After reading chapter 8 of her latest book, titled “What Happens in Psychoanalytic Treatment? What's it All About” I found Jane Hall's ideas resonant with my own work with patients and with a contemporary neuro-psychoanalytic understanding of therapeutic models of change. Hall credits Norman Doidge's book “The Brain That Changes Itself” for providing the neuro-scientific foundation to her ideas.
As Hall's book seems geared towards professionals and those not as familiar with psychoanalysis, she begins the chapter revisiting central tenets of psychoanalysis. Hall outlines how developmental trauma is internalized and acted out as adults in a maladaptive fashion. What may have been necessary or useful as a child, no longer functions for the patient in an adaptive way. It is these limited emotional/relational repertoires that underly the psychological pain that bring folks into therapy.
Hall elegantly summarizes the transformative value of a psychoanalytic treatment as: “Perceptions that had been black and white and one dimensional expand into colorful multidimensionality.” In essence, treatment she says, births an openness to alternative possibilities that expand upon the limited set of priors based on earlier experience. She elaborates the mechanism whereby “different brain pathways exist along the side of the old ones.” This idea is consistent with current neuro-psychoanalytic thinking of therapeutic change which cites that as more effective means of navigating emotional conflicts are discovered, less psychological energy is needed to bolster defenses.
Jane Hall identifies the fear of change and stepping outside one's comfort zone as the roadblock to incorporating the insight that is gained in a psychoanalytic psychotherapy. Most importantly, she stresses the connection between the two people in the room, the patient and the therapist, as the principal catalyst to bring about such change i.e., to rework
the old and create something new. This, in a sense, helps development get back on track.
Hall keenly points out the double-edged nature of psychoanalytic work which both fosters a dependency and needed connection alongside promotion of self-sufficiency. Untangling these two and seeing that they are not “oil and water” appears to be a central part of therapeutic work. Hall goes on to reiterate the psychoanalytic directive of bringing what was once unconscious into awareness through enactments in the transference. The pain that accompanies the prior maladaptive solutions can be dissipated via a co-created reparative process that takes place within the analytic dyad.
I do have one disagreement with Hall when she speaks about how reality changes with growth. Perhaps this is semantics, but I don't see that it is reality that changes, but rather our predictions about it change as we develop. I think it would be more apt to say our internalized model of the world changes as we grow. A $5 bill takes on new meaning to an adolescent vs. a toddler. This is not because a bill has changed in reality, but rather the internalized model of how an adolescent sees the bill has changed.
Nevertheless, her conclusion remains consistent with modern therapeutic approaches in that there is a need to address the patient with an approach commensurate with their level of developmental trauma e.g. a highly empathic approach with those who have suffered ‘soul murder’ from caregivers at an early age. Hall acknowledges that “independence is not always realized” in a psychoanalytic psychotherapy “due to one's pull towards the safety of the familiar.” But that on some level, “the past gets revised due to fresh perception.” She continues that this revision is mediated by the relationship with the analyst whose benign curiosity fosters an atmosphere of recognition to allow exploration of past trauma, and, ultimately, address distorted ideas that the patient holds about themselves.
Halls thesis is best encapsulated with her emphasis on therapeutic action occurring within a ‘conversation’, where intimate ideas are exchanged with a non-critical empathically attuned adult. Hall argues that many have not experienced such a vulnerable and growth promoting
interaction in their development. Her conception is simple and speaks to what I see as a fundamental relational truth about a healthy and effective therapeutic relationship. A conversation offers a critical pathway for human connection as well as how we learn from each other.
I do wish she would have stretched the idea of ‘conversation’ a bit farther to include any type of deep relating within a dyad where there is empathic attunement and a desire to understand and exchange information with the other. In my view this does not necessarily require spoken words, although spoken language tends to be given a preeminent status in a psychoanalytic therapy. In this context, the spirit of her thesis still holds, that is relationships, good enough or not, are a principal medium in which all of us develop our sense of self and the world around us. Healthy ones can therefore be utilized in the service of learning how to help oneself.
Hall provides two brief vignettes to bolster her ideas. In one she tells of a woman, Donna, who struggles with a problematic maternal transference towards her analyst. An important conversation occurs when the therapist confronts Donna, stating that something is happening between them given Donna's resistance to incorporating the therapeutic work in her life. Donna responds desperately and angrily that the therapist isn't able to help her get better. The analyst confronts her stating that Donna is relating to her as if she were her presumptuous mother. This comment interrupts Donna's transferential spell, affording Donna the ability to see that she is motivated to defeat the analysis in a deleterious attempt to not lose the analyst. In a moment of disclosure, the analyst responds that perhaps Donna can keep her in mind even when they are not together, as the analyst did with her own analyst.
Although implied in the chapter, Hall's presentation of conversation between patient and analyst is not a one-way mirror, but one that requires vulnerability and disclosure from all parties. Not only is the transference called to attention, but the analyst reveals her own humanness in her response; that she too has had to struggle with the loss of an important person in her life. The analyst shares her strategy of attenuating the pain of loss by maintaining a mental conversation with her own analyst. Whether or not Donna takes up this strategy may not be the point, rather, the point being that there is a means of working through loss. There are
possibilities beyond being stuck in the same self-defeating cycle.
Hall shares another vignette about a wounded man, Bill, who internalized an abusive and abandoning father figure. His identification with distorted aspects of masculinity resulted in an estrangement from familial relationships and ultimately himself. Bill only learned to tolerate his own shame of feeling defeated and weak through the relationship with an analyst. The analyst was able to contain Bill's anger and disdain, while remaining empathically attuned. As a result of these ongoing conversations, Bill's ‘soldierly façade melted’. The point Hall makes is that through a corrective relational experience, unconscious distorted patterns can be illuminated, and newer, more adaptive ways of relating can be promoted within the dyad.
In her chapter on “What Happens in Psychoanalytic Treatment? What's it All About?” Jane Hall shares her wisdom of five decades in the field as a psychoanalyst. In doing so she provides a roadmap of what a successful psychoanalytic therapy can look like. When one strips away certain theoretical language, what comes to the foreground is a simple idea, one of an authentic conversation. Hall stresses the idea that the analytic setting affords a space for non-critical listening and attunement where real learning can take place. This is not the one-way mirror of interpretation characterized by psychoanalysis of old. Developmentally many of our patients have never experienced this type of an atmosphere as means of working through their emotional struggles. In such a therapeutic relationship a patient can recognize their problematic unconscious patterns and find more adaptive means of living and relieving their psychological distress. Richard Lane, a psychiatrist and researcher of psychotherapeutic change, captures a similar idea, he calls it the corrective relational experience. There is a natural convergence with Hall's lifetime of work and that captured in contemporary psychotherapeutic research. In other words, I think Hall is on the money…