by David Brazier
Endings are immensely significant. They have deep symbolic, which is to say, subjective, importance. How the experience of loss is handled conditions our ability to relate again. The inner decisions made at such a time can have lasting consequences. Losses can deepen appreciation of life or undermine faith.
Everyone has suffered loss and separation. For many clients the primary reason for coming into therapy is to find some relief from the pain of separation. Yet therapy itself is a temporary relationship which will come to an ending. How this ending is regarded and celebrated may have lasting results.
Why is separation so painful? Why do we fear loss? Why is grief so bitter? And why do some grow strong as a result of their painful experience while others decline as a result of similar experience? What can we do as therapists to give our clients the opportunity to grow strong and how can we avoid reinforcing their sense of defeat? In short, can we understand how psychotherapy heals?
This paper looks at three of the classic theories of psychotherapy with a view to seeking answers to these questions. The theories of Sigmund Freud, Otto Rank and Carl Rogers at first glance seem to have little in common. One is tempted to think that their separation is unbridgeable. The argument of this paper, however, is that a fruitful reconciliation may yet be possible.
To begin, I would like us to consider the fact that one of the most bitterly evocative considerations at any time of loss is reflection upon the fact that many things can now never be repeated. "We will never again walk together in the park hand in hand." It is thoughts such as this which bring the most copious tears. So what does it mean that the desire to repeat is so deeply embedded in us?
THE COMPULSION TO REPEAT
Memory appears to be closely connected with action. We remember what we do. And to remember is, in one way or another, to repeat, if only in the imagination. The past leaves its traces upon us and these traces are in the form of an urge to walk in old tracks.
The connection between memory and action goes back a very long way and is not just a human phenomenon. We might think, for instance, of how salmon swim half way round the world taking all manner of risks in order to return to the river where they hatched.
Our whole sense of our identity is bound up with what we do; and when we say "what we do" we mean what we do habitually and repeatedly. It is what is repetitive which constitutes what we think is our character. I repeat, therefore I am.
Change is threatening. Anticipating it we feel anxiety. Experiencing it we often feel fear, inadequacy, loss of identity, fragmentation and panic. Embracing change does not come easily. The typical immediate reaction to change is denial. The first line of defence is to assume it is not happening. We are geared up for repetition, not for novelty.
If the change is undeniable, the next strategy is commonly regression. What is regression? Regression is the abandonment of what has been most recently learned in favour of the repetition of what was learned at an earlier stage of life. Regression is repetition. The instinctive reaction is to go backwards, to retrieve.
Although we may believe in a principle of growth and constructive change operating in people, it is difficult to avoid the conclusion that there is also a strongly conservative tendency at work in all of us.
The question of how to let go, therefore, bears on some of the most basic issues of psychology. Growth and change are the watchwords of much humanistic theory and this outlook is thought of as optimistic. However, when there is a great deal of change in life, optimism quickly begins to take the form of a hope that things will soon settle down.
If the principle of growth and change were the only force at work, it is doubtful if we would consider endings to be sad occasions, for every ending is also a beginning. To understand the problem of ending and beginning, therefore, we have to try to reconcile the principle of growth with the principle of repetition, self-actualization with conservatism.
The advocate of the actualization theory with whom we are probably most familiar is Carl Rogers. One of the most interesting investigators of the repetition theory is Sigmund Freud. The bridge between Freud and Rogers, both conceptually and historically, is Otto Rank.
For Rogers, the presence of a self-actualizing tendency which is an inherent tendency toward constructive growth and change, was the essential basis for his theory: "The person-centered approach.. depends on the actualizing tendency present in every living organism - the tendency to grow, to develop, to realize its full potential. This way of being trusts the constructive directional flow of the human being toward a more complex and complete development. It is this directional flow that we aim to release" (Rogers 1986, p137).
Rogers was influenced by two sources of relevance to us here. The first was Kurt Goldstein, to whom we will return in a minute. The other was Otto Rank. Rank's ideas came to Rogers indirectly via some of Rank's pupils with whom he worked at an early stage of his career.
Rank had a vision of life as a series of separations. First, and most significantly, the baby is physically separated from the mother's body at birth. Rank called this "birth trauma" (Rank 1929), an idea which has continued to influence various schools of psychological thought since. There then follow a series of further separations with weaning, walking on one's own legs, going to school, going to bigger schools, leaving home, taking on responsibility in a career (ie independent action), and ultimately, of course, death.
At every separation there is resistance within the person which must be overcome. The overcoming of resistance is the emergence of the will, which Rank saw as the vital element in growth and psychological health. The resistance itself gets expressed in the vast array of ways we all have for preserving the status quo of our lives and comforting ourselves. One particularly significant form of such pleasure seeking, which also involves a giving up of separateness, is the sexual act. Also in this category, however, would be all social institutions since they have as their prime purpose to make sure that nothing changes too much.
Each stage of life, therefore, begins with separation, with an ending, with a more or less well achieved letting go. Each stage requires the achievement of a new internal psychological balance. Freud's colleague Franz Alezander pointed out that "Rank himself has shown us in the most convincing way that man never gives up the lost happiness of pre-natal life and that he seeks to reestablish this former state, not only in all his cultural strivings, but also in the act of procreation" (Alexander 1925, p.107).
We can easily see that from this viewpoint, the phenomenon of transference in therapy is a manifestation of the client's resistance to change. Ideally the client would like the therapist to make it possible for the client to return to the womb itself or at least babyhood. Failing that we will have a repetition of infancy. And if the therapist is not very co-operative with either of these regressive plans, then the client may fall into the grip of an urge to seduce or, alternatively, to settle into a comfortable and civilized dialogue in which there will be plenty of content but no necessity to face the frightening task of exercising the will in the direction of change. Hence the two different types of transference which we now recognise as "primal" or "narcissistic" on the one hand and "oedipal" on the other (De Jonghe et al. 1991).
In Rank's view, every separation constitutes a growth point, but also a point of risk at which defeat may have serious repercussions for subsequent life. Most clients coming into therapy have suffered such a defeat or imminently fear one. All responsibility, growth and creativity involves some form of striking out on one's own into new territory. So here we find growth and separation equated and every ending is indeed a beginning.
In Rank's system of thought, the key role is played by the will. It is the emergence of the will which enables a person to separate and to do so positively. The problem of therapy, from this perspective, therefore is the problem of the emergence of the will. And the end of therapy is the crucially significant separation in which the client asserts a separate will, a will to be separate from the therapist. In Rankian therapy, therefore, the ending is the most important element in the whole process and the whole course of therapy is a working up to the ending.
Rank believed, therefore, that in therapy it is not the finding and analysis of historical material which changes the person, but the experience clients have of exercising their will within the therapy relationship. Neurosis is seen as a state in which the will, which we must remember is the willingness to be separate, has been immobilised.
In general terms, this immobilisation comes about as follows. Initially the child is surrounded by beings more powerful than him or herself. The first emergence of will is, therefore, inevitably a counter-will. The child's first wilfulness is in resistance to the adults.
Counter-will inevitably brings guilt and/or inadequacy; that is, when the counter-will triumphs there is guilt, when it fails there is inadequacy. Rank thought that Freud concentrated on the guilt aspect and Adler on the inadequacy aspect but that both missed the underlying fact that any exercise of counter-will brings inner conflict in its wake. When this conflict becomes too intense, people dissociate from their own will either by becoming overly self-conscious or by becoming compulsive.
Either way, the client needs, through the experience of therapy, to reconnect with the will both by discovering that the will is there and by finding that exercising it in relation to the therapist is not disastrous. The former is in part achieved by the therapist's alertness to the ways in which the client does indeed exercise his or her will both in the session and in life. The client often will rationalise non-use of the will by expressing uncertainty about what the "right" course of action might be. The therapist is not so much concerned with whether the course is right or wrong as with the fact that, by choice or default, a course is chosen.
For the client to gain the confidence that separation will not be disastrous, it is necessary that therapists themselves are not daunted by it. In this context we might remember Rogers' question to himself: "Can I be strong enough as a person to be separate from the other? Can I be a sturdy respecter of my own feelings, my own needs, as well as his? Can I own and, if need be, express my own feelings as something belonging to me and as separate from his feelings? Am I strong enough in my own separateness that I will not be downcast by his depression, frightened by his fear, nor engulfed by his dependency?" (Rogers 1961, p.52). Rogers then goes on to express the fascinating paradox about separateness: "When I can freely feel this strength of being a separate person, then I find that I can let myself go" (ibid.).
Separation, therefore, is both about becoming somebody and about letting oneself go. Growth, change and actualisation come about, not as a result of being sought, but as a by-product of living in the spirit of letting go. If we do not actively let go, then the instinctive tendency toward repetition will always reassert itself. So let us return again to the theory of innate conservatism and see where this takes us.
The notion of an "actualizing tendency" was in fact first formulated in biology. Kurt Goldstein (1939), while making studies of brain-injury was interested by the amazing capacity of the organism to find a way round difficulties. Even severely injured people often found alternative routes to express their cognitive and emotional capacities. He concluded that "we have to assume only one drive, the drive of self-actualization" (p. 197) and by 1951, Rogers had come to the same conclusion in the field of psychotherapy: "The organism has one basic tendency and striving - to actualize, maintain and enhance the experiencing organism" (Rogers 1951, p. 487).
Rogers used Goldstein's idea as the basis for a theory of growth and constructive development. If we examine it a little closer, however, we can see that it is just as legitimate to regard it as a theory of conservatism. The organism will do everything possible to restore its former state.
At a rather earlier date, Sigmund Freud, looking at much the same evidence had come to his own conclusions. He saw the instincts as conservative. He rejected the notion of an instinct toward perfection. "It may be difficult, too, for many of us, to abandon the belief that there is an instinct toward perfection at work in human beings, which has brought them to their present high level of intellectual achievement and ethical sublimation and which may be expected to watch over their development into supermen. I have no faith, however, in the existence of any such internal instinct and I cannot see how this benevolent illusion is to be preserved" (Freud 1920, p. 314). "There is unquestionably no universal instinct towards higher development observable in the animal or plant world, even though it is undeniable that development does in fact occur in that direction" (ibid, p. 314). "An instinct is an urge inherent in organic life to restore an earlier state of things which the living entity has been obliged to abandon under the pressure of external disturbing forces; that is, it is a kind of organic elasticity.. the expression of the inertia inherent in organic life.. of the conservative nature of living substance" (ibid. pp.308-9).
It was Freud who, in this same work, was the first to point out how very common it is for us to repeat the pattern of our relationships with different people: "we have all come across people all of whose human relationships have the same outcome" (ibid. p.292). He gives numerous examples, including "the lover each of whose love affairs with a woman passes through the same phases and reaches the same conclusion" (ibid.). He cites other examples of repetition compulsion in the dreams we have after severe trauma in which, seemingly contrary to all that is in our own interests, we go on reliving the horror again and again; and, more benignly, in the play of children, so much of which is simply reenactment of what they have seen or done.
We cannot deny these phenomena. They are matters of everyday observation for all therapists. If there were no conservative process at work in us we would have no problem with endings and bereavement would occasion no grief, whereas the reality is that bereavement is the paradigm for virtually all major forms of human suffering.
RECONCILING THE ACTUALISING TENDENCY WITH THE CONSERVATIVE INSTINCT
We, therefore, have to ask: Are the views of Rogers and of Freud, which, each considered separately, seem convincing, reconcilable? and: Does this reconciliation throw light on the problem of letting go?
I think the first question resolves into: Is it possible to have an actualizing tendency without an actualizing instinct? In order to be able to continue this paper at all, I would like to assume for the moment that the answer to this question is affirmative. We will thus free ourselves for the task of investigating what the nature of such a reconciliation would be. On first thought, it seems logical that if there is a consistent tendency for something to happen, there must be some force pushing in that direction. We have to show here, however, how it could be otherwise.
By way of encouragement we might pause for a moment to consider the example of Darwin. In his book, The Origin of Species, Darwin manages to explain how it is that there is a tendency toward the proliferation and constructive development of species without there being any necessity to posit either an instinct or an intention within any of those species to perfect themselves. The progress of species is a by-product of the process of natural selection.
Is it possible, then, that in a similar way, the perfection of individuals may be a by-product of some other encompassing process, and if so, what process would that be? Could it be that the tendency toward self-actualization and individuation is, in fact, a by-product of the working out of the conservative instincts. This seems to be the question of vital significance.
Rogers provides many descriptions of the "fully functioning person" (Rogers 1951, pp. 530-2 & 132-196; 1961, ch.8 & ch.9; 1977, pp.264-274; 1983, pp.283-295) or "person of tomorrow" (1980, pp.350-352) who is, in his theory, the end point of such a process and we can see from Rogers descriptions that we are here talking about someone who has no problem with letting go at all: "he is completely engaged in the process of being and becoming.. he lives completely in this moment" (Rogers 1983, p.290).
Paradoxically, although this fully functioning person is "independent", the process which enables such a state of completion to come about is one dependent upon the existence of a defined set of external psychological conditions (Rogers 1957). There is more than a suggestion in the way Rogers formulates his hypothesis that actualisation, whatever it may be, is just as much a product of outside forces working upon the organism as it is of internal ones.
At this point, I think we need, once again, to bring in Otto Rank. Rank and Freud are agreed that there is a conservative impulse, ultimately a longing for return to the womb. Rank and Rogers are agreed that there is a tendency for the person to emerge as a separate being with a will of his or her own. Rank, however, introduces the notion that it is separation which precipitates growth.
Let us attempt some kind of unifying statement bringing together elements of all three theories. It seems possible that the instincts we all carry are conservative and lead the individual along the path of his or her ancestors, ultimately seeking death at the appropriate time and along the way producing the "compulsion to repeat" and all the other conservative impulses which keep us and our societies intact, more or less. These conservative instincts do, however, themselves generate some change since they involve physical growth and so on as we recapitulate the experience of our distant species ancestors. Beyond the purely physical, however, it also seems possible that "becoming a person" who is able to transcend, but not eliminate, these instinctive urges is mediated by those unavoidable external factors which are the experiences of separation. Things around us do not stay the same. We come up against reality and have to respond in some way. People leave or die. Siblings arrive and displace us. Rivals challenge what we had taken for granted. Change is both unwelcome and, potentially, growth promoting. It is also, however, as Rank points out, risky. What then determines whether a change or separation experience becomes a moment of growth or a moment of defeat? It seems possible that the factor which swings the outcome one way or the other could be Rogers' core conditions. A person who experiences these conditions at the time of the separation or who can, at such a time, draw on a strong memory of having experienced them in the past is likely to fare much better and, we might suggest, is likely to come out of the experience stronger rather than weaker. Such a person is more likely to meet change willingly.
HOW DOES PSYCHOTHERAPY HEAL?
Rank showed how people have a longing to return to the womb, the safe place. And when we have outgrown the womb and it is becoming uncomfortable, we long to restore its earlier feeling and so have to learn to push. This urge to push is what Rank called the will. When we have pushed our way out of the womb, if all goes well, we are rewarded by being received into the arms of loving parents who do everything possible to give the baby the sense of being still in a womb of sorts. Even being born is a way of getting back to a former state, as far as circumstances will allow.
If we are staying with the repetition theory, it seems likely that this earliest experience, the experience of being in the womb leading to being born, is the paradigm, some might say the archetype, for all subsequent change and growth.
Rogers attempted to define the psychological environment which the therapist needs to create for therapy to be effective. Although he lists his core conditions as three, for our purposes here we can see that they fall into a twofold division. Unconditional, empathic, positive regard defines the psychological womb. Congruence ensures that when the baby begins to push, there is something to push against.
My suggestion, therefore, is that by offering the core conditions, the Rogerian therapist triggers a repetition of the one experience which almost all clients will have had, namely that of being born. Therapy is a womb in the world. It is clients' repetition of the old pattern which, in the end, drives them forward into a new separation.
In passing, we could note that this hypothesis suggests that it would be interesting to see if clients who were born passively by surgery respond to therapy differently, though it could also be asserted that such clients will still have had the instinct to push even if they did not use it at the appropriate time and will have had to learn to use it in some other way in order to survive. In this case therapy may actually provide opportunities to use the pushing instinct and so to get the feel of this most basic action embedded into their memory stream and, of course, therapy methods such as rebirthing also attempt to do this in a very practical way.
I think this hypothesis does show how it is possible that there is indeed, as Freud maintained, no instinct toward perfection or completion, that it is the very conservatism of our instincts which, in interaction with the hard realities which bear upon us and which we push against, inadvertently propels us into new steps forward and that it may be the task of therapy to retrigger the most basic form of repetition when the willingness to move forward has seemingly become immobilised.
This is a thorough going paradox. The most radically utopian social movements can readily be seen as an attempt to return to the womb, to recreate the paradise lost. The emergence of separate individuals too can be seen as the attempt by each of us to recreate his or her own womb-world in portable form.
Therapists, as Rogers says, need to be adept at both being themselves and at letting themselves go. To recreate the womb for the client, I have to let go of my self and be there for him or her in a mirror-like fashion (cf. Kohut 1971). Then when I feel the pushes starting, I have to remain firm, full of anticipation of the coming birth but not unmindful of its risks.
And the reorganization of personality which is achieved by such a birth, itself creates a new womb. The child who has been borne lovingly is born into the matrix of identity with the mother (Moreno 1951, p.130) which is itself a womb in the world. The child who, in real life, was born into a hostile environment, may, as an adult, find the process of therapy difficult because of the lingering wish never to have been born the first time. However, we can rely upon the fact that they were born and so will repeat the pattern and this time we can provide a better experience.
Letting go, therefore, starts from the very beginning of therapy. The therapist provides the conditions for the client to regress not as an escape from growth but because this is the only path to growth. The skilled therapist does not lead the client on but, rather, is continually going back and making it safe to go back.
This is true right down to the details of communicative technique where the empathic reflection does not go beyond what the client has already given. The reflective activity of the therapist is the reenactment of the repetition process. The client expresses something and the therapist's reflection wraps the womb around it. This induces a slight discomfort in the client who instinctively and immediately then produces the involuntary push which takes him or her beyond what was previously said. In one sense, the whole process of empathic reflective therapy can be seen as a work out of the pushing reflex. Through such repeated exercise the client recovers familiarity with the responses which are needed to go beyond and to carry on going beyond obstacles. At an instinctive level these are obstacles to the urge to return to the womb. In terms of their effect, however, they constitute the motive process of the self-actualising tendency.
When endings are couched in a loving environment, the person goes on to recreate a new womb, in the form of a new self. The self is the womb we carry with us and, in the healthy and vital person, it is in constant renewal. Each stage of life begins with a separation, a shedding of the old skin, and the urge to restore the old heaven within the new one. The self is always, however, a limiting skin and sooner or later its confine begins to chafe and we are again driven to grow in our attempt to restore.
So the reconciliation of these different observations by the founders of psychotherapy leads us to some unexpected conclusions. It is the attempt to return which carries us forward. It is the hope of regaining the womb which enables us to push out into the future. So letting go and holding on are found no longer to be opposites but simply aspects of the same process. This process of growth and change is also the process of return. And when we have grown most, in the moment of completion, we know that we are coming home.
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