Alcoholism is such a common condition that therapists must be exposed to clients who suffer from it, whether the therapist is Regarding Developmental Perspectives Brigitte Rota Abstract: This case study presents the work with Frederic and how a bridge is being built between his current problems and an understanding about how his identity was built. The case study presents a dialogue with the client and therapist in the therapeutic relationship. Transference, countertransference issues are discussed along with inquiry, attunement, and involvement in the therapeutic journey “we are making together”. ____________________________ Frederic is 41 years old and lives with his companion. He has a 2 year old boy. He is a choreographer, a composer and a dancer. He has conceived a “numeric dance” and with a technician, he has invented movement sensors, plates that are placed on the body that are recording body movements and transmitting them to a computer that is translating them into sounds, sounds that the dancer can listen to, thus hearing what his body is creating. “I am connecting to the intensity of the inner movement. I am liberating the bodies where there is no shell. First connection - with movement sensors, I am attempting to create a dialogue between the body and the music, thus making it body music. The sound is born through the movement. Finding the instinct. Totally connected to oneself. The song of the body.” I am amazed. By his creativity, by this extraordinary setup of body sensors he is inventing. I will use this notion of body sensors and shift it to emotional sensors. When Frederic says “I am connecting to the intensity of the inner movement”, I am myself in contact with the starting movement of integrative psychotherapy that he conceives as a creative step, loaded with the hope “of being connected with the other” and I perceive, as if by anticipation, the despair. Like the famous man who is writing in prose without knowing it, Frederic is practicing integrative psychotherapy without knowing it. Frederick came to therapy one year ago because he felt he was in a situation of failure with a group of dancers in a show he had created, a feeling that this situation is repeating itself. “I’m living too badly. I want to understand where this has its roots; I want to scrape the bottom of the drawers to defuse what I’m loaded with. I have trouble making myself understood, getting what I want. I’m keeping a low profile and then I give up. I’m working with wild cats (the dancers). I have hatred; I didn’t manage to win the respect of the people with whom I am working.” Listening to him as he talks about what he is experiencing at the moment, I’m wondering what he’s talking about. And whom he’s talking about, and how he is International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 33 speaking to me about his history. “My dream is to find someone who would talk on my behalf, using the words I have in my head, who would tell about the unfair things I have experienced and who would take a stance for me. I am outside of everything, without a tribe to welcome me.” I understand what kind of therapist he wants me to be for him, and he gives indications about the treatment plan that needs to be constructed while shedding light on his wounds. Frederic is the only son of his parents. He has a half sister he doesn’t know, a daughter from his father’s first marriage. He presents her as “paranoid” who has been hospitalised in a psychiatric hospital on several occasions. Frederic severed the link to his father one year ago, in order “to catch breath. I can’t deal with the violence that has been inflicted”. His father is in the army; he was a mercenary during the war in Algeria. Frederic describes him as being violent, abrupt, discounting, and never satisfied. And he presents his mother as being without emotional echo, unwelcoming, without emotional sensors to sense his emotional reality. He describes himself as a child locked in its own world, a world defined by loneliness and isolation, a bit like a flower that closes when it’s touched, or the eyes of a snail. Without knowing it, he invites me to be careful, and tells me how important it is to stick to his own rhythm. His world is a world of science fiction, of planes, of models and planets. A world of dreams and loneliness. He lived in an apartment complex in a working class neighbourhood of Paris and in the power struggles he found a code, at last, and attempted to hide his sensitivity with his snail’s eyes. It was a code one had to decipher, to integrate, that was making contact possible and was giving access to the other: “To lower the eyes when you come across someone you don’t know. Respecting authority. In a code of violence.” Frederic speaks freely about his current suffering or about his history after the age of 16 “I’ve started to exist when I was 16”. When I’m exploring on the phenomenological level, example his feelings or his body sensations, he cuts the contact by talking about something else, or by laughing. The meanders of his thoughts in which Frederic stays in a current dialectic of his trouble with relationships are like attempts to cling to something that is known and manageable. He also cuts the contact with laughter. Laughing is used in order not to feel; laughing interrupts the contact with himself and with me. I chose not to confront him and to accept his frame of reference thus also accepting his defence system, in order to form an alliance. In the proximity with little Frederic, his laughter hurts me. No hurry. Being there. With what I know. With what he can’t know about his own experience. Every time I mention the relationship to his mother, Frederic answers me with the neighbourhood. As if the neighbourhood had had a maternal function that was giving an access code to communication. Even when it is violent, this code gives access to the other person. “I built my identity when I was 16. I started to exist in the street. With dance. I needed to be a member of a tribe, I needed to belong.” I hear: looking for access codes, attempting to make sense, looking for stimulation and contact. Looking for another, for relationship, for family. Frederic gives an indication of what has been missing during the first 16 years of his life: “I started to exist with dance, that is creating movement, connexion, that is articulating the body and stimulating the senses. Music is setting the rhythm. A rhythm that is carrying and structuring the movement. And that is creating a link to oneself and to the other.” International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 34 And in my head I’m thinking of Winnicotts concepts of holding and handling; the music as a good enough mother that is creating stimulation, rhythm and movement. My comment bemuses him and we decide on a contracting dynamic to help him bring to consciousness what previously was unconscious, and to explore his phenomenological experience when he’s talking about his current problems. We are building a bridge between: - Today and his history - His body sensations, his emotions, his behaviour and his thoughts; We have to construct together the story of the first 16 years of his life in order for him to own the missing parts. I offer him the space to create this missing story. And thus the missing relationship with another who is present and caring for his experience. This dynamic aims to give sense, to bring matter to the self, to the self that has been missed. And to the self that is missing, to the interruptions in contact with his inner truth, to his confusion and his wounds. Body sensations. At the body level, Frederick feels pain. He feels that he was born when he was 16 through the movement of dance, feeling that he belonged to a tribe. Stimulation of the body, awakening of the senses. Initiating life in contact. Dead stimulation in the relationship to his mother. Affect. Affect is repressed or expressed in an exaggerated way. It’s the expression of a disavowal, a way of freezing emotionally. Behavior. On the level of behaviour he mobilizes his energy to create, thus hoping to create a connexion to the other. In his childhood, Frederic talks about his need to create objects, models and other devices to struggle against anguish. The articulation between thought and behaviour seems to be the favourite area in his personal and interpersonal dynamics. “ The hope of my life is to meet someone who would hear what I need. I’ve always been afraid of my increasing frustration and violence, I’m afraid of destroying. So I’ve decided to be stronger than my own violence, to be smarter (than whom?). I’m letting myself being treated like a doormat, the other one doesn’t take me seriously because I’m afraid I could escalate into violence”. Because his anger didn’t make an impact on the other. “It contaminates my potency and part of me surrenders. It’s like a gap in a leaking ball. I so much would like someone to understand what I’m experiencing. I feel like a helpless chick that is complaining, that is exaggerating, that is overdoing things. My mother kept telling me that I was overdoing things, that things weren’t so bad, that what I was experiencing wasn’t important. It was unimportant. She certainly said that to protect me, to reassure me. - And what are you thinking today? - She didn’t give me any importance, no value. I hate myself for being like that, I feel guilty, and I feel like an alien. - And what did you conclude? - That she was right, and I was messing around. - Instead of… - Tell me mum that it’s not me who is messing around, but that it is you. - It was a necessity for the child to believe there was something wrong about him. It’s a necessity for him to believe that and to convince himself of that. It prevents him International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 35 from feeling the rage against his mother, and his helplessness to change what is wrong with her.” During the last performance of his show, in a youth club that is not very adapted to the constraints of his staging, the spectators come and go, not very respectful of the show. “I felt violated, disfigured, ashamed. I am my creation. I’m asking the dancers to stage what is in my head, what I feel. They don’t understand and they don’t go to the end of the work”. I understand that Frederic entrusts the dancers with his heart, expecting them to grasp what he is experiencing inside and to connect with him. Like a good enough mother would do. The Champollion mother who is deciphering, decoding the sense of what her baby gives her to know. A mother who lets herself experience the connection, feeling and offering an adequate response. He stages (behaviour), thinks about was he is staging, and entrusts to the dancers as maternal substitutes his emotions and his hope for connection. I can feel Frederic’s despair, his quest, the sense of this quest on an existential level, this baby looking for arms, for adequate responses, for attention that would focus on the reality of its being. And while I let myself experience this desperate quest I let myself cry while connecting to the very small Frederic. I feel compassion for this small boy. (Me) “I’m touched and moved. I measure the sense of your words and your involvement in your shows. You are expecting a very special connexion to another who would capture what you feel, what you experience. What the small Frederic missed mostly. What all children need to live, and to feel that they exist in the connexion to another who is present, stable, available.” Frederic is surprised. I ask him what he is feeling when he sees me touched. “It’s a technique. A professional skill to let oneself be touched. - To let oneself be touched is not something one learns, it’s a human availability to receive the pain of another person.” Faced with the defensive reaction of Frederic, I’m realizing what he is projecting onto me: Uninvolved, neglecting, unconcerned parent neglected child The client will project onto the therapist the same realities as those he has regarding his inner parents. Attunement to a sensitive and connected other and to his own history is something unthinkable, unrepresented in Frederick’s frame of reference. The risk of a connection is too big and it would let the pain caused by what was missing emerge (we are talking here about the pain of juxtaposition): “I’m too afraid of what I need the most. It brings me down.” He comes furious, livid, to the following session. He says he’s being mistreated, not considered, and disavowed by a colleague for whom he has composed a piece of music: “I don’t feel that I exist. International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 36 - Your anger means that you need something that you don’t get from this person. - I’m afraid that the other doesn’t take into consideration what I feel. - What you need is being taken into consideration. And when you are afraid that it won’t happen, what are you telling yourself? - I can’t imagine that I will obtain reparation or consideration. (Laughs) That’s not possible. - This looks like the conclusion of an old story. - Yes, it seems so. It’s always been like this. - What might the little Frederic feel when he doesn’t receive consideration for what he feels and he needs it? - He feels furious, livid, and that he doesn’t exist. - What are you feeling right now? - Hurt, I feel sad.” In the following session he says he has contacted his colleague. “I don’t feel understood, I’m shutting down, I’m withdrawing feeling heart sick, like when I was small. - Where are you withdrawing to? - Into my world. - And what is little Frederic’s world like? - It’s a science fiction world. I need to build things, models, planes that could take me to another planet. - Where there would be someone who would show consideration for little Frederic’s feelings. (Laughter). - I’m mad that I’m still there. At the same point. I gave a lot hoping that one day… - One day… - I would find security, a permanent dynamic, that the emptiness would fill up. Instead I’m not peaceful; I have no trust in myself.I gave a lot, my trust, the best I have, I have smoothed the edges, I’ve kept my feelings to myself, I’ve answered to their demands (the dancers’). Always wondering: have I brought the answer he was waiting for? Am I as expected? It has cost me a lot to try to do it right. And it is unbearable, I am feeling helpless. Desperate.” It is easy for me to shift the expression of what the grownup Frederic feels now to the little Frederic. While listening to him, I represent the child to myself, a small man smoothing the edges, keeping his feelings to himself between a mother “ taking good care of my food and clothes”, who has been living in a convent, who is considering her life as a sacrifice, and a dad who is either absent or violent. I imagine with pain this little boy in his world of dreams and hope. And suffering. “I’ve made all the efforts in the world to gain the dancers’ respect. I am resentful. - Who are you talking about?” I understand that he is talking about the dancers and I hear the transferential shift dancers/daddy/mummy. “ You’ve hurt me too much. - You? - The dancers, my parents. Since I was a young boy, I’ve been trying to find the access code to my mother. There isn’t any. It gives me the creeps. I don’t know why International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 37 I’m thinking of this right now (laughter). Some time ago I saw the movie A.I. (Artificial intelligence) by S. Spielberg (laughter). Strange that I think of that now (laughter).” I ask Frederic to tell me the story of that little boy, the hero of the movie. While he tells me, Frederic is shifting between laughter, moments of silence, moments where he says, “it’s crazy what this little boy did, and all for nothing”, moments during which he seems touched and in pain. He is restless on his seat and he punctuates his sentences with “this is crazy, what a waste!” I punctuate his sentences with “an abandoned child looking desperately for a connexion to its mother and that is wandering about in a world full of danger in order to become an exceptional child: worthy of its mother’s love.” I hurry to buy the DVD of the movie and I let myself enter the triangulation between Frederic, David (the movie’s hero) and me. In the movie, humans share their daily life with very sophisticated robots called mecas as in mechanics. A prototype of a child robot is programmed to devote an unconditional love to its parents. The child robot is sent to a foster family. The legitimate child of the family is in a deep coma and kept in ice. It eventually returns to the family and there trouble begins for David, the child robot. David desperately seeks the connection to a mother who doesn’t understand his attempts and decides to abandon him. David understands that something is the matter with him and he wants to find the blue fairy that will change him into a genuine boy, thus making it possible for his mother to love him. The blue fairy comes from the story of Pinocchio mummy used to tell him (before the return of the legitimate son). He begins the quest for this fairy, meets a love meca (played by Jude Law, there I crack… Jude Law as love meca!) So, together they go to consult Dr. Know, the doctor who knows everything to find the whereabouts of the blue fairy who has answers to everything. The blue fairy exists in just one place at the end of the world where the lions are crying. That’s where dreams are born… then my mummy will come to tuck me in and she will tell me stories, she will sing for me because I’m exceptional, unique. There will never be anyone like me, she’ll cuddle me and will tell me a 100 times a day that she loves me… At the end of the story we stay silent. My eyes are filled with tears, and Frederic cries inside. During the next session: “There’s never been a true connection between my mother and me - How do you experience this child that is deprived from the connection to its mother? - I don’t - What kind of music would you write to represent it? What kind of music would capture what this child is experiencing? - A music that would talk about the need for arms. About arms that are reaching out and that don’t find anything. Nothing in front of them. The tunes would not be right, they’d be out of synch, hurting the hear, an endless note, like long stretched threads corresponding to a note. It’s as if the note was stretching into the infinite. The note will stop when the small one is exhausted. Out of despair. - What do you feel in your body? - Tight - And in your heart? - Sad. I see myself crying. International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 38 - How old are you when you see yourself crying? - Small. I was a depressed child when I was 6-7 years old. I was skinny, I didn’t eat, I was fainting. I think it was because of the fear. - How are you cutting the connection? In order to cut yourself from the fear?” At this moment Frederic feels pain in his hip. The same pain that was preventing him from walking when he was small. (Laughter) “It’s funny, I haven’t felt this pain since I was a child, it’s incredible.” (Laughter). He leaves the session limping, shaking with laughter. This pain is a language. This body memory tells about something traumatic, without words and without being able to verify its contents. In terms of process, this body memory erupts as a means to cut off the emotion. In the following session Frederic is desperate. “I don’t believe in myself anymore. My time has passed. I couldn’t or didn’t know how to exploit the right people at the right time. I depleted all my resources in order to keep existing. It’s as if I was experiencing an end of the world. It’s like when I was 11-12 years old, I was already afraid of the void. I feel lonely. - And when you feel lonely, what is the colour of the world? - The world is grey, the sky is grey, I’m looking out of the window, there’s nothing. I’m alone and there is no noise. I’m in anguish to leave my bubble to go to school or to music school. I remember, when I was 7-8 years old, I was afraid of death. Death is there, present. I’m going to die, to disappear. I can’t go to any other place; I can’t run away from time. I’m locked up in this process. As if I was a prisoner of the planet earth, I see the blue earth, there’s only me, a small point, there’s no one. - No one ‘s there, there’s no other place to go, it’s as if one was a prisoner and no one else is on the planet earth. I understand it makes you feel like dying. It’s like an end of the world. - At night, if I called mummy because I was thirsty or I needed to pee, the monster that was living in our flat could hear me. So I kept quiet, or I called her very softly. I was afraid of the darkness, because he could see me while I couldn’t see him, so I switched on the lights to see him. - And no one there to hear the fear of that little boy who believes there’s a monster living in the flat. No one to look under the bed, to open the closets with him. No one to protect this child and to comfort him. All alone on the planet. - To get out of my nightmares I used to switch from black and white to colour, I invented myself a Disney world, as if I was pulling the curtain of a theatre, hop, and it was gone. - It was a smart move to invent this curtain, to put some colour to get a grip on your anxiety. By lack of anyone. - I have trouble imagining that it could be otherwise. I often have the impression that I’m exaggerating. I’m not the only one who experiences this; I have to move on, as my mother used to say. - I am moved by this small one who is struggling on his own against a monster and his fear of darkness. Who feels he’s dying from fear, which is living on a grey planet. Alone. Like a small dot on the planet where there is nobody else. Who doesn’t feel he exists as a person. Because he is without relationship.” We stayed silent. Without words. Without laughter. Just there. International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 39 International Journal of Integrative Psychotherapy, Vol. 1, No. 1, 2010 40 And here we are, in this journey together we are building step by step. The impression that one is exaggerating is a desperate attempt to minimise or trivialise what one feels: it’s a way of cutting contact with oneself. I suppose that this kind of emotional avoidance can also represent an attempt to conform to the discourse of his mother in order to make contact, using unconscious defensive identification. I understand this process as a self-soothing system and as a way to smother his feelings and/or the intensity of it. The analysis of transference “I am alone in the world, no one can understand what I’m experiencing, no one can give an answer to my need for consideration. You can’t do anything for me”, and of my counter transference is a valuable source of information allowing us to make sense of what is occurring in the therapeutic relationship. When in my countertransference I am communicating to Frederic what is happening in me, the impact of his story on me, when I’m transposing what he’s telling me about his problems with the dancers to the world of the little boy, he is surprised in his awareness here and now. It is as if this communication was creating a space and time allowing him to begin to be in contact with himself. It’s a relational process that can act as an anticipatory projection of my availability to welcome him. I am using what I am feeling in my heart and in my thoughts; I am formulating hypotheses while keeping my own sense of a distinct self. I am using the contact with myself to make contact with Frederic, as an emotional base to reconnect the self. The function of this attunement is to facilitate the integration of feelings, of emotions, of physiological sensations in order to integrate the unconscious to the conscious. Through my sustained presence and contact, the cumulative trauma caused by the lack of satisfaction of needs can be addressed and treated in the relationship. The objective is to support the complete regression that will make it possible for the child to develop a sense of self. Brigitte Rota is a clinical psychologist and psychotherapist. She is a trainer and supervisor of the International Integrative Psychotherapy Association. She supervises professionals in Psychotherapy, Health and Education fields and uses body meditation and arts to foster change in the therapeutic process. She works in Marseille, France.