Changing Habits of Mind

A Brain-Based Theory of Psychotherapy

Zoltan Gross

• Editorial: Routledge
• Año: 2020
• ISBN:
  9781000176223
• Edición: 1
• Categoría: Psicología
• Categoría: Personalidad en psicología

Changing Habits of Mind presents a theory of personality that integrates homeostatic dynamics of the brain with self-processes, emotionality, cultural adaptation, and personal reality.

Informed by the author's brain-based, relational psychotherapeutic practice, the book discusses the brain's evolutionary growth, the four information-processing areas of the brain, and the cortex in relationship to the limbic system. Integrating the different experiences of sensory and non-sensory processes in the brain, the text introduces a theory of personality currently lacking in psychotherapy research that integrates neurobiology and psychology for the first time. Readers will learn how to integrate psychodynamic processes with cognitive behavioral techniques, while clinical vignettes exemplify the interaction of neurophysiological process with a range of psychological variables including homeostasis, developmental family dynamics, and culture.

Changing Habits of Mind expands the psychotherapist's perspective, exploring the important links between an integrated theory of personality and effective clinical practice.

Chapter 1

The Dyad

Adventures in Psychotherapy’s Wonderland

The Whole Is More Than the Sum of Its Parts

About a year after my resignation from the United States Army Air Corps, where I served as a celestial navigator in the Air Transport Command during World War II, I fell in love with psychotherapy. That startling moment happened when I was a student in Grace Fernald’s Reading Clinic at UCLA. I was interviewing the mother of a six-year-old boy with whom I worked at the clinic. It was my first professional interview. We talked about her son, who was having difficulty learning to read, and about her worries about his future well-being. She left the interview relieved and I felt wonderful. I knew where I was headed in life.

When the war ended, I returned to UCLA to finish the doctoral program I interrupted to enlist in the Army Air Corps. In my doctoral dissertation, I hypothesized that lobotomized patients would suffer a learning deficit (Gross, 1952). At that time, there were no psychological tests that showed psychological impairment resulting from the lobotomy operation. My dissertation clearly showed that lobotomized patients had been seriously impaired by the operation. The research primed my mind to think about brain dynamics. I could have used my dissertation as a way of becoming a research neuropsychologist, but by that time I was hooked on becoming a psychotherapist where for over the past 60 years I have been enriched by that devotion.

At the beginning of my private practice, I went into my own psychoanalysis, which was then regarded as the most effective psychotherapy in the marketplace. Times have changed. Psychoanalysis has lost much of its almost religious beliefs. I went into it to resolve my own emotional difficulties and to learn more about psychotherapy by being in it myself. Early in my practice, patients would lie on my couch and free associate. I would interpret their associations and dreams and try to be a blank screen. I wasn’t too successful at that. My patients teased me about being the great stone face. Try as I might, I was unable to totally keep my person out of my psychotherapeutic work with patients. I am now convinced that it is impossible for any therapist, of any stripe, to keep his or her person out of the therapeutic relationship. Nor do I believe that it is therapeutically desirable to do so.

In pursuit of my efforts to unravel the mysterious emotionality of my practice, I turned to Josef Breuer’s¹ report of his work with Anna O.: the first psychoanalytic case study. To my great surprise, I discovered that it was not the talking cure it was reputed to be. This study triggered the birth of psychoanalysis. And it is the source of the many misunderstandings about the nature of cure, the nature of the therapeutic relationship, and the nature of what is meaningful in that relationship.

As I pursued my interest in the Breuer/Anna O. relationship, I found that there are two very different literatures about it (Jones, 1953; Gay, 1988; Breger, 2009; Skues, 2006). The conventional one describes it as the inspiration of psychoanalysis. The other one, more recently published, disputes the claim that it was a talking cure. The Breuer/Anna O. relationship is a sadly misunderstood infatuation that dramatically affected both of their lives and shaped the course of psychoanalytic thinking.

In this chapter we will see that the curing of Anna O.’s symptoms, which were celebrated as the effects of the talking cure, arising from her enchanted relationship with Dr. Josef Breuer. Reading Breuer’s report of his treatment of Anna O. confirmed my belief that the personality changing power of their psychotherapeutic relationship happened within the therapeutic relationship itself instead of Anna O./Breuer’s and Freud’s explanations of it.

I will describe the reasons for my conclusions as I present evidence for them in the following discussion. We will also see how difficult it was for them to acknowledge the therapeutic meaningfulness of the relationship that enthralled them.

They had a truly playful collaborative relationship. With much pleasure, they came up with explanations of what caused her personality changes. Not only were their explanations fun, they enabled Anna O. and Breuer to be blind to the infatuation that magically dispelled her grief and madness.

Many of Breuer’s explanations are still thought to be meaningful in psychotherapeutic thinking. Understanding, catharsis, interpretation, and insight are still strongly held beliefs about the nature of what Anna O. called her talking cure. My re-examination of Breuer’s case study validated the misgivings I had at the beginning of my practice about the therapeutic meaningfulness of these explanations.

Many years ago, I had the good fortune to have dinner with Rollo May, with whom I shared my theoretical misgivings about psychoanalytic personality theory. He agreed, saying that “Freud was a genius in asking all the right questions. Unfortunately, he came up with the wrong answers.” At that time, I didn’t know enough to understand this paradoxical agreement. Now I understand that Freud did ask brilliant questions and because of the limitations of understanding about personality and neurology 130 years ago, he could not come up with the right answers. His answers may have been wrong, but by applying a Darwinian metatheory to what he saw clinically, he made profound contributions to the creation of psychotherapy and he opened up new ways of thinking about human nature.

Looking at the Breuer/Anna O. relationship from today’s perspective we can see the power of their emotional relationship in what they called a cure. A re-examination of their relationship sets the stage for a contemporary description of interpersonal relationships which is paradigmatically different from those currently used to describe the therapeutic relationship.

The Breuer/Anna O. Relationship Revisited

In 1880, on nightlong vigils, Anna O. cared for her dearly loved dying father. Finally, exhausted with excruciating grief, she developed a variety of hysterical symptoms, which prompted her mother to call Dr. Josef Breuer, a highly regarded Viennese physician. In the course of his treatment of Anna O., Dr. Breuer generated concepts about catharsis/abreaction, repression, and interpretation that inspired Freud to give birth to psychoanalysis. For many therapists they are still thought to be meaningful explanations about the nature of cure (symptom removal): which was the goal of his medical treatment. It was not psychotherapy as we know it these days.

Looking back at it from today’s perspective will give us a better understanding of the nature of intimate relationships; especially the relationship that occurs in intensive emotionally oriented psychotherapy. We will see that their relationship ameliorated her suffering and the symptoms that plagued her. It also illuminates our human devotion to explanation and why we have overvalued it as a psychological change technique.

And, finally, it raised questions about the nature of and duration of personality change. The Breuer/Anna O. relationship vividly highlights the difference between psychotherapies that help people feel better and psychotherapies that help people escape from the characterological prisons of their childhoods. It is the difference between relieving the ache of loneliness by making emotional contact and the painful work of changing habituated character structures and creating more stable age-appropriate ones.

On hot summer nights, Breuer described his treatment of Anna O. to his dear friend, Freud, who was fascinated by Breuer’s account of Anna O.’s cure from her painful illness. He told Freud that, when Anna recalled repressed painful or disagreeable emotional experiences, which, he believed, caused her symptoms, the symptom was either alleviated or it disappeared. Within the tradition of the time, if the doctor relieved a patient of a symptom, he believed she had been cured.

This was the beginning of the belief that returning the repressed to consciousness was curative. Fifteen years after treatment was terminated, Freud persuaded Breuer to publish his case study of Anna O.; Breuer did so with some reluctance. Here, I will present parts of Breuer’s account of his relationship with Anna O., which reveal the close loving relationship they had with one another. I will conclude my description of their relationship by showing how the denial of their love led them to change the ways they lived the rest of their lives.

From my reading of Breuer’s description of her condition and his treatment of her, it was clear that he and his patient had different unacknowledged and nonconscious personal agendas about the purposes of their relationship. The following quotations from Breuer’s report highlight the emotionality of their relationship.

On December 11, [1880] the patient took to her bed and remained there until April 1…. There developed in rapid succession a series of severe disturbances which were apparently quite new.

It was while the patient was in this condition that I undertook her treatment, and I at once recognized the seriousness of the psychical disturbance with which I had to deal…. For two weeks she became completely dumb and in spite of making great and continuous efforts to speak she was unable to say a syllable. And for the first time the psychical mechanism of the disorder became clear. As I knew, she had felt very much offended over something and had determined not to speak about it. When I guessed this and obliged her to speak about it, the inhibition, which had made any other kind of utterance as well, disappeared…. thenceforward she spoke only in English…. At times when she was at her best and most free, she talked French and Italian. There was complete amnesia between these times and those at which she talked English.

(p. 23–24)

Shortly after she left her sick bed, her father died. About his death, Breuer said,

This was the most severe psychical trauma that she could possibly have experienced. A violent outburst of excitement was succeeded by profound stupor which lasted about two days and she emerged in a greatly changed state.

(p. 26)

When she recovered from the trauma of her father’s death, her physical symptoms improved. However, her relations with others changed dramatically. She could or would not recognize people who displeased her and her tolerance for people, even those she liked, were short lived. Breuer went on to say,

I was the only one whom she always recognized when I came in; so long as I was talking to her she was always in contact with things and lively, … She had eaten extremely little previously, but now she refused nourishment all together. However, she allowed me to feed her.

(p. 26)

During this period, he introduced her to another physician to care for her while he would be gone for a short period of time, “whom like all strangers, she completely ignored while I demonstrated all her peculiarities to him” (p. 27). The cigar-smoking visiting physician tried to get her attention but to no avail.

[Until] he succeeded in breaking through [her dismissal of him] by blowing smoke in her face. Suddenly she saw a stranger before her … and fell unconscious to the ground. There followed a short fit of anger and then a severe attack of anxiety…. Unluckily I had to leave Vienna … when I came back several days later, I found the patient much worse. She had gone entirely without food … and her hallucinatory absences [psychotic episodes] were filled with terrifying figures, death’s heads and skeletons.

(p. 27)

I have been quoting these sections of Breuer’s case study to call attention to four aspects of his report; his presence was the most reliable condition that led to symptom removal. In essence, the warmth of their relationship was disregarded by Breuer. It was their warmth with one another that probably had its beginnings when he unsuccessfully tried to hypnotize her in an effort to reduce her anguish by suggesting it out of existence. Despite his failure to hypnotize her, the gentleness of the hypnosis induction procedure likely eased the pain of her grief and was the beginning of a loving relationship that created difficulties for both Anna O. and Dr. Breuer.

He describes her hostile and distant emotionality toward others, but he does not discuss the emotionality of their relationship, which is evident in her positive feelings toward him and the nightly devoted attention he gave to her.

His caring for Anna eventually caused his wife to complain about the amount of time he was away from home attending to Anna O. Breuer calms Anna O.’s anxiety. She lets him feed her. And she is “in contact and lively” when he talks to her. As treatment progressed, she calmed herself by insisting on telling him “stories.” In the following quote, he says:

The stories were always sad and some of them very charming, in the style of Hans Andersen’s Picture-book without Pictures…. If for any reason she was unable to tell me the story during the evening hypnosis² she failed to calm down afterwards, and on the following day she had to tell me two stories in order for this to happen…. I used to visit her in the evening, when I knew I should find her in her hypnosis, and I then relieved her of the whole stock of imaginative products which she had accumulated since my last visit. It was essential that this should be affected completely if good results were to follow…. She aptly described this procedure, speaking seriously, as a “talking cure,” which she referred to it jokingly as “chimney sweeping” … she would never begin to talk until she had satisfied herself of my identity by carefully feeling my hands…. When I was present this state [her emotional condition] was euphoric, but in my absence, it was highly disagreeable and characterized by anxiety as well as excitement.

(p. 29–30)

Breuer vacationed for several weeks and returned to find

the most convincing evidence of the pathogenic and exciting effect brought about by the ideational complexes [in Anna while he was on vacation] … During this interval no “talking cure” had been carried out, for it was impossible to persuade her to confide what she had to say to anyone but me—not even to Dr. B. to whom she had in other respects become devoted…. The situation only became tolerable [when] … evening after evening [I] made her tell me three to five stories. When I had accomplished this, everything that had accumulated during the weeks of my absence had been worked off.

(p. 31–32)

After a time, her “stories” were added to the talking cure which removed the symptoms from which she was suffering. Breuer describes this as follows:

Each individual symptom … was taken separately in hand; all the occasions on which it appeared were described in reverse order, starting before the time when the patient became bed-ridden and going back to the event which had led to its first appearance. When this had been described the symptom was permanently removed. In this way her paralytic contractures and anaesthesias, disorders of vision and hearing of every sort, neuralgias, coughing, tremors, etc., and finally her disturbances of speech were “talked away.”

(p. 35)

It appeared to Anna O. and Dr. Breuer that when she repressed her emotional reactions to external events, the repressed emotional reactions wer...

Índice

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgments
• 1 The Dyad: Adventures in Psychotherapy’s Wonderland
• 2 The Paradigmatic Shift: The Tyranny of Habits of Mind
• 3 A Theory of the Mind
• 4 The Ghost in the Machine
• 5 The “I” and Its Psychological Selves: Without Our Navigator We Can’t Be Sure of Where We Are Going
• 6 What Emotions and Feelings Really Are!
• 7 Emotions and Feelings
• 8 A Portrait of the Person
• 9 The Art of Psychotherapy
• Appendix
• Bibliography
• Index