Relationships in Microcosm in Cognitive Analytic Therapy: Based on a workshop given at the 2012 ACAT Conference in Manchester

Hepple, J., 2012. Relationships in Microcosm in Cognitive Analytic Therapy: Based on a workshop given at the 2012 ACAT Conference in Manchester. Reformulation, Winter, pp.35-38.


Abstract

In this paper I use the starting point of a dialogic understanding of enactment in CAT and discuss it with reference to three additional ideas: the Microcosm, the Matrix and Bakhtin’s Great Time. An awareness of the complexity of ‘what is going on’ in the relationship between client and therapist can then be used in therapy and supervision to uncover material that could have remained under the surface - disavowed, forbidden or too terrifying to bring into dialogue. I suggest a simple exercise that I have developed at a number of workshops that can help with this process.

‘Enactment’ in CAT describes the way that reciprocal roles are played out in the client-therapist relationship. Although this is CAT’s restatement of transference / counter-transference, I believe that the concept of enactment in CAT is richer due to CAT’s dialogic understanding of relationships. As I described in my previous paper for Reformulation: ‘The Chicken and the Egg’ (Hepple, 2011), I think that the idea of enactment in the therapy relationship is flexible enough to offer an integration of both transference/counter-transference, personal and elicited counter-transference and even the separation of a reciprocal role into a polarity or top and bottom roles.

I am suggesting that the core concept of enactment in CAT describes a dialogic meeting place in the therapy space where two whole people and their dialogic back-stories intertwine to create something entirely new and unique – an enactment. This creation exists in-between the client and therapist and contains influences from the distant past and all sorts of things that are unthought, felt and experienced somatically. This is a rich and unfinalisable understanding. It is a ball of spinning light that allows glimpses of the complexity within. It can never be pinned down and fully dissected. It is constantly in a state of flux; of evolving into something new. It is wonderfully dialogic.

So, you may ask, what is the point of getting into all this woolly unfinalisability?  Doesn’t it seem to make everything impossibly complicated? Some people even experience this richness as nihilistic and downright depressing. Nothing can be fully known; or nothing is the only thing that is fully known! I don’t experience it like this. For me, the complexity is exciting and ultimately hopeful. This is the way it is, so you may as well embrace it and realise that your attempts to describe, name and map things in therapy are, as Tony Ryle has described reciprocal roles: ‘A necessary simplification’.  We have to start somewhere in order to communicate.  I can tell you something about the sky using a word.  The sky is blue.  It’s a start.

Now, I am going to use this starting point, this dialogic description of enactment in CAT, and introduce some additional concepts that seem to me to help in thinking about this complexity. Each offers a different starting point or glimpse of what we are struggling to describe. The ideas are: Microcosm and Macrocosm, Foulke’s ‘Matrix’ and Bakhtin’s ‘Great Time’.

Many hundreds of years ago the tomb of a great magus was discovered in a desert (some myths suggest it was found by Sarah, the wife of Abraham; or others name Alexander the Great). The tomb contained the remains of Hermes Trismegistus (thrice great!) and on an emerald tablet was found the central remit of what was to become the Hermetic tradition of Western esoteric philosophy. The words were: ‘As above, so below’. This describes perfectly succinctly the neo-platonic idea of microcosm and macrocosm [ ‘μιқроѕ’ (small) and ‘μακροÑ•’ (large) from the Greek and  ‘κοσμοÑ•’ meaning ‘ordered world’].

‘Macrocosm and microcosm is an ancient Greek Neo-Platonic schema of seeing the same patterns reproduced in all levels of the cosmos from the largest scale (macrocosm or universe-level) all the way down to the smallest scale (microcosm or sub-sub-atomic or even metaphysical-level).  In the system the mid-point is Man, who summarizes the cosmos.’ 

Wikipedia, 2012.

A modern example of this idea from the world of physics is that in the universe there are black holes that are large enough to swallow whole galaxies but conversely at the tiniest or quantum level there exist black holes smaller than the atom!
Madame Blavatsky, the guiding force behind the modern day Theosophical Society, in the major work of 1888 called ‘The Secret Doctrine’, expands on the hermetic inscription:

‘Everything in the universe follows analogy.  As above, so below…

The universe is guided from within outwards… we see that every external motion, act, gesture, whether voluntary or mechanical, organic or mental, is produced and preceded by internal feeling or emotion, will or volition, and thought or mind...
…More than this; there is no such form or shape can possibly enter man’s consciousness, or evolve in his imagination, which does not exist in prototype.’

Madame Blavatsky, The Secret Doctrine, 1888.

Perhaps this means that there is ‘nothing new under the sun’ and that everything we do, think and feel is just the movement of one link in a chain, and that one experienced moment is really a momentary re-experiencing of something that has gone before. (I think of this in relation to a client in therapy. Could this be a description of empathy?)

William Blake, himself a sudent of the Hermetic tradition, describes the microcosm in these poetic words:

‘To see a world in a grain of sand,
And a heaven in a wild flower. 
Hold infinity in the palm of your hand. 
And eternity in an hour’. 

William Blake, Auguries of Innocence.

Siegfried Foulkes, one of the originators of the group analytic tradition, developed the notion of the ‘Matrix’ to describe the connectedness of meaning between members of a group.

‘The matrix is the hypothetical web of communication and relationship in a given group. It is the common shared ground which ultimately determines the meaning and significance of all events and upon which all communications and interpretations, verbal and non-verbal, rest.’

S. H. Foulkes, 1964.

There is similar thinking underlying the systemic family therapy approach. An experienced family therapist once used the metaphor of a mobile to describe the way a family was connected. Movement of one item caused all sorts of different reactions in different parts of the mobile due to the way each element is connected together.

Finally, I would like to thank Rachel Pollard for introducing me to a couple of descriptions, by Mikhail Bakhtin, of his concept of ‘Great Time’ in her article in the previous edition of Reformulation, (Pollard, 2012)

‘In Great Time, memory has no borders and reaches back to pre-human times. The history of each human individual begins a long time before the awakening of his consciousness. In this great experience everything is alive, everything speaks. This experience is essentially and profoundly dialogic.

Mikhail Bakhtin, ‘On matters of Self-Consciousness and Self-Evaluation, 1943-6, not previously translated into English, cited in Shepherd, 2006.

‘I have a term: Great Time. Now in Great Time nothing ever loses its significance.  Homer and Aeschylus and Sophocles, and Socrates, and all the ancient writers and thinkers remain in Great Time. Dostoyevsky too is in great time. And it is in this sense that I consider that nothing dies but everything is renewed. With every new step forward our previous steps acquire a new additional meaning.’ 

Mikhail Bakhtin, 1971 in above.

These descriptions of Great Time are more explicitly dialogic rather than esoteric but seem to me to be talking about the same thing. Relational and dialogic meaning is the result of the coming together of a trillion threads, woven together over eons of time and forming a rich tapestry that continues to grow one thread at a time, gradually evolving and changing its pattern, colour and nuance as more and more is added.
So, what use is all this to a therapist sitting in a room with a client or a supervisor in a room with a therapist? A lot, I hope. I think that allowing oneself to become aware of all the subtle and fleeting things that are happening to you in relation to the client can open up the work of the therapy and can give access to experiences and material that may otherwise be avoided because they have been disavowed, forbidden or are too terrifying to discuss.

Wilfred Bion advocated starting every session of his analytic therapies ‘Without memory, desire or understanding’  (in Casement, 1990) so that he could be open to his experience with the client. I think this can be employed too in supervision so that the ‘parallel process’ between superviser and therapist can be reflected upon in the same way. I will use this idea in the exercise/technique that I describe at the end of this paper.

In my marking of case studies for ACAT courses, I sometimes get the feeling during my reading through that although everything looks OK on the surface of this case - reformulation is detailed and empathic, map is nicely laid out, client has written a congruent goodbye letter; there is something missing. When the therapy relationship and enactments are reflected upon by the therapist there is often acknowledgement of reciprocal role enactments involving admiring to admired; critical to placating/striving and rescuing to rescued (for example). My sense of what has not been brought into the therapy is often to do with neglecting to neglected, disgusted to exposed/shamed and sometimes abusing/defiling to abused/defiled. These reciprocal roles are packed with seemingly unmanageable feelings and it is not surprising that it is more comfortable for both client and therapist to stay in the arena of secondary or adaptive role procedures, keeping clear of the real core pain that remains off the map, under the surface and out of dialogue.

An example: At a workshop, a therapist described how she had felt overwhelmed in relation to a client she had seen for CAT. This had interfered with her ability to think about the client between sessions and in the session. The therapist was unsure where these unmanageable feelings were coming from in the client’s story or what the therapist was actually frightened of in relation to the client and the risk she posed. We traced back to when the therapist had first felt like this in relation to the client and it was when the therapist had tried to phone the client on her mobile phone when she had not attended an early session. Someone seemed to answer the phone but said nothing and then was cut off or cut the phone off. At that instant the therapist felt the full bodily experience of acute fear and dread and desperately tried to phone the client again although the phone was now turned off.

To me, this feeling of dread is often linked to attachment and fear of abandonment and annihilation. I asked the therapist if the client had experienced any abandonment in her life. The therapist’s mouth then dropped open in a sort of ‘eureka’ moment and she said several times: ‘She was left on the steps, left on the steps…’. The therapist had suddenly ‘remembered’ that the client had been left on the steps of Social Services as a baby. The power of the neglecting enactment had prevented this piece of information being fully brought into dialogue at the time of the therapy. 

As a supervisor I am interested in everything that is going on in the room in the way the therapists are bringing client material. The client folder that never seems to get to the top of the pile, an averted gaze at the name of a client, a snap back at a suggestion about a client in therapy! I quite often shut my eyes (this is OK if you explain what you are doing) and ask myself the question: ‘What is going on, what is going on?’ and then wait for whatever odd thoughts, feelings, words, images or day dreams emerge. In order to help people develop the ability to be open and observant of more of what is going on in the room in therapy or in supervision, I have developed the exercise (found at the bottom of this page) that frees up one person to observe/reflect on the supervision process being played out.

I hope that you find this experience helpful. I don’t think there has been a workshop without some jaw-dropping experience for one of the participants when something suddenly falls into place or finally makes emotional sense. Emotions can get quite powerful and different self-states can be split off into different people in different parts of the room, so the whole thing can need careful handling and plenty of time for debriefing and the opportunity for affected participants to talk things through with the facilitator after the workshop if they are not comfortable talking in a group.

Finally my thanks to all the people who have participated in the workshop and helped me develop this exercise.

References

Blake, William (1959) Auguries of Innocence. Grossman Publications.
Casement, P (1990) Further learning from the patient. London: Routledge.
Foulkes, SH (1964) Therapeutic Group Analysis. London: George Allen & Unwin.
Hepple, J (2011) The chicken and the egg. Reformulation  37: 19-21
Madame Blavatsky, (1888) The Secret Doctrine: The synthesis of Science, Religion and Philosophy. Theosophical University Press Online Edition. www.http://theosociety.org
Pollard, R (2012) Great Time: Blade Runner to Bakhtin.  Reformulation 38: 32-34
Shepherd, DG et al (2006) The Bakhtin Circle: In the master’s absence.  Manchester University Press.
Wikipedia (2012) Macrocosm and Microcosm. www.http://en.wikipedia.org (accessed 17th October 2012).

Exercise: ‘What is going on?’

Clear your heads.
In threes: One therapist, one supervisor, one observer.

Therapist:
Think about a significant incident, a strong feeling, a conflict or a ‘stuck’ situation with a client (please preserve confidentiality).

With Supervisor:
Find a ‘voice’, feeling or image in yourself that encapsulates the situation.
Try to go back to when it first started.
Identify the role you are playing.
Try to construct the reciprocal role.

Observer:
Keep a clear head and be open to any feelings/images that occur.
Are they missing something?  Intervene if you like.

Full Reference

Hepple, J., 2012. Relationships in Microcosm in Cognitive Analytic Therapy: Based on a workshop given at the 2012 ACAT Conference in Manchester. Reformulation, Winter, pp.35-38.

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