Elisabeth R. Crim, Ph.D.
In this article, psychoanalyst/psychotherapist vulnerability is addressed through a neuropsychoanalytic lens of somatic counter-transference. The article explores the neurobiological and psychospiritual vulnerability of emerging, often unconscious bodily states. These vulnerability inducing states can either be activated immediately in response to something within a session, or can manifest over time within a therapist in context of an ongoing therapeutic relationship that requires empathic attunement with a patient or can emerge in related contexts, such as during a clinical conference presentation.
Vulnerability is a concept that is difficult for individuals to understand, tolerate, and embrace, let alone attend to with care. This can be even more difficult for those of us who identify as psychotherapists or psychoanalysts. The dynamics of these identities, and the relationships that ensue, can foster the myth of our invincibility and the denial of our vulnerability. Yet, we are vulnerable beings at multiple levels of our existence: mentally, emotionally, physically, spiritually, and relationally.
Most of us who do psychodynamic work, listen with our whole being. Our minds, bodies, and spirits are all profoundly affected by the clinical material we encounter. Our listening, engaging, and attuning to the patient, at any moment, is a neurobiological and psychospiritual process (Crim, 2012, 2015). Neuropsychoanalysis notes that we are participants in the shared neuropsychoanalytic (interpersonal/neurobiological) space that holds both the patient and self, and that process, in this shared intersubjective field. In that field, our empathy is activated.
Empathy is a highly integrated neurobiological process involving both the cognitive and the somatic, both brain and body (Rothschild w Rand, 2006). When attuning to our patient, our mirror neurons engage and our bodily systems activate. We are vulnerable when engaged in the neuropsychoanalytic process of empathy. As we sustain empathic attunement, we often experience the same trauma effects that our patients are experiencing and sharing with us.
Our own vulnerability when left unattended, can yield compassion fatigue, re-activating our own past trauma, vicarious or secondary trauma, and even lead to burnout. Unattended expressions and states of countertransference can yield problems not only for patient and the treatment, but also for the individual who is the psychoanalyst, or the psychotherapist. The integrative field of neuropsychoanalysis and the current zeitgeist of mind-body-spirit, integrated health and mental health treatment invite exploration of these issues through transference and counter-transference.
Somatic Transference and Somatic Countertransference are terms I use to capture the process of emerging, and often unconscious, bodily states that are activated, within and between, therapist and patient in the shared relational space. The term “bodily” refers to the “physiological, energetic, bio-chemical, and/or neurological organizing activity of the intersubjective states between two people that is inherently relational (Crim (2012, adapted from Stolorow, Bandchaft, and Atwood ,1987).’” Somatic Transference emerges both consciously and unconsciously in a shared relational space. This can be expanded, for instance, to include the relationship of the IFPE Conference participant with highly activating presented case material, often experienced throughout multiple clinical presentations. This process can be seen in many other shared relational contexts as well.
Singular, or repeated and unattended, counter-transference experiences with one patient or with many patients, over time, can result in compassion fatigue, with its accompanying imbalance, dysfunction, fatigue, mental disorder, physical illness, and/or existential or spiritual difficulties for the psychoanalyst or psychotherapist (Crim, 2015, Portnoy, 2011). During psychotherapy sessions and during clinical conference presentations, for instance, somatic transference and counter-transference can emerge in varying neuro-bio-psycho-spiritual processes. Vicarious traumatization can occur in response to empathically listening to another’s clinical experience. Increased attention to our own vulnerability, and its “discontents,” invites a response of attention, care, and restoration.
Attending to our own vulnerability from within the analyst’s or therapist’s chair, requires a mind-body-spirit-relational intervention. Talk therapy interventions absolutely have their place. Yet, they are, from a mind-body-spirit perspective, incomplete. Alan Schore states, “…Spontaneous non-verbal transference-countertransference interactions at preconscious-unconscious levels represent implicit right brain to right, brain face-to-face, nonverbal communications of fast acting, automatic, regulated and especially dysregulated bodily based stressful emotional states between patient and therapist (Schore 1994, 2009c as cited in Petrucelli, 2010, p. 186). Pert (1997) states that we “store some memory in the brain, but by far, the deeper, older, messages are stored in the body and must be accessed through the body.” This is true for both the dysregulated traumatized patient and the therapist who is experiencing the, often traumatic, effects of empathic attunement to that patient.
How do we attend to our vulnerability, release and rebalance––neurobiologically and psychospiritually? Cole (2004) and Lasater (1995) state that yogic breath and postures can attend to the mind-body dysregulation often experienced by therapists. Breath, posture, and positive social engagement can each activate the parasympathetic nervous system to calm the activated sympathetic nervous system, when countertransference states, and vicarious or secondary trauma occur. Shankar (cited in Anderson, 2015), states, “when the mind cannot control the mind, use the breath; it is easier”.
Taking a moment between each session of therapy or between each session of conference case presentations, to release and re-balance oneself can actively combat compassion fatigue, and is one way to attend to our vulnerability. These moments of intentional self care can include mindfully entering a balanced seated or standing posture, a stretching movement, and breathing with intention. Intentionally breathing and moving can release the neuro-bio-psycho-spiritual energy that empathic attunement can activate each clinical hour.
Yoga is an ancient and long-established practice that incorporates breath, posture, and movement for mind-body-spirit balance and for health. There are many types of yoga breathing exercises and postures that facilitate a sense of returning to balance, and of feeling grounded, that releases stress, fatigue and negativity, while enhancing self-expression and confidence. Each of these can be areas of vulnerability for the therapist experiencing countertransference and vicarious or secondary trauma. Though yoga is not the only approach for learning how to breath, sit, stand, and move mindfully, it is a powerful and well-researched mind-body-spirit approach (See the Journal for the International Association for Yoga Therapists at www.IAYT.org).
Regardless of one’s approach, an active plan for self-care and restoration at the mind-body-spirit level is essential for maintaining healthy functioning for the individual who serves as a psychoanalyst, psychotherapist or IFPE or other clinical conference participant. Having a self-care plan for management of somatic counter-transference states between clinical sessions, and doing so over time, will allow for better integration, assimilation, and release of the clinical experiences and affective material presented (Crim, 2012, 2015).
Interventions that incorporate breathing, posture, movement, mindfulness, and meditation have been researched and are supported as effective neuro-psycho-physiological and neuro-psychoanalytic interventions for fatigue, bodily pain, depression, anxiety, and relational distress––some of the many discontents that result from our inescapable human vulnerability. Living from a stance of honoring our vulnerability and attending to our need for care, by including a routine plan of care for self (the person who is the psychoanalyst and psychotherapist), is an indispensible key for our own individual mind, body, spirit, relational health.
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Elisabeth Crim, Ph.D., Licensed Psychologist, Certified Relax/Renew Yoga Trainer, Founder/CEO Moonstone Center (Psychotherapy, Wellness, Professional Development). PhD and MA Psychology, MA Theology, MA Counseling. Providing treatment 25 years, she is an engaging speaker and author, offering psychotherapy, consultation, and training from an Inter-Subjective Psychodynamic (Stolorow) & Holistic Mind-Body-Spirit approach. Editor of the monthly e-newsletter+video, The Healer’s Life! Sign Up & Invite to Speak: www.MoonstoneCenter.com, www.DrElisabethCrim.com
Elisabeth Crim can be contacted at: firstname.lastname@example.org