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Eating Disorder Treatment from Perspective of Disorder of Intimacy Preferred Provider Conference, Feb. 2009 Mark Schwartz, Sc.D. and Lori Galperin , MSW, LCSW Castlewood Treatment Center for Eating Disorders 800 Holland Road 636-386-6611 www.castlewoodtc.com.
Preferred Provider Conference, Feb. 2009
Mark Schwartz, Sc.D. and Lori Galperin, MSW, LCSWCastlewood Treatment Center for Eating Disorders800 Holland Road636-386-6611www.castlewoodtc.com
Concept of Bebe research
42 minutes of age.
Child imitates parents facial expressions
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.”
Karen, R. (1994). Becoming Attached. New York: Warner Books
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.”
(Karen, R. (1994). Becoming Attached. New York: Warner Books)
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.
(Karen, R. (1994). Becoming Attached. New York: Warner Books)
…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.
Self-cohesion requires the presence of others (self-objects,) the relationship between the person and the other is the “source” and the transitional object allows for symbolic representation.
The need for the experience of self objects is never-ending. A weak self is therefore the result of faulty self-object experiences.
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.
Ref: Pamela C. Alexander, Oct. 1991
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
2. Hyper-sensitivity and hyper-reactivity to others, especially in reaction to rejection or abandonment.
3. Gullibility and suggestibility in relation to authority.
4. Complaints of isolation and neediness, without self-support
5. Boundary problems, inability to conceive of self without reference to others.
-- memories of special and tender concern and soothing when ill.
-- memories of having done something bad, expecting to be punished, parents caring and
-- memories of having done something perceived bad by teachers,etc. and supported by
-- memories of childhood fears and being comforted
(3) Instrumental attention
(5) Present occasionally
(7) Good enough parenting
What is love?
Turn child to object
-- Turning back on child’s dependence, affection, attention, need and attachment.
-- Speaker avoids discussing relationship with parent on emotional terms.
-- Speaker report rejection of siblings.
-- Speaker recalls favorite towards siblings.
-- Speaker describes being “spoiled rotten” by parent
-- Speaker described self as favorite and others rejected.
-- Fear parent would leave.
-- Overtures to parent rejected.
(3) Mildly rejecting of attachment, aloof, “differentially showing me love.”
(5) Child seldom given encouragement
(7) Parent mad when child sick misses graduation
(9) Wish child not born
What to look for in interview
-- Making it clear that the child’s presence is necessary for maintenance of own sense or well being
(1) Parent looking to child for parenting.
(5) Parent is looking to child as substitute spouse
(7) Parent depends on child’s attention for safety.
-- Taking care of children seems a bit too much.
-- Parent confused or helpless; parent not a real adult.
-- Parent complains children are too much.
-- Parent afraid to stand-up to another person.
-- Child advises parent on how to behave as a parent.
-- Parent over-protective.
-- Parent martyr, guilt-inducing “child not loving enough” for parent.
-- Child focused on pleasing parent.
-- Child felt guilty for bad grades, etc. “hurting “ parent.
-- Child says, “I was my mother’s” whole life.
-- Child remembers desire to protect parent
-- Parent treats child as friend or spouse.
So important for interview
-- Parent inattentive preoccupied, uninvolved or inaccessible.
(distinguish neglect from rejection – he never had time for us would be neglect)
(distinguish neglect from role-reversal – parent ill can be neglect)
-- Parent preoccupied with work, family, household.
-- Parent unable to spend time because kids are too much for them.
-- Child remembers crying at night.
-- Parent always busy thinking of someone else.
-- Parent always with friends, at bar, etc.
-- Status or position overemphasized.
-- Over-concern with school performance with emphasis on how it looks “regarding the family.”
-- High ratings when parental withdrawal of affection if child fails to perform.
-- Child very anxious regarding report card.
-- Parent “pushed” child to care for self and parent unloving.
-- Early excessive excellence stressed.
-- Child pushed to do adult’s work young.
(see David Wallin, Attachment in Psychotherapy, Guilford Press, 2007)
Implications of Psychotherapy:
From Greenspan, S. (1997). Developmentally Based Psychotherapy, Madison: International Universities Press, Inc.
Love is not primarily a relationship to a specific person; it is an attitude, an orientation of character which determines the relatedness of a person to the world as a whole, not toward one “object” of love. If a person loves only one other person and is indifferent to the rest of his fellow men, his love is not love but a symbiotic attachment, or an enlarged egotism…If I truly love one person I love all persons, I love the world, I love life. If I can say to somebody else, “I love you,” I must be able to say, I love in you also myself.”
From The Art of Loving, 1956, Erich Fromm
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.
- Alice Miller
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.
(Mary Harvey, Ph.D.)
Authority Over Memory - Can take event from past, talk about it with sense of empowerment.
Integration of Memory and Affect - Can feel some appropriate affect with cognition. New affect (adult-oriented)(1995).
Affect Tolerance and Trauma - Related Affect - Feeling no longer overwhelmed, get overwhelmed and back into the trauma, ignore and walk into danger.
Symptom Mastery - Hypervigilant, anxiety, depression, dissociation, somatic, compulsivity, how much do we need to measure remission.
(Mary Harvey, Ph.D.)
Self-Esteem - Capacity for self-care and regard, properly eat, exercise, sleep, self-soothe.
Self-Cohesion - How one experiences oneself, fragmented, compartmentalized, self-trust
Safe Attachment - Negotiate and maintain safety in relationships.
Making Meaning - Making meaning of their experiences.
Lori Galperin 2008