Tag: Depression

Al Pesso Keynote Address, German Humanistic Psychotherapy Congress, Oct 27, 2014

Al Pesso Keynote Address, German Humanistic Psychotherapy Congress, Oct 27, 2014

al pesso germany 2014As the theme of this conference is depression, this will be what I will attend to in this address.  I will also focus directly on the treatment of depression at the end of it.  Along with the topic of depression I will address the issue of client resistance to getting personal and therapeutic needs met, for there is a linkage here that I will highlight.

Now, to begin with I will supply you with the concepts that I hope will shed light on those dilemmas.  For then you will have the information and viewpoint necessary to follow what I have found to be a way toward understanding and solving the conditions of depression and resistance.  First and foremost, they arise from the experiential history of clients who share the characteristics of chronic depression and chronic frustration of the satisfaction of maturational and interpersonal needs.

Let us now look at what elements comprise the satisfactory and necessary foundation of a good life here on earth.  I take a philosophical, quasi-spiritual and biological position when I confront this question: “What is life all about?”  The answer that arises in me is, “We are made to be able to be happy in an imperfect world that is endlessly unfolding, and we human beings are the local agents of that cosmological unfolding.”  So, here it is. We are not only organically living beings, but we have a fundamental cosmological push toward fulfillment, not only of ourselves, but also of all others on this evolving planet and the unfolding cosmos itself.  Quite grandiose, isn’t it?  Yes, and those who suffer depression and resistance to experiencing personal satisfaction are severely conditioned by a too early awakening of that primordial push. For that push, though stated here in philosophical cosmic dimensions is, in my mind, to be found in the genetic information instilled in us at conception.  Our actions and behaviors do have personal and cultural dimensions, but below those individual histories lies the fundamental, genetic organization that attempts to attend to the fulfillment of the spiritual or cosmological element of aiding the fulfillment of all that is, and all that we see and experience. (An aside here: we are made of matter and matter is the stuff of the cosmos.  I personally do not see a separation of matter and spirit, but see matter itself as divine.  When I think of divinity I do not think of a personal seeing, hearing, talking, thinking, punishing god.  I want to simply state that my concept of god is all that is.  And, so if all that is is the cosmos which is endlessly unfolding, so is my concept of god endlessly unfolding.  I don’t know if this, is something that I should admit to in a Humanistic Conference.  I do think we living beings are part of a divine process, but in no way divine in the traditional concepts of a living talking, etc. god.  In my way of thinking, all that is, is precious.)

A bit much perhaps, but now I will go through the steps needed to look at life this way.

At the moment of conception, we inherit the information in our genes which has within it the history of that which has successfully lived from the beginning of time.  What a lottery prize!  That information regarding all that will become us in the future is simply a very compressed condensed bundle of information which will form our bodies and minds so that we can successfully live here on earth.  Not only form us, but inform us through our senses of what is good or bad for us.  That way, when we have become alive and corporal with body and flesh we can deal with and experience what is out there and be able to be happy enough doing so, in good times and bad.

But there is a timeline for the fulfilment of all this.  We are not immediately embodied and adult. We go through a maturational process which our genes attend to without our conscious collaboration or participation.

Before I attend to the timeline, I want to speak of what I see as the passions or pushes already in that bundle of information at conception that will unfold in good measure as we become embodied and slowly mature. I have no scientific proof of this, but here is what my experience has taught me about what passions or pushes we are fundamentally made of and that work through us without us necessarily having any consciousness of it.

The first push is The Survival of the Self.  The little being comes out fresh with the desire to live.  If it could speak, I am sure it would eagerly say “I want to live.”  It doesn’t say that, but just look around you at infants and how eager they are to see, hear and do things in the world with curiosity and vigor.

The second push is Survival of the Species, or in other words, survival of the others in our immediate lives and then, the intentionality to deliver the stuff of the next generation with the materials in our bodies that can do that, our eggs and sperm and all the sexual drives connected with the utilization of that push or passion to make more life.

Right here in those first two passions or pushes you can see that there should be sufficient time to mature the self in ease and satisfaction before one becomes confronted with the needs of others or one’s sexual drives and energies have been awakened too early by unfortunate circumstances.  Some of our above mentioned clients may very well be included in that population.

I know that there will be little disagreement with the above first two descriptions of genetic passions or pushes, but here come two more which I have come to believe also exist.  The third is the passion or push to make things whole.  Living things of all kinds seem to be very disturbed of that which is not whole and they are mightily pushed to make things whole.  Biologically this is apparent in the healing process in all living things.  It is obvious in the spelling itself, as well as the sounds of those words, at least in English, that healing and wholing are so similar.  Another way to view that is that nature abhors a vacuum.  We are drawn to fulfilling the task of making things whole.

I regularly like to illustrate this on its simplest basis by asking a group to watch me describe a circle in the air with my hands.  And then, note their reaction and response emotionally and physically.  Here it is.  (He demonstrates tracing a circle in the air with two fingers which at the end pause an inch apart without completing the circle.) And, how did you react to this? Do you like the stoppage of the directionality of the arc to completion?  Of course not. Didn’t you feel the motoric impulse to close the circle in your own limbs?  Watch what happens when I do the closure.  (He demonstrates tracing the circle in full.)

Just observing that simple motion in front of you has an impact on your body as well as on your mind.  Your mind may well have a feeling of discontent and frustration at seeing that, but I am sure many if not all of you, felt an impulse in your own arms and bodies to move the arc to completion.  And then, when I move it to completion and you see that, your own arms probably relaxed and your feelings of discontent and frustration changed immediately to relief and satisfaction.  Isn’t it impressive that such a simple hole in the air can make such a feeling of discomfort immediately in you, the viewer, and all other viewers as well?  It seems apparent that this is universal.

Now, let us proceed to the fourth passion or push which is an elaboration of the previous one which is a relational wholeness.  The fourth one is when we perceive an empty space in the context of living relationships.  Here is my way of understanding how we react to empty spaces in human relations.  I suspect that our genes prepare us for the sense of what a complete family structure should be.  We are made of a mother’s egg and a father’s sperm, and that must lead to innate knowledge that our mother and father must have been made the same way, leading to an innate notion of grandparents, and that our mother and father may have had siblings, and that would prepare us for aunts and uncles, and that those siblings may have had children leading us to anticipate cousins.  All this is obviously very simply put, but clearly we are biologically prepared to live within a family context of one kind of another for we are social animals by nature.  Many social animals demonstrate this and I have read and learned about birds and other species which show a very clear discrimination and particularity in sharing with other birds depending on their social relationship.

With us humans, I believe this sense of completion on the social level goes beyond our immediate family and extends to our culture and national history.  I am extending this in this manner to highlight and underline the next genetic passion or push, which is a step up from making things whole.  It is the passion or push to do justice — to make things just, just as they should be.  In English, just as and justice are quite similar and highlight the innate drive to make things balanced and right as well as complete.  I suddenly noted for myself my reaction to doing things right.  That impresses me, that what is not right, is wrong and that feeling of justice has to do with undoing the wrongs and making things right.  Just think of the satisfaction people that immediately feel when wrongs are righted and the frustration and anger people and also primates feel when wrongs are continued and tolerated.

Okay, now that I have spelled things out somewhat let’s review the list of four passions or pressures that are genetically based.

  1. Survival of the self
  2. Survival of the species
  3. Making things whole
  4. Doing justice on an interpersonal and social level

Looking at in this way it becomes clear that there must be timelines attended to in fulfilling those drives, even though the drives themselves are present at conception.  Clearly, the circumstances of one’s life will have an impact on the timing of the activation of those drives, and that impacts those clients who suffer depression and resistance or the inability to experience  having their essential maturational needs met. And, those needs as I will now demonstrate have to be met at the right age and with the right kinship relationship – all these, I believe, are genetic programs of expectation of satisfaction of those needs.

In my mind, the first two drives highlight that there is an internal agenda of what needs to be accomplished or experienced in life in order to be maturely ready and prepared to successfully attend to the survival of the species, i.e. to become a well-balanced parent.

I believe there are the 5 inherent tasks that must be successfully met in order to be ready to attend to survival of the species.

  1. Maturational needs met at the right age and with the right kinship relationship
  2. Integration and unification polarities
  3. Development of consciousness and language
  4. Development of one’s autonomy, i.e. pilot or neurologically speaking, sufficient pre-frontal cortex development
  5. Fulfillment of one’s personal uniqueness and potentiality i.e., to bear fruit

For this talk I will deal primarily with the first and partially with the second.

Here is the list of what I believe must be attended to in the satisfaction of maturational needs.

  1. Place
  2. Nurture
  3. Support
  4. Protection
  5. Limits

Each of these must be supplied on two levels. First literally and then symbolically in a state of benign dependency before one becomes autonomous.

Briefly, Place means coming into the world wanted and having not only a physical place in the mother’s uterus, but also a psychological place in the mother’s consciousness.  Then, one can be at home both in their own body and in the world, and further have a place in their own mind with a conscious sense of self.

Briefly, Nurture means we have to be supplied with that which sustains life. First, literally via the umbilical cord and mouth. Then, through the sensation of being given the stuff of life and love on a non-literal level.  When these needs are met one is capable of feeding and satisfying one’s self.

The same sequence is needed for Support and Protection, and I need not go further on that at this time.

Limits is a powerful issue for us to attend to in regard to our primary topics of depression and resistance. There is much to say about limits, but in this discussion I want to highlight the need for limits of the two nuclear forces that are the suppliers of the forces to live life.  The two forces are the capacity to make life, sexuality, and the capacity to destroy life, aggression.  Those two forces must be contained, unified and modulated by loving parents so that the child can learn to use those tamed forces in their future life of work and creation.  The limits topics make the nuclear forces of those primordial forces useful as controllable engines to run the activities of life, just as a nuclear reactor can provide power to communities without being destructive.

Now, I will jump ahead and speak about how we work with clients in general in PBSP doing what we call structures which is a process of creating new symbolic memories to provide the satisfactions of basic needs that may not have been provided in one’s historical reality.  We have found a successful and satisfying way to symbolically go back in time to experience having what we call ideal parents who would have had the love and capacity to do for us what our genes had anticipated so that we could go on with our lives prepared to attend to the unfolding of ourselves in the service of participating in the unfolding of the rest of our environment including our family, culture, nation and the planet itself.

In short, we start an individual session with the client by micro-tracking their present consciousness which is understood as a tapestry woven of threads of memory.  Here I will take a moment to speak of the three kinds of memory that influence our present consciousness.  The first is, of course, genetic memory and we have looked at what was stored in that.  I call that storage.  Then, there is our personal history and autobiographical memory which is a record of those elements of our genetic memory that have been satisfied in reality, resulting in a life of hope and satisfaction and what elements of our genetic memory have not been satisfied in our history leading toward a life of frustration and disappointment.

Those needs don’t go away.  If they are not satisfied at the right age with the right kinship relationship, they attempt to be met later in life and not with the gene-anticipated parental figures.  Sometimes I refer to that condition as marriage. The third memory which influences how we live and react in the present is the memory of absent figures in the family network and injustices to our family, culture, religion, or nation, as well as injustices to nature and the planet. The intended result of micro-tracking present consciousness is to surface the history that is the basis for the feelings and thoughts in the present.

Then, when the history that arises is one of frustration and absence of satisfaction of basic maturational needs, we construct a role-played event with group members taking the role of ideal parents and then have those needs met and planted in the client’s mind as having been accomplished at that earlier, right age.  This takes careful precise work.  In my workshop on Holes in Roles I illustrated that process in great detail.

When we offer that role-played event in the therapy session, most clients readily participate in it and experience the relief that this provides.  And then, this brightens their expectation for satisfaction of reality needs in the present.

Now, we come to our main topic.  Those clients who, though having had miserable histories with massive frustration of their basic needs simply cannot accept or believe such a thing is possible or worth doing.  They are extremely resistant though they have spent much time in therapy bewailing the fact that they have had such miserable histories.  Enough said. Now, what to do and why.

Here is what we have found over the years that is the crux of the dilemma.  Let’s go back to you seeing that incomplete circle in the air.  You were affected by it.  Think of what happens to a child who sees the reality of missing figures in the family, culture etc. or further hears or reads stories about such unjust events done in histories of their family, culture, etc. or are inculcated in church, synagogue, mosque or wherever the injustices were perpetrated on their sacred ancestors.  We have come to the conclusion that when compassion and empathy are aroused too early in a child’s life, the child is consciously and unconsciously motivated to do something about it, just as you all felt compelled to do something about the unfinished arc of the circle.

We believe that a part of their brain not available to consciousness makes what we call a “movie” where they are the one and only healer.  Kind of like a Messiah who is the one and only that so much of the planet is absorbed with.  The brain which is known by all of us able to make movies that we see and act in, namely dreams, has we believe the capacity to make movies that we do not see or even have the slightest awareness of their creation, where we are the primary actors and healers of the incompletions, the injustices, etc.  This movie is unconsciously created whether or not the child makes any reality effort in that regard.

The consequence of this movie has two powerful effects.  One, being the one and only there is no longer the innate sense of the nuclear powers being contained by another, and they subsequently break loose.  The power to destroy and the power to create are not felt as those powers in most people, but they are felt as physical overloads with no name except they result in panic attacks and anxiety.  Here is where depression as a defense comes in.  Those of us who do not act on those released atomic forces have what I call systemic defenses.  Here are four defenses that I have regularly noted that our brains use to keep us from acting on those emotions in the world.

  1. Depression: This type of depression doesn’t come from a feeling or experience of loss, but comes as a depressant of those nuclear forces and lowers the thermostat, so to speak, of their over-heated state.
  2. Dissociation: The client habitually loses contact with inner states and often speaks of feeling nothing.
  3. Retroflection: The client directs some measure of those powerful forces at the self as an unconscious way of not creating destruction on the outside world.
  4. Never Finishing Things: The client doesn’t finish things off, so to speak, as a way not to finalize the expression of those destructive forces.

Now, let’s look at resistance.  What has that got to do with this state of things?  Somehow, and I don’t know how, the brain seems to shut down the ability to receive and have pleasure from the satisfaction of getting what is longed for.  The client doesn’t decide to resist, but the receptor sites or materials for experiencing relief and pleasure are simply no longer functioning or operable.  We can see examples of this dilemma in martyrs who are endlessly taking care of the other and yet continue to live in misery.

How do we work in PBSP to solve this dilemma of chronic depression and inability to receive satisfaction?  We make a conscious counter-movie to offset the need and arousal of the unconscious healing movie. We ask the client, who at this moment is unable to receive or experience the satisfaction of maturational needs in the therapeutic context described earlier, “Who did you feel compassion or empathy for when you were a child?”  We put it that way because the child’s brain, which has not yet been fully developed, has no cortical oversight and modulation of limbic system impulses and has in all likelihood made the kind of healing movie mentioned earlier.

In the therapy session we make a movie using objects to exemplify the various people in one’s inner drama.  If the unconscious movie had to do with stepping in to be the husband of one’s grandmother whose actual husband had died too early leaving her and her offspring in danger, misery and poverty, then in this make believe movie that is seen in the mind’s eye of the client it is seen as people not just stones representing people.  For they no longer see the stones in their minds; they see the figures they represent and what is seen in the mind’s eye moves the mind’s body to repair or feel relief. Just as what we saw in the mind the unfinished circle our mind‘s body and real body feels the impulse to complete it. And then when the completion was done externally the mind and body of you viewers felt the relief and pleasure.

This procedure is replicated in this imaginary movie.  The client sees the grandmother with a long-living husband.  When asked, “How does your grandmother feel with that husband who has just said in the movie that he would be there with her for her entire life?” the client may say, “She is feeling so relieved and happy.”  Then, we go back to the movie scene and have the Ideal Husband say, “If I had been your ideal husband I would have been there your entire life and you would be relieved and happy.”  The client then may lean back, exhale and take a pleasant and deep breath.

At that moment, we have the figure, represented by the rock in the “movie” figuratively come out of the movie screen and speak to the client who is, so to speak in the audience, watching the “movie”.  The Ideal Husband says, “It is my job to be her husband and give her relief and happiness, not your job.” And then he goes back into the movie.  The reaction to that kind of statement is something to observe.  The client usually straightens up and says something like, ”I feel like something fell off my shoulders and I feel lighter inside.”  The client’s gaze often shifts and then may say, “I see more light.”

This is all part of the feelings of the relief of that closure of the hole and the client’s body relaxation is a consequence of that closure.  For now they are no longer the one and only, and the unconscious restraint of aggression and sexuality and motor endeavors connected to this situation relax physiologically for other parts of the brain now take over the modulation of those primordial energies which are no longer without limits.  The relief is experienced in the mind and body of the client and, surprisingly, it opens the door to receptivity of one’s own needs.

Then, the session generally shifts from the movie and then the client, who had been offered an ideal mother or father in their history who would have satisfied the basic need that had been absent in their life becomes open to receive that experience.  In the role-playing event that generally follows the memories of actual situations of frustration and loss can now be ameliorated by the Ideal Parents and experienced as real.  The therapist helps the client feel that level of relief felt in the now and helps the client access the mind’s body memory of themselves as a child. They are guided to place that experience of relief and pleasure experienced in the moment into the long term memory of the body of themselves as a child.  The shift here is impressive, for a different depth of satisfaction is then experienced because it is now linked to the memory and history of the self and not only felt in the present in the therapy room.  When the client expresses their feeling that they can be a child now and play and be happy that is a signal for the Ideal Parent to say, “If I had been your Ideal Parent when you were a child, I would have taken care of you and you could play and be happy.”

Somehow the client then feels the childlike pleasures of being in that state and their body might show playful motions and behaviors. Then, slowly as the memory has been embedded into what we hope is long term memory, the client returns to the present.  Their gaze will be more open and they often say that say they see more light.  The client may nod and indicate that the session, or structure as we call it in PBSP, is over.  The therapist then goes through the process of de-rolling all the figures in the session, with the Ideal Parent or Parents de-rolled last.  The client returns to the group and there is sharing in the group.

This is only the beginning of the healing.  One movie and one healing session is not the end of therapy.  There now is the possibility of discovering and unearthing numerous other movies that the client had made unconsciously.  He or she, moved by losses, for example, incurred during a war may need a movie where all their family members and neighbors would have been in a country with no war.  Another example for those who had been told repetitively in Church, Mosque and Synagogue about trials and tribulations of members of their culture one thousand years ago might have to see a movie with powerful figures who would have rescued their antecedents in those events and offset any possibility of cataclysm.  The number of movies can be enormous over time.  And each one provides another level of relief, which enables the client to then once again receive the blessings of satisfaction of other maturational needs at the right age and with the right kinship relationship.

Those experiences in the therapy room, now embedded in long term memory, make the client more likely and able to find ways to deal with this imperfect world of reality without giving up in despair and resignation, but able to seek and find solutions and satisfactions in real situations. And then as a result they can feel joy and pleasure living on this imperfect planet.

There it is.  I hope my words and images have given you a way to see your depressed clients who have similar histories to the ones I have spoken about in a brighter light.  Further, I hope you can find your own way to adapt and utilize some of the theories and techniques I have described for your clients’ benefit.  Thank you for listening.