Eating Disorder Treatment from Perspective of Disorder of Intimacy Preferred Provider Conference, Fe
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Realistic appraisal of medical dangers
Ability to take responsibility for self and eschew victim mentality
Triad for Relational Disturbance
Concept of Bebe research
The mothers of the anxiously attached children, by contrast, seemed unwilling or unable to maintain an appropriate distance. Some became intrusive and made it impossible for the child to have his own experience. “They couldn’t tolerate the child having any frustration, “ Albersheim says. “They would just get in there and almost solve the problem for him because it was too painful for them to watch the child struggle. But if children don’t get to struggle a little bit – and be able to see either that they can accomplish it or that they need a little help, and to be able to figure that out on their own – if that’s interfered with, it’s a real loss for the child.”
Molly’s mother was controlling in a different way. She constantly told Molly how to play with toys (“Shake it up and down – don’t roll it on the floor”), and, in effect, rode rough-shod over Molly’s natural rhythms of interest and excitement. Her exertion of power over the baby was such that Stern and his colleagues often experienced a tightening knot of rage in their stomachs as they watched the tapes. Molly’s solution was compliance: “Instead of actively avoiding or opposing these intrusions,” Stern wrote, “she became one of those enigmatic gazers into space. She could stare through you, her eyes focused somewhere at infinity and her facial expressions opaque enough to be just uninterpretable and, at the same time..by and large, do what she was invited or told to do. Watching her over the months was like watching her self-regulation of excitement slip away.”
Such manipulative misattunements take many forms and are, Stern argued, the likely origin of later lying, evasions and secrets. The child, and later the adult, comes to feel that if people are allowed access to his true inner experience, they will be able to manipulate it, distort it, undo it. Only by freezing them out can he keep his inner experience unspoiled.
…In the course of time there arrives a sensation or an impulse. In this setting, the sensation or impulse will feel real and be truly a personal experience…The individual who has developed the capacity to be alone is constantly able to rediscover the personal impulse.
…When alone in the sense in which I am using the term, and only when alone, the infant is able to do the equivalent of what in an adult would be called relaxing. The infant is able to become unintegrated, to flounder, to be in a state in which there is no orientation, to be able to exist for a time without being either a reactor to an external impingement or an active person with a direction of interest and movement…
Although many types of experience go to the establishment of the capacity to be alone, there is one that is basic, and without a sufficiency of it the capacity to be alone does not come about; this experience is that of being alone, as an infant and small child, in the presence of the mother. Thus, the capacity to be alone is a paradox; it is the experience of being alone while someone else is present.
The infant learns to view those affective experiences to which the mother misattuned as falling outside the realm of shareable experience and to deny or disavow such feelings. To the extent, then, that defensiveness, denial, confusion or inability to recall interferes with a parent’s ability to attune to the infant’s needs and feelings accurately and empathically, a parent is more likely to repeat past patterns of behavior. Furthermore, the relative comfort or discomfort of the mother with certain kinds of emotional states can influence the infant’s subsequent access to those same emotions at a very early age.
Parents who are intensively over-involved with their infant cause the child to develop a false self based upon compliance. Care-giver doesn’t validate the child’s developing self, thus leading to alienation from the core self. Parenting practices that constitute lack of attunement to the child’s needs, empathetic failure, lack of validation, threats of harm or coercion and enforced compliance, all cause the true self to go underground.
1. Absence of true sense of self
Early dyadic processes lead to a “primary breakdown” or lack of integration of a coherent sense of self, i.e. Unintegrated internal working models.
Pressured to achieve during childhood
Transformation of the self through relationship.
Implications of Psychotherapy:
There is good reason to believe that large segments of the population lack many critical capacities, such as self-observing abilities, necessary for mental health, and that even patients who have them, have them only in part. These capacities which can be called “structural capacities” (Greenspan, 1989) have to do with critical abilities such as self-regulation, relating, presymbolic-affective communicating, representing and differentializing experience, representing internal experiences and self observation.
If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But, the line dividing good and evil cuts through the heart of every human being, and who is willing to destroy a piece of his own heart?
Nevertheless, the need to repeat also has a positive side. Repetition is the language used by a child who has remained dumb, his only means of expressing himself. A dumb child needs a particularly empathic partner if he is to be understood at all. Speech, on the other hand, is often used less to express genuine feelings and thoughts than to hide, veil or deny them and, thus, to express the false self. And so, there often are long periods in our work with our patients during which we are dependent on their compulsion to repeat - for this repetition is then the only manifestation of their true self.
Different developmental trajectories
Start with the assumption that every symptom is a valuable piece of data!
Where part got the idea that it had to coerce and shame her into dieting, working, being nice – usually a parent monitoring and scorning – part like a single parent – these are inner censors and tyrants that control us, keep our noses to the grindstone and do not risk any behavior that brings us the slightest embarrassment.
Self-injury is the container for unmetabolized traumatic stress and underlying unresolved trans-generational trauma and loss.
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