Breaking the Trauma-Bond Between Your Patient and Their Family: An Object Relations Approach to Resistance in Treatment

DESCRIPTION:

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 realizes that s/he is pulling away from their family of origin, both internal and external, and cannot imagine surviving alone.

W.R.D. Fairbairn recognized 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. 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 harbored 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 minimizing resistance and early termination.

Registered participants will receive the Workshop Handout prepared by Dr. Celani, entitled “Fairbairn’s Metaphor of the Human Mind and the Trauma Bond.”

The Extreme Dependency of the Child on Mother and the Consequences of Rejection
Fairbairn was one of the first analytic writers to recognize 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.

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 internalizations 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.

A Fairbairnian Approach to Change:  Minimizing Patient Resistance, While Maximizing 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 that 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.

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 internalized 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 modeled to illustrate the surprising potency of this approach.

LEARNING OBJECTIVES:

After completing this seminar, participants should be better able to

• Apply Fairbairn’s understanding of the child’s absolute dependence on its maternal object to analyze your patient’s unresolved dependencies and psychological underdevelopment.
• Apply you understanding of child’s dependence to analyze patient’s damaged, incomplete and unintegrated sense of self.
• Analyze the emergence of attraction to or attachments to destructive external objects that seem to be discordant with the patient’s self-presentation as the actions of  split-off sub-egos that are unknown parts of the patient’s personality.
• Analyze transference as the projection of inner structures on to the analyst, who then is transformed into a bad object, and rendered impotent.
• Apply their understanding of attachment to bad objects to the patient’s strong emotional bond to the veryparents that abused or neglected them in childhood. This attachment allows avoidance of the external world, and offers the patient an illusory hope of developmental closure.
• Analyze patient’s dissociated selves by gradually introducing the conscious central ego to events of parental empathic failure that actually occurred, but only emerge gradually and obliquely.
• Utilize creation of a “casual” therapeutic narrative that emphasizes the patient’s reactions to these remembered but minimized or excused events.
• Utilize their awareness of the extreme impact of early empathic failures on the patient’s psychological development to gradually co-create a model of their childhood that becomes acceptable to their central ego.
• Utilize the patient’s ability to internalize external objects to create an internal conflict between the preexisting internalized bad objects and the new internalized analyst who is a good object.
• Analyze the patients enactments in the therapeutic sessions or repetition compulsions with external objects as projections of the inner structures onto external objects.
• Utilize the emphasis on parental failures rather than confront the patient’s unrealistic, almost delusional (split-off) visions of the “goodness” of their objects in order to minimize resistance.

SHORT BIO:

REGISTRATION AND FEES:

____ Early Bird registration (before March 11, 2021) – $50 regular/ $35 grad students & candidates/ $15 undergrad students. If CEs are requested – there is an additional fee of $25 (can be paid on the day of the conference or in advance).

____ Pre-registration discount (March 18 – April 17, 2021) – $60 regular/ $45 grad students & candidates/ $20 undergrad students. If CEs are requested – there is an additional fee of $25 (can be paid on the day of the conference or in advance).

____ Registration ‘at the door’ (on April 18, 2021) – $70 regular/ $55 grad students & candidates/ $25 undergrad students. If CEs are requested – there is an additional fee of $25 (can be paid on the day of the conference or in advance).

Please Note: If CEs are requested — there is an additional fee of $25 (can be paid on the day of the conference or in advance).

SPECIAL SCHOLARSHIPS are available for undergraduate and graduate students, as well as for retired or disabled practitioners, or need-based or/and those who live outside of the USA.