Tuesday, April 15, 2014

Books: A Gradual Awakening

4.0 out of 5 stars Mostly Marvellous, April 15, 2014
By Not Moses (Loma Linda, CA USA)
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This review is from: A Gradual Awakening (Paperback) by Stephen Levine, 1979

Mindfulness and meditation (by one name or another) were popular in America in the mid and late 1800s, in the 1920s, and again in the 1960s. And owing to the heaps of research on their combined effectiveness as psychotherapeutic techniques in the "mindfulness-based cognitive therapies like DBT, MBSR, ACT and MBBT, they've made yet another comeback over the last decade. And there are books galore nowadays.

But in the whole (and currently very rapidly growing) pantheon of books on mindfulness and meditation, =AGA= continues to be right there with Hart's =The Art of Living= (on Goenka's version of vipassana meditation) and very little else in terms of shucking the jive and getting down to what actually matters. Levine's artful prose is both edifying and easy to understand in contrast to most of the Brahman-woo-woo-toned -- as well as the psychotherapeutically mechanistic -- offerings currently flooding the bookshelves. It's also more accurate and first-hand-experience-founded than much of the hearsay evidence published in Levine's own time and slightly before.

Levine understands, for example (and as many others don't) that the mind never really shuts up, and there's no such thing as "thought stopping" (even if there =is= thought-displacing, which can be risky depending upon who's offering the displacements). "Even the wandering mind, if watched without desire for it to be otherwise, holds the key to great wisdom." "The demons aren't the noise; they are our aversion." "If nothing is moving in the mind, the opportunity for understanding what binds us does not occur." "Gradually we get so that we can watch liking and disliking with clarity." "By watching the contents of the mind change... we start to see the process." "Restlessness [itself] becomes the meditation."

No less an authority on the two topics than the late Jiddu Krishnamurti asserted that mindfulness and meditation are not the ends; they are merely the means to them. In his view, too many people run around thinking that because they "follow their breath" or "maintain their attention to the sound they are making" or "watch their thoughts like leaves floating by on the stream" that they are guaranteed a "desirable result." Levine clearly got that and produced a slight volume here that separates the chicken ___ from the chicken salad.

Because the truly experienced and actually insightful meditator comes to understand over time that meditation is itself merely a re-training of the mind back to the capacities to observe to notice to recognize to identify to acknowledge to appreciate to accept to own to understand what actually is vs. all the verbal representations and sense memories of what once was... and what we require things to be in a non-existent future. (Figure this: The future is and always will be a projection.)

Levine provides some dandy guided meditations (and some that aren't; see below) including the terrific Guided Meditation on Dying, which, if understood as "dying to the immediate past and the ego's attachment to it," is one fine little trip. He also offers a bunch of useful conceptual metaphors like "mind as sky; contents as clouds," and the reward being =in= the process rather than the outcome of it, as well as one of the most straightforward disquisitions on karma I've ever seen.

He is, however, slavishly adherent at times to some of "church Buddhism's" social organization pronouncements, as well as surprisingly (considering the rest of the book) snagged by recitations of "good idea" procedures that don't (or at least may not) actually produce the suggested results. You'll find such instances on pages 16, 24, 26, 85-90, 92, 94, 103 and 118-121.

On the whole, =AGA= continues to be a valuable contribution to the mindfulness and meditation literature... so long as one digs into others like Deikman, De Mello, Kramer, Krishnamurti, Ornstein, and Somov for leavening.

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Sunday, April 13, 2014

Back in the Bipolar / Borderline Bull Ring

Seduction, F.O.G., Plausible Denial & Unconscious Sadism in Subtle NPD / BPD + Obvious Bipolar 

It wasn't my first rodeo. I've been in the borderline and/or bipolar bull ring off and on since 1972. In (greater) Hollywood, New York City, Scottsdale, Palm Springs, other places where behavioral facades are well-constructed and carefully tended by the physically and intellectually gifted. The games and scripts ultimately turn out to be pretty much the same, but it can be difficult -- and unsettling -- to stay on the bull as the dramas play out before one recollects to let go of the rope and just take the inevitable tumble.

We tell ourselves to get off the screen (or the stage) and into our ("detached," "disengaged") seats in the audience. We say, "I will see it coming and set boundaries with the empathy and compassion due to this poor (man or) woman who is only doing what (he or) she does because of what was done to (him or) her." But there is venom in the snake's bite, and we too often do not recognize the new and different sound of the rattling before we feel the fangs.

We've read about the "double-binding," "paradoxical injunction-slinging," "classic, hysteric vampire" in Bateson et al, Beck & Freeman, Beck, Bernstein, Clarkin & Lenzenweger, Gabbard, Golomb, Grinker, Gunderson, Hare, Kernberg, Kreger, Livesley, Mason & Kreger, Meissner, Millon, Payson, Searles, and Watzlawick et al. (It may seem that I "piled on" even further in the references and resources section at the end, but I wanted to make it clear that I am more than merely "observantly experienced" with respect to borderlinism. And that there are times when it doesn't matter.) 

We've watched Barbara Stanwyck, Bette Davis, Joan Crawford, Sharon Stone, Glenn Close and Demi Moore do them on the big screen... and Madonna, Gaga and Miley on the small. The sirens are neither hard to hear nor the seething rage difficult to see... or feel. We are appropriately forewarned and moved to put on our fire suits -- albeit as discretely as possible -- but often not until we're a bit singed from the indulgence of our reprised, anxious attachment.  

We say, "I will do as the sainted Father Carl (Rogers) instructed and demonstrate (my act of) empathy, compassion and unconditional positive regard for this understandably injured, reactive and rageful person." We say, "Oh. Another case of lingering, complex post-traumatic stress disorder whose Eriksonian path took opposing but parallel courses when (his or) her Trust split in either/or dichotomy into polarized mis- and dis-, Autonomy became too over-reaching and too restricted, Initiative became too much and too little, Competence became obsessive and learned helpless, Identity became whatever worked -- and didn't -- in the moments of opportunity, and Intimacy became a shattering experience... or a means to an end."

"Marsha (Linehan) warned us all about their dichotomism and dialectical deficits," we tell ourselves.

"One size fits all" is a poor policy everywhere in a world of contextual complexity, however, and it certainly doesn't work with revenge-obsessed reptiles with IQs of 120 or more. Even so, having failed to leave our own "smarter than average" egos at the door, we insist upon trying to pigeonhole those reptiles and make them fit the labels we are trained to paste upon their foreheads to protect us... from the affective rebound one will have when compassion is replaced with reactive shame, guilt, rage or whatever that's "unacceptable." It might not be a bad idea to get very present and mindful in place of stuck in the labeling we picked up in the past.

Iain McGilchrist's notion of seeing and feeling them in the right hemisphere, conceptualizing them and forming hypotheses to be tested in the left, and then returning to the right to "just watch" is always worth lengthy consideration in these deals. Observe, notice, recognize, acknowledge, appreciate, accept, allow, and own what is going on in the transferences and counter-transferences in both dance partners. To "understand" in the manner described and discussed so often by Jiddu Krishnamurti (and star pupils like Joel Kramer). And "get it" at the level of neurobiology described by Priem & Solomon.

And learn (the hard way, because it usually will be) again that watching ourselves feel, think and act in response to them is the route to revelation of the object relations in play (see Bion in Symington, Fairbairn, Kernberg, Klein in Mitchell, Klee, Scharf & Scharff, and Sullivan in Evans).

. . .

Hugely intellectually and physically gifted with an IQ of at least 150, barely "legal" and looking two or three years younger, she inquired because of increasingly discomfiting -- but nevertheless denied and unaccepted -- angst about isolation and alienation in a world full of naive, indolent, unconscious, untrustworthy, "dangerously stupid" (my phrase, not hers) saps. 

(According to the DSM IV-R, Akiskal et al, Basco et al, Bauer et al, Bearden et al, Benazzi, Hirschfeld et al, Johnson et al, Koob, Lumpien et al, Maj et al, Mansell et al, Mauss et al, McEwen et al, Mendlewicz et al, Molina, Quarantini et al, Reid et al, Savitz et al, Sie, Suppes et al, Takeshima et al, and Yamamoto et al) she presented hypomanic bipolar II, allostatic load and pre-noradrenergic dysfunction symptoms at the outset, and responded to discussion thereof by seeking medicinal treatment (with a modern, atypical AP). Before the medication could take effect, however, her control obsessions took control of her compulsions, and she began to act out in classic, sexually seductive fashion with the textbook typified, wholesale conversion from nervous but wholesome and innocent schoolgirl to hyperseductive here / "I-couldn't-care-less" there, femme fatale.

Along with trip-wired responses to probing about her romantic involvements, her non-verbal behavior -- including eyelid and pupil expansion -- inferred that she relished the flummoxed discomfort she could induce by overstimulating and abandoning males. It seemed pretty obvious that she had been repeatedly rewarded and reinforced thereby (see Aviezer et al, Basco et al 2012, Berne, Bernstein, Byrne, DePaulo, Donovan & Marlatt, Golomb, Marlatt & Donovan, Skinner, Stone, and Watson). And that she had a good -- if possibly unconscious -- reason or two for so doing in her pretty classic, Bowen Family Systems family of origin (see Lykken in Millon 1998, Peck, and Zimbardo on the socialization and normalization to mild to moderate to severe, rationalized and/or unconscious evil in the typical American family). Further probing resulted in denials of sadistic intent, and the denials were couched in terms that could be taken to be plausible (e.g.: "I was younger; it's just what young girls do") (sometimes, but far from always).

Her dress toned down slightly (but only slightly) in future encounters, and the sexual imagery continued to be brassy despite protestations that she just enjoyed looking this way, and that there was no intention to be seductive, manipulative or sadistic. At this point -- owing to the sudden change in "packaging," I had already sought counsel with three different, and diversely resourced but equally astute observers of adolescent female manipulation behaviors. 

One suggested that she was not transferring revenge, but was merely desperate to "hook" a Rescuer (because of repeated parental abandonment) and took the subtly, but nevertheless widely, modeled route taken by many (most?) women with males trained in this cult-ure to play the dishonest game of "White Knight" to get laid or "capture the queen." It's an hypothesis I could consider, but question in light of other evidence of transferred revenge imperatives offered with and without prompting. 

I also dug up some online reminders of the "F.O.G." dynamics of emotional blackmail (fog, obligation, guilt; see Forward). The first component was blatantly evident; the second and third were considered immediately from the viewpoint of one steeped in co-dependence theory (Cermak, P. Evans, Mellody, Rapson & English, Schaef, and Weinhold & Weinhold were most helpful, as usual).

Raised as the boys on my psychosocial bus were by an adoptive mother who employed all three mechanisms (including a powerful sexual fog) to control her mystified spouse and child so as to deal with her own denied / un-contemplated (see Prochaska & DiClemente on the five stages of addiction treatment) anxieties and coping reactions, the boys were greatly unsettled by their new archetypal icon (see Jung in Laszlo).

Because one can be blinded to F.O.G. by others who use it a) cleverly, and b) in manners similar to the original and/or earlier emotional blackmailers. I dug into the possible Karpman Drama Triangle implications (see Garrett, and Karpman) and saw my "boys'" efforts to get out of the Victim (guilt) corner at the bottom and move up to Rescue (their maternally conditioned obligation), as well as become Persecuting owing to the seduction-induced frustrations of not being able to have the ostensibly menu-available, delicious, adolescent cake for dessert. (That she resembled their adoptive mother as well as several other iconic "fog machines" of the past made the dessert appear all the more compelling to them, of course.)

(In addition to Baumeister, Beck, Golomb, Grand, Hare, Meloy, Millon, Payson, Peck, Tangney et al, Stone, Vaknin, Van Vliet, and Zimbardo) one benefits hugely from a studied grasp of Lawrence Kohlberg's work on the six stages of moral development and how the lower stages can be manipulated by the fast-processing, narcissistic sociopath and/or passive-aggressive.)

Her behavior continued to cause me to ask things like, "Has she seen 'Poker Face' and 'Wrecking Ball' too many times?" "Is this a stimulation- and risk-addicted, little death-wish princess?" and "Is this a Black Dahlia in training?" The "boys" wanted the worst way to Rescue her from her obsessions, but would have to take an awful lot of bait-and-bite to do so. How much, then, is enough... if the other is still relatively empowered, ego-defended, effectively compensated and hostile to self-awareness at the denial / pre-contemplation stage? 

The interlocutor in such a circumstance has to face the music. He has to observe to notice to recognize to acknowledge to appreciate to accept to allow to own to understand and digest / metabolize / process (as per Garrett, and Kernberg) the affects induced by the iconic, seductive, F.O.G.-spraying, plausibly denying, castration-bent borderline... or he will have his de-composed, dis-integrated, and potentially de-compensated mind served to him on a platter. And if things get to the licensing board or some courtroom, the fact that his internal object relations nailed him will be irrelevant.

That over-cathected (adult) Children (as per Berne) displace their Trust- and Autonomy-rooted frustration toward authority figures (upon whom they depended for their lives; no transference potential there) with Initiative- and Competence-rooted coping strategies for failing to understand their initially healthy narcissistic needs to move up Erikson's ladder to functional Identity and Intimacy is hardly news. (At the post-doctoral level, anyway. I don't run into many MA/MS-level people who keep Erik in mind anymore. Tsk, tsk. Risky.) But how many times have we all forgotten this challenging load of "high concepts" and fallen into co-dependent counter-transferences? Like romantic delusions in the hyper-cathected Child here and righteous, reactive rage in the alternately but equally noisy, rule-bound Parent there. 

(Regardless of the "patient" being a brainy and beautiful (or studly) adolescent, this goes for over-identifying, under-processed and -- as a result -- only semi-conscious gay male therapists every bit as much as heterosexual males. As well as for over-identifying, under-processed and -- as a result -- only semi-conscious, heterosexual female therapists with co-dependent mothering and K.D.T. Rescue issues.)

Let's face it; there is a lot to keep in mind here. Should we review a daily checklist? Maybe.

The therapist who has fallen into the common cultural trap of believing that he or she is immune to F.O.G., "Rapo," "Mud Pie" and other "games" (see Berne 1961 & 1964) just because he or she has "seen that movie too" is headed for trouble. More basic and mindful (see Bien & Bien, Brach, Brown & Marquis, Deikman, De Mello, Forsyth & Eifert, Goenka in Hart, Goleman, Hafenbrack et al, Hayes et al, Kabat-Zinn, Lang, Lazar et al, Lejeune, Levine, Marra, McKay et al, Morris et al, Ogden, Ornstein, Orsillo & Roemer, Pederson, Raffone et al, Raja, Reid et al, Segal, Siegel, Siegel, Somov, Thich, Van Dijk, and Williams et al) approaches are mandated. 

I assert this because I have seen the movie / been to the rodeo a bunch of times, and I am (as is hopefully suggested in the references below) fairly well read on the topic. But I am still subject to being tossed about by a borderline-organized bucking bronco who can plausibly deny what (he or) she does because it happens in some "compartmental vault" "over there" where it can be rationalized in some "acceptable" (or ego-defending) manner... or just denied out of hand. For just as long as I do not stop to observe to notice to recognize to acknowledge to appreciate to accept to allow to own to understand and -- as a result -- metabolize the psychological and neurological effects of having my inner children re-activated (see Craig, Damasio, Garrett, Ogden, and Whitfield), I'm asking for trouble.

But one had better be observing, noticing, recognizing, identifying, acknowledging, accepting and owning at all times in the borderline bull ring. Because in there, mindfulness is a must

References & Resources

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© 2014 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

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Tuesday, April 08, 2014

Books: Berne's seminal Transactional Analysis in Psychotherapy

I guess I am surprised to find a mere four reviews [at http://www.amazon.com/Transactional-Analysis-Psychotherapy-Eric-Berne/dp/0345338367/ref=sr_1_3?s=books&ie=UTF8&qid=1393399860&sr=1-3&keywords=eric+berne+transactional+analysis] ahead of my own. 

I came up in the field when TAIP and Games People Play were required reading along with Harris's I'm Okay; You're Okay and anything one could get their hands on about Stephen Karpman's Drama Triangle. 

How were we supposed to understand what the h**l was going on in those "f**k & fight" marriages or "crazy-making" schizophrenogenic families? Greg Bateson, Murray Bowen, Aaron Esterson, Jay Haley, Jules Henry, Don Jackson, R. D. Laing, Theo Lidz and Paul Watzlawick were mightily helpful, but hard to summarize much of the time. Eric Berne, however, made sense instantly. 

How, for example, could we have the simple and straightforward "FOG" (fear, obligation, guilt) model of emotional blackmail without Berne's identification, demarcation and operational description of Parent and Child ego states in which emotional blackmail are played? 

Berne's work launched a generation of professionally degreed mass market writers like Claudia Black, John Bradshaw, Pia Mellody, Anne Wilson Schaef, Charles Whitfield and Janet Woititz onto the seas of the "inner child" concept in the '80s and '90s. Combined with Albert Ellis's REBT and Aaron Beck's CBT, Transactional Analysis continues to be a powerful therapeutic device when utilized by those who understand it at full concentration rather than at its later dilutions. 

But combined with the new, millennial-era mindfulness-based therapies like Kabat-Zinn's MBSR and MBCT, Linehan's DBT and Hayes's ACT, Berne's TA is psychotherapeutic rocket fuel. These new therapies raise consciousness / awareness / perceptive-observational capacities very quickly, producing an effect upon TA (and vice-versa) not unlike automotive "supercharging." One becomes aware of interpersonal dynamics and how to deal with them functionally and effectively in very short order. 

My appreciation goes out to Berne, as well, for addressing and clarifying such issues as major event vs. cumulative, multi-minor-event trauma; cross-contaminations of ego states; culturally normalized pseudo-attachment and the actual attachment of clarified Child ego states in marriage; and the "re-vivified" child... as well as his wonderful summation of "therapeutic hints" (post it on the wall); and very cogent re-statement of the id, ego and superego vs. child, adult ad parent ego states. 

This is a little gem no therapist (who wants to get the job done for his clients) should be without.

(c) 2014 by Rodger Garrett; all rights reserved. Links are permitted. Please comment or inquire to not_moses@fastmail.fm. Thank you. 

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Thursday, April 03, 2014

Transactional Analysis Refresher

Twenty concepts to keep in mind when using Berne's TA for countertransference management, etc. 

Relative to observing the transactional games listed in the previous article (to which I want to add the rather sinister "Cat & Mouse," especially with respect to "double-binding" and "paradoxical injunction" say-this-and-do-that games in which a child or weaker spouse is unable to physically exit the game field*), the schooled transactional analyst needs to keep all of the following in mind. For a similar and somewhat more detailed (in some, though not all respects; Berne was not hip to Buddhist mindfulness**) rundown, see Berne 1961. All quoted material here is from Berne 1961 unless otherwise noted.

1) Differentiate the Adult from the Child in both patient and therapist.

2) Describe what each of them are observably doing.

3) Differentiate the preponderant Parent from the Adult & Child by getting a description of each parent's typical interactions with the patient and with each other.

4) Describe the patient's Parent as both observed and abuser-imitating.

5) Get the clinical dynamics down well before presenting the psycho-educative explanation of the TA structure in general (not particular; let the patient develop that from the general).

6) Allow the patient to listen to (and consider) the P-A-C schematics of the other, more experienced members of the group.

7) If the patient does not develop his or her own P-A-C schematic descriptions, theorize three pertinent, diagnostic illustrations of and for them.

8) Consider the best one to described first, and second, holding the third in reserve if the patient fails to understand or accept the first and second. 

9) Determine whether or not the diagnostic descriptions of the patient's Parent-Child schematic are accurate on the basis of reported and or observed historical material.

10) If the diagnoses are bought into by the patient, use them as "platforms upon scaffolding" to work toward ever closer densification -- or "dot-connecting" -- so that historical and current behavior are seen as

. . . . . a) "understandable" (as per Krishnamurti),

. . . . . b) "karmically related"  (cause-and-effect, as per Levine),

. . . . . c) "socialized" and "normalized" (as per Garrett),

. . . . . d) neither "right" nor "wrong," nor "good" nor "evil," and therefore

. . . . . e) shame-free and shame-freeing.

11) Take the trichotomy literally: Each patient (and therapist) are (at least) three different personas.

12) Analyze transference in terms of the six different personas in any diadic relationship, including that with the therapist. Ask who is doing what to whom... and receiving what from whom.

13) Fearlessly and ruthlessly observe for, notice, recognize, acknowledge, accept, appreciate and own all counter-transference in terms of six different personas (see Gabbard, Garrett, and Searles).

14) The descriptive notions "childish" and "mature" are set aside; see below.

15) All patients (even psychotics, says Berne) are presumed to have a "structurally complete Adult. The question is how to get it cathected [to take command of displayed behavior]. There is always a radio; the problem is how to get it plugged in." 

16) The Child may be confused and/or loaded with retained, destructive affects, but it is the Child in which the force of life resides (see Mahler, Brazelton et al, and Stern).

17) While a patient's intellectual grasp of the Child is useful, it is his or her direct, experiential apprehension of the Child as a living, feeling, behaving being in the patient's own mind-body that is therapeutic (the mass market concept of the "inner child" is not quite the same, but close enough to be worth understanding if for no other reason than to understand what many patients think a "Child" is; see Anonymous, Bradshaw, Cermak, Melody, Schaef, and Whitfield).  

18) The Game is a "specific sequence of operations, to each of which a specific response is expected" (or "required," as per Block) with a (usually unconscious) goal in mind, leading -- if "successful" -- to a checkmate of the other party in the dyadic relationship (or "external object," as per Bion in Symington, Fairbairn, Kernberg, Klee, Klein in Mitchell, Scharff & Scharff, Searles, and Sullivan in Evans; my sense is that a solid grasp of object relations is really helpful for the TA therapist).

19) The Game is played relentlessly, obsessively, compulsively and unconsciously; the activating left hemisphere is running the show, and the observant right hemisphere (wherein the Adult observes) is de-commissioned.

20) "The ideal intervention is... meaningful and acceptable to all three [ego states], since all three overhear everything that is said."

*See Bateson, Koopmans, and Watzlawick et al.

**See Alpert, Block, Brown et al, Chodron, Craig, Damasio, Davidson et al, Deikman, Eifert et al, Flavell, Forsyth et al, Hafenbrack et al, Hanson et al, Hart, Hayes, Kabat-Zinn, Lang, Levine, Marra, McKay et al, Morris et al, Orsillo et al, Paturel, Raffone et al, Raja, Segel, Siegel, Somov, Williams et al.

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Forward, S.: Toxic Parents: Overcoming their Hurtful Legacy and Reclaiming Your Life, New York: Bantam Books, 1989.

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Golomb, E.: Trapped in the Mirror: Adult Children of Narcissists in Their Struggle for Self, New York: William Morrow, 1992.

Hafenbrack, A.; Kinias, Z.; Barsade, S.: Debiasing the Mind Through Meditation: Mindfulness and the Sunk-Cost Bias, in Psychological Science, Vol. 25, No. 3, 2013, DOI: 10.1177/0956797613503853

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