Emotions and the Therapist

A Systemic-Dialogical Approach

Paolo Bertrando

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429913211
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In recent years, systemic theory and practice adopted a dialogical orientation, centred on the persons of the therapist and client. This has led to a growing attention toward emotions, which, in this book, is developed in terms of emotional systems. An emotional system in therapy may be viewed as the sum of the emotions existing and interacting in people's lives. Relevant changes in life happen when emotional stances and sequences change within the system, leading, for example, to a greater sense of agency or hope, or to a different perception of the situation. This book looks at emotions within human systems in terms of dominant and silent emotions, which shape and are shaped by human relationships, and may be played in several ways according to reciprocal emotional positioning. The therapist uses his or her own feeling, and understanding of the emotions within the therapeutic dialogue, in order to create hypotheses and new dialogues which allow change.

Chapter One
Systems and emotions

The context is a clinical workshop, where I am the presenter. young psychologist, who is concluding her systemic training, asks for supervision. It is a case she is working on, during her internship as psychotherapy trainee, in a neurology hospital ward. I accept, deciding to use all of the participants as a supervision group (Bertrando & Gilli, 2010). The therapist describes the situation of Lorenzo, a young man of twenty-nine, who has shown since childhood continual epileptic crises (absence seizures). He is said to present also with a mild cognitive deficit, albeit never quantified. He works in a sheltered environment, and has very few acquaintances. He lives with his mother and stepfather, since his only sister literally fled from home when she reached the age of eighteen. Lorenzo is described as “stuck to his mother”, an observation confirmed by another participant in the supervision, who saw the two of them during some sessions of an aborted attempt at family therapy. The therapist adds that her patient weighs approximately 120 kilograms, with the tone of one who considers this as relevant information.

She came in contact with Lorenzo when the director of the neurology department asked her to provide a psychometric evaluation. During that evaluation, a “need for support” emerged, leading, according to the same director, to a recommendation for individual therapy. Our therapist decided to see him once every fortnight. To Lorenzo, though, such an interval between sessions is too long. He begins to ask for more meetings, to call his therapist repeatedly, to wait for her, painstakingly, out of her office in the ward. During the sessions themselves, on the other hand, little or nothing happens: to the therapist, even the fortnightly interval is too frequent. When I ask her about herself, she answers that she feels manipulated, perceiving Lorenzo as too clingy. She feels subject to discomfort, stalked, trapped in a situation she cannot escape. At the same time, she appears worried for him: for the first time, the past week, he missed a session without warning—although he called immediately afterwards for a new appointment.

Up to now, it is a classic situation, a therapeutic impasse within a fairly complex system: an ongoing therapy, a difficult enough family (referred, as it happened, to family therapy, which only lasted for a handful of sessions), the involvement of the health system and social work, and the hierarchy of the ward where she is practising.

My sensation, though, is that the main problem lies exactly in the sense of clinginess that reappears again and again in the narrative. I reflect on the complex emotional plot woven around it. Cognitive evaluation seems unimportant to the therapist, although it had been the original reason of her involvement with Lorenzo, whereas feelings occupy a central position: when Lorenzo keeps some distance, he generates anxiety in her, but when he gets too close she feels he is clingy; the more she feels his clinginess—and therefore rejects him—the more he feels abandoned and, hungry for contact, he gets stuck to her.

At this point, I could follow several diverse pathways. I could investigate their feelings from a developmental point of view: wonder what, in their respective pasts, made him clingy and her intolerant; or I could wonder which relational modalities they have learnt in their families of origin, maybe constructing a genogram of the therapist, and asking her to reconstruct Lorenzo’s. If I were a psychoanalyst—which I am not—I could propose a reading centred on projective identification, and so on.

I choose, instead, a way I feel is more appropriate. My impression is that, as long as my gaze stays on the dyad, the situation will appear insoluble: the therapist would feel relieved only if Lorenzo stopped asking for more therapy, but this could happen only if the therapist were able to accept him more, and so on, ad infinitum. But if we widen our vision, and we take into account the wider system, where all this is happening, things change.

Lorenzo’s ability to be clingy, surely developed in the course of his history, exists within well-defined conditions. First, the therapist receives Lorenzo from the director of the department where she is an intern in training, and where she is asked to be “available” to inpatients. The therapist, thus, wants to be available for her patient, but at the same time she is bound (stuck) to him by the availability she is asked for by the head of the ward. (All this without considering that old organic psychiatry attributed to epileptic patients a “sticky personality”—see for example Bleuler, 1916—and such a notion, old as it is, is probably part of the cultural background of that ward. Thus, the ward culture has a role in making him unavoidably sticky, and her forcibly available.)

If the therapist cannot separate these two contexts, therapy and internship, she will always feel restricted, in clinical work where she needs freedom. This overall situation generates—or at least exasperates—the stickiness: if I am forced to see a patient more often than I would like to, I feel annoyed, and I discharge my annoyance on the “cause” of it, namely my patient. The feeling of frustration and distress is also connected to anger toward the director of the ward, but it must remain unexpressed, focusing only on poor Lorenzo. But if I get an awareness of the situation creating the distress, the stickiness becomes less annoying; or, at least, I perceive Lorenzo’s attitude as less frustrating.

During the supervision, we observe the therapist’s mood becoming progressively lighter; the 120 kilos that burden her seem less and less heavy. She has not decided whether she should leave her internship and slam the door on it. Operative choices are not so important, but she says that, reflecting on the relational side of Lorenzo’s stickiness, she changed her sensitivity: if clinginess is not one of Lorenzo’s intrinsic qualities, then she can afford to work without the risk of getting glued to him. This is not an operational strategy, but rather a change in her emotional disposition. It seems very effective for her, anyway.

None of this is revolutionary, as anyone can see. With hindsight, it is even hard for me to recollect why this supervision made such an impression on me so that it stimulated all my interest on the role of emotions in systemic therapy. All in all, it was a very traditional job: when I mentioned it to a colleague, enthusiastic as I was for the novelty I perceived in it, she commented: “What, then? Watzlawick could have done it exactly the same.” Which is true, of course: the novelty, as it often happens, was not in what happened, but rather in my way of reading it.

The case was interesting in itself, but I had a sense from its very outset: that the basic issue lay in the actors’ feelings. Specifically, the therapist appeared to feel her feelings despite herself; which led me to look for connections and hypotheses mostly based on emotions. In turn, such a focus made emotions relevant in themselves, rather that as pointers to interactional patterns. And our reflection on emotional links had brought the therapist to a different state, a new emotional tone, that could not be explained as the mere consequence of a cognitive reframing. It really seemed to be a different way of feeling.

Then again, my supervisory work had not been neutral in allowing specific emotions to emerge. It was my choice to focus on that aspect, the clinginess which kept stuck, in a close relationship, first Lorenzo and his mother, then Lorenzo and his therapist, and finally the therapist and the supervisory group. Her feeling of well being then, was perhaps also born from the feeling of being in tune with the theory that guided the supervision. We had built an emotional system, I could say, where satisfaction was our common emotion.

Briefly, that supervision had led me in an unknown territory. I had found my orientation through groping around, and using methods I know pretty well: widening the context, consider institutions, evaluating cultures and belief systems. Yet, I felt that the essential dimension was the emotional one. And the feeling was of touching a blind area in my own theory—or even in my clinical experience. It was not a theoretical reflection that made me feel so clearly the usefulness of locating emotion, rather than “in the depths”, in the virtual space existing between the elements of any human system. It was the living encounter with that colleague, with the supervision group, and—albeit only through narration—with Lorenzo himself.

Any human system is (also) an emotional system

Someone might say: psychotherapy lives on (in) emotions, so it is obvious for any therapist to move inside them, and she is also presumed to know how to do it. This is the reason why the interest toward emotions is ubiquitous, both in psychotherapy in general (Greenberg & Pascual-Leone, 2006), and in family therapy (L’Abate & Frey, 1981), not to mention the axiomatic case of psychoanalysis (Orange, 1995). Things change, though, when I wonder to what extent and how emotions can be theorised within the systemic model.

Many recent theories consider emotions as inherently interactional processes—therefore, at least broadly speaking, systemic. This is the opinion, among others, of philosophers like Ronald De Sousa (1987), Paul Dumouchel (1995), and Martha Nussbaum (1986); psychologists like James Averill (1974), Rom Harré (1986; Harré & Parrott, 1996), James Laird and Nicholas Apostoleris (1996); Peter Fonagy’s psychoanalytic group investigated the relationship between attachment, mentalisation, and affect control (Fonagy et al., 2002); lastly, even neuroscientists appear to look in the same direction, albeit from different viewpoints: Joseph Le Doux’s (1996) neurology, Alberto Damasio’s (1994) neurosurgery, and Giacomo Rizzolatti’s research group’s neurophysiology (Gallese, 2001).¹ In this chapter, I am interested in how, while aware of the existing literature, we can try to read emotions as systemic therapists.

If I privilege a systemic account, I may hypothesise that we all live in complex systems, made up of the events we participate in, and of our ways of experiencing them. Any moment I am together with (at least) another person, a system of relationship is created, and emotions are part of it. Moreover, even when I am alone with myself, I live, anyway, in relation, with thoughts, fantasies, expectations, connecting me to other people; they have emotional connotations too. Because such connotations are unavoidable, intrinsic to human systems, and inseparable from them. I can ignore them, voluntarily or not, but I cannot deny either their existence or their ubiquity.

I can say, thus, that any human system is (also) an emotional system. I think anybody could agree on this point, provided they accept the term “system”. What is essential for me, however, is not only to see human systems in an emotional way, but also to conceive emotions systemically. One consequence is that emotions change their sense: they become a way, possibly one of the most relevant, to create and modulate connections and relationships among people. I like to say: any emotion comes from somewhere and goes somewhere, meaning that any emotion I feel and show is—to an extent at least—a consequence of and a response to emotions shown by somebody else, and at the same time, a more or less intentional message sent to somebody else. The others, in turn, are influenced by the emotions I show, which leads them to change their own emotions toward me and toward other people, and so on: emotion is diffused and developed within and through the system.

Thus, we can conceive all human systems as emotional networks, where emotions are transmitted partly through discourse, mostly through nonverbal interaction (see de Sousa, 1987; Hatfield et al., 1994). Gergen (1991, p. 166) maintains that any emotion anybody feels in a given moment is but part of a more complex interaction, which he defines “emotional scenario”. The emotion I feel as “mine” is simply the part I play within the scenario, and, if I consider that scenario, the system becomes for me an emotional system.

This does not mean that I think I have discovered another “kind” of system. If we accept that a system is what a sufficient number of people consider as such, and that criteria vary according to our ways of considering it, then any system can be seen through multiple perspectives. Originally, Bateson was thinking in terms of communicational systems (Harries-Jones, 1995), Jay Haley (1963) of power systems, the original Milan group of systems of alliances and coalitions (Selvini Palazzoli et al., 1978a), Anderson and Goolishian (1988) of linguistic systems, and so on—without any implication that one characteristic of systems is “truer” than another. We can, for the purposes of this book, consider any human system in relation to the emotional interactions that characterise it.

We need to remember that emotion should not be used—according to a famous Batesonian phrase—as a dormitive principle (Bateson, 1972, p. xx), as a way of taking for granted definitions that I do not fully understand. To talk of emotional systems, in fact, has a strong prerequisite: that I know exactly what I mean by the term “emotion”. Actually, the systemic therapy tradition, more than others, took emotions for granted, as if we all knew the sense of that word only because we use it all the time. According to Britt Krause (1993), most systemic authors consider emotions as universal motivational factors (see Appendix Two). Emotion would be, in this perspective, a “thing”, a sort of object, self-evident as, say, a table, a sunset or a cat are self-evident: a good example of the fallacy of misplaced concreteness (Whitehead, 1925).²

To say what exactly are the emotions that characterise my emotional system, then, is no easy task. Perhaps it is best to proceed by exclusion. I would like, first of all, to shed some light on the prejudices, the commonplace ideas, the pitfalls I always risk succumbing to when I deal with emotions, in order to outline, then, the ways in which I always try to escape them (at least) in therapy. Possibly such prejudices are not common to all therapists; they have a great influence on me. And I think that their origins lie in the heart of Western thought. To philosopher Paul Dumouchel, from a francophone perspective, they can be ascribed directly to Descartes:

According to Descartes’s first thesis, emotions are unmanageable feelings of the souls, with no relationship except with the soul itself. In accordance with the second thesis, emotions are physical events and dispositions to actions. In the third place, emotions are, like instincts, animal behaviours that help our survival. All their use and usefulness, all their reason to be, lie here. Now, if we only dust this slightly aged vocabulary, and we substitute the mind, or the transcendental I, for the soul, the vascular system or the hormonal balance for the blood flux, and natural selection for the Creator’s wisdom, we make appear, very clearly, several hypotheses that have full circulation in our own culture. (1995, p. 36)

Therefore, if we listen to Dumouchel, the basic issues about emotion are its inner nature, its irrationality, its animality, its immediacy. Taking these ideas for granted, therapeutic theories have been created, and therapeutic principles have been constructed. If I follow them, as I have done in the past, I have obvious opportunities, but also several limitations. I will try to deal with both in the pages that follow.

Emotions and the system

We will encounter Dumouchel’s (and Descartes’) issues again and again in our journey. Right now, I have to deal with the first thesis: that emotions, to put it simply, are individual and inner facts, that emerge from the inside to the outside in order to find expression (and, as such, very far from the tangle of relationships that constitute a human system). I will again begin by narrating a clinical situation.

A sad family

A family of seven: father, mother, eighteen-year-old son with his fiancée, considered part of the family, seventeen-year-old daughter, and, last, the two siblings considered as problematic for their continuous fighting, a girl of thirteen and a boy of eleven. It is a consultation, and it will be the only time I will see them; it happens in Hobart, Tasmania (of all places in the world …), where the family has been referred by the social services of a country village. What strikes me, as I enter the room, on the one hand is the tension and wariness, probably dictated by the context itself, that emphasises the problematic character of their being together; on the other, an underlying sense of shame. The first exchanges describe their unbearable difficulty in living together. Then the mother takes the centre stage: she is the true spokesperson for the family. Exasperated as she is with her two children, she seems, most of all, mad at her husband, who, she says, is unable to discipline them, or to create some order in the home chaos. “Anyway,” she adds, “he didn’t even want them!”

In contrast to her, an apparently solid and determined woman, who sits in an open position as to challenge the whole room, the father seems skinny, nervous, introverted, closed on himself. He has, I learn, a long history of “deviance”, a past diagnosis of schizophrenia, several hospitalisations and imprisonments for petty theft. Presently, anyway, he has discontinued his medication treatment, in accordance with his psychiatrist. From the beginning, he radiates a sense of desolation. Up to now, he has talked little, holding a peripheral position. Now I address him, and everybody looks in his direction.

I ask him: “Is it true? You really didn’t want to have children?”

He looks me in the face for the first time. His eyes are reddened, full of tears. Hesitantly, in a thin voice, he replies: “I didn’t want them to become like me …”

All of a sudden, everybody’s attention is on him. The silence is charged, almost solemn. I say: “Were you afraid they would inherit your problems? Did you want to protect them?” He nods.

The seventeen-year-old daughter comments: “With Mom we have more contact, but Dad is the one who thinks most. If we have a problem to solve we go to him …”

Thus, this family, who initially appeared to live only...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• SERIES EDITORS'FOREWORD
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Systems and emotions
• CHAPTER TWO Emotional systems
• CHAPTER THREE The interplay of emotions
• CHAPTER FOUR The therapist
• CHAPTER FIVE Emotional systems in therapy
• CHAPTER SIX Emotions and dialogues
• CHAPTER SEVEN Direct talk
• CHAPTER EIGHT Moments of truth
• APPENDIX ONE Definitions
• APPENDIX TWO Perspectives on emotions
• NOTES
• REFERENCES
• INDEX