The Table Video

Marie Hoffman

Born to Relate: In Trauma, Transformation, and Transcendence

Associate Professor of Psychology, New York University / Co-founder of the Brookhaven Center for Counseling and Development
May 10, 2014

Marie Hoffman (New York University, Brookhaven Institute) suggests that the human heart seeks relationship from conception. In utero twins seek contact with each other far more than contact with the womb. Psychoanalysis, influenced by Freud’s underlying Judaic narrative, has always placed relationship at the center of human brokenness, cure, and destiny. A child, being entirely dependent on its caretakers, clings to that tie with ferocity. If any aspect of the tie is not satisfactory in the actual relationship, the child will create an unconscious tie through identification, which becomes part of the relational template used for life. We call this attachment to bad internal objects. From this unconscious place, the parental figures “haunt” the life of a child turned adult, who cannot understand why they are behaving like a parent, or attracting others to themselves who treat them like their parents did. Because of the hunger for a relational tie, the “sins of the fathers are visited to the children.” When these patterns emerge in the treatment relationship, the new relationship with a caring other slowly brings release from bondage to “the old man” and creates a berth for new relating to the therapist, to others, and to God in a “new creation.” An outgrowth of this healing is the seeking of relationships in which the restored person, in gratitude, serves God by making a difference in the lives of others.

Transcript:

It’s been a lovely conference thus far. Quite a roster of stimulating speakers. And I hope that today, I’ll offer you something that’s a slightly different perspective. The lens through which I will be looking is relationship. And following what Ev said, I would say that the highest human value is relationship. And that’s what you wanna look for. Whether it’s in the problem, transformation, or where you’re headed in destiny, relationship is the highest value.

Okay, I’m a psychoanalyst, so I read my papers, and I hope that I’ll make it as engaging as possible, even though it will be read. “Every human being is formed to be a spectator “of the created world and given eyes “to be led to its author by contemplating “so beautiful a representation,” writes Jean Calvin in his commentary on Romans 1. Theologian Belden Lane adds, quote, “Calvin knew “that human desire at its best is but a mirror “of God’s own desire for relationship,” unquote. Calvin’s religious anthropology commences with humans hard wire to desire relationship with the Creator, who desires relationship with them. Relationship is at the heart of psychoanalysis, as well.

In radical departure from Freud’s drives and instincts, Ronald Fairbairn, psychoanalyst, Scottish object relations theorist, and lifelong Christian envisioned the infant as born with that same innate longing toward relationship. Psychoanalyst Stephen Mitchell, acknowledging Fairbairn’s momentous move to relationality, states, “Fairbairn was suggesting that object-seeking, “in its most radical form, “is not the vehicle for satisfaction “of a specific need, but the expression of our very nature, “the form through which “we become specifically human beings,” unquote. Fairbairn’s ideas resonate in attachment research, as well as in neuroscience.

In a study on prenatal twin fetal activity entitled Wired to be Social, the ontogeny of human interaction, Castiello, Gallese, et al. provide empirical evidence of the innate longing to relate. They write, “By the 14th week gestation, “twin fetuses display movements specifically aimed “at the co-twin, the proportion of which increases “between the 14th and 18th gestational week. “Kinematic analysis revealed that movement duration “was longer, and deceleration time was prolonged “for other directed movements, “compared to movements directed toward the uterine wall. “We conclude that,” they go on to say, “Other directed actions are not only possible “but predominant over self-directed actions, “grounding for the first time Martin Buber’s I/Thou “on quantitative empirical results,” unquote.

I will first seek to establish that if relationship-seeking is central to our human aliveness, then relationship ruptures must be implicated in human trauma and psychopathology. Next, developing an apologetic from theology, neuroscience, and psychology, I will suggest that loving human relationship is essential to transformation. Lastly, I will pause at that healing is not merely an individual phenomemon, experienced solely for personal betterment, but it achieves transcendence when it becomes a relational vehicle of redemption in God’s Kingdom.

Born to Relate: In Trauma. Cathy was exhilarated when she married Peter. He was a worship leader whose father and grandfather had pastored his country church. She had now moved beyond her less than stellar beginning, though truth be known, she was also intimidated by the Christian pedigree of Peter and his family. Cathy was born in the small Pennsylvania town to parents whose family history held many secrets. Suicides and untimely deaths dotted the genogram. But Cathy knew few specifics.

Nonetheless, she was a bright woman, rising within the ranks of her church community, and bringing many to faith in Christ through her youth work. Life moved along well for Cathy until the day her 18-year-old nephew committed suicide. The chaos of her childhood, the mixture of sadness and rage at her nephew’s father, her brother, the feelings of unbearable inferiority to her husband’s family, all came crashing in upon her bucolic life.

When she came to see me, her moods were cycling from despair to rage, and she feared her own destructiveness. Once, when angry at her husband, she had taken a pair of scissors and cut to pieces several pairs of pants. On another occasion, in an explosive rage, she rammed her car into the parked car he occupied. In sessions, she would vacillate from rageful woman to panic-stricken child. Understanding such behavior from Calvin’s perspective, one comprehends that though the created order was initially marked by internal and external harmony, a cataclysmic relational event reorganized a world now separated from God and others.

The world became marked by the “absence of sympathy,” quote, “or affinity that formerly aided understanding, “and the loss of harmony within ourselves in the plurality “of conflicting motives and emotions,” unquote. Jonathan Edwards recapitulates Calvin’s linkage of separation from God to alienation with others. And I’m quoting him. “Each person shrank, as it were, “into a little space, circumscribed and closely shut up “within himself, to the exclusion of all things else. “Sin, like some powerful astringent, “contracted his soul to the very small dimensions “of selfishness, and God was forsaken, “and fellow creatures forsaken, “and man retired within himself,” unquote.

The Biblical narrative further describes how sin becomes repetitive, reflecting a bondage of the will. This tenacious pull toward such behavior leads Paul to cry in Romans 7, “Wretched man that I man, who shall deliver me “from the body of this death?” Bondage of the will was a familiar theme in the Scottish Free Church sermons of Ronald Fairbairn’s youth, and often sung hymn-proclaiming, “Thy power alone, “oh Son of God, can this sore bondage break.” Extrapolating from his reformed heritage and his philosophical studies, Fairbairn proffered a relational perspective on the bondage of the will.

To Fairbairn, and this is a really important point I want you to get, to Fairbairn, the repetition of sinful behavior did not implicate lack of will, though he did acknowledge its enslavement. Rather, he understood the compulsion to repeat sinful behaviors as derivative of a relational longing. Children needing to remain attached to parents who have failed them internalize parental behaviors and repeat them, ensuring a relational connection through identification. This identification is also responsible for the iniquity of the fathers being visited on the children, Exodus 20:5. When one attaches to the significant caretaker through this unconscious identification, it becomes transmitted generationally, and one often will relate to others out of that identification. Enslavement to sin is more than an individual pathology. It is a relationally transmitted pathology.

Let us return to Cathy and examine how her behaviors might be motivated by such relational strivings. I came to understand that Cathy had felt marginally close to her father and very distant from her mother and brother. Largely neglected by her parents, she was never alone, for her brother would be there to rage at her, torment her, then dismiss her. Mother was perpetually ill and seeking care from Cathy, who feared that she was responsible for Mother’s sicknesses. Cathy eventually came to understand that her shifts from rageful person to needy child derived from her longing to be close to Mother, Father, and brother. She needed to feel attached and had unconsciously become them. She behaved like the terrifying or sick mother, the neglectful father, and the rageful brother toward herself and others.

As Cathy grasped her identifications with family members and her burial of any negative feelings toward them, she understood that she’d been occupied. They were actually controlling her life from within. I utilized Christian language to explain that what felt comfortable and familiar was the natural man, and suggested that simultaneously, she was a new creation. The person who so lovingly reared her children, did not neglect them, or terrify them, Cathy had fulfilled her need to relate through pathological identifications with her family, binding her into shameful and guilt-producing behaviors.

I just wanna say this parenthetically here. I have so many people over the 25 years that I’ve been working come to me and say, I wish I could change, I wish I could change. And until they realize this relational connection of identification with a parent or a grandparent or whatnot, they feel bound and guilty, because they’ve oftentimes been given all sorts of recommendations as to how to change, and they can’t do it. And it’s not until the truth sets them free. And they say, oh my goodness, it’s because I wanted to be close, I wanted to be attached, that they finally are able to bring it to consciousness and make choices.

Born to Relate: In Transformation. Our Savior’s love moved Him from being merely a hope, a wished for messiah, spoken of by Old Testament prophets, to becoming incarnated as the living Word to dwell among us. Why was Old Testament revelation not enough? Why was learning the truth of the Law insufficient? Why is simple delivery of cognitive principles and behavioral exercises many times inadequate for interrupting the transmission of parental sins to the children? Incarnation, a relational initiative, not just instruction, was required to break the bonds that shackled humankind. Similarly, in psychotherapy validated by neuroscience, incarnation in the form of re-enactment of relational patterns between people, is often necessary for the breaking of old patterns and the experiencing of new.

In Cathy’s case, feelings that were painful were dissociated into storage in the right hemisphere of the brain. Right hemisphere functions include the storage of highly charged memories, while the left hemisphere is more focused on verbal comprehension. Cathy was motivated by those buried feelings, the elephants, without recognition of their source. This points to the necessity of a psychotherapeutic approach that addresses the affective loading of dissociated material stored in the right hemisphere of the brain.

A psychodynamic approach targets these dissociated memories and affects, allowing them to occur between patient and therapist, have meaning, and eventually be comprehended by the left brain. Efram Ginok, in an interdisciplinary study, explains the implicit affectively charged nature of psychoanalytic reenactments. “Neuroscientific research,” she says, “has demonstrated that what enactments communicate “in such gripping and indirect ways are implicit, “neurally encoded affective and relational patterns. “Patterns formed before verbal memory “was fully developed and those defensively dissociated “later on by an emotionally overwhelmed sense of self. “What gets to be empathically known through enactments, “then, are relational patterns and self-representations “that cannot become recognized “through verbal interchanges alone.” And in the case, I’m gonna give you a picture of an enactment.

What I mean by that is spontaneously, something will happen between the therapist and the patient. Let’s say the therapist is running five minutes late, and the patient is somebody, who in their childhood, was always abandoned and dropped by their parents. The patient becomes enraged for the five minute delay. That then becomes an enactment of something buried in the person. If you were to ask them, you’re enraged at me because your parent did this, and so I say, what are you talking about? But when it happens, immediately, in the moment, and you deal with it in the moment, it’s alive. And even though psychoanalysis has moved a long way from Freud, I still like his quotation, “You can’t kill something in effigy.”

You have to have it alive in the room to really deal with it. Now, for the graphs. [audience members laughing] Psychiatrist and researcher, John Cornelius, offers compelling data regarding the insufficiency of sole reliance on cognitively-based treatments and the mounting evidence for relational psychodynamic approaches. Now, I wanna make it really clear. I think that anyone that’s doing any kind of psychotherapy is touching on all these things. But what I am saying is if you are not relating, there’s not gonna be change.

Relationship is what is core, and every study has shown that the therapeutic alliance, and even what Ev said about the time spent, makes a remarkable difference. So in the United States, the massive NIMH-funded Sequenced Treatment Alternatives to Relieve Depression study, called STAR*D, completed in 2006, found that the benefits of CBT treatments for depression erode with relapse rates of 55 to 71%, the average time to relapse occurring in less than four months. And there, you’ll see Step 2, which is, Step 1 was giving the people medication. Step 2 was adding CBT. And the relapse rate in 3.9 months was 55.3%. So while initially, it did really well, within 3.9 months, it had eroded to relapse.

Step 3 was adding another medication, as was Step 4. And the more medications they added, it typically was the more chronic the situation, and so the relapse rate obviously was going to be higher. The independent Cochrane Library Meta Analysis of 23 randomized controlled trials with 1,431 patients receiving short-term psychodynamic psychotherapy had end of study effect sizes of .97, which is really high, for general symptoms. .81 for somatic symptoms, .59 for depression symptoms, and 1.08 for anxiety symptoms. Now, please understand Cochrane Library is an independent evaluator. They’re not like psychoanalysts going there and trying to just have a bias. So that’s what they came up with. Nine months later, outcomes improved even further with a 1.51 for general symptoms, 2.21 for somatic symptoms, .98 for depression symptoms, and 1.35 for anxiety symptoms.

So what psychoanalysis or psychodynamic therapy seems to suggest is not only do people not relapse, but this relational factor and the bringing out of the past and the care that is given time to develop in the relationship actually produces greater effect sizes the further out it gets. It’s a longitudinal study. In stunning research by Bateman and Fonagy, after 18 months of psychodynamic treatment called mentalization-based treatment, 57% of patients with a borderline personality disorder diagnosis, and that’s like, that is anathema. If you get that diagnosis, it’s like, a really a bad sign. 57% no longer met the criteria for borderline personality disorder. The benefits of the treatment increased over time with 87% of participants no longer meeting criteria at eight year followup.

Though cognitive behavioral methods offer rapid alleviation of symptoms, evidence is accumulating that the effects dissipate and the rate of recidivism is dismally high. From a theological and relational viewpoint, this comes as no surprise. So while I’m shooting some things down, I’ll move on to the next one. Another example of the insufficiency of non-relational methods pertains to the recent and in many ways needed clinical application of mindfulness. Originally practiced in Buddhism, mindfulness aids a patient in developing a moment by moment accepting awareness of one’s thoughts, feelings, and experience. Jeffrey Rubin, psychoanalyst and meditation teacher, in his book, “Meditative Psychotherapy: “the Marriage of East and West,” while advocating the benefits of mindfulness, and I advocate them, too, in conjunction with relational therapy. Points out its insufficiency when used alone.

He relates this story. “My client, a graduate student, “practiced the Tibetan technique called touch and go. “She sat still and open to whatever arose, “often sorrow and loneliness, “identified with these feelings momentarily, “and then let them go. “‘I learned,’ she told me very confidently, “‘that through meditation, I could lay my feelings “‘about my life to rest.’ “Effective as it might be, her meditation “also cut her off from feedback about her emotions. “She didn’t yet realize that addressing their meaning “was vital to figuring out what haunted her. “The loss and abuse that she thought were put to rest “returned in the form of her symptoms and suffering. “She had spent 18 years “anesthetizing herself with meditation “instead of dealing with the experiences of her childhood, “which caused her sadness. “My patient called our therapy touch and stay “because we contacted and stayed with the feelings “of sadness and loss in the past “and the neglect in the present. “She was able to grieve and mourn, and then let go.” While initial improvement often is experienced through mindfulness, it does not foster the witnessing of suffering through a comforting attachment to a caring human, the deepest need our patients bring. As with this patient, success is often short-lived or new symptoms emerge, necessitating a redoubling of meditation attempts.

And what Jeffrey Ruben recommends is that there be a combination of depth psychotherapy with meditation, which then helps the person to actually live out the new learnings that they have received in a relational context. The power of incarnation, that of relationship, opens the door to enacting a relational trauma and repairing it in real time, and is supported at a theological level in Scripture, as well as the empirical level in neuroscience. But does incarnation lead us directly to resurrection? Both theology and psychoanalysis would say, no.

There can be no resurrection without death. Simply relating kindly and with positivity will not stop the cycle of attachment to bad behaviors and identifications. Written shortly before his death, the use of an object was British psychoanalyst Donald Winnicott’s unwitting translation of his early Wesleyan theology into theory. Winnicott believed that unless the therapist was attacked by and survived the patient’s attacks, which come as a result of childhood distortions, the patient will never see others and themselves apart from those formative distortions. Patients come to us peering through the the misty lenses of past relationships and identifications. And we in turn look back at them through our own, and unwittingly become sin for our patients.

We endure the punishment and rebuke that both we and significant others before us deserved. And we also suffer unjustly for sins committed by others and transferred onto us. “It is only then,” Winnicott theorized, “that the mist clears and the newness “of resurrection is possible.” When we survive crucifixion, our patients can see that we and others are not the wounding parents they thought we were. The therapist may aptly say, I am crucified with Christ, nevertheless, I live. Such focus on the relationship between patient and therapist moves the locus of redemption from mere verbal discourse to the messy environs of hand-to-hand combat with evil. Let’s return to Cathy’s story.

Cathy began to see a reduction in outbursts, and when she did experience them, she self-regulated more quickly. But the sense that she was bad and sick and dangerous, a consequence of her relationship to her mother, her identification, continued to surface. It is at this point that my dog, Rudy, becomes a character in Cathy’s story. Rudy came to us when just a few months old, following the death of another beloved Pomeranian. He was cute as a button, but his brain cells were just not fully developed. Cathy always brought treats for my dogs, whom she deeply loved. On an ordinary day, she came in and gave Rudy his treat.

We want on with our session until she commented to me that Rudy had not moved in awhile. I looked down, and to my horror, Rudy was not breathing. I don’t know how long he’d been in this state, but it was long enough that he had involuntarily defecated. I screamed, “My dog is dead, my dog is dead!” As I ran to him, held him upside down, and performed the Heimlich to no avail. His lifeless body did not respond.

Finally, I laid him on the floor and did CPR. Compressions, breaths, as my terror-stricken patient watched. I cleared his airway by hand and found a treat lodged sideways. But still, no respiration. I tried a second course of CPR, still nothing. I was giving up hope. But Cathy, who had begun studies in medicine years before, pleaded, “Try one more time.” I did, and Rudy began to cough.

He was very disoriented, but so were we. [all laughing] He curled up on my lap and slept as Cathy and I talked of what had just happened. How do you go on in a session after something like this? My mind went quickly to what must have been stirring in Cathy. I asked her what she felt, and we discovered that this incident led to the heart of her fears. Her love and her hate were destructive. Her treat had nearly killed my dog.

We explored her feelings of responsibly for her mother’s well-being, which could oscillate to virial and hatred at Mother’s total self-absorption. We discussed her feelings of envy for her brother, who had been favored, and her guilt over wishing him ill. Through our shared horror for Rudy’s apparent demise, I had not only witnessed Cathy’s terror, but I had vicariously experienced the terror that Cathy felt. Until Cathy’s dissociated fear spontaneously emerged, it had been unavailable for her to recollect or acknowledge.

And we had been unable to access what had perpetually held her in bondage. She felt bad. She didn’t know why she felt bad. She felt dangerous. It was not until those feelings came up in the moment that she thought she’d killed my dog. Now, I’m not suggesting everybody goes and gets their dog killed in sessions to do this. I’m just giving it as an example of how you can you can use what emerges spontaneously in a relational way.

When Cathy experienced my humanness, my panic, she was able to relinquish her idealization of me and be reassured that her own intense feelings were normative. Cathy’s desire to feel normal and good became more often realized, and she was further freed from the repetitive cycles of anger that kept her in bondage to her past. Born to Relate: In Transcendence. Ronald Fairbairn understood the analyst’s task as finding an entree into the closed internal world of the patient, to offer a redemptive relationship with a real other. Fairbairn variously characterized the analyst’s function as messiah, savior, exorcist, and evangelist.

This is a psychoanalyst we’re talking about, ‘kay? Keep that in mind. The patient comes to experience the analyst as a new good relationship, hopes for the possibility of something better, and in Fairbairn’s words, “may be induced “to relinquish the bad and attach to the good.” More than a century before Fairbairn’s contributions, the founder of the Free Church of Scotland, Thomas Chalmers, presaged Fairbairn’s formulations in a legendary sermon entitled “The Expulsive Power of a New Affection”. I’ll replace Chalmers’ use of the word, world with the term bad relationship and see how it fits. “The love of the bad relationship cannot be expunged “by a mere demonstration “of the bad relationship’s worthlessness. “May it not be supplanted by the love “of that which is more worthy than itself? “The heart cannot be prevailed upon to part “with the bad relationship by a simple act of resignation. “But may not the heart be prevailed upon “to admit into its preference another, “who shall subordinate the bad relationship “and bring it down from its wonted ascendancy? “It is not by exposing the worthlessness of the former, “but by addressing to the mental eye “the worth and excellence of the latter, “that all old things are to be done away “and all things are to become new. “In fullest accordance with the mechanism “of the heart, a great moral revolution “may be made to take place upon it.”

What Fairbairn deduced from this famous sermon, and that was somebody that he was very familiar with in his circles. Was translated into his work with patients. Fairbairn realized that the therapist stood in the role of Christ to the patient, and through forging a deep loving relationship could release the enslaved patient from bondage, enabling them to respond to and give love in external reality. It is the renewed capacity to see others in reality without a projection of past identifications that becomes the vehicle for transcending old patterns of relating and converting that knowledge into an empathy for suffering others.

The ashes of our own pain become the very substance with which we transcend our past through feeling the other’s pain and bringing comfort to them, in alignment with God’s redemptive design. We are not simple released from bondage to feel better, but to fulfill the Father’s heart, “Thy Kingdom come.” Cathy, as we will see, began to experience evidences of such a shift. The first evidence occurred when she returned to school to complete her medical training. Although in mid-life, the constraints of parents who did not encourage her academically, were now diminished. Cathy excelled in her studies. Concurrently, she worked in a medical setting in which she experienced deep compassion for suffering people. She had longed to heal her mother and could not. Sh had longed to be comforted and was not.

Now, as an adult, she could offer to herself and others what was denied her in childhood. The more surprising evidence of conversion, and I have another paper that I’ve written on conversion, and that is the taking back of that territory that was lost, and bringing it into a redemptive trajectory. That’s God’s design of conversion. Emerge not in her career, but in her marriage. A previously undisclosed revelation by Peter of a long buried falsehood enraged Cathy. She had been the defective wife, while Peter had been the saint, and it had all been a lie. Her rage returned with a vengeance, and some of Cathy’s maturational gains were eclipsed.

For months, Cathy remained regressed, distant from Peter for whom she felt unabating rage, until a space opened in which she could mourn. Only after Cathy’s illusions of Peter’s perfection and her supposed defectiveness were laid bare, could she see her own role in maintaining Peter’s defenses against knowing his own suffering and recognizing both his own neediness and his own evil. She needed him to be her savior. Cathy began to see that Peter’s family, who had appeared spotless, was riddled with falsehood and unacknowledged pain.

After a significant period of her reactive disdain of Peter and his family, Cathy gingerly moved toward empathy for her husband, whom she eventually understood as someone who suffered from his own unacknowledged wounds, just like she had. After this reparative period in her marriage, old feelings of defectiveness projected onto her by her parents and brother only rarely threatened her. And she could experience empathy and forgiveness toward Peter, who could now acknowledge his own shortcomings. Peter is in his own psychotherapy, and together, they have come to see themselves as broken and wondrous, enjoying their marriage more than they ever had thought possible. Nice, I met with her just this past week, and she was just really excited about my being able to share this. She’s a very dear person.

Conclusion. In over 25 years of full-time practice as a clinical psychologist, I found no more powerful means of transforming the lives of patients and cooperating with the sanctification process than working in this fashion. The privileging of left hemisphere verbal understanding or the reliance on mechanistic approaches to our patients has promised much but yielded little lasting change. Consequently, many who feel hopeless have received treatments that targeted a part of the brain that did not carry the weight of the tragedy, treatments that often excluded elements not fully reducible to the laboratory, such as comfort, love, and hope.

I close with a note that Cathy gave me, sharing her feelings of disbelief and wonder at the growth that has occurred in her life. She writes, “Projectors are artists. “They make an art of drawing portraits of themselves “on your soul. “Their blackness, their shame, their emptiness, their evil. “When you’ve been trained as a child to allow them “to paint their portrait over yours, you become confused. “In your heart, you know the ugly picture they’ve painted “doesn’t look like you. “But you begin to doubt yourself. “It hurts deeply. “Sometimes you know the portrait “they’ve painted looks familiar, but you’re not sure why “because you’re focused on the hurt you feel “and the urgent desire to defend yourself. “If only you can step out of yourself, “turn and look yourself in the face, “you would instantly see the transparent portrait “of the projector layered over your own face. “The psychologist teaches you what has happened “and it’s like standing in front of a portrait “at the art museum, studying it, captivated by it. “And then, you recognize the distortion for what it is. “An obliteration of the goodness of your heart, “reflected in the distorted face. “When you’ve learned to identify the projector “and the unique feeling when he paints his face over yours, “you become free to peel off the offending layer. “And you begin to see the real person you are. “And you want to cry, “because you weren’t allowed to see it before. “It’s good, just like you knew it was.” Thank you.

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