Le presentazioni ai Congressi terminano nel momento in cui il relatore finisce di parlare: ne rimangono tracce nel libro degli Abstract, in alcune video registrazioni, o negli appunti e nei ricordi di qualche partecipante presente in quell’ora, in quella sala, all’interno di quella specifica sessione, per il resto svaniscono perché sono tante e appartengono a moltissimi colleghi.
Le brevi sintesi che sono presentate contengono il lavoro di un singolo o più spesso di un gruppo di clinici, studiosi, ricercatori che raccontano un pensiero sull’essere umano che proviene dall’esperienza e dalla riflessione.
Sono importanti perché hanno la funzione di fotografare la situazione contemporanea della Psicoterapia: nel loro insieme esprimono l’attualità sulla professione e per questo motivo è di grande utilità rileggerle a posteriori per capire meglio il presente.
Credo che come le Tesi di Laurea e di Specializzazione siano materiale da rivalorizzare e che soprattutto debba essere messo a disposizione di tutti.
18° Congresso dell’Associazione Mondiale di Psichiatria Dinamica.
Firenze, 19-22 Aprile 2017.
Title: Psychodynamic Psychotherapy and Human Development: creativity, phantasy and transformation of parental relationships in adolescence to build the identity of the adult.
Presenter: Michele Battuello.
Good afternoon dear colleagues, many thanks to be here to listen to my presentation.
I’m a psychodynamic psychotherapist in Rome, Italy and my model is combined individual/group psychotherapy starting from individual, proceeding with combined individual/group and ending with the group only.
What I’m supposed to highlight today is the role of dreams in psychotherapy as the tool we have to recollect the unconscious images of first years of life and their fundamental significance for human development.
The process was first clinical then theoretical because it is from the images of patients’ dreams that I am going to describe the unconscious evolution of the identity since birth.
I think that more than methodologies or theoretical frames, the clinical experience is the main possibility to have a picture of the person: specifically in terms of psychodynamic therapies supervision must be associated to participation to groups and their dreams.
For this reason in our Centre in Rome (Centro di Psicoterapia Roma), we work also on research and education and therapists and/or students attend psychodynamic groups.
I had a long experience of listening to hundreds of dreams as a participant in a psychodynamic group and also as a therapist since more than 5 years.
Therefore today I will try at my best to talk about physiology and less about pathology or if it happens, it is a consequence of non-physiological steps.
I am sure that each of you here has a personal vision of development and rather than offer my perspective coming from clinical experience my major purpose is to enhance the role of dreams in our wonderful job.
Dreams that must be used, listened to and interpreted: what I see in present times is the devaluation of their role for the understanding of the very early dysfunctional dynamics and of the process of growth of the baby to restore it when failed in some steps.
I start with the title of the abstract that is at the same time the conclusion of my considerations: if the child since birth had a valid environment, the identity of the adult at adolescence will be represented by an unconscious transformation of the internal image of the parents.
This is the result of a spontaneous activity of phantasy, I intend as phantasy not an unconscious wish-fulfillment but a process of creativity.
Since birth to adolescence all the moments of affective significance in the relation of the child with the mother first, then the father and all the others relevant, will leave unconscious traces in the mind.
These traces are represented by images emerging from dreams that show the progressive establishment of the sense of Self and the subsequent ability to invest the same Self in the realization of the identity (that are the relationships).
The more the child is able to separate him/her self from the mother as we will see in few minutes, the more at adolescence the image of the mother as physically herself will disappear for a completely new image that corresponds to the identity of the adult.
It is the result of an unconscious act of creativity. The phantasy is free to create an autonomous possibility of Self.
This image is the representation of the kind of affective investment of the adolescence in adult relationships.
When this transformation is not possible the adult will look for affective situations in which the unconscious expression is represented by images of identification, control, assistance that are fixed and fastened.
The phantasy has been mortified by the defense mechanisms.
Psychotherapy gives the possibility to experience or re-experience this unconscious transformation if the developmental process failed. I consider it the restoration of the identity.
The progression of the psychotherapeutic work and the resolution of the internal conflicts show that as at adolescence, patients start to transform the fixed image of the precedent affects (mostly the mother) in a completely new, personal, subjective image that is the identity.
When the therapeutic work let emerge dreams that have the significance of arriving at adolescence, the therapy ends and it is possible to listen to dreams that show the transformation of the same therapist and/or psychotherapy generally condensed in images full of phantasy.
I use this metaphor to show more concretely to patients what happened: when you make a realization (a job, an important relationship, a child…) you don’t make a list of who helped you to be the one you are now. Otherwise every time you should say “thanks to my mother, father, my teacher, my first friend, my girlfriend etc.”… but it’s you that made the realization and at the same time this “you” contains all the relevant moments and experiences with the environment to become who you are now.
At the end of therapy the new images in dreams don’t represent these relationships included the therapeutic one but at the same time their affects are inside it, you can perceive it.
Concretely the significance is that for you patient it is like as you didn’t attend psychotherapy but yourself contains the psychotherapy anyway.
Now I want to focus that the first years of life are the main core to allow this process.
I think that we all are very happy that today neurosciences are integrated with psychological sciences but at the same time I really find a lack of my personal comprehension of how all the findings we have of the baby and the relationship with the mother are used inside the psychotherapies of the unconscious.
This integration shows the relevance of first years life for the development of the baby.
Allan N. Schore for example demonstrated (Affect Dysregulation and Disorders of the Self: 2003, W. W. Norton & Company, New York – London) that the right brain is involved in processing social-emotional information, facilitating attachment functions and regulating bodily and affective states; at the same time it is important in the control of vital functions and enabling to cope actively with stress.
The maturation of these capacities of the right brain is experience dependent, experience embedded in the attachment relationship between the infant and primary caregiver.
Moreover the right brain is dominant in the first three years of life.
So, if we all agree that the baby is sane since birth and the relevance of the relationship with the mother is widely recognized for the process of construction of the identity, the emerging unconscious of that period is central for dynamic psychotherapies.
Our job brings us to the same conclusions of neurosciences arriving from the opposite side of the Human being, the patient (the adult) therefore we can absolutely explore the first years of life in which the irrational life is prevalent.
The double activity of understanding when the relationships of this period failed and at the same time when they were effectively valid is the real possibility for the patient to recovery and we have one special tool for all this.
I refer to dreams and their interpretation. What is clear in my experience is that together with the internal conflicts and pathological dynamics, dreams represent perfectly how is and was the development of that person.
We know that is quite impossible to have conscious memories of what happened in our first years of life but at the same time these years are traced in our minds.
Dreams only can give shape to those memories showing what worked and didn’t in the relation with the mother that will have so important consequences in the development.
They are the force we have to transform the dysfunctional dynamics and/or experiences.
I totally agree with someone who could say that what didn’t work in the first years of life is detectable in the actual relationships included the therapeutic one, but to transform the present we have to see the unconscious in its whole history and representation.
A small example: the sense of emptiness for my experience is the worst for the patient, it is so well represented by a hole in the identity, the hole is loss, fragmentation, disruption and fear of death.
The substitutes for loss are all defensive strategies to survive to this experience that is completely unbearable.
Moreover exploring the emptiness, another characteristic is that often is a very early experience and this makes it more unbearable.
The hole appears in the relationship and in dreams and we see that there are situations in which rationally the person remembers this feeling and associate it with the family’s style but many times there are no evident dysfunctional situations.
Only dreams can give shape to this so old terrifying sensation represented in some kind of images.
They are completely different from confusion or distortion, it seems as they are so old that is not possible for the mind to put an adult image, as usual happens in dreams, to represent those feelings.
I can describe them as sensorial and rarefied.
So you see for example the perspective of the child at breast looking at the mother, of the smell of her skin and the touch of her hands.
And the emptiness could be represented by images that show that in the arms of the mother the child felt cold, or the sensation of falling from these arms etc.
If we therapists don’t give life to these so early feelings and emotions emerged in dreams, the unconscious of the relation is not enough to understand this sense of loss.
Then it is necessary to transform the emerged hole/emptiness using the traces of the valid moments that are recorded in the mind.
They appear together with the dysfunctional feelings because at the beginning the baby was not fragmented or split: he functioned in the relationship anyway.
The historical valid experiences match with the therapeutic relationship and their recognition by the therapist together with the interpretation of dysfunctional dynamics allows the act of transformation and the hole can be filled definitely.
The emerging first and then the interpretation of these dreams give really breath to the patient: he/she realizes that it can be bearable for the first time in his/her life.
So if adolescence is the arriving point of development and the first years of life obviously are the beginning, the separation process is the bridge between them.
I am sure that all of you are confident with these steps or other similar and it is not a debate about the process of growth but I underline the need of use dreams for our wonderful job, the psychodynamic because it is the only that can explore the human at all.
The separation process is critical but not traumatic: the baby finds that is not possible to be with the mother all time.
The mother allows the separation day by day giving to her child the safeness that he/she can be alone and it’s not sense of loss, despair and death but an affective frustration.
The affective images previously and continuously experienced in the relationship are used as the power and the engine to proceed in the exploration of the world outside when the baby is alone.
During this time mother and child try to transform the quality of the relation in sense of Self: better autonomy for the baby and increased identity for the mother.
It must be a capacity of both that is a spontaneous activity of the human being as result of the Human Potential and act of creativity.
The separation is a fundamental step because the unconscious creativity is at disposition of the self for an affective consistency during loneliness that allows the phantasy to play, to search and explore the space around.
The time of separation that emerges from dreams is a period strongly located between 3 and 4 years of life but is a process that goes on for many years, the latent period until adolescence.
In these years the father’s figure, the rational thought, the experiences with peers and many others significant figures guide the growth of the child.
The child uses the unconscious experiences (internal images) he/she lived until that moment to invest him/herself affectively with the others and brings on the maturation of the identity, not time by time but experience after experience.
In these years of preparation for the adulthood there is a continuous activation of process of unbending and separating from the relationships in which unconscious phantasy is focused to build the Self progressively.
This period of exercise if we could call it so, will bring to the adolescence that will definitely take the form of the adult, mature play and relationships.
At this time comes the most creative moment of the development as I described earlier even if the repeating of the process will be played all life long enhancing the identity of the adult.
In my presentation I started with the description of the unconscious act of creativity at adolescence that transforms the internal images of the relevant relationships to give shape to a completely new one that is the identity of the adult.
This identity is affectively separated from the mother and the relevant figures because separation includes the re-elaboration and the condensation of the feelings experienced and it is necessary to let phantasy play.
In psychotherapy we allow the patient to restore the developmental process arriving to the sense of adolescence as end of the therapy, the adult is now ready to go with his legs.
It is necessary to consider the dreams as the way to explore and transform the first years of life that are the engine of the process of development.
Also in the more critical patient it is possible to find old images (dreams) in which the baby at the early beginning was sane and was functioning in relationships, these traces are the valid Human Potential the therapy can recollect and use for change and recovery.
The beginning of a psychodynamic psychotherapy is not related to a clinical diagnosis or kind of symptoms but at the capacity, during the evaluation sessions of the couple therapist/patient to find and let emerge the first years of life to overcome the pathological dynamics.