Introductory Lectures on Neuropsychoanalysis: Lecture Six Part 2 " Treatment Case Example Mr. C" Middle Phase

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MIDDLE PHASE ...............At the same time I was assessing Mr. C's unpleaurable feeling of RAGE and how it resulted from the unmet need of impediment removal, I began to look to his history and his interactions with me to discover his unconscious, repressed prediction. Mr. C was suffering unnecessarily because he was trying to live out a repressed, childhood prediction that may have worked for him as a child but it certainly was not working for him as an adult. There were many times in his adult life when he needed to be angry and even to RAGE, but he was unable to do so, lest he overreact and destroy those he loved. His main defense was reaction formation. When he should have felt anger he felt it's opposite instead--love. Therefore he could never take care of himself with others or get some of his basic needs met. He could never successfully remove impediments that were in his way. I spent the opening phase of therapy helping Mr. C come to realize what had happened to him that day in his car, and why he was having angry feelings toward those he loved as well as angry dreams........ The next phase of treatment was the Middle Phase.  Because his unconscious, repressed prediction could not be remembered and worked through, we had to look at other routes for determining what was the prediction.  This is where transference and extra transference work came into play.  Transference has to do with the relationship of the patient with the therapist.  Extra transference has to do with the patient's relationship with everyone else.  It is true that the patient cannot remember the prediction from childhood, but he does repeat the pattern in his relationships today--both with the therapist and his significant others. This means that the memory of the prediction is now only a procedural memory--an action patten or an emotional response. With my interpretations of these repeated patterns in his relationships, Mr. C began to realize he did not express anger or rage appropriately in all his relationships.  By pointing this pattern out to him again and again he was able to see it in the present.  This is called Working Through.  The therapist helps the patient work through the repetition of the pattern in many different contexts.   We next explored Mr. C's history to see where his repressed, unconscious prediction/solution originated. Over time he was able to see this pattern of where other people would have been angry, he was not.  Once Mr. C was able to see this pattern of an inability to express anger appropriately, he was eager to understand why this was the case.  But he still did not know where the solution started and exactly what was the childhood situation that first led to the repressed prediction.  So after he shared some memories of his interactions with him mother where he was not angry but should have been, I ventured  a Reconstruction of where the pattern may have begun.  Throughout the treatment  Mr. C had made various references to his not feeling childhood anger at his mother.  I attempted therefore to reconstruct his childhood years where he clearly should have been angry at her but was not.  We looked especially at some severe spankings he received from his mother.  I said something like," Your little childhood mind could not handle the thought that you not only loved your mother, but in that moment you also wanted to destroy her in order to stop the pain. So you put that thought out of your mind."  You repressed that thought.  Your mind rendered it unconscious.  The problem is you have now continued to act on that thought even though you cannot remember it.  And you continue to act on it today. And though you could repress the thought you could not repress the feeling and you continue to feel the RAGE toward her and other women in your life today.  This is called "the return of the repressed." And to protect yourself from this unbearable feeling of RAGE that will not go away, you defended yourself with the defense of reaction formation, which causes you to feel the opposte of anger, which is love. But in the car that day your defense of reaction formation broke down and failed to work.  Thus your RAGE, with all its original power, energy and bodily explusion was once again felt.  The thought (childhood prediction/solution )remains repressed, but the feeling returns.  With this reconstruction and explanation Mr. C began to understand his suffering in the present more clearly. He realized how it was being repeated today in his adult life and where it may have come from originally in his childhood.  Once he way this through my interpretations and reconstructions, he found hope that together we could do something about it.  He could actually change the pattern!  He could change it to an adult pattern that works.  He could explore a more workable prediction than the childhood one that was so clearly dysfunctional.  With his adult resources he could now come up with better solutions.  He could learn that adults can tolerate loving and hating feelings toward their Mothers and other significant persons at the same time.  That he could tolerate ambivalent feelings toward his loved ones, and not destroy them and lose them as objects of his love.  So Mr. C began to look at workable adult predictions that he could implement, and not just the childish one he had first come up with as a young child.