Introduction
to the Dynamic Activities
As mentioned in chapter I, research data support the view that, in order
to start a therapeutic process bringing about psychodynamic change, the patient
needs to be enabled to experience
his/her conflicting feelings with a sufficient
intensity. For this reason, the sooner this emotional experience takes place
with sufficient intensity and the dynamic process gets started, the briefer
psychotherapy will be. Activation
amounts to bringing about a sufficient
increase of the intensity with which the conflicting feelings are being experienced by the patient.
Since what we need is to activate the conflicting feelings,
represented as X in the Triangle of Self, and since these are kept
unconscious by the defenses D and by anxiety A, we need to alter
the complex balance existing among the three forces. It is certainly reasonable
to act on the D corner, so as to weaken defenses, and on the A corner, thus regulating the anxiety
loading the conflicting feelings. If, however, it were possible to act even on
the X corner with a direct
facilitation of emotional experiencing, we would actually be able to act on
all the three forces involved in the
maintenance of the conflict.
On the basis of these considerations, we will describe three main dynamic activities a therapist can
engage in: Defense Restructuring,
and Anxiety Regulation
–respectively addressing defenses and anxiety- and the activity addressing the
conflicting feelings, which we call Emotional
Maieutics. A first general description of the three dynamic
activities and of the corresponding attitudes and contributions of the
therapist concludes this chapter and will be the theme of the next three.
Defense
Restructuring (DA)
The
purpose of this dynamic activity is to weaken the patient’s defenses, which are
making a direct experience of the conflicting feelings impossible or
insufficiently intense. The therapist:
(1) concentrates on identifying all the
defenses, so as to be able to mirror them to the patient;
(2) follows the pathways enabling the
patient to drop or put aside his/her usual defenses.
While
restructuring the defenses, a therapist needs to be attentive and systematic,
so as not to omit to address every single defense which is being employed. A
sense of strategy and an ability to sustain confrontation may turn out useful
for this activity.
Emotional
Maieutics (XA)
The Oxford English dictionary defines “maieutic” as “pertaining to
intellectual midwifery, i.e. to the Socratic process of helping a person to
bring into full consciousness conceptions previously latent in his mind.” When
applied to maieutics as used in the context of E-STDP, however, this definition
can be paraphrased as follows: “pertaining to emotional midwifery, the process of helping a person to fully
experience emotions present in him/herself.” What a midwife (= maia, in Ancient Greek) does is to help
the mother to give birth, and to withstand the pain of delivery. The parallel
with what a therapist can do is not just metaphorical. Emotions are in fact
felt through the body and moving them out (in Latin e-movere means “move out” or “move from”) can indeed be painful.
Our culture is sometimes forgetful of this aspect of emotions and I am grateful
to Leigh McCullough for reminding me of this with her videorecorded cases. The
therapist:
(1) makes him/herself as much
emotionally available to the patient as s/he can, giving him/her a sense
of being connected;
(2) concentrates on the emotion that is
being experienced, mirroring what s/he perceives and helping its bodily and
verbal expression.
The
emphasis here is, for the therapist, on lending his/her physical and emotional
perceptive capacity and on being close to
the patient. Being at ease with one’s body and emotions, and having access
to one’s instinctive, animal nature, are important qualities for a therapist
willing to act maieutically.
Anxiety
Regulation (AA)
Either autonomously on the patient’s part, or following on DA and
XA, anxiety can become so intense as to act as a cloud, covering up all
the other emotions. Consequently, in E-STDP, the main purpose of AA is
to regulate the level of anxiety, making it compatible with emotional
experiencing. The therapist:
(1) explores, with the patient’s help,
his/her ways of discharging/trying to control anxiety through his/her body,
posture, expression, speech etc., and mirrors them to the patient;
(2) acknowledges the patient’s anxiety
as a normal manifestation within a relational situation charged with feelings.
From the foreword by
David H. Malan
“Dr. Osimo
explains the principles of his technique with great clarity. His special
contribution consists of his detailed description of the various kinds of
intervention available for dealing with each of the three corners of the
Triangle of Conflict - defense, anxiety, and hidden feeling. In particular he
introduces the concept of “maieutic” interventions for facilitating the full
experience and open expression of deep feeling (the word is derived from the
ancient Greek for “midwife”). Interventions of this kind have been used by many
good therapists, but Dr. Osimo is the first to spell them out...”; “An
especially favourable feature of the book is the exceptionally high proportion
of illustrative case material, together with follow-up, from which the reader
can gain an excellent idea of how the technique can be applied and the truly
remarkable therapeutic results that it is able to achieve.”