Integrating Relational Psychoanalysis and EMDR: Embodied Experience and Clinical Practice provides contemporary theoretical and clinical links between Relational Psychoanalysis, attachment theory, neuroscience, and Eye Movement Desensitization and Reprocessing (EMDR). The author, Hemda Arad, delineates the ways psychoanalysis and EMDR can complement each other through a presentation of fundamental concepts and an abundance of insightful and moving clinical vignettes. Arad describes a view of a modified EMDR approach capable of reaching many patients, beyond the trauma work for which it is known, in order to lend its more embodied approach to the work of relational psychoanalysis. Read an excerpt from chapter 7, “I-dentity: is trusted love ever an option?”, below.
Anxiety as an emotional skin
The shaking stops. Not only now, not only here. Everywhere, all the time. It is an eerie silence she notices for the first time, for as long as she can remember. Now that the constant buzz is gone, some relief can be felt. She no longer fears entering a room, any room. “You know,” she says, “I did not feel anxious coming in today. I think it is gone.” But with it a renewed sense of loneliness slips in. Lynn was feeling a longing for a connection that might take the place of the now lost buzz.
Before we parted following our previous analytic hour, Lynn said, “This was important.” She was referring to a discovery she had made. This discovery cut through decades of repulsion toward her mother and Lynn’s own obsession with hidden love and a more recognizable anger toward her mother, who was emotionally lost to her early in life. I am saying lost as opposed to the more common “unavailable” to highlight the depressive melancholia that resides within her. What Lynn has stored in memory are the moments of anger and rejection she had felt as a pre- teen, and even a vague memory as a toddler. She remembers crying for a mother that never showed up. She remembers calling, terrified, to a mother who stepped in to scold her for wanting. She also remembers feeling brokenhearted by a girlfriend who bullied her in middle school and approaching her mother with a rare request for a hug of comfort only to be pushed away coldly. But with all of these memories she never remembers this that she has discovered in the session. “Astonishing,” she thinks. It is astonishing that she doubts her own memory of things. Her feelings are of the magnitude of that earlier kind of a memory. But now, for the first time, there is a match.
She wonders why she feels so anxious. Rational understanding does not explain her lifelong companion of angst in every human interaction. She carries the sense that she cannot relax into a conversation, cannot be around others without a worry, and cannot feel comfortable with an intimate partner. “Yes,” she says, she knows it has something to do with her mother, but why can’t she shake it off, after all these years?
Of course, I do not know the answer to this question. Something is folded up tightly in this Rubenesque body, in her coy smile, her discomfort in lying on the couch. Her moods shift, passing through with only the slightest change of expression or word. One moment she is soft, present, and wise, yet in another she is coiled and tensed up, unable to find a comfortable position, her lips twitching, saying that she feels stupid. Every change gives her hidden desires and fears away, but with no specificity.
Lynn, a woman in her early fifties, who grew up in the south, is a professional musician who works with students studying at a conservatory. She is not only a talented musician herself, but also an admired teacher for scores of young musicians who have taken the main stage nationally. She was referred to me by her physician, who had concerns for her emotional well-being, particularly the depression that has hindered her ability to perform and teach. Lynn has not been able to play her instrument recently, and — worse — feels that she is about to fall apart. She finds herself angry at the conservatory director in ways that surprise her, and she is afraid that she will further harm this important working relationship. In short, Lynn feels that she is out of control in a way that is destructive to her personal and professional sense of integrity. She cannot imagine not voicing her difference, but it never comes out quite right. She feels humiliated and embarrassed by her behavior, yet she cannot stop. She thinks about unpleasant events incessantly and feels a compulsion to act even as she sees the effect of the potential destruction. It is that perplexity that has brought her into my office. Lynn talks often about what she sees as her mother’s abuse of her older sister, turning her into a boy and a “homosexual.”
In the preceding weeks in therapy, Lynn has struggled through a series of exposures that are emotionally exhausting. In her twenties, she started a decade-long therapy that gave her a virtual home, although not much of a sense of belonging. This affiliation took away the remainder of her trust in knowing who she was, and the awareness of her deep wishes. She talks about a failed marriage in which she could not reconcile her wish for closeness with a conviction that she does not deserve to have closeness, especially as she fears sexual intimacy. There is no known incident of molestation in her history, though she felt overstimulated by both parents’ enactments as a child. As we explore her fantasies about both men and women, in which only women have contact with her, she is both ashamed about and helpless to stop the power of her sin. She is also confused. Now, Lynn reports that she feels angry at me, saying that she fears I want to make her be a lesbian (in a later session, she says her real fear is that I will make her find out that she is a lesbian). In my being a midwife who is allowing her to utter her fantasies, she can hear another voice announcing how this shows her failure to be a decent citizen of this world. Through the exploration of her fantasy of what my motivation might be, she recognizes her own fear of not really knowing who she is, and that fluidity scares her (Harris, 1991). As Laplanche (1999) stated,
It is the adult who brings the breast, and not the milk, into the foreground — and does so due to her own desire, conscious and above all unconscious. For the breast is not only an organ for feeding children but a sexual organ, something which is utterly overlooked by Freud and has been since Freud. Not a single text, not even a single remark of Freud’s takes account of the fact that the female breast is excitable, not only in feeding, but simply in the woman’s sexual life. (p. 78; italics in original)
The normalization of the power of fantasy and exploration, which expands the range of what these options might mean to her rather than simply determining her sexual orientation, helps reduce the level of torment. Gradually opening the door for a discussion of her preconceived notions of sexual orientation as badness helps create a potential space in which ideas can be examined without becoming concrete. This is the first time that Lynn describes a wish to be contained, which she begins by recognizing that maintaining what she feels are our separate perspectives on who she is feels burdensome. She needs for me to stay in an as-if position, in which we are both on the same illusionary page. I am reminded of a patient who said, with disappointment in his voice, that he felt completely understood by me until I started talking, at which point he had to see that our subjectivities were separate, and he did not welcome that. As Slochower (2005) suggested, holding may be attained by way of not necessarily having to interpret. She wrote, “It seems clear that the holding process requires that both patient and analyst bracket their awareness of the illusory nature of absolute analytic attunement for a time” (p. 38).
The hardware and software of co-(l)laboration
In this afternoon session, however, Lynn feels that she would like to work on why she is so anxious in most situations. She becomes teary, and when I acknowledge her distress she says that no one has ever taken care of her. Suddenly she stops crying and says that perhaps her mother could see that she did not want her to come near her. “But why am I afraid of her? She is frail and can no longer hurt me, but I am afraid of her.” As she ponders this she says, “I have a feeling that something happened when I was young, but I do not have any memory of it. I just know.” Although I hear this distress as also pertaining to the transference, so that she is now afraid that she will not open up with me and will miss opportunities for closeness and change, I suggest we try an EMDR set, sensing that she needs to express something possibly preverbal that resides in her body and to which she has no access in her thinking as such.
I can tell when she begins lifting her shoulder toward her ear, her head turning away and her mouth twitching, that she is “there,” dissociated and haunted by the “it” that has no name. In this case, when she uses the tappers and sinks into her fear, the image changes. She is agitated and cannot find a comfortable position. She says that she is alone, playing in her crib, when she hears her mother come into the room. She feels her entire body tense up. She looks up and can hear the door. Her mother is entering. She is mortified. As we stop for a short debrief, Lynn says she does not know why, but she is certain her mother hurt her. She is not sure how exactly she was hurt, maybe in changing the diapers, perhaps sexually. She does not know why she feels this way, as she has no memory of anything like that occurring. We process the fear with that scene in mind. Her thought is of her mother finding her to be unworthy.
With a few sets of BLS, Lynn feels the anxiety begin to release. The next break we take as we check back in, Lynn is flabbergasted, but feels that something like that must have happened. I comment that the anxiety is an accumulation of her excitement about her mother’s entrance into the room and a deep dread of what her mother would bring, together with her presence that itself is terrifying to her.
Lynn takes a deep breath, her eyes wide open and says, “That sounds possible.” She stops breathing and then continues, saying that that explains so much about her relationships to others. Although she seems rattled, the color returns to her face. She feels guilty for her thoughts about her mother and we process some of these feelings, putting them in context. Following the conversation, I offer that her longing and shame for having a woman’s body might be triggered by being both over- and understimulated. She says, “Now I can see why I feel that I was abused. That explains so much.” We part, each of us feeling the weight of what we have witnessed, a weight she has carried all along without sharing it until that moment.
With the example of Lynn’s experience of the integrated treatment modality we can begin to grasp what EMDR does for the benefit of the relational psychoanalytic inquiry. It is activating, through a subdued rattle to the body, and with the holding direction of the therapist, the hardwired strata of the patient’s anxiety, which is fixated in motion on pathways that were born in trauma, yet is also now inviting the possibility of gaining access to the yet unthinkable. We can liken the EMDR protocol to an intervention at the hardware level, allowing the mind to create new pathways in part by making possible access to the thus far unused software. In this example, following several sessions of EMDR, which are always combined with a more relationally oriented analytical process, Lynn begins to access feelings she did not know existed, and finds new layers of her psyche of which she could not be aware earlier. From this place of awareness, Lynn starts on a gentler path outside of therapy. She is able to see her attachment to old ways, begin to stand on the side of her own internal interests, and subtly change her attitude toward her right to consider her needs and wishes first. Some of these changes are unpleasant. She finds that instead of general fear of her mother, she can now feel anger at lost opportunities. Her anger is more focused, and the fear does not disappear, but she feels that she has a beginning of clarity about the feelings that are triggered in her in certain situations. That clarity she can feel in her body. She knows it to be right and therefore trusts it more in real-life situations.
Read the complete chapter here.
This excerpt from Integrating Relational Psychoanalysis and EMDR: Embodied Experience and Clinical Practice is published with permission from, and thanks to, the Taylor & Francis Group.
Integrating Relational Psychoanalysis and EMDR: Embodied Experience and Clinical Practice can be purchased on the Routledge website here.
Hemda Arad practices Psychoanalysis and psychotherapy in Seattle, Washington. Dr Arad is also a certified EMDR therapist. She works with individuals, couples and groups and provides professional consultation and supervision.