Back to the Beginning: An exploration of the treatment and effects of therapeutic regression to dependence in psychotherapeutic practice Lorraine Price Thesis submitted in partial fulfilment for the award of Doctor of Philosophy January 2014 Doctor of Philosophy of De Montfort University 1 We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time. T.S. Eliot, “Little Gidding” 2 Acknowledgements I want to thank my husband, Ian for his support over many years. He has always been willing to step into the breach and do what was necessary to help, even when it really cost him. My children David and Helen and their families have tolerated my inability to be there for them, even when they really needed me. My friends Julie and Doug, who have known I could succeed, and Denis, Lorna, Jo, Lionel, Rosemary and my other friends and colleagues at SPTI who have tolerated my stress and supported me through it their own different ways. My thanks also go to my friend Sue who has patiently shared her wisdom with me. My supervisor, Brown has offered me his experience and challenge, and I am grateful for his support. Finally, my appreciation and thanks to two people without whom my work would not have happened, Dorothy and Richard. Dorothy has tirelessly and generously supported me both practically and emotionally throughout the whole process of this work. She has kept me going and has sat at my computer for many long hours. She deserves an award. Richard has loved me through it and taught me many things. He has understood who I am even when I have lost sight of me. Thank you to you all. 3 The author of this study has published two articles addressing similar themes: Price, L. (2007) The Dark House of Infancy: An Exploration of Regression to Primitive Pre-Verbal States for Clients in Integrative Psychotherapy. The British Journal of Psychotherapy Integration, 4:1, 81. Price, L. (2009) From Theory to Therapy: An Exploration of the Relevance of Winnicott’s Theories in Regression to Dependence. The British Journal of Psychotherapy Integration, 6:1, 29-39. 4 Abstract This research builds upon and explores an enigmatic set of experiences which theorists in the Object Relations tradition have characterised as regression to dependence, a return to a primitive, pre-verbal relational process presenting in some clients in psychotherapy. This research is a study of the concept of regression to dependence, its manifestation within the psychotherapy process, and facilitation within the therapeutic relationship. The Psychoanalytic theoretical positions on regression to dependence are explored, together with the Relational/Developmental perspective which recognises regression and its importance within psychotherapy. This exploration seeks to understand the experience of regression to dependence, how regression to dependence can be effectively worked within Integrative Psychotherapy, and makes recommendations for Integrative practitioners and theorists related to effective facilitation of clients, showing how the Relational/Developmental approach can effect repair. The study employs a qualitative methodology. A heuristic study was undertaken in which eleven practicing psychotherapists were interviewed and data was collected via semi-structured interviews. Most participants were interviewed twice, with a view to collecting data on both their personal experience as a client in psychotherapy and also their experiences as practitioners when working with clients who were experiencing regression to dependence. The transcripts from these interviews were analysed for emergent themes. The themes are discussed in the context of and with reference to the Psychoanalytic theoretical position and the Relational/Developmental perspective. An account is offered of how these experiences have come to be understood as recollecting difficulties in early infantile relationships. Reflections are made on the essence and qualities of a therapy that can facilitate regression to dependence in order to promote healing. Recommendations are made for the practice of Integrative Psychotherapy and the training of Integrative Psychotherapists in order to prepare them for this work. These recommendations for therapists include; having sufficient preparation, knowledge and understanding to be able to recognise and work with a regressive process emerging in the client; having an understanding of the need to facilitate this process for some 5 clients; and to be aware of the need for particular adaptations in the therapeutic stance in some circumstances, and the difficulties which may arise. Recommendations are also offered regarding the support needed for the therapist whilst working with this process, which include the need for ongoing personal therapy, and supervision. The researcher’s personal story is an intrinsic part of the research, and as an integral part of this study is in accordance with the heuristic and autoethnographic styles, and with the practice of Integrative Psychotherapy, where the use of self is seen as a crucial clinical tool in the therapeutic process. Throughout this study reflexivity has been used regarding the personal experiences of the researcher as client, therapist and researcher. 6 Contents Chapter One - Introduction ................................................................. 12 In summary ............................................................................................................ 22 Chapter Two - Literature Review ....................................................... 23 Introduction ............................................................................................................ 23 Historical perspectives............................................................................................ 26 Object Relations and Attachment............................................................................ 28 The metaphor of the baby ....................................................................................... 32 The contributions of Balint and Winnicott in the understanding of infant development and psychotherapeutic theory ............................................................. 33 The influence of Kohut ........................................................................................... 39 Theoretical concepts of splitting ............................................................................. 40 Theorists’ responses to the concept of therapeutic regression .................................. 41 Transference within the therapeutic relationship ..................................................... 44 The importance of narrative in the development of self........................................... 45 Reservations regarding regression to dependence ................................................... 46 Concepts from trauma theories ............................................................................... 49 Contemporary concepts on the therapeutic relationship .......................................... 53 Relational needs ..................................................................................................... 55 Developmental concepts from shame theory ........................................................... 57 Concepts of boundary within the psychotherapeutic relationship ............................ 61 Touch ..................................................................................................................... 62 Pre-verbal experience: the neuro-scientific connection ........................................... 65 Chapter Three - Methodology ............................................................. 68 Introduction ............................................................................................................ 68 Quantitative and qualitative research concepts ........................................................ 68 Applying qualitative methods to psychotherapeutic research .................................. 70 7 Feminist research ................................................................................................... 71 The interview process develops .............................................................................. 72 Reflexivity ............................................................................................................. 74 Choice of method ................................................................................................... 77 Application of the heuristic research style............................................................... 79 Validation .............................................................................................................. 88 Use of self .............................................................................................................. 89 Search for a meaning .............................................................................................. 90 The value of story telling ........................................................................................ 90 Finding the research topic ....................................................................................... 91 Seeking ethical approval ......................................................................................... 92 Research questions ................................................................................................. 92 Participants, requirements and rationale .................................................................