How a Lack for Primal Love can Heal
A reader writes: “I feel like I’m done with therapy but not done with my therapist. The only reason I’m still going after many years is that I am so deeply attached to him and can’t imagine life without him in it. I’ve worked through many of my issues and we talk all the time about my feelings which have not lessened in all the time we have worked together. I feel like it’s time for therapy to end. When you say antidote, what exactly do you mean? Is it possible that it can’t be resolved?”
Principle 1: Give before you take. The goal of psychotherapy is to replace maladaptive patterns with more satisfactory ones. The first thing I think therapists need to realize, myself among them, is that our field, and the medical model in particular, have come from a place of negativity. We talk about disorders and pathology and our goal is to take them away. The movement of positive psychology has done us a favor in reminding us that attempts to take away unhealthy coping patterns without giving something positive is not going to be very successful. When it comes to attacking Entrenched Maladaptive Patterns (EMPs), we should think first of what we have to offer in trade. Only when they see something positive will our clients be able to accept the loss of something as vital as primal love.
Principle 2: Full replacement of Primal Love is not possible. Replacement is usually the goal of the inner child, the obvious remedy for something life saving that is missing. For better or worse, full replacement is not actually possible. Therapists can’t offer 24/7 attentiveness and they cannot give the incredible degree of love that healthy parents naturally do. On the other hand, since empathy naturally leads to warm feelings, therapists generally do like their clients quite a lot. Furthermore, where therapists come the closest to being like parents is in empathy. Therapists can and do give large doses of accurate empathy. This is the essence of love, the ability and motivation to be attuned and to repair breaches when attunement fails.
Despite the gift of empathy, there are areas where therapy can’t substitute for primal love. One is the asymmetry, the one-way quality that protects client and therapist. In most relationships, giving and receiving are in the same currency. In the therapy relationship the client pays a fee, but is not responsible for the emotional wellbeing of the therapist. In addition, in contrast to parents of young children, but similar to parents of grown children, therapists cannot take ultimate responsibility for their clients’ decision making. So, in the end, for those have been shortchanged in childhood, replacement is not the answer. The solution has to be something different.
Principle 3: Acceptance won’t happen until all paths toward replacement have been followed. Since replacement of primal love is not really possible, then we have to think about accepting that things weren’t so good in the beginning but a fulfilling adult life is still possible. This sounds great, but no one likes to accept losses, and when it comes to life and death needs, acceptance just can’t happen without a deep conviction that replacement of what was missing is not possible or even desirable. Humans don’t accept defeat unless they absolutely have to. Even when we declare outwardly that we are accepting, deep down a degree of hope remains that somehow things will turn around. True acceptance is hard to achieve and, for critical needs, simply not possible until all efforts at replacement have been exhausted.
Principle 4: Work towards replacement before acceptance. The way we can convince the inner child that replacement is not the answer is by exploring every avenue by which replacement might happen. One result is realizing that full replacement is not possible. Another is becoming aware that true primal love is not what adults need or want. Having someone watching over you 24/7 isn’t really that great. It turns out that having another adult read your mind is less than satisfactory. And, within the therapeutic relationship, crossing boundaries just doesn’t work. Interestingly, while convincing the inner child that replacement can’t work, this therapeutic operation actually leads towards awareness of the good things that come with adult life. For example, the inner child discovers how much adult autonomy, the ability to choose partners, and enter voluntarily into real world relationships can be happy and positive experiences.
For a time, the therapeutic relationship may fill a genuine need for a surrogate relationship. Damaged trust and lack of skills may make outside relationships temporarily impossible. The therapeutic relationship can, and often is, a laboratory for exploring the world of relationships. This needs to be managed with care. Therapists walk a fine line between providing a substitute relationship and promising or implying fulfillment of something we can’t deliver. Among the components of a relationship that we can’t deliver are mutuality, equal emotional risk, and the physicality of a healthy adult relationship. What this means is that the therapist needs to convey, not solely in words, an ongoing and clear understanding that the therapy relationship can’t be a substitute for the kinds of relationship our clients might be seeking in the outside world. The goal of engagement with the outside world is a moving target and needs to be adjusted over time. At the beginning of the therapy, outside relationship might not be feasible, while later, it may become the main goal.
Principle 5: Internalization is ultimately what replaces primal love. Erik Erikson used the term “basic trust” to describe the result of healthy development over the first two years of life. He meant a broad sense of confidence that things will turn out OK. Margaret Mahler wrote about how young children internalize a sense of the continued existence of a supportive mother even when she is not physically present. Over time and under good conditions, children internalize something based on the primal love they receive, which then becomes their own and portable, basic trust. They carry it with them for a lifetime and it gives them a fundamental confidence and resilience, even when they are feeling discouraged. It forms a kind of floor for hopelessness such that it can only reach a certain degree. Can this kind of internalization take place later in life?
Principle 6: The mechanism of internalization. I don’t know what internalization really is, but I have a working hypothesis that fits with observed data. Internalization means that something is retained in implicit memory that, like the skill of drinking from a glass, doesn’t go away. What triggers the process of internalization might surprise you. It is attachment anxiety. When there is anxiety due to the perception of possible loss of connection, that is what makes us internalize the attitudes and values of the other. I think this process can take place very slowly in small increments or rapidly under more urgent conditions. That’s the answer I came up with years ago when I first identified the question as important. Not surprisingly, one of the sources was Freud’s concept of identification with the lost object. (To learn more about why I believe this, it is in my textbook, Psychotherapy: A Practical Guide. p. 207.) If correct, what this implies is that to let go of an attachment to the therapist, one needs to approach the possibility of saying good bye. We are extremely sensitive to separation, so it probably means doing this in tiny increments over whatever time it takes. On the other hand, it might happen more rapidly if conditions required that. There’s catch! If the threat of separation is too rough, then internalization stops.
Principle 7. Pendulation. Peter Levine, in his book, In An Unspoken Voice, talks about “pendulation.” What he means is that clients seeking to heal must go back and forth between a position of safety and one of voluntary willingness to encounter the things they dread. It’s a great concept and it applies nicely to internalization. When letting go is forced or not done under loving conditions, then the result is traumatization. The brain goes into emergency mode and internalization ceases. Levine makes it very clear that when clients swing towards what they dread, it needs to be done by choice and with a feeling that the time is right. Suggestion is OK, but pressure or forcing is not.
This is also why arousal regulation is such a central part of trauma therapy, where triggering the sense of danger is always close at hand. It is also why one of the four “facilitative factors” I have listed elsewhere is arousal regulation, one of several things therapists do besides directly seeking change.
Principle 8. Rapid internalization. Internalization is not always gradual. I recently communicated with a person whose beloved and very effective therapist suddenly discharged her. It was painful but somehow she knew it was time and that she would be OK. This event seemed to trigger a last chunk of internalization of her own power and choice. Perhaps she had already internalized enough of her good therapy, but it was also true that she had come far enough to know that she had not been erased from his mind or even emotionally rejected. Her sudden discharge was not traumatic.
It also probably happens that necessity can lead to acceleration of internalization. Traumatic identification with the aggressor is an example of how survivors internalize negative attitudes towards the self that were expressed in some way by the perpetrator. This undoubtedly happens under survival conditions. So it appears that somehow the brain can remain open for business, at least in compartmentalized areas, even when arousal is high. We’ll have to wait for neurophysiologists to look at this for an adequate explanation.
Principle 9. Acceptance and internalization may be the same. Accepting a painful truth seems to have many of the same characteristics as internalization of connectedness or primal love. Under traumatic conditions, it generally doesn’t happen and leaves the inner child still waiting. It doesn’t happen until all alternatives have been tried, and it doesn’t happen until there is something to take the place of what is lost. But in the end, making genuine peace with loss, where the loss is transformed into something benign, seems very similar to internalizing a positive reality such as primal love. For now, I’ll make the assumption that full acceptance and internalization are two sides of the same coin.
Putting it all together
So, putting this all together, I think clients and therapists need to work together to help the client take periodic “swings” at a better life without the constant presence of the therapist. It’s far less likely to trigger a stress response if it comes from the client. Even a hint from the therapist is likely to trigger a neglected or traumatized person into a stress response. Unfortunately, most of the time when clients suggest termination or a break from therapy, it is with a rejecting attitude towards the inner child and leads towards a kind of pseudo-separation. This leaves the inner child unchanged and in hiding. What works is when therapist and client are in tune with one another and focused on taking steps towards a healthy and positive outcome.
This kind of pendulation might start with nothing more than an idea, but should naturally move towards action to engage with the world and learn the skills of appropriate trust and healthy interaction, skills that are needed to make such moves safe and positive. Each encounter with “attachment anxiety,” if it takes place in a positive context, results in a small chunk of internalization. Once in a while, it might be a big step and a large chunk, but, within the world of therapy, the requirement for the context to be supportive and positive remains the same.
It’s worthwhile to think how long this operation takes in normal humans. Even if we have firmly internalized basic trust, the process of separating from parents and taking full ownership of our own lives is very slow. The turmoil of adolescence is testament to just how ultimately difficult separation is.
As a positive and exciting but sometimes scary pendulation takes place over time, I think there is a silent, incremental internalization of the support and caring that has been part of the therapeutic relationship. That, in the end, is the closest we can come to replacement of primal love and opens the door to true acceptance of what can never be replaced.
Jeffery Smith MD
Photo by Johann Walter Bantz on Unsplash.