilt.
We see this very often in our work with women who come to prison over and
over again. We can imagine Ms B felt a tremendous sense of guilt about her
mother’s suicide.
Endings – coming to the end, closure?
One of the many things I love about working as a psychotherapist in
prisons is the opportunity to work with many women who would not
come within a million miles of a psychotherapist. After 25 years I feel
more strongly than ever that psychotherapy is relevant and useful to a
wide variety of people, and definitely has a wider reach than to the
often maligned worried well.
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Psychotherapy is a long and slow process, hard to evaluate and difficult
at times to champion. Relationships take time to develop and I hope
the opportunity for long term psychotherapy in prisons will not be
compromised by the closure of HMP Holloway where so much excellent
work is carried out by colleagues.
Planned, thoughtful endings play a key role in the psychoanalytic
process. In ending now I want to thank you for letting me give a brief
sketch of my work and I end with the hope that such work will not
disappear.
To end perhaps it is fitting to leave the last word to one of my current
psychotherapy patients, a 25 year old woman in for attacking with a
knife. We have worked together for 9 months and will continue meeting
weekly until her release in the Spring 2016.
“One of the positives I can take from the time I have spent in prison is
my therapy sessions. Therapy is something I always thought was a
complete waste of time, a load of rubbish. I dreaded every Tuesday
afternoon. I now feel very differently. Something has clicked into place.
I want to go to my sessions. I am beginning to understand myself. I
have spent my life in vicious circles. I am now in a very different place
and for me therapy has been life changing. I am very thankful for
having the opportunity to access the help and support I have received.”
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