Book Review by Samoan Barish, Ph.D.
Author: Lawrence E. Hedges, Ph.D.
Publisher: Jason Aronson, Northvale, NJ
Increasingly many people who are archaically organized are presenting themselves to us for treatment. This poses a big challenge for many reasons–not the least of which is that we are no longer residing (if we ever really were!) in the comfortable, familiar land of the neurotic, replete with the capacity for symbol formation, verbalization, ambivalence, internal conflict, and triangular Oedipal dynamics. Rather, we are dealing with deeply emotionally troubled people whose traumatic experiences are encoded non-verbally. Instead of words, they express in the language of the soma–of physical sensations, touch, smell, taste, and feeling (Winnicott’s notion of “In dwelling”). This is a developmentally earlier version, if you will, of Proust tasting the madeleine cookie, only to have spread before him a vast storehouse of sensations and memories of his boyhood summer days in Combray.
Hedges expressly addresses experiences from the distant past. His work on the “organizing experience” is thorough, encyclopedic, and original. He has a carefully reasoned, well researched, logically constructed theoretical and clinical schema for understanding and working with people who “cannot make or sustain full emotional contact ’Discussion of Working the Organizing Experience by Lawrence E. Hedges, Ph.D. at Dialogues for Prominent Clinicians which was sponsored by the California Institute of Clinical Social Social Work on September 16, 1995. with others.” These are people who subjectively had devastating attachment experiences in the first days, weeks, and months of their lives. He defines his term “the Psychotic Mother” as the internalized representation of the other who was experienced as traumatizing to early connecting possibilities.
Hedges utilizes many evocative terms in an attempt to help us empathize with the reconstructed terrified infant in our consulting room without blaming the real mother. I especially appreciated his deep empathy and appreciation for people with organizing experiences, and for their hellish struggle of push and pull, to and fro, as they seek a necessary, but emotionally life threatening, connection to another person (the therapist). When working with these difficult patients we are often held to an exquisitely narrow margin for engagement. Because of this we are often prone to cast aspersions on these patients and to be pajorative-both because of the primal anxieties awakened within us by them, and because of the. overall stressful and frustrating nature of working with people in such regressed states. Hedges goes a long way towards dispelling some of this negativity by his impressive empathy and appreciation of their emotional plight which he conveys poignantly and graphically.
Hedges builds his clinical theory out of the works of the British object relations theorists, as well as from contemporary American and continental theorists and a panoply of infant observation studies. Using his own “listening perspectives” language and pointing out the major paradigm shift that is taking place in contemporary clinical thought, Hedges outlines schematically central themes of the organizing experience, major issues on the organizing path, techniques for achieving therapeutic contact, and most importantly, propensities for particular countertransference configurations.
I personally had some trouble with what I felt was too proscriptive an approach for case management, but Hedges has his convincing rationale for the employment of provisions. Although I subscribe to the notions of optimal responsiveness (Bacal) and optimal provisions (Lindon), in reality there is not always such a clear line between therapist’s enactments and impingements, and therapeutic responsiveness; nor between a therapist creating a necessary space for the patient (in Winnicott’s sense of the moment of hesitation) and therapist unresponsiveness.
Hedges has incorporated some theories and beliefs from the British independent group, particularly notions of development that pivot around early bonding and connections with the mothering one. Clearly, these issues are center-most in working with patients, who, as infants, did not experience the essential “protective shield” (Khan). Many of the ideas included in Hedges’ approach have become increasingly integrated into more mainstream psychoanalytic thinking. For example, Bowlby’s work features attachment styles such as secure, insecure, anxious, avoidant, disorganized, and recently, the traumatized, as elaborated by Ainsworth and Main. Bowlby views attachment behavior as an utterly innate, bio-psychological requirement for development and growth, the foundation for “a secure base.” Suttie, an early object relations theorist, discussed the “innate need for companionship that all humans have, starting from birth and a primary need to belong.” Fairbairn avowed that the infant was “object seeking.” Balint presented us with the notion of “primary love,” where there is an interdependence between the mothering one and the infant and where the infant experiences both a sense of oneness and a sense of difference. Winnicott’s work highlights ideas such as the indivisibly of the mother infant unity, primary maternal preoccupation, the facilitating environment, the spontaneous gesture, and holding.
Bion’s concept of the container and the contained speaks to the essential requirements of the mother-infant unit. Trevarthan, a contemporary infant researcher, demonstrates in his studies the infant’s primary needs to connect to the outside, as well as the baby’s high interest in the mothering one.
Another contribution that has high relevance for Hedges’ work is Balint’s notion of the “basic fault.” Balint saw the basic fault as emanating from a lack of fit between mother and infant. We can think of the basic fault as a descriptive term. It is essentially a crack that spreads throughout the whole psychic system. Balint’s view of treatment is the necessity of the patient regressing to the basic fault, which can then lead to structure building and a “new beginning.” Further, Hedges’ organizing experience seems to have echoes of Fairbairn’s and Guntrip’s notions of schizoid phenomena; the schizoid defense where the person is detached and struggling with bad internalized objects, and the schizoid dilemma with its preemptory, vacillating movement towards and away from the other.
All of these contributions and countless others attest to the essential requirement for connection, bonding, and attachment and the primacy of the infant-mother dyad for development. Hedges’ work utilizes this rich heritage of bonding studies to demonstrate how breaks, breaches, or ruptures in the connecting experience give rise to an internalized propensity to avoid and/or to destroy connections—a feature of human emotional life which can be fruitfully studied as transference, resistance, and countertransference manifestations.
Hedges work, bolstered by the contributions of many others, leads us to a profound recognition of the life and death quality of the struggle that people in the organizing experience engage in around their inevitable relational longings (no matter how disavowed),
and their sheer terror of recreating in transference their primordial traumas. In short, no matter how damaged any of us may be as humans, we are compelled to make connections with another. Yet these very connections are at times experienced as threats to our sense of psychological survival. Attaching is sometimes so agonizing that people cannot live with it, and yet they really cannot live without it. Truly, this is a Catch 22 situation without an iota of the humor. Joseph Heller, where are you when we most need you!
Hedges believes that people in such a plight are amenable to good analytic therapeutic work, with the therapist actively creating as safe a holding environment as possible. He presents his treatment recommendations clearly. He works with the organizing psychotic transference, tracks contact moments, and watches for opportunities to analyze contact ruptures. He strongly believes that the therapist must be actively involved, emotionally present, and interactive to do this kind of work. Further, he takes a position, while being fully mindful of possible professional and legal censures, that at certain moments and under certain conditions “interpretation by way of human touch is necessary.”
Hedges’ very thoughtful and stimulating book stretches our imaginations and raises our consciousness about the earliest period of human life; highlighting the increasingly convincing fact that from utero on, the little human being is actively encoding his or her perceptions and experiences. And further, that early traumas (whether shock or strain) and faulty attachments have enduring consequences. Hedges adds significantly to our clinical belief that human beings, no matter how traumatized in infancy, can be transformed through carefully thought out and empathically engaged in therapeutic interactions.