Traumatic Early Bonds Called Guilt

In the last post we saw several reasons why it is so difficult to abandon our own pathogenic beliefs and schemas, even when our experiences disprove them. Among the different factors contributing to this fact, one of the more relevant is unconscious guilt. As Freud (1916, 1923, 1925, 1929) pointed out decades ago, patients punish themselves with their symptoms and problems; and, as suggested by Fairbairn (1952, 1963), their suffering is a function of their bonds with bad internal objects.  According to Control-Mastery Theory, we could add that the strength of unconscious guilt is a good approximation of the strength of these bonds.

Guilt is a painful moral emotion depending on our capacity to feel empathically the distress of another person, on our attributing to ourselves the responsibility for this distress, and on our desire to avoid or repair it (Friedman, 1985). Recent developments in affective neuroscience and cognitive, developmental, and evolutionary psychology (Zahn-Waxler & Robinson, 1995; Bybee & Quiles, 1998; Hoffman, 2000; Panksepp & Biven, 2012) stress that guilt is a function of our altruistic/pro-social motivations (Tomasello, 2016), which are as primary as our egoistical and self-centered motivations. If individual natural selection can explain why we may be so egoistic, our altruism evolved thanks to group selection (Wilson, 2007, 2015): we harbor pro-social altruistic motivations because we are a eusocial species living in groups.  The abilities and motivations that drive us to help another human being have been “rewarded” by evolution because they have promoted the survival and reproduction of our groups.

Guilt stems from fear (of losing the bond with or the love of another person), attachment (to that person), and care (for him or her) (Gazzillo et al., in press; Kochanska, Gross, Mei-Hua & Nichols, 2002).   In contrast to classical psychoanalytic thinking, there is no need to harbor aggressive wishes in order to feel guilty; believing that what you want or do could harm your loved ones or your relationships with them is sufficient to cause guilt. And in contrast to classical cognitive models (e.g., Kohlberg, 1969), contemporary moral evolutionary psychology shows that feeling guilty is not a consequence of complex reasoning, but of an intuitive emotional assessment of the reality we face.

There are six “moral foundations” (Haidt, 2012) that we all share because they are “wired” in our brain and shape our moral sensitivity: we value protection and condemn harm, appreciate loyalty and criticize betrayal, reward equity and punish cheating; we appreciate the respect of legitimate authority and condemn arbitrary subversive actions; we want to be free and disrespect oppressing others and, finally, we feel that our body is to a certain extent sacred and are morally disgusted by its degradation.  Different cultures shape the meaning and give more weight to some of these foundations and less to others, as do our personal experiences -- in particular the early, traumatic experiences that are the bases of our pathogenic beliefs. These beliefs may transform guilt, which is basically adaptive, in a relevant pathogenic force.

Control-Mastery Theory (Bush, 2005; Weiss, Sampson & The Mount Zion Psychotherapy Research Group, 1986; Weiss, 1993) has focused its attention to four families of pathogenic beliefs which give rise to four kinds of guilt: survivor guilt, separation/disloyalty guilt, omnipotent responsibility guilt and self-hate. Survivor guilt refers to a painful emotion that people may experience when they are surpassing important others, believing that they are hurting them by being more successful, happy, fortunate, etc. Separation guilt stems from the fear of harming others by becoming independent and moving away, while disloyalty guilt stems from the belief that being psychologically different from them will be hurtful to loved ones. Omnipotent responsibility guilt involves an exaggerated sense of responsibility and concern for the happiness and well-being of other people, and it is based on the belief that one has the duty and power to save loved ones in trouble. The last kind of interpersonal guilt, self-hate, arises when an individual complies with severely critical, abusive, or neglecting attitudes of important others, often a parent. It describes the feeling of being inherently wrong, inadequate, guilty, and not deserving of love, protection, and happiness. These interpersonal guilt feelings described by CMT are compatible with four of the six moral foundations pointed out by Jonathan Haidt (2012).

Unconscious interpersonal guilt condemns people anytime they try to be separate, different, or better off than their loved ones and anytime they try to give value to themselves and their life. Various childhood experiences give specific meanings to being different, separate, or better off than love ones, but the basic conflict remains the same: am I allowed to pursue my personal and relational wellbeing or must I sacrifice my life to my early love objects?

Finally, according to CMT guilt often supports chronic shame, which is an expression of compliance to shaming parents or identification with shameful parents; in either case, shame is maintained by difficulties in differentiating and becoming independent from or displeasing parental figures.  In other words, the feelings of shame are maintained by guilt toward loved ones.  In a zero-sum game, interpersonal guilt causes us to experience our gain as a loss for the people we depended on, and leads us to sabotage our life out of loyalty and solidarity with the relational vestiges of our past.

 

References

 

Bush, M. (2005). The role of unconscious guilt in psychopathology and in psychotherapy. In G. Silberschatz (ed.), Transformative relationships. The Control-Mastery Theory of Psychotherapy (pp. 43-66). New York: Routledge. 

Bybee, J., Quiles, Z. N. (1998). Guilt and mental health. In J. Bybee (Ed.), Guilt and Children (pp. 270-291). London: Academic Press.

Fairbairn, W. R. D. (1952). Psychological Studies of the Personality. London: Routledge & Kegan Paul.

Fairbairn, W. R. D. (1963). Synopsis of an Object-Relations Theory of the Personality. International Journal of Psycho-Analysis, 44, pp. 224-225.

Freud, S. (1916). Some Character-Types Met with in Psycho-Analytic Work. The Standard Edition of the Complete Psychological Works of Sigmund Freud, (Vol. 14, pp. 309-333). London: Hogarth.

Freud, S. (1923). The Ego and the Id. The Standard Edition of the Complete Psychological Works of Sigmund Freud, (Vol. 19, pp. 1-66). London: Hogarth.

Freud, S. (1925). Inhibitions, Symptoms and Anxiety. The Standard Edition of the Complete Psychological Works of Sigmund Freud, (Vol. 20, pp. 75-176). London: Hogarth.

Freud, S. (1929). Civilization and its Discontents. The Standard Edition of the Complete Psychological Works of Sigmund Freud, (Vol. 21, pp. 57-146). London: Hogarth.

Friedman, M. D. (1985). Toward a Reconceptualization of Guilt. Contemporary Psychoanalysis, 21 (4), pp. 501-547.

Gazzillo, F., Gorman, B., De Luca, E., Faccini, F., Bush, M., Silberschatz, G., Dazzi, N. (in press.). Preliminary data about the validation of a self-report for the assessment of interpersonal guilt: The Interpersonal Guilt Rating Scale-15s (IGRS-15s). Psychodynamic Psychiatry.

Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. New York: Pantheon/Random House.

Hoffman, M. L. (2000). Empathy and moral development: Implications for caring and justice. New York: Cambridge University Press.

Kochanska, G., Gross, J. N., Mei-Hua, L., Nichols, K. E. (2002). Guilt in young children: Development, determinants and relation with a broader system of standard. Child Development, 73, pp. 461-482.

Kohlberg, L. (1969). Stage and sequence: The cognitive development approach to socialization. In D. A. Goslin (ed.), Handbook of socialization theory (pp. 347-480). Chicago: Rand McNally.

Panksepp, J. Biven L. (2012), The Archeology of Mind. Neuroevolutionary Origins of our Emotions. New York. W.W. Norton & Company.

Tomasello, M. (2016). A natural history of human morality. Boston: Harvard University Press.

Weiss, J. (1993), How Psychotherapy Works. Process and technique. Guilford, New York.

Weiss, J., Sampson, H., & Mount Zion Psychotherapy Research Group (1986). The psychoanalytic process: Theory, clinical observation, and empirical research. New York: Guilford Press.

Wilson, D. S. (2007), Evolution for everyone: How Darwin's theory can change the way we think about our lives. New York: Delta Press.

Wilson, D. S. (2015). Does altruism exist: culture, genes, and the welfare of others. Boston: Yale University Press.

Zahn-Waxler, C., Robinson, J. (1995). Empathy and guilt: Early origins of feelings of responsibility. In J. P. Tangney & K. W. Fischer (ed.), Self-conscious emotions: The psychology of shame, guilt, embarrassment, and pride (pp. 143-173). New York: Guilford Press.

Beliefs and pathogenic beliefs

In order to adapt to reality, since the very first moments of life (Stern, 1985) we start to develop and test reliable “maps” of our world.  We do it first unconsciously and then consciously, and in developing these maps we pay particular attention the kinds of situations, experiences, and people that make us feel safe or in danger. These “maps” organize our perceptions, cognition, emotions, behavior and they shape our temperament as well as the development of our personality (Silberschatz, Sampson, 1991). They are our guides into the world and describe how we are, how other people are, how the world is and how we must behave in order to reach our goals and to avoid dangers. These maps, which we will call “beliefs”, define our “reality” and “morality” (Weiss, 1993). Our “beliefs” or more precisely, our “system of beliefs”, are not originally expressed in words, so that we have sensorial, motorial, and procedural maps together with verbal maps which tend to be hierarchically structured. We can formulate most of these beliefs as “if…then” structures, and try to make them as coherent as possible.

The beliefs we develop are strongly influenced by the emotional/motivational systems which are active when we first develop them, and even as we modify and build new beliefs throughout life the beliefs we developed as children (and adolescents) tend to be particularly powerful.  Why are beliefs formed in childhood so compelling?  Children are totally dependent on their caregivers and consequently can easily feel endangered: our attachment (and care) needs are stronger than ever, we need to have a good enough relationship with caregivers and will do anything we can to preserve this vital relationship. We need to see our caregivers as strong, good, and wise, and if there is a disagreement we think that we are wrong and they are right.  In fact, children tend to think that the way their parents treat them is the way they deserve to be treated. Thus, the implicit and explicit demands, teachings, and the experiences we had with our caregivers are the foundation of our core beliefs. The beliefs that we develop when we are children are also influenced by our cognitive and emotional immaturity and by the paucity of our experiences.  As children, we tend to put our self at the center of any situation, often give  ourselves more power than we have,  blame ourselves more than we deserve, and  overgeneralize on the basis of very few cases (Weiss, Sampson, & the Mount Zion Psychotherapy Research Group, 1986).

Each of our beliefs is then connected to four possible strategies: compliance (with the parent and the belief), identification (with the parent who “taught” it to us), rebellion (against the parent and the belief) and counteridentification (with the parent who “taught” it to us). These strategies, together with the belief they are associated with and the affects that connotate it, give rise to our “schemas” (Silberschatz, 2005).  

We are very slow in changing our beliefs and schemas (which is basically adaptive) and tend to more heavily weight information or experiences that confirm them (confirmation bias) - particularly for the beliefs that warn us against danger. And there is a subset of beliefs and schemas that we call “pathogenic beliefs and schemas” because they make us suffer, inhibit us, fuel our symptoms, or push us to behave in ways that are dysfunctional. They are generally formulated during our developmental years and their defining feature is that they associate the pursuit of a healthy and pleasurable goal to an internal or external danger to ourselves or to loved ones. Pathogenic beliefs and schemas may be conscious but are generally unconscious either because they are repressed or because they are based on implicit/procedural knowledge.

Pathogenic beliefs and schemas derive from both “shock” and “stress” traumas, and they originated as efforts to adapt to these traumas: we developed them by processes of inference, trying to understand how the trauma happened, what we did to cause it and how we can prevent similar traumas in the future.  However, with the changing of our needs, relationships, and experiences these beliefs and schemas become maladaptive because the negative consequences they have on our lives are too burdensome and painful.  Consequently, even though it feels dangerous, we are deeply motivated to disconfirm them and this is the main reason a patient looks for a therapist.

Just one example: Seeing that my mother looked hurt any time I wanted to spend time with people other than her, I developed the pathogenic belief that the people I love are easily hurt if I do not remain close to them.  As a result of this belief, I may tend to: (1) always stay very close to people I love (compliance) and feel guilty if I do not do so; (2) avoid interpersonal closeness and feel a claustrophobic anxiety when another person wants to be very close to me (rebellion); (3) require people I love to be very close to me and become hurt or angry when they want to be with other people (identification), or (4) convey the message that I do not need loved ones to stay with me and then become anxious or guilty when I sense that they feel that I need them to stay close to me (counteridentification). These could be my pathogenic schemas.

 

References

 

Silberschatz, G. (2005). (ed.), Transformative relationships: The control-mastery theory of psychotherapy (pp. 219-235). New York: Routledge.

Silberschatz, G., & Sampson, H. (1991). Affects in psychopathology and psychotherapy. In Safran, J.D., Greenberg, L.S. (eds.) (1991), Emotion, psychotherapy, and change. New York: Guilford Press, pp. 113-129.

Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. London: Karnac Books.

Weiss, J. (1993). How psychotherapy works: Process and technique. New York: Guilford Press.

Weiss, J., Sampson, H., & Mount Zion Psychotherapy Research Group. (1986). The psychoanalytic process: Theory, clinical observation, and empirical research. New York: Guilford Press.

 

Some notes on testing

If we should say which single concept may best differentiate CMT from all other approaches, probably our choice would fall on the concept of testing. Why was Weiss the only theorist able to identify the testing activity of patients?  As pointed out by Marshall Bush some years ago, it was probably because he was so clearly able to understand that our unconscious functioning is fundamentally adaptive. If we see our basic functioning as adaptive, we can try to understand the adaptive aims of our thoughts, emotions, communications, and actions even if they appear meaningless or “crazy”. And we should try to understand what patients do in psychotherapy according to this perspective.

What does testing mean? Tests are trial actions (unconsciously) aimed at disproving our pathogenic beliefs, at checking the level of safety of the interpersonal environment we live in, and at mastering the trauma which are the basis of our pathogenic beliefs. Testing means hoping that the trauma we experienced were not the only experiences we could have had, and that they were not deserved.  The testing concept also implies that our pathogenic beliefs are not the only possible truth about ourselves and the world and that we can find other people and other relationships to help us disprove them.  More generally, it implies that we want to get better, feel that this is possible, and basically that we know what we need in order to do so. The testing activity is intersubjective at its core, and it shows the implicit (and then explicit) ability to mentalize that human beings have since they are 10 months old (Murray, 2014).  I can test only if I believe that you can believe something different from what I believe.  From another perspective, testing is like devising clever scientific experiments by which we try as hard as we can to disprove grim, painful hypotheses that constrain our life.  However, this metaphor does not sufficiently take into account the pressure that we exert on the other person while testing, always with the aim of disproving our pathogenic beliefs. As scientists, we are not “neutral” at all.

Tests can be brief or longer lasting, mediated by actions, communications, silences, or attitudes.   Testing can be the primum movens of a specific kind of “acting”, while other times the testing activity functions as an “inner observing eye” carefully observing reactions to our enactments.  Although any communication or action can have a testing dimension, this is not inevitably the case because we can also simply behave according to our pathogenic beliefs, self-punitive motives, or efforts to adapt as best as we can to our environment.  However, we can be sure that testing is central when a patient stirs up in us strong emotions, pushes us to do something, or behaves in a particularly “absurd” and “excessive” way (Weiss, 1993).

Moreover, we all know that we can differentiate transference tests from passive-into-active tests, and we can also differentiate compliance tests vs tests by rebellion/non- compliance. We all utilize different testing strategies; most of us “select” one (or a few) favorite strategies and utilize it/them most of the time, which is one of the elements defining our “personality”; others may use a variety of strategies at different times for testing particular beliefs.  Finally, patients may test us simply by observation, in an effort to understand if our attitude, behavior, reactions and so on convey that we share their pathogenic beliefs – hoping, of course, that this will not be case.

The meaning of any patient behavior needs to be understood according to the pathogenic beliefs particular to that patient and activated in that specific situation.  Optimally, patients are best understood if we have developed an accurate formulation of the patient plan (Curtis, Silberschatz, 2007).  Moreover, similar behaviors, communications or attitudes may test different pathogenic beliefs at different points in therapy.  A case-specific plan formulation is typically the most useful guide to the therapist for understanding the patient and for passing the patient’s tests.

As a final note it is useful to keep in mind that in those moments where a patient seems to be most resistant or problematic, are the very moments where the patient is vigorously testing or working unconsciously to get better.  This point can be enormously helpful in our therapeutic work because it preserves hope and optimism exactly when they are most needed.

References

Curtis, J.T., Silberschatz, G. (2007), The Plan Formulation Method. In Eells (ed.), T.D., Handbook of Psychotherapy Case Formulation (2nd edition).    Guilford Press, New York pp.198–220.

Murray, L. (2014), The Psychology of Babies: How relationship support  development from birth to two. Robinson, London, UK

Weiss, J. (1993), How Psychotherapy Works. Process and technique. Guilford, New York.

Welcome

Welcome from Rome to all the members of the San Francisco Psychotherapy Research Group (SFPRG)! I would like to say thank you to George Silberschatz and the Board of Directors of the SFPRG for the opportunity of working on this blog of the SFPRG website, and to Marshall Bush for his ongoing support. The aim of this new blog will be to share and discuss some of theoretical, clinical, and empirical facets of CMT through brief posts.

The first topic I would like to talk about is the centrality of adaptation in mental functioning.  We try to adapt to our environment first unconsciously and then consciously because our unconscious functioning is basically sophisticated and adaptive. It is quite likely that such basic concepts are taken for granted by any CMT therapist, but I think that they deserve more reflection. In fact, therapists trained in different theoretical frameworks are not so accustomed to asking “To which kind of environment has s/he tried to adapt by thinking, feeling and behaving in this particular way?” It is much more likely that they try to understand which kind of desires s/he is trying to fulfill, which kind of defenses s/he is showing, or what kind of deficit is manifested by his/her problems. In contrast CMT therapists try to understand the kind of environment and traumas the patient needed to adapt to, how s/he is likely to have shaped his/her view of relationships, and how s/he would need this relationship to be in order to get better. However, quite interestingly, in a few recent papers clinicians and researchers working with Peter Fonagy (Fonagy, Luyten, Allison, Campbell, 2017a, b) within the framework of the mentalization theory have started to conceptualize psychopathology as an expression of their adaptations to traumatic environments.

It is not obvious that each person does her/his best to adapt to their particular reality first unconsciously and then consciously. In general, both lay people and psychotherapists tend to think that adaptation is a conscious (or preconscious) motivation pursued by conscious (or preconscious) thinking. The idea of an adaptive unconscious, that now is supported by y experimental data (see, for example, Wilson, 2002; Gladwell, 2005), is at the core of Joe Weiss’s theory.  Weiss developed his ideas from systematic clinical observations and from several hypotheses developed here and there by Sigmund Freud (1920, 1925, 1938) in the last twenty years of his life. While Heinz Hartmann in 1939 wrote a famous book on adaptation in psychoanalytic theory, most dynamic models developed after Freud regarded adaptation as only one of five metapsychological point of views (Rapaport, Gill, 1960), and rarely a very relevant one in understanding how patients work in analysis. So, the idea of an adaptive unconscious is quite specific of the CMT model, and informs the view that we understand what patients do in therapy as an expression of their adaptive efforts to get better (Weiss, undated, “The adaptive use of the analyst”). 

Saying that adaptation is central does not mean that there needs to be an “adaptation drive” or “survival instinct”.  Survival and adaptation are not something that we are motivated to pursue; they are the “expected outcome” of how our unconscious (and then conscious) mental functioning has been shaped by hundreds of thousands of years of individual and group selection (Minsky, 1986; Wilson, 2007). Our unconscious functioning, shaped by evolution, is basically adaptive in its motivational, affective, cognitive, and behavioral components. And it would be better to talk about multiple and relatively independent unconscious processes than about a single unitary unconscious mind.

Adapting to an environment means both modifying ourselves to fit the environment and also modifying the environment so that it fits with what we need. If my body needs food, it is adaptive that my mind indicates to me this fact making me feel hungry. And if I feel hungry, I start looking for food, and I may pull a fruit from a branch, and this modify my environment. Along the same line, if a little child wakes up and does not see her mother, she feels sadness and starts crying, which is very adaptive, and this crying alerts the mother, who will be pushed by her care system to go to her little child, which is adaptive too. So, adaptation means often a modification of the environment we live in – or we believe to live in.  

One of the main expressions of the centrality of adaptation in our mental functioning is our need for safety, which is initially personal safety, but in CMT it is much more -- we cannot feel safe if we believe that something bad may happen to our relationships and the people we love. So, in CMT safety involves not only the attachment emotional/motivational system, but also the care system and the play/cooperation system.  In this regard, CMT anticipated, and is in line with, the results of recent evolutionary and developmental psychology and neuroscience data showing the centrality and the precocious emergence of prosocial motivations in human functioning (Gilbert, 1989; Liotti, Fassone, Monticelli, 2017; Haidt, 2012; Panksepp, Biven, 2012; Tomasello, 2009; 2016; Wilson, 2015)

Just one more suggestion. It has been not rare that turtles had been seen to “suicide” under the wheels of cars on beachfront streets. Does this fact mean that even turtles, as human beings, may act so maladaptively and try to kill themselves? No. Actually, the behavior of these turtles is a perfect adaptation to the environment they are programmed to live in. They were simply looking for their way back to the sea at night after having deposited their eggs on the beach, and they were using the street lights as indications of where the sea was. If no cars had been there, the only light they could have seen would have been the moonlight reflected by the surface of the sea. So, they were acting according to an adaptation to an environment that had gradually changed. They were victims of a ghost from the past. Similarly, psychopathology is typically based on pathogenic beliefs, which are adaptations to an early traumatic environment.

Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017a). What we have changed our minds about: Part 1. Borderline personality disorder as a limitation of resilience. In Emotion Dysregulation. 4 (1), 11.

Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017b). What we have changed our minds about: Part 1. Borderline personality disorder, epistemic trust and the developmental significance of social communication. In Emotion Dysregulation. 4 (1), 9.

Freud, S. (1920). Beyond the Pleasure Principle. The standard edition of the complete psychological works of Sigmund Freud. (Vol. 13, pp. 1–64). London: Hogarth.

Freud, S. (1925). Inhibitions, Symptoms and Anxiety. The Standard Edition of the complete psychological works of Sigmund Freud, (Vol. 20, pp. 75-176). London: Hogarth.

Freud, S. (1938). An Outline of Psychoanalysis. Standard Edition. New York.

Gergely, G., & Watson, J. S. (1996). The social biofeedback model of parental affect-mirroring. The International Journal of Psycho-Analysis77(6), 1181.

Gergely, G., & Watson, J. S. (1999). “Early socio-emotional development: Contingency perception and the social-biofeedback model” (pp.101-136). In Rochat, P. (Ed), Early social cognition: Understanding others in the first months of life.

Gilbert, P. (1989). Human nature and suffering. Hove, UK: Lawrence Erlbaum Associates Ltd.

Gladwell, M. (2005). Blink: the power of thinking without thinking. Boston, MA: Little, Brown and Co.

Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. New York: Pantheon/Random House.

Hartmann, H. (1939). Ego Psychology and the Problem of Adaptation. New York: Int. Univ. Press.

Liotti, G., Fassone, G., Monticelli, F. (2017). L’evoluzione delle emozioni e dei sistemi motivazionali. Teoria, ricerca, clinica. Milano: Raffaello Cortina Editore.

Minsky, M. (1986). The Society of Mind. New York: Simon & Schuster.

Panksepp, J., & Biven, L. (2012). The archaeology of mind: neuroevolutionary origins of human emotions. WW Norton & Company.

Rapaport, D., & Gill, M. (1960). The Structure of Psychoanalytic Theory. New York: Int. Univ. Press.

Tomasello, M. (2009). Why we cooperate. Cambridge, MA: MIT Press.

Tomasello, M. (2016). A natural history of human morality. Boston: Harvard University Press.

Wilson, D. S. (2007), Evolution for everyone: How Darwin's theory can change the way we think about our lives. New York: Delta Press.

Wilson, D. S. (2015). Does altruism exist: culture, genes, and the welfare of others. Boston: Yale University Press.

Wilson, T. D. (2002). Strangers to ourselves: Self- insight and the adaptive unconscious. Cambridge, MA: Harvard University Press.