Wednesday, January 11, 2012

psychoanalytic basics- Reichian therapy

The video I’ve chosen to write on is called ‘Room for Happiness’. It is a video on ‘psychiatric orgone therapy’ which is also known as orgonomy or Reichian therapy. It was produced by the American College of Orgonomy which is one of two institutes that continues to teach the clinical techniques pioneered by Wilhelm Reich to medically trained doctors. In this essay I will describe the essence of the technique as it is shown in the video and then go on to show that it is a complementary approach to the psychoanalytic theory of repression and the unconscious. Lastly, I will evaluate the video in regards to how well it holds up to the theory.

The treatment begins with psychotherapy in which the patient expresses his concerns and complaints to the therapist. In the first therapy shown the patient expresses her fear to tell her father how she really feels about him because she doesn’t want to have his disapproval. The Reichian therapist tells her to stand the anxiety and express herself. The patient also relates that some sessions are all talk and no body-work and it’s when she doesn’t feel like talking that the body-work begins. The patient moves from the chair to a mattress and is instructed to breathe deeply through the mouth which is supposed to engage a more primitive respiratory pattern and bring in more energy or excitation to the organism. It heightens both feelings as well as defences against these feelings. So, either the patient gets more in touch with the feeling she is resistant to talking about or the defences against those feelings are worked with in their somatic manifestations. The concept is that all feelings have bodily expressions. One wants to hit out or bite in anger, one wants to reach out in longing, one wants to sob in sadness, etc. as a child who lacks the complex psyche of the adult would express herself. The therapist sees tight muscles or the muscle spasms that suppress the repressed feelings and applies pressure to the area in order to force the muscles to stop holding. The emotional response breaks out and the patient discharges the affect and therefore no longer has to expend the energy to hold it in check. What is the most impressive in watching the video are the strong displays of affect which the patients undergo. Specifically, the fourth patient is covered in sweat and striking the bed with amazing force as he expresses his rage.

Although the video only shows the application of character analysis when the body-work is being done, in theory, it is also performed during verbal interchanges. The third patient has a puffed up and rigid chest and when the therapist presses on the chest the patient begins to cough and the muscles begin to spasm. The therapist explains that the muscular armour is being released but the patient is resisting the expression of the impulse and it is manifested in the coughing. Conceivably, the therapist might go on to work with another segment of armour but the patient begins to talk. In response the therapist says, “mr superior, mr. independent, doesn’t need anyone” and goes on in a voice over to say that the patient doesn’t want to experience being vulnerable or being dependent on people because if he did, he might be hurt; he keeps himself very much aloof and emotionally cut off from people to protect himself. This analysis of the resistance isn’t made at a deep interpretative level but draws attention to the resistance in the here and now.

Orgonomy or Reichian therapy evolved out of psychoanalysis or more specifically the character analytic technique of Wilhelm Reich while he was still a member of the IPA. The reason I chose to compare orgonomy to psychoanalysis is because it recognizes everything that Freud says is essential to psychoanalysis but only adds the dimension of bodywork. Famously, Freud said that any investigation which takes “the facts of transference and resistance… may call itself psychoanalysis, though is arrives at results other than my own” (Freud, ‘History of the Psychoanalytic Movement’, p. 16). Reichians also follow a later, less known qualifying statement he made that excludes many who today call themselves psychoanalysts:

the genesis of a neurosis invariably goes back to very early impressions in childhood…. This therefore makes it nonsensical to say that one is practising psycho-analysis if one excludes from examination and consideration precisely these earliest periods—as happens in some quarters (Moses and Monotheism, p. 73)

In Reich’s Character Analysis he follows the dialectic between psychoanalytic clinical technique and meta-psychology and explains how character analysis adds an important new dimension[i]. Basically, Freud began by way of a topographical point of view in which he used interpretation to make the unconscious conscious[ii]. From this position he went to resistance analysis that is linked to the dynamic point of view[iii]. This approach examines not the repressed impulse but


… the analyst takes a more passive attitude and attempts to get an insight into the more contemporary meaning of the patient’s behaviour, why he or she doubts, arrives late, speaks in a ranting or confused manner, communicates only every third idea or so, criticizes the analysis… the analyst will endeavour to influence him through a consistent interpretation of the meaning of his actions (Reich, Character Analysis, p.44)

The analyst interprets how this resistant behaviour is based upon the transference of feelings from the early relations of the patient’s childhood onto the analyst. Reich’s innovation in Character Analysis is to move from content to form and to offer an order of what is to be analyzed. He writes:

[a]dherence to the basic rule is something rare, and many months of character-analytic work are required to instill in the patient a halfway sufficient measure of candidness. The way the patient speaks, looks at and greets the analyst, lies on the couch, the inflection of the voice, the degree of conventional politeness which is maintained, etc. are valuable cues in assessing the secret resistances with which the patient counters he basic rule… it is not only what the patient says but how he says it that has to be interpreted… (ibid. p. 49, emphasis mine)

For Reich the secret resistances are both ways that the patient has regressed to positions that take him away from genuine contact with the analyst, and also fixations/adaptational problems which see him desire or fear too much contact with him. Both get in the way of allowing the unconscious material to emerge. The patient who eagerly produced associations and assented to interpretations but who wasn’t getting better is someone who epitomizes these problems and had a latent negative transference. In Reich’s presentation this is a step that leaves the dynamic point of view for the economic. The economic can be understood as the position of energy across several systems that emerge from the principle of dynamic creation. For example, the ego qua perceptual consciousness system is derived from the id. The child doesn’t come out of the womb talking and with the ability to do arithmetic. Classical psychoanalysis holds that cognitive abilities are derived from dynamic conflicts between id and object and the following ‘desexualization’ of the internalized representation of the object[iv]. Even though everyone dynamically goes through many stages of dynamic development and desexualisation some individuals economically function more in certain cognitive styles than others and in comparison to other people[v]. Reich’s concern isn’t with the economics of the ego’s functioning but with the economics of the libido within an individual[vi]. In his theory, orgastic potency is synonymous with the ability, or hope to, love another and the desire to succeed in life. When disappointments in love or narcissistic injuries see a person repress these desires then sexual stasis occurs (Character Analysis, p.14, 257). In sexual stasis the energy that was outward directed (success, love) is turned inward and the unconscious becomes activated (Function of the Orgasm, p. 130, 158,164)[vii]. This stasis energy activates pre-oedipal impulses (fixations) which are in turn tied to archaic superego responses which the individual may regress to[viii]. Reich gives an example of the character-analytic technique:

Finally a characteristic of his behaviour in analysis struck me. His movements were languid, his mouth drooped as if tired. His speech, scarcely describable in writing, was monotonous and gloomy. When I had guessed the significance of this note in his voice, all was at once clear to me: he speaks as if he were in torment, as if he were dying. I learned moreover that in certain other situations outside analysis he would also sink into this unconsciously posed lethargy. His speaking in this way also meant: 'See what my father has done to me, how he torments me, he has ruined me and made me unfit for life'. His attitude was a severe reproach… The effect of my interpretation of his 'dying', reproachful and complaining manner of speaking was astonishing… (Reich, ‘Character Formation and the Phobias of Childhood’, p. 229)[ix].

Reich linked the regressive dying quality of the patient to the hatred that couldn’t be directed towards the father. He held that the economic point of view means that this kind of regression must be worked through first before the positive transference of the patient could be analyzed[x]. Libido must be moved from the pre-oedipal regressions to the genital position before the patient can work through it[xi].

In his next move into body-work, what needs to be added to this metapsychology is a genetic standpoint to explain the muscular armouring. Following the dual use of economic above it can be conceived of as the determination of the specific stages in which cognitive styles and the fused aggressive and libidinal impulses (i.e. drive to bite vs. to mutilate vs. to murder vs. to he held, etc.) and the defused forms of superego these two drives take. However, it can also be taken in a more general sense to talk about the act of repression itself. As opposed to a Cartesian view that places the mind over the body the route Reich took to orgonomy was based upon a dialectical materialism that recognized that the ego derives from an id. The id is first and foremost a bodymind which, when one considers all the vital processes occurring (from the hearbeat, secretion of chemicals, to synapses firing) ego consciousness plays a very small role in what goes on in the body from one moment to the next. The aggressive and libidinal drives, along with emotions, exist as bodily expressions of the id. This means that in order for repression to occur suppression must occur and the impulses have to be held back before they are ultimately banished from seeking expression. This creates muscular armour when the impulses are reactivated since it is the muscles that allowed repression to take place and so they are dynamically connected to the repressed impulses. Reich followed his intuitions that the far away eyes, tight jaws, stiff necks, raised shoulders, collapsed chests, upturned pelvises, and ungrounded legs of his patients were related to the genesis of the repression of certain impulses[xii].

In working with the muscular armour against these impulses/affects Reich and those who have followed his efforts or have come to these ideas without the metapsychology of psychoanalysis have found another way to access the unconscious. However, new forms of body-psychotherapy often leave the psychoanalytic foundation of Reich’s thought behind, ignore the unconscious impulses and their derivatives, and focus on PTSD[xiii]. The approaches also generally focus on the client’s own awareness of the muscular armour and their mindful relaxation of it as opposed to the Reichian technique of forcing the muscle to relax. Some of the most recent approaches which show these trends are the sensorimotor approach of Pat Ogden, the work at the Trauma Center done by Bessel Van Der Kolk, Somatic Experiencing by Peter Levine and various yoga and mindfulness programs arising throughout America and Europe. Despite the poverty of theoretical understanding and sometimes blatant mysticism in many of these new approaches the number of yoga, minfulness, ptsd programs, etc. are increasing in public facilities.

In the video and what it represents of the current approach of orgonomy there are two major things that fall short of the theory. Firstly, as mentioned above, the psychoanalytic stance of neutrality (not giving advice, using a couch, and working with derivatives of the unconscious in dreams or slips and not just in the transference) is not followed. The approach is a psychotherapeutic one and no longer psychoanalytic. Secondly, as opposed to interpretation of the form of resistance as per the example of dying or in terms of how ‘secret distrust’ will undermine the therapy itself, the therapist attacks the character resistance. Reich himself talks of destroying the armour and uses aggressive language but in his examples of therapy he doesn’t brow-beat the patient but empathically mentions how narcissistic or masochistic tendencies will undermine the therapy[xiv]. The subtlety of describing the form of the patient’s bearing or movements is not displayed in any of the therapies. Reich often mentions that it is precisely this factor of hitting upon the dead-like, lord-like, and even animal-like qualities that people display which bring forward the changes (‘Character Formation and the Phobias of Childhood’, p. 223-5, Function of the Orgasm, p.320).

It appears that Reich’s character analytic technique and the analytic stance from which it was developed have fallen from use within the community that still preserves Reich’s body-based innovations. Additionally, it also seems like many analysts practice an interpretation or resistance analysis that is still content based and hasn’t made use of the form as Reich had advocated. Character analysis as such would seem to represent a peak that separates psychoanalysis and body-psychotherapy and which neither can claim as their own.

Bibliography:

Room For Happiness (2004) Dir: Dick Young, studio: American College of Orgonomy,

Adler, A. (1964). ‘The Accentuated Dogmatized Guiding Fiction’ in The Individual Psychology of Alfred Adler. H. L. Ansbacher and R. R. Ansbacher (Eds.). New York: Harper Torchbooks

Forman, M. (1976). Narcissistic Personality Disorders and the Oedipal Fixations. Ann. Psychoanal., 4:65-92

Freud, S. (1914). On the History of the Psycho-Analytic Movement. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV

Freud, S. (1920). Beyond the Pleasure Principle. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XVIII

Freud, S. (1923). The Ego and the Id. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIX

Freud, S. (1926). Inhibitions, Symptoms and Anxiety. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XX

Freud, S. (1930). Civilization and its Discontents. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XX

Freud, S. (1939). Moses and Monotheism. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XXIII

Reich, W. (1931). Character Formation and the Phobias of Childhood. Int. J. Psycho-Anal., 12:219-230

Reich, W. (1933) Character Analysis, tr: Vincent R. Carfagno, New York: Farrar, Straus and Giroux,

Reich, W. (1942) Function of the Orgasm, tr: Theodore P. Wolf, New York: Farrar, Straus and Cudahy

Spotnitz, H., Meadow, P. (1976). Treatment of the Narcissistic Neuroses, NY, Man. Center For Advanced Psychoanalytic Studies.

Totton, N (2006) ‘Birth, Death, Orgasm, and Perversion: A Reichian View’ in Perversion: Psychoanalytic Perspectives on Psychoanalysis By Dany Nobus, Lisa Downing, Great Britain: Karnac

[i] The International Dictionary of Psychoanalysis (vol.3) shares Reich’s position regarding metapsychology and technique:

A dialectic existed in Freud's work between metapsychology and clinical practice: the identification of new clinical facts would bring about a corresponding evolution in metapsychology, and this in turn had an affect on theoretical-clinical description. Although the foundations of metapsychology are well established, there is no reason to believe that it is incapable of change and enrichment from advances in clinical knowledge, just as it may evolve through metapsychological research papers (http://www.enotes.com/metapsychology-reference/metapsychology-188005).

[ii] Just like the French settlers in new territory speak an antiquated version of French and didn’t move along with the changes in France so to does psychoanalysis show it’s history by the new territories it came too. Those of the Kleinian English school remained at the level of the original interpretation of the impulses. Hartmann, Lowenstein, Jacobson, etc. and the American ego-psychology school retained the resistance analysis synonymous with Anna Freud, Fenichel, and made important contributions of their own (as did Klein). Then Reich’s economic ideas came in to American humanistic psychotherapy in leaders of the movement like Frits Perls (Gestalt), Arthur Janov (Primal), and the many existential approaches that work with liberating the aliveness of an individual.

[iii] “The topographical point of view determines the principle of technique to the effect that the unconscious has to be made conscious. The dynamic point of view dictates that this making conscious of the unconscious must not proceed directly but by way of resistance analysis” (Reich, Character Analysis, p.42).

[iv] “the ego deals with the first object-cathexes of the id (and certainly with later ones too) by taking over the libido from them into itself and binding it to the alteration of the ego produced by means of identification. The transformation [of erotic libido] into ego-libido of course involves an abandonment of sexual aims, a desexualization” (Freud, ‘The Ego and the Id’, p.45-6).

[v] The processes involved in the formation of a neurotic phobia, which is nothing else than an attempt at flight from the satisfaction of an instinct, present us with a model of the manner of origin of this supposititious ‘instinct towards perfection’—an instinct which cannot possibly be attributed to every human being. The dynamic conditions for its development are, indeed, universally present; but it is only in rare cases that the economic situation appears to favour the production of the phenomenon (Freud, ‘Beyond the Pleasure Principle’, p.42)


This also leads us to the work of Shapiro in Neurotic Styles who looks at how different defences such as paranoia, hysteria, etc. go hand in hand with the economically based cognitive style of an individual.

[vi] In this use of economic Reich is effectively adding another dimension to Alfred Adler’s notion of superiority by conceptualizing love and disappointments in love to be another factor leading to mental illness. Adler effectively creates an economic view of narcissism in an individual in which there is a contact point with reality to the extent that an individual seeks to realize his superiority in rational achievement through work and community. When an individual begins to remove himself from work and relationships due to the pride of wanting to be seen as superior (when others don’t recognize him as such) the economy shifts to ‘guiding fictions’ or illusions about one’s superiority to others on a spectrum to the delusions of grandeur in the psychotic (Adler, ‘The Accentuated Dogmatized Guiding Fiction’). In footnote xiv the Adlerian economics of narcissism are clearly visible in Reich’s description of addressing the secret resistances.

[vii] The unconscious is activated in various aggressive (biting, mutilation, murder, etc.) or libidinal drives (desire to be touched, for vicarious pleasure, for sex, etc.). These impulses have a dynamic relation with various manifestations of the superego. Freud writes:


the super-ego, originating as it does from the id, cannot dissociate itself from the regression and defusion of instinct which have taken place there. We cannot be surprised if it becomes harsher, unkinder and more tormenting than where development has been normal (Freud, ‘Inhibitions, Symptoms, and Anxiety’, p. 115-6).


…that the prevention of an erotic satisfaction calls up a piece of aggressiveness against the person who has interfered with the satisfaction, and that this aggressiveness has itself to be suppressed in turn. But if this is so, it is after all only the aggressiveness which is transformed into a sense of guilt, by being suppressed and made over to the super-ego (Freud, ‘Civilization and Its Discontents’, p.138).


The libidinal impulses are also paired with superego reactions in which defusion leads to reactions of abandonment, self-pity, dissociation, (etc.). Where guilt or self-pity are obviously very complicated superego reactions Freud conceived of earlier forms of the superego as being things like the oral fear of being eaten by the totem animal (Freud, ‘Economic Problem of Masochism’, p. 164-5). Melanie Klein’s work has been to outline these earlier forms but Reich’s work seems to be about registering their phenomenology and interpreting their form.

[viii] “[W]e find two layers of repressions in the compulsive character: the outer layer consists of sadistic and anal impulses, while the deeper layer is made up of phallic impulses. This corresponds to the inversion which takes place in the regression process: those impulses which receive a new cathexis lie closest to the surface; whereas object-libidinal genital strivings are deeply repressed, ‘covered over’ by layers of pregenital positions (Reich, Character Analysis, p. 216).

[ix] As per footnote vii, I believe this regression to a feeling of deadness should be taken as a primitive superego reaction. This explains the dynamic linking of the ‘contactlessness’ of the character to the aggressive or libidinal impulse as seen in Reich’s work:


It is seen again and again in analysis that the dynamic value of the same element of repressed material varies depending on the degree to which the ego defences have been loosened. If… the affects pertaining to the defensive formation of the character are liberated first, then a new cathexis of the infantile instinctual expression takes place automatically. (Reich, Character Analysis, p. 81-2).


This kind of regression seems common with narcissistic disorders, often paired with hypochondria, and the phenomenology seems well established:


The other major diagnostic signs and findings involve the phenomenology of the narcissistic regression. The fear of temporary fragmentation, or the temporary fragmentation itself, results from a temporary decathexis of the self or self-objects. These structural regressions of the self and the attempts to adapt to them have certain characteristic ways of being described by the patient or observed by us. One way the patients manifest this is to worry about the mind and/or body and its functioning. They report vague, or sometimes insistent, preoccupations with fears of cancer, dying, or heart attacks. A related complaint is feeling like a “mummy” or “ghost,” or the sensation of having a plastic shield all around the body. In other words, the patient doesn't feel or experience himself as being in touch with others, the world, or himself. We know that these are complaints of an underlying feeling of deadness, a dreaded feeling that is metapsychologically a manifestation of decathexis of the self and/or a temporary fragmentation of the archaic self…When the dominant experience is that of “mummy” or “ghost,” the mood the patient lives out is one of low energy, remoteness, distance, depression, and isolation. His voice and presence have a kind of lifelessness which the patient will describe as a state of being “turned off.” (Forman, ‘Narcissistic Personality Disorders and the Oedipal Fixations’, p.71)

[x] I concentrated my presentation on the problem whether, in the presence of a latent negative attitude, the analyst should interpret the patients incestuous desires or whether it would be better to wait until the patient’s distrust had been eliminated. Freud interrupted me. ‘Why don’t you want to interpret the material in the sequence in which it appears? Of course, it is necessary to analyze and interpret the incest dreams as soon as they appear!... The whole things was foreign to Freud. He did not understand why the analyst should not interpret the material in the sequence in which it appeared… (Reich, Function of the Orgasm, p.167-8).

[xi] Nick Totton, a ‘neo-Reichian’, persuasively argues that Reich’s notion of genitality is not related to the Oedipus complex but actually to the castration complex and that orgastic potency is in fact linked to perversion. See ‘Birth, Death, Orgasm, and Perversion: A Reichian View’ in Perversion: Psychoanalytic Perspectives on Psychoanalysis. Totton isn’t saying that only perverts have orgastic potency but that its perverse impulses in narcissistic, neurotic, and perverse structures that produce the orgasm discharge that Reich originally though of as genitality.

[xii] In general both the aggressive and libidinous impulses and the part they play in narcissistic (self-love) and masochistic (other-love) economies are gauged together in one large economy in the body-psychotherapist’s examination of the vitality and health of the body.

[xiii] PTSD in a post-latency manifestation is a re-living of a traumatic experience while pre-latency it is seen in the repetition-compulsion and may be re-enacted. This difference is noted in a war neurosis in which dreams or thoughts lead to the trauma re-playing in one’s mind where Freud relates the earlier repetition compulsions to being paired with impulses on the individuals part: “cases of simultaneous object-cathexis and identification— cases, that is in which the alteration in character occurs before the object has been given up. In such cases the alteration in character has been able to survive the object-relation and in a certain sense to conserve it” (Freud, ‘The Ego and the Id’, p. 29-30). For example, the repetition to have an “injured third party” in romantic relationships or to groom a protégé who ends up leaving you are examples of repetitions that are traumatic and repeated.

[xiv] Reich doesn’t interpret to the patient that she is narcissistic and superior but rather brings her attention to how her pride would cause her to leave the therapy:


To begin with, I explained that her strong inhibition about discussing these things was connected with her pride, i.e. she was too proud to admit such emotional stirrings. She immediately agreed, adding that her whole nature rebelled against such admissions. Asked whether she had ever experienced love or desire spontaneously, she answered that this had never been the case. The men had always desired her; she had merely acquiesced to their love. I explained the narcissistic character of this attitude, and she understood it very well. I further made it clear that there could be no question of a genuine love striving; rather she had been irritated to see a man [the analyst] sitting there completely unmoved by her charms and found the situation unbearable. The fantasy had been an expression of the desire to make the analyst fall in love with her. That this had been the case was confirmed by the recollection that, in the fantasy, the conquest of the analyst had played the major role and had afforded the actual source of pleasure. Now I could draw her attention to the danger concealed in this attitude, namely that, as time went on, she would not be able to tolerate the rejection of her desires and would eventually lose interest in the analysis. She herself was already aware of this possibility. (Reich, Character Analysis, p.133-4).


Hyman Spotnitz the creator of modern psychoanalysis could be seen as beginning the metapsychological structural point of view to therapy. He notes that the schizophrenic’s ego doesn’t have either the cognitive capacities of the neurotic because of regressions, is more sensitive to injuries and disappointments, and has a primary narcissistic problem with the ‘otherness’ of the analyst. He writes:


‘Do we want a narcissistic transference to develop?’ We do because in a negative, regressed state, the patient may experience the analyst as being like him or part of him. Or the analyst may not exist for him. The syntonic feeling of oneness is a curative one, while the feeling of aloneness, the withdrawn state, is merely protective. Because traces of narcissism remain in everyone, we seek, when beginning treatment, to create an environment that will facilitate a narcissistic transference so that, first we can work through the patient’s narcissistic aggression. (Spotnitz, Treatment of the Narcissistic Neuroses, p. 58).


He advocates joining the defences of the patient until they have their own insight into them. While this is no doubt is necessary with psychotic and severely regressed patients it doesn’t do anything to assuage the pride of the patient in the example above. Joining her narcissism about her beauty or interpreting it both fail to bring it to bear on its relation to the analyst (as Reich masterfully did). A full structural point of view applied to therapy would have different techniques with the different psychotic, perverse (impulsive), and neurotic (compulsive) structures.

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