(Post 7)

In treatment, we will emotionally experience with our patients, their first two years of life during the first two years of therapy, as their unconscious comes to the surface when the patient “Says everything.”

Normal psychological development goes through the following stages in this order: Autistic Phase, Symbiotic Phase, Practicing Phase, Reproachment Phase, Object Constancy Phase.

Autistic Phase

According to Mahler (Pp. 3 & 4 of Dropbox link in Post 6: https://www.dropbox.com/s/66tivdvlyycfxxq/Transference%20and%20Countertransference.doc), from birth to four months, a newborn is in the Autistic Phase, where he isn’t aware that he is now outside his mother’s womb. Psychologically speaking, he “thinks” he is still inside the womb, where all of his needs are taken cared of.

For Example:

A patient comes into the session and talks non-stop about whatever is on her mind, such that you can’t get a word in edge-wise. You feel that she would be saying the same thing no matter who is sitting across from her. She also doesn’t make any contact with you in the session (doesn’t ask you for feedback or to even stop to give you a chance to make a comment). This is usually an example of someone in the Autistic Phase of treatment.

Treatment Suggestion:

When we observe that our patient is in the Autistic Phase, asking of one or two Object Oriented Questions would help the patient to realize that she is not in the room by herself. That, you, the therapist, is a separate Object, and you are present in the room with her.

Object Oriented Questions

These are factual questions aimed to help our patients to become more aware of her surroundings in the session. These questions consist of “what,” “who,” “where” and “when” that have to do with the content of what the patient is sharing. We ask these questions in order to either let the patient in Autistic Phase know that someone else is in the room with her, or, to slow down a patient who is flooded with too much emotions in the moment.

For Example:

The patient says: “I woke up this morning in a panic, as I had slept through my alarm! I didn’t have time to take a shower or even eat breakfast and had to run out of the house to try to catch the bus to go to work…” The therapist interjects and asks: “Which bus do you usually take to go to work?” Or, “What kind of breakfast do you usually have in the morning?” This type of question causes the patient to have to stop her rant and think of a response, thus slows her down, and/or causes her to realize that someone else is in the room with her…

Narcissistic Transference

While in the Autistic Phase, the newborn feels he is one with his mother inside the womb. During the second developmental stage of a newborn, the infant is in the Symbiotic Phase where he feels one with his mother, now on the outside of the womb. To him, however he feels is how his mother feels, and however his mother feels is how he feels.

The patient needs to be able to feel safe in order to share his deepest thoughts, feelings, desires, yearnings and needs with us. This is so the patient can then say everything in therapy (which is the goal of therapy: to bring what’s in the unconscious to the conscious (Please review Post 1). To accomplish this, the therapist taps into the Symbiotic Phase to help the patient form a therapeutic bond with her. Once the patient feels he is one with the therapist, he feels seen, heard, understood, accepted and loved unconditionally. This then enables him to open up and say everything.

The therapist needs to “insert” herself into the patient’s unconscious by helping the patient to become aware of the therapist’s presence.

For Example:

The patient says, “Everyone always abandons me. My father left my family when I was two, and shacked up with his secretary. My mother was so depressed that she checked out emotionally when my father left. My older sister left the house as soon as she could go to college, leaving me to fend for myself without a father, living with a depressed mother…” The therapist inserts herself into the patient’s conscious by asking, “What about me? Have I abandoned you as well?” This type of question helps to instill in the patient’s mind that the therapist is in his life and starts to think of the therapist outside the session.  Usually, when a patient reports in the session that he “heard” the therapist say so and so to him (in his head) outside the session, it is an indication that the patient has entered into Narcissistic Transference phase of treatment. He is now “carrying” the therapist in his conscious mind.

The goal of establishing the Narcissistic Transference is to eventually get to Objective Transference, where the patient is ready to see the therapist as a Separate Object, outside of himself. He is then ready to received feedback and direction from the therapist and to follow through with suggestions given by the therapist. This is when Cognitive Behavioral Therapy is most effective: the patient is ready to cooperate and use his conscious thought to combat his underlying issues.

Modern Psychoanalysts believe that unless the therapist is able to establish a Narcissistic Transference with the patient, the patient’s Resistance would stand in the way of cooperating in his treatment process.