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정서적 의사 소통
작성자  simonshin 작성일  2017.08.12 08:29 조회수 53 추천 0
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 Dr. Paul Geltner 의 정서적 소통에 대한 소개 논문 2 부  
 

과목: 정서적 소통 / 현대정신분석의 개입 기법

주제: 정서적 소통에 대한 소개 논문 2부

강사: 신현근 / 박혜원 / 김양자 교수

내용: “정서적 소통의 저자 Paul Geltner 박사가 쓴 스스로의 이론에 대한 소개 논문

교재: Geltner, P. (2013). Emotional communication: Countertransference analysis and the use of feeling in psychoanalytic technique. New York: Routledge.

 Introduction to the use of emotional communication in

countertransference analysis and technique.

Paul Geltner


TECHNIQUE

            The distinguishing feature of this theory of technique is in how the analyst uses and expresses his feelings.  They serve three primary functions:  1) to meet the patients unmet maturational (developmental) needs; 2) to modify particular maladaptive defenses, usually those involving the ability to experience and express aggressive feelings; and 3) to help the patient to consciously experience any feeling impulse that he might have, no matter how extreme or unacceptable, while being able to refrain from acting upon it unless he consciously decides to do so.  The feelings the analyst expresses are genuine -- the analyst does not adopt a role and the feelings are not feigned.  However, they are expressed in a goal directed way -- to the extent possible -- and not in order to facilitate an authentic exchange of feeling in itself, unless this is the goal at a particular moment.

            The feelings the analyst expresses are carefully attuned to the state of the transference in terms of both the relational mode and the specific feeling that the analyst thinks that the patient needs to experience. Sometimes this feeling is the same as, or very close to the feeling that the analyst experiences in the countertransference. But often it differs in the intensity, the specific feeling, or the relational mode. 

            The purpose is to induce a change in the patients feeling state at a particular point in the transference in order to loosen the grip of the transference/repetition, which enables the patient to experience a greater degree of emotional freedom.  (This model fully acknowledges that much -- perhaps most -- feelings the analyst expresses are done so unconsciously and/or spontaneously but not deliberately.  When they are well attuned, these unreflective emotional communications are often therapeutic; when they are not, they can be destructive.  However, the focus of the aspects of technique under discussion (and this is not a complete theory of technique) is on what the analyst does deliberately, not involuntarily.

            All verbal psychoanalytic interventions are conceptualized as communications: like all communications, they comprise an emotional communication and a cognitive communication.  Different types of interventions are viewed as different combinations of emotional and the cognitive communications -- and different ways engaging with and relating to the patient.

            Two different dimensions of the patients mind that can be addressed by the two components of the intervention.  One is the reasonable ego, which is conceptualized in the classical way:  it is the more adult, present-focused part of the mind that is reality oriented, rational, less under influence of the repetitions, and can step back and engage in self-observation.  The other part of the mind is the afflicted ego, the part of the mind that is driven by and experiences the world through the lens and the logic of the repetitions.

            Each component of an intervention (indeed, any communication) can address the same part of the patients mind, or each can address a different part.

            Within this framework, Classical interpretations, in which the analyst forms an alliance with the adult parts of the patients mind, are interventions in which both the emotional and the cognitive communications both address the reasonable ego: the analysts understanding  of the patient, conveyed in the interpretation, is addressed to the most mature, reality-oriented dimensions of the patients mind,  as is the emotional communication.  The feelings and the perceptions that make up the repetition are talked about, observed but not engaged directly. 

            Affective interpretations, on the other hand, address the emotional communication to the afflicted ego -- the part of the mind that experiences the repetition in the analytic relationship -- and address the cognitive communication (again an interpretation) to the reasonable ego. The emotional communication is stronger in the affective interpretation, and conveys a wider range of feeling than in the classical interpretation.  This is the type of interpretation that is often used in Intersubjectivity and Relationality.

            Finally, there are interventions in which both the emotional and the cognitive communications address the afflicted ego.  These tend to be non-interpretative, and sometimes appear to be non-rational as well.  The emotional communications actively engage the afflicted ego with a wider, more intense range of feeling that either type of interpretation, while the cognitive communication conveys the logic of the afflicted ego, not the adult, reasonable mind.

            Although this technique makes use of all three types of intervention, the most distinctive techniques are the non-interpretative interventions in which both components address the afflicted ego.  While some of these interventions may seem shocking -- except, perhaps, to analysts heavily influenced by Secheyhaye and Searles, close readers of Winnicott, and some Interpersonalists and Relationalists, I suspect that most have been used at times by individual analysts from other schools.  But this model provides a fully developed theory of technique that conceptualizes and guides the use of an extremely wide range of relatedness and therapeutic relatedness.

            In principle, there is almost no limit to what the analyst might say.  She might tell a shy patient that she is paralyzed with anxiety at parties or describe her favorite sadistic fantasies to a patient who afraid of his aggressive feelings.  He might order an emotionally withholding patient to go home and make love to his partner after the session -- or told that he should never give his partner a drop more affection than absolutely necessary.  The analyst might read a poem to the patient, recommend a hotel, or explain how to cook asparagus.  She might tell a patient about her own clumsiness to help the patient feel better about his own ineptitude -- or to provide a target for him to attack.  A patient might be told that the analyst loves her or that he hates her, that he admires her or that he wishes he could adopt her.  All interventions are expressed with appropriate feeling as whatever degree of intensity is necessary, attuned to the characteristics of the transference -- the specific feeling and relational mode -- and conceptualized in terms of the afflicted and observing egos.

            To explain the use, context, and rationale of all of these interventions, or to give a full exposition of the theory of technique, is well beyond the range of this paper.  Instead, I will discuss one particular intervention in specific context.

            The patient feels frustrated with just about everything that happens when she goes out in the world:  people are nasty, men catcall her, women she is attracted to arent interested, and everyone is rude and inelegant.  From now on, shell stay inside, go out as little as possible.  Shell cultivate her own garden, with the only person that she can completely trust -- herself! Seeing that naked drunk sleeping in the subway was the last straw.  Who needs to go out, anyway?  She can work from home, she can order food in.  She will read French literature and listen to the jazz she loves.  Shell probably get skin cancer if she goes out in the sun too much.  From now on, shes an urban hermit.  When she announced her plan to her friends and parents, they were all sympathetic to her frustration, even empathic, but they sound alarmed and said her plan is self-defeating, that shes giving up.  What do they know, she asks?   Maybe she will keep coming to her sessions, maybe shell call in.  Not that it really matters: analysis cant change the world, can it?  Does understanding that you are in pig sty make it smell any better?

            The analysts first feeling is the same as everyone elses: she shouldnt become a hermit.  Sure, things have been awful for her, and the flashing was absolutely assaultive and traumatic.  But thats no reason to become a hermit.  Besides, the stuff about the sunshine sounds paranoid, crazier than she had previously thought about the patient. 

            But as the analyst reflects, she sees that the patient has a constant hunger to have people be like her, not just understand her.  This is a subtle but profound difference in the quality of the relatedness that the patient seems to be seeking.  Both are within the narcissistic realm of relatedness, but the former conveys a stronger sense of narcissistic relatedness.  In this situation, the patients friends response (and the analysts initial (unverbalized) response) is partially empathic: they respond in a way that seems to understand her feelings; but their difference from her is evident by their alarmed response to her plan and their well-meaning protectiveness.  But nobody really shares her desperation or outrage.  The patient clearly feels that if they really understood, they would agree because;  how could they not -- its self-evident!  Which, from the perspective of her afflicted ego, which is dominant at this point in the transference, is true.

            The analyst realizes now sees that this repetition has taken other forms.  The patient complains that she has never fit in anywhere, she never found her niche in the world.  Nobody is really like her, everyone is different, even if they care about  her. Shell never find a soulmate.  She was happiest as a militant in a political movement in which she felt that everyone shared her vision, but left when she saw that there were differences of opinion and goals there too.  Her favorite movie is The Man Who Fell to Earth, a movie about an alien among humans.  There have been times when the analyst has felt deeply empathic with her, and tried to communicate this.  The patient said that she felt understood, but she seemed untouched by it.  This made the patient think about her last comment about understanding not changing anything.  The patient experiences an unmet maturation need for the experience of an intense narcissistic relatedness; her repetition is that she cant find this experience with others, and doesnt relate to them in a way that induces it, even though she is able to have people in her life who care about her empathically.  But nobody gives her the more powerful narcissistic emotional relatedness that she craves and needs.

            As the analyst reflects, the less distance she feels from the patients feelings, the more she feels aligned with her.  What is so good about going out, anyway?   Why should she?  Why shouldnt she stay in the house, read Colette (the analyst loves Colette), and seal herself off from the world?  The analyst associates to all the times that she herself wanted to withdraw from the world, to  cocoon.  She liked The Man Who Fell to Earth, too.  At this moment, she doesnt simply understand the patient, she thinks and feels the same way the patient does -- at least in part.

            To communicate understanding without full blooded agreement with the feelings and perspective wouldnt be strong enough -- wouldnt provide the maturational experience of relating to a twin that the patient craves.  She decides to tell the patient:  "That sounds like an excellent plan!  Fuck the world before it fucks you again!  You can get by without it.  Your friends may be well meaning, but they just dont get it! Nobody who hasnt lived your life can really get it.  But you are right -- why risk one more frustration, one more assault, one more disappointment.  Stay home. Come to sessions if you can, but if its better, you can always call me.  Theres no need to put yourself at risk to come here.  It would be completely counterproductive."  The tone attempts to convey that she thinks and feels just like the patient does.

            The purpose of this intervention is to directly meet the patients need for a specific type of narcissistic relatedness, in the context of the analytic relationship.  The emotional communication addresses the afflicted ego and the cognitive communication takes place within the logic of the afflicted ego as well.  While it is obviously based on an interpretation in the epistemological sense, it is not designed to convey intellectual understanding or insight of any sort.  It is formulated on the basis of the repetition, but makes no overt reference to the repetition.  It can only work in the context of their relationship, but makes no overt reference to that either.  Sometimes the patient later understands what transpired and why, but often she doesnt.

            It is not the communication that provides the strongest possible sense of narcissistic relatedness.  Similar interventions communicate an even more strongly narcissistic relatedness:  "I feel the same way.  Id never leave the house if I could avoid it."  Or, "I never leave the house if I can avoid it."  Unlike the previous intervention that communicates sameness, these go further and imply an even lesser degree of differentiation.  These are within the range of what might be used within this model.  However, they would be for a used when the patient needs a communication that emphasizes their twinship more strongly -- and if the analyst really feels it.   In this example, the analyst reached a point where she really has the same perspective as the patient -- at that moment in the treatment; and she thinks that this feeling will meet the patients needs.

           

            When this type of intervention is successful, the patient usually experiences a tremendous relief that they have found someone who really understands her.  This often leads to greater emotional flexibility and a restarting of the stalled maturational process.  In this case, it likely to lead the patient to reconsider her decision to become a hermit.  But it might not.  The intervention is designed to meet a maturational need, not influence her behavior in any particular direction.  In either case, the patient will do so on the basis of feeling less alone in the world, and her sense of self will be more stable and solidified.  Its rare for a single interchange will meet a maturational need, but these first moments are often turning points in the patients development. 

 

 
 
 
 
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