Louise Elwell and Nicola Kimber-Rogal, 2005. Reviews of ACAT CPD Events. Reformulation, Autumn, pp.30-33.
Reviewed by Louise Elwell
We were treated to two excellent and extremely throughtprovoking presentations by two non-CAT therapists: Sue Gerhardt, who spoke on ‘The Baby in the Consulting Room’ and Phil Mollon on ‘Enhancing Psychotherapy with EMDR and Energy Therapies.’ (EMDR stands for Eye Movement Desentization and Reprocessing.)
Using her recently-published book as a starting-point, Sue Gerhardt opened the day by describing to us some recent research on how unresolved distress in infants leads to a lack of proper development in key brain structures. It appears that this trauma causes cortisol levels to be raised which, in turn, will directly and adversely affect brain development. Amongst others, those parts of the brain connected with impulsivity, affect regulation and the capacity for self-reflection will be stunted.
She described her own work and others’ which indicates that it is not the trauma or distress per se which leads to this apparent change in normal brain development, but the lack of comfort and soothing from a carer, the lack of an intervention that would help the distressed infant to regulate his affect. Until this function is successfully internalised, the infant relies on another to help him achieve this transformation. In physiological terms this intervention reduces stress levels with a resulting drop in circulating cortisol.
For me, these details felt very sobering and sad. Abuse and neglect, (or possibly just leaving one’s baby at a nursery too early in life), suddenly seemed startlingly measurable: for instance, a reduction in size of between 13% and 17% in one brain structure. Borderline Personality Disorder may be one possible outcome for such infants later in life.
Sue Gerhardt went on in her presentation to express her doubt that a 24-session therapy would be adequate for this group of clients, for if the early deprivation was so clearly physical in its impact, and the effect so marked, how could a few months’ work make good this deficit? This is obviously a very interesting question and one with which apparently research upon brain functioning cannot yet help us as there is far less specific information as yet about the process of change and of therapy. What interested me, and doubtless others in the audience, is the question of what is in fact occurring at the level of brain functioning in a CAT, given that our repeated observations are that CAT is so remarkably effective precisely with this group of patients, and rapidly so in many cases. What does it mean then that the brain’s development appears stunted? It is hard to know, it seems to me, and it is tempting to say, that further research on the brain will tell us. Though perhaps, as Lawrence Welch suggested in the discussion time, the complexities of human relating and the human mind, (and brain, if we are to make the distinction), are such that we may never be able to pin-down all those details that we are curious about.
If I am allowed to speculate for a moment about CAT with clients presenting with a Borderline picture, it would seem to me that there might be something about the collaborative nature of the relationship, indeed of the whole enterprise, and the meta position then adopted in the Reformulation process, which activates or stimulates that part of the front of the brain which reportedly is critically involved in reflective function, stunted or not. From there, other physiological, not to mention psychological, changes may become possible. But may be I’m just falling into the trap of suddenly needing to find some sort of physical description for something in fact immensely more complex than this.
I think Sue Gerhardt’s concerns about CAT with such patients raises another interesting point: when one starts to think about the person in front of one, as possibly ‘brain-damaged’, how will this affect our work and the therapeutic relationship?
In Phil Mollon’s presentation it felt as if we were suddenly on the other side of the table: this time it was we who may have found the descriptions of treatment extraordinary-sounding. He stayed very much in empirical mode throughout and stressed that this is how EMDR and the Energy Therapies have developed: not theory-driven but purely based on what was discovered to be effective, stage by stage. Thus, the American psychologist who, after unsuccessfully attempting to treat a patient with a severe aqua-phobia over a period of eighteen months and feeling very frustrated with lack of progress, one day asked her to tap on the bottom rim of her eye socket, knowing this to be a relevant acupressure point. The phobia was apparently cured, instantly and completely and has remained so over the years. From this experience, which astonished him, he went-on to develop more complex treatments. And others have joined him in this work. Phil Mollon described for us the way EMDR is carried-out and the way he personally might use it within his own work, (he is trained as both a psychologist and psychoanalyst). He also described the use of tapping on particular sequences of acupressure points during therapy when indicated, (this is done by the client); this apparently can rapidly reduce overwhelming and distressing emotion connected with particular experiences. He explained this intervention as probably accessing the encoded information at the interface between mind and body.
A volunteer from the audience was invited to undergo a brief intervention of this type. Phil Mollon asked her questions as he worked, about the nature of the distress she would like to address and accordingly suggested short sequences of tapping on acupressure points, asking her at intervals to rate her distress in relation to the identified problem on a scale of one to ten. After ten minutes or so the distress was reportedly down to manageable levels. What the volunteer said she was left with at that point were emotions relevant to and in proportion with the reality of the distressing situation in her mind, rather than their feeling overwhelming and out-of proportion as before.
Phil Mollon made an observation about the development of psychoanalysis during this presentation which I found fascinating. He said that in terms of the work that he is now doing with patients, Sigmund Freud’s original method of freeassociation was most helpful in working effectively. The later development of the emphasis on working-in the transference in psychoanalysis, thus focusing the material into this area of the present relationship, means that other important material is less readily available for the work of the analysis.
This presentation seemed full of exciting possibilities to me for further exploration: I look forward to reading his book. ‘Why Love Matters: how affection shapes a baby’s brain’ Sue Gerhardt. Brunner-Routledge
1-58391-816-7 July 2004 264pp. £40.00 hbk
1-58391-817-5 July 2004 264pp. £9.99 pbk
‘EMDR and the Energy Therapies — Psychoanalytic Perspectives’ Phil Mollon. Karnac
Catalogue No: 18787 ISBN: 1855753766 Pub: Nov 2004 pp260 Price £22.50
Nicola Kimber-Rogal MSc PhD ACAT C Psychol
I found the workshop both theoretically stimulating and practically applicable. The pace was gentle and informative allowing time for case studies (both leader’s and delegates’) to be interwoven meaningfully into the conceptual component.
The mix of delegates – psychotherapists, clinical psychologists and psychiatrists was also useful – and the leader used the questions and discussion skillfully, allowing people to develop arguments and new ways of thinking (in the true tradition of education: to lead out). The proof of this pudding was evident in our lunch break conversations which carried on topics cited during the morning.
In addition, the purely didactic part on neurobiology and `focussing’¹ was particularly informative for me since I am a novice in this area. So far I have known about the work on focussing picked up and integrated with theology² by and I would like to use this more in my work.
I would welcome more of this type of workshop where other paradigms (theological, philosophical, psychiatric etc) would be discussed by interested and informed parties in relation to CAT.
1. Gendlin, E. (1996) Focusing-Oriented Psychotherapy: A Manual of the Experiential Method Guilford
2. McMahon, M, & Campbell, P.A. (1991) What is Focussing? (Institute for Bio-Spiritual Research). Sheed & Ward
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Book Review: "Why love matters â€“ How affection shapes the babyâ€™s brain" by Sue Gerhardt
Poggioli, M., 2011. Book Review: "Why love matters â€“ How affection shapes the babyâ€™s brain" by Sue Gerhardt. Reformulation, Winter, p.43.
Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.
Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.
CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study
Cristina Fiorani and Marisa Poggioli, 2005. CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study. Reformulation, Autumn, pp.13-17.
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