Client’s Observation

Sometimes a client makes an observation in a therapy session that is so profound and eloquent that I am moved to write it down and, with permission, share it.  Here is such a comment:

“It really can’t be overstated, how much we carry from childhood, of being hurt, abandoned.  And the resulting kind of adaptations, adjustments we make to survive, when we’re so broken.  It just feels so old, it never ceases to surprise me how present that feeling of old pain is, or old loss, or old sadness.  I feel better today, but still I feel the loss as a child.  I suppose we never really completely lose that, do we, that sense, except through embracing the child, of course, and caring for it, respecting it, offering consideration and space and voice to that child, like any normal child…In some ways those original patterns remain, and we simply build new patterns around them or through them.  Which is kind of a cool thought, because as we evolve through, we can refer to those old patterns as we help others.  What a nice gift…It is a wonderful experience, reencountering the gift of transcendence.  It’s very cool.”

On Loneliness: Notes from the March, 2012 Chicago Assn. for Psychoanalytic Psychology Conference

The Chicago Association for Psychoanalytic Psychology’s 2012 annual conference was on the theme of “Loneliness:  An Interdisciplinary Exploration,” and I have written up my notes here, which may be of interest.  They are only my personal notes, and are neither intended to reflect a comprehensive review of the presentations nor fact-checked. The speakers were:

• John Cacioppo, Ph.D., at the University of Chicago, where he is Tiffany and Margaret Blake Distinguished Service Professor; Director of the Center for Cognitive Neuroscience, and Director of the Social Neuroscience Laboratory; presenting on: “Loneliness:  Human Nature and the Need for Social Connection.”

•Molly Witten, Ph.D., faculty member at the Erikson Institute, Chicago, and the Chicago Institute for Psychoanalysis, gave a case study presentation on: “Relational Mis-Attunement in Infancy and One Path Into and Out of Loneliness.”

•Ann-Louise Silver, M.D., faculty member at the Washington Center for Psychoanalysis, who’s presentation was entitled: “The Interrelationship of Our Patients’ and Our Own Loneliness.”

Dr. Cacioppo got the conference off to a great start with a well informed and (at least for cognitive neuroscience nerds and therapists, of which I am both) very catchy presentation on the cognitive and social neuroscience of loneliness.

“It’s your ability to have grandchildren that determines whether your genes make it into the gene pool,” he said.  What differentiates us from other animals is how much we learn socially.  Research has focused too much on the individual and not enough on the group and the individual’s relationship to the group.  “What it means to be an adult in a social species is to be the one on whom others can depend.”  To which I would add, to be able to depend on others.  “The pain and dysphoria of social isolation evolved as an aversive biological signal to support social connection, as well as vigilance for predator threat.”

Over five different studies, more socially integrated people have longer lifespans.  The hypothesis has been that other people encourage us to live a healthier lifestyle, so people with others around them will tend to live longer.  But Dr. Cacioppo disputed that hypothesis, noting that “All social animals either die early or show pathology when isolated.  The fruit fly that dies in the absence of company doesn’t die because other fruit flies don’t encourage it to exercise…Loneliness is a predictor of mortality regardless of exercise, so that nails the coffin of the ‘social connection encourages exercise’ hypothesis.”

Emotional loneliness is characterized by:

•lack of companionship

•feeling left out

•feeling isolated from others

•being unhappy about being so withdrawn

Dr. Cacioppo consults with the military, and noted that people, especially men, underestimate their own loneliness.  A military leader told him, “Loneliness is not a word we use.”

People who are socially connected are giving when with others and take individual time for solitude as needed.  Marriage is health protective if it is a positive connection, negative if the individual feels trapped.

Dr. Cacioppo used chronic pain as an analogy with loneliness.  “Loneliness is the social pain that connects the person socially.  Acute social pain motivates us to reconnect with others.”  Loneliness can be factored into two kinds.  “Social loneliness” involves feelings of relational connection, and a predictor for social loneliness is the number of personal contacts the person has had over the past two weeks.  The second kind of loneliness involves a kind of social or collective connection, for which the number of group associations a person has is a predictor.  The relational area is a little more important for women, and the collective area is a little more important for men, Dr. Cacioppo said.

Loneliness is not necessarily about how many people one knows.  “People can be around others and still feel lonely, or have one significant relationship and feel close.”  Loneliness seems to be about 50% genetic and 50% environmental.

Children are sent to time out because they are acting selfishly.  A more effective time-out is in the presence of others, rather than sending children to their room with toys.

Neurocognitivelly, the lonelier you feel the less activation of the tempero-parietal region bilaterally, which is involved in “theory of mind.”  Lonely young adults rate hassles as more severe than socially connected adults rate the same hassles.  The anteroventral striatum lights up at scenes of beauty (like a butterfly) and social connection (like a baby smiling), and lights up more in socially connected people than in lonely ones.  Social and physical pain overlap in the brain; acetaminophen and opiates both lessen the pain of loneliness.

There are significant differences between lonely and non-lonely people in factors of social support, shyness, social skills, anger, anxiety, self-esteem, fear of negative evaluation by others, optimism, positive mood, and negative mood.  Interestingly, the effect size of the differences is just as large between the same people when hypnotized to feel lonely or not lonely, in research at Stanford.

Lonely people have a different pattern of genes turned on and off compared to non-lonely people.  Feeling lonely changes the oldesst cells in the immune system.  Isolation increases immune arousal.  Loneliness also affects sleep:  the lonelier they were, the more microawakenings each night and the less beneficial the sleep that subjects experienced.  Lonely adults take more sleep medications.

An AARP study found that 35% of people are lonely.  The prevalence of loneliness seems to be increasing, as is the proportion of people living alone.

Oxytocin, the neurochemical associated with emotional bonding, decreased the perceived threat in picures, and loneliness decreased with both the amount of and sensitivity to oxytocin.  Lonely people may perceive threats and react to others as if they are threatening, which drives the perceptions and responses of others toward them.

Denmark has declared loneliness to be a national problem.

Later on, in panel comments, Dr. Cacioppo observed that “The brain has 5% of the body’s weight but uses 20% of the oxygen” that we breathe.  He also observed that “consciousness is a small part” of mind, most of which functions implicitly, even if in ways that were once learned consciously.

More information on Dr. Cacioppo’s work is at:

Dr. Witten then presented a case study of a child whom I’ll call:  “David”

Dr. Witten’s presentation changed the focus from the general and researched to the individual and clinical, but was no less fascinating and informative.  The subject was the relationship between “David,” who was nearly 10 months old when he and his parents came to see Dr. Witten, and his parents.  David’s one-minute and five-minute Apgar scores were 7 and 7, and he had low motor tone and couldn’t suck, so he’d fall asleep when nursing.  His mother had a history of depression and of having been the daughter of a mother who was so depressed that she ended up mothering her own mother, in some ways.  When David was six months old, his parents found a dula who gave him a preemie nipple and then he could suck, but by then he’d become “prickly.”  At nearly ten months, David would become upset and then “shut down his sensory-motor functioning by limiting what he would allow himself to take in and inhibiting how he would allow himself to relate,” a response which Dr. Witten saw as a kind of dissociation.

Luckily, David’s parents had consented to videotaping sessions and to their use in professional education, and Dr. Witten played tapes from an early family therapy session, and from one much later; I didn’t note the dates, but recall it being about a year and a half later.  I didn’t take detailed notes on the clinical presentation–partly because I was so busy watching and listening and partly because it’s easier to take notes on a research-based presentation like Dr. Cacioppo’s than a clinical one, especially when there’s a videotape.  My notes indicate that David’s mother (and father) were challenged in establishing a healthy reciprocal relationship with their new infant because of their own histories.  “The baby becomes the (projective screen) on which those images (of parent history) are played out,” Dr. Witten said. She quoted Andre Green:  “We carry within us the totality of our past, not as memories but as organizers (italics added).”

In her family therapy work with David’s parents and David, Dr. Witten helped his parents learn to engage with David rather than disengaging from him when he disengaged from them.  A videotape clip of a session later session, when David was walking and talking, showed a much more engaged family unit.

Dr. Witten’s psychoanalytic background made it possible for her to focus on two important processes which are acknowledged in psychoanalytic culture, but only emerging in neurocognitive culture:  dissociation and a kind of implicit organizing memory that analyst Christopher Bollas called the “unthought known;” which workers in the neurocognitive domain might think of as an implicit affective-perceptual-attributional memory.  This raises the question, “What kind of memory, neurobiologically, is not ‘remembered’ consciously but organizes perceptions and responses?”

In the final Question-and-Answer session, Dr. Witten commented, “Being a therapist means having a higher than average capacity to ‘be with’ someone else.  It’s not ‘mirroring,’” in the sense of just reflecting back to clients what they have said.  “To ‘be with’ is to be a witness to someone else’s experience.”

Ann-Louise Silver, M.D.:  Frieda Fromm-Reichmann & Therapy with Psychotic Patients

Dr. Silver’s presentation focused on the life and work of Frieda Fromm-Reichmann, one of the pioneers of psychotherapy, and the importance of doing therapy with psychotic patients, as Fromm-Reichmann did, rather than consigning the treatment of psychosis entirely to medication, as is so often done today.  Her presentation was highly informative–I didn’t know that the William Alanson White Institute, a rebellious psychoanalytic training program in New York where several of my teachers were trained, was started by therapists working in Washington, D.C., among whom was Fromm-Reichmann–but didn’t really address the topic of the interrelationship of patients’ and therapists’ loneliness.  Yet Dr. Silver’s humanity was clearly shown throughout her presentation.  “We need to wean ourselves from a professional dependency on the DSM,” she said, “thinking of loneliness as a depression.  One person (the client) comes with suffering, and you’re forming a team until the person doesn’t need you anymore.”

In all, it was a really valuable conference.  Thanks to CAPP, and President Bernadette Berardi-Coletta, Ph.D., for conceiving and organizing it.  (I’m a member of CAPP and Chair of Peer Study Groups.)