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Thanks to Ayala Klimak

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Metaphors in Therapy 76-850-01

Lesson 1: 12/11/08

This course will be about the use of metaphors by the patient. We can only treat what the patient brings into the therapeutic hour and this is therapy through speech. We help people change their behaviour through words.

We will see how we can connect between the cognitive and the emotional/affect aspects of the world. People come to therapy to get to know one another and understand how they think, act, behave. We need to understand both cognition and emotion because we use them in an integrated form. We never feel only one or the other. Sometimes we interpret something from a rational level but we do not feel. Of sometimes we react emotionally and feel we are with the patient when he needs a rational objective perspective. When we hear something disproportionate or exaggerated we know we are in the area of mental disorders. This is an Axiom according to Spero. E.g. «The end of the world» as a title in a newspaper article. But we know that it is not really the end of the world therefore this is an exaggeration. Is there no mental disorder here? From a psychodynamic perspective there is a constant disorder which we see in our dreams we would see numerous disorders since there is no logic whatsoever and there are many exaggeration. This is no psychopathological. Some disorders are part of daily life and this is fine. Freud wrote «The psychopathology of everyday life» (coming late, jokes, slips of the tongue, strange clothing and hairstyles etc). According to the Freudian model there is a certain pathology in daily life, normative thinking and adequate feeling. Freud's model about the development of man - it is a conflict model. Any behaviour pathological or not is always due to a conflict between causes. There is always a conflict between the biological id and the ego and the superego, which attempts to make impulses more delicate. Axiom - the conflict is always there even though there is compromise. The id always wants to be expressed and the superego always wants to make is more subtle. Conflict is not necessary negative according to Freud.

Hartman, Lowenstein & Kriss advocated that conflict is not always a necessary component. They claim that there are behaviours or structures which are relatively without conflict. They thought that people would understand Freud's use of conflict as pathology. They said that there are mental states which are more stable and frequent and therefore conflict does not seem to be the appropriate term to describe these situations. For example, Freud claims that the ability to write and to enjoy writing is a transformation from the anal stage. We are no longer interested in mud, shit and sandy beaches, so we transform and sublimate these needs to writing. There are pathologies when people have obsessive writing styles of write only with certain pens, or don’t cross t's and dot i's. There is some pathology in writing which can be seen in the above examples. Hartman, Lowenstein & Kriss say that if there will also be conflict with writing we will not be able to write. They said that there need to be situations in which people are not in conflict. Also, they claim that there is no conflict is seeing or hearing - these are innate abilities. We don’t need conflict to explain how these work. Cognitions and the natural ability to think should not be connected to conflict. Freud claims that there is always conflict even though we are not aware of it. In therapy everything is under the lens of therapy. What is yawning? Blinking? People react like this because of a conflictual issue that he is talking about. When people lie they blink their eyes because there is a conflict. Everything that people do is in some way connected to conflict and sometimes the conflict is under control but if we dig into the internal world of the person the conflict will be revealed. When a person has a need or desire which he needs fulfilled and he can't get it there is a conflict, which will be expressed in various ways. In therapy we will always talk about the conflict behind something. There are also automatic reflexes but sometimes when an automatic reaction takes place without stimuli we can conclude that there is a conflict underlying this physical reaction or response.

A person cannot come to therapy and say that he is not speaking about a certain subject. Therapy will change a person and a person needs to take the risk if he wants to come to therapy. Therapy will touch and then analyze conflicts and everything is connected so we cannot place taboos on certain topics. If there is a taboo area then the ego will place all other conflictual issues in this taboo zone. Everything is connected. Things that were autonomic will become less autonomic.

One of the things expresses through pathologies such as neuroses or borderline states is extreme exaggerated behaviour. What about day to day conversation. The ability to construct a sentence with nouns and verbs and sentence construction. Reading and writing and the connection between them this is all very important. People use words to express themselves and speak themselves. People have different styles of speaking but why. What is a style of communication? It is very relevant in therapy because this is the main tool - grammar; syntax etc. In this way we see how people maintain something automatic in his speech and how in control they are. What if people have exaggerated styles of speech? What if a person says «it the end of the world» - he brought into the room something destructive and terminal. We need to relate to what he brings into the room and not to try to encourage him. Sitting in the room with a patient the therapist may also feel as if it is the end of the world through transference.

«Like» - contemporary speech is littered with the word like. It is saying something and not saying it.

Metaphor: Meta - above; Ferein - move - transfer

Metaphor (Condensation - ãçéñä): We express something (emotion, feeling, sense etc.) through another completely different word with no connection to the original word unless I made the connection because it will aid in transferring feelings and meanings from one field to another. «My love is like a fluttering cloud» - we know there is no connection between clouds and love but a cloud moves along without a reason and just flutters in the sky, comes and goes and I think that it is like love in a way. The characteristic of a cloud can be similar to characteristics of love.

Metonym (Displacement - äòú÷ä): It is less intense that a metaphor. Something is described by a part of itself. «Thirty sails» - which represent 30 ships.

Part-pro-toto (partial pro-for total). Both of these terms show us we are in the world of symbols.

Lesson 2: 19/11/08

Metaphor (Condensation - ãçéñä); Symbols - ñîì

Metonym (Displacement - äòú÷ä); Signs - ñéîï

We will analyse these two terms from a clinical point of view. In therapy we need to interpret and we need to feel the therapeutic hour.

30 sails represent 30 ships. Something that is part of something else is a sign for it not a symbol. The crown is part of the monarchy. The crown is a sign and not a symbol. There are different signs for things like logos or mathematical signs. When something is part of a whole and stands for the whole it is usually a sign (part pro toto). Freud's picture is not a sign of psychoanalysis because the term Freud has been saturated with psychoanalysis. Sometimes terms can be so condensed or saturated there is no place for more interpretation. Freud's picture is so condensed it cannot symbolize anything. Freud is a sign for too many things now. Freud is psychoanalysis. It can be neither a symbol nor a sign. If we want Freud's picture to symbolize we will need to turn the picture into a caricature. Freud is a shallow sign! A map is a shallow sign.

The «big apple» is a symbol for New York because there is no connection between apples and New York.

A patient who speaks metaphorically will need a suitable interpretation. A person who is symbolic will regress to a more concrete stage in service of the ego and he will no longer be interested in symbolic interpretations, nor will understand them.

What about dreams in which a person sees 7 thin cows which swallow 7 fat cows and do not change in shape and size? This is a sign for something but can also be a symbol for something. It is a sign because it is the use of a certain language, like a Rebus puzzle of codes and pictures. Each thing is a sign for something else and a sentence can be constructed. Some people do not cross their t's nor dot their i's often due to castration anxiety and not learning disabilities. This way a person expresses his anxieties towards father and authority - this is no longer a sign but a symbol.

2x / 2y =? The x and y are signs for something/anything. When something becomes a symbol is when something is very abstract. The cows begin to symbolize other things like 7 poor years and 7 prosperous years. Years of hunger can in a way swallow years of satiety. In dreams things can be signs and also symbols for other things.

In the unconscious everything can be a symbol. It is the ego which looks for reason and limits us. In the unconscious anything is possible. We need to feel the therapeutic hour to see if we are in the world of signs, symbols or just words…

We use metaphors to spice up our language all the time. Metaphors can be from various developmental levels (oral, anal, phallic, oedipal). I feel like shit (anal). What happens if a patient brings a metaphor from a developmental level into the room he decreases/increases the therapeutic hour by this metaphor and this level? He increases or decreases the space in the therapeutic room. «Fat» metaphors increases therapeutic space - we like patients on symbolic levels. Words signify and symbolize. A psychotic patient cannot receive a symbolic interpretation from the therapist because he will not understand it. Intelligent symbolic patients are often very concrete in therapy; there are no symbols, no creativity, there is boredom. Why dose the patient not communicate and use the therapist as he is able to. When the system of symbols is inactive, arbitrary words are used and content is said without emotion.

Metaphor (Condensation - ãçéñä/òéáåé): Molecular structures are condenses so that in a small space we have the intensity of the big world - the atomic theory. It is not the size but the intensity. We use one thing to symbolize many things. I hate girls, I hate blacks, I don’t eat fish. We all have these - some are political ideas, others are attitudes. Condensation can be effective and serves the ego but it can also be pathological or symptomatic. «My love is like a fluttering cloud» - I condense a lot into my words. Words can carry a lot and can be very intensive.

Metonym (Displacement - äòú÷ä): When things are displaces, they are transferred from one place to another. A person is stressed at work and he cannot confront the boss but returns home and snaps at his wife. Emotions have not been expressed in the right place but in another place in which a person felt more secure. An example of a person who is cleaning himself and his shoulders and jacket and becomes very compulsive in his behaviour. A person displaces something like frustration, eroticism from one place onto trivial things. Displacement onto trivia characterizes most obsessions. Metonyms are litter almost always displacements. Saying «I'm almost their, in Freud's house» but not their yet then the displacement works. This is a part of the whole.

Lesson 3: 26/11/08

In clinical situations people use metaphors and we need to understand why. There is no therapeutic hour without metaphors or metonyms. If this hypothetically happens we need to understand why. Metaphors are also common in dreams. There is no treatment without dreams; otherwise therapy is not deep enough. Because therapy is based on the idea that dreams are the path to the unconscious therefore in intensive therapy we need to get to this depth. The issue is in how we interpret dreams. In the past social workers did not refer to dreams in therapy, nor to transference, nor Rorschach. They believed that once you touch these, various dynamics come to the surface that may not be dealt with properly. Today social workers refer to these aspect too since they received the correct education.

If there are no dreams in therapy then we can check what is happening in therapy because one of the signs is missing. There is no sign that something is happening. Through seeing bubbles in the water we can infer that the water is boiling, such are dreams in therapy. Dreams are an intrinsic aspect of the unconscious. This is a sign that the patient gives us something in treatment - a gift to the therapist. The patient cooperates and has a desire to be treated and therefore the therapist can help. The therapist expects the patient to use metaphors and metonyms to express himself, his transference, inter-subjective thoughts and feelings. If this does not happen then there is resistance. There is an exception. We sometimes also see the unconscious expressed in different ways. There can also be good therapies without dreams, because dreams are just one way to express the unconscious. In dreams we will also see object relations. Slips of the tongue also reveal the unconscious. We expect to see dreams in good deep therapy. What if there is good treatment without dreams, what can we conclude. The dream is the best way to express unconscious according to Freud but there are other ways. Sometimes patients act out (enactment) instead of speaking their thoughts and feelings; there are slips of the tongue, fantasies, counter transference, hours of therapy which are regressive enough; use of metaphors and metonyms.

A case study of a 14 year old youth:

A youth has problems at home; is in an institution. In one of the conversations he says that there is a strange/ delinquent relationship between himself and his friends. The therapy is good and patient uses metaphors. The youth said: «it is like throwing a piece of metal into the water and the water is unable to remove it».

Interpretations:

There is no way out! Or, Metal is heavy and is put into soft water and therefore cannot be taken out.

What is an advantage or disadvantage in either of these two interpretations in this therapy? If there is another metaphor will it be as abstract or concrete as the first or different. And what if this is the only metaphor? Most of the conversation was concrete and the metaphor is distorted and illogical. Some things float; others don’t; heavy on light etc… We need to stay with the patient and his metaphor and not to run forward quickly. In the therapeutic hour water was relevant and things similar to metal were also relevant.

Each symptom reveals and hides something. Symptom means I want to show something but also don’t want to show something. There is ambivalence.

Lesson 4: 10/12/08

When we refer to metaphors we think more broadly about the relationship between emotions and cognition - they are intertwined. There are people who are more «emotional» while others are more «rational thinkers» and this is how they define themselves. But, there is no such situation in which these two are disconnected but often they are at a distance one form the other. Like in mania a person is mostly emotional, does things without thinking, but we cannot say they are not thinking at all - their thoughts are polluted by too many emotions and is cut. Schizoids mainly think and are logical and need to put there feeling aside in boxes - this means that they have emotions but they have to do something with them like hide them or repress them.

Case study:

A patient who is intelligent and emotional, especially when she in therapy - she has emotional outburst, has complaints connected to entitlement (why don’t I have and others do). Spero can offer her to try to understand how she feels about it and whether she has a hand in her situation. She goes to the couch, but comes into the room and says «you the professor is all rationality without understanding of emotion». She sees the world as a split. This is a strong transference which is intended to shut the therapist up.

A person in an oral, anal or phallic stage who has issues from these developmental levels will describes his emotions, thoughts, speech and perceptions about the world from these developmental positions. David Shapiro 1968 «Neurotic Styles». He says we needn't think only of negative things: which style has which fixation. These are not only emotional styles but we would expect to see parallel styles of thought in these people and these thinking styles may be oral, anal or phallic.

Oral stages: Pulling in and out, getting draw into, need to be nurtured, dependence, speech, pleasure, kissing, whistling, split objects, islands of experiences and not something integrated, perceiving world partially, partial objects.

Oral thought: Hysterics are also in this stage. All of nothing perception. One way thinking without alternatives. There are absolute theories and axioms. There is a black or white perception of life. Egocentric thought - without seeing others. The ability to think of another option is like the ability to see something from somebody else's perspective. By the use of our metaphors we present our way of thinking according to oral stages. One who is not interested in narcissistic. Psycho-social stages of Erick Erickson. His first stage is trust vs. mistrust and will be expressed in paranoia and issues of trust. There is a problem with reality judgment. What is truth? What is a lie? What is exaggeration? Almost every child exaggerates. They do this because they do not trust the world and see it in a deformed way. They see the world in a grandiose way. This is like an artist's perception of reality, as in abstract art. Magical thought is also connected to oral stage thinking. The logic of magical thinking is the thinking of the unconscious. A person whose name is Mary says «My name is Mary, I am a virgin, therefore I am Jesus' mother». This is an error in deductive thought of psychotics. She made a generalization and this is too immediate. Magical thought is immediate - the conclusion is too quick. Instead of checking more cases therapist often jump to conclusions without listening to the end and hearing all the associations. The therapists also deduce too quickly. When a person thinks quickly he has magical and oral thoughts, because he does not weigh other alternatives. Magical thought means that a person thinks that words are objects - «I want a doll», meaning now. A Magi bring the future closer to the present. The star told of the future birth of Jesus. Abra-ke-Dabra (what one says will be). The way a person relates to the world is the way he thinks (gorging, immediate, global etc). A person is hysterical and this is also expressed in his thought.

If a person brings a metaphor or a metonym into therapy then the metonym is closer to the oral stages because the metonym is closer to the object, is more immediate. The metaphor is more symbolic, more distant. Metonym allows libidinal gratification faster than the metaphor. In a metaphor there is less satisfaction because there is a distance that is created and therefore satisfaction is more delicate or further away. The more symbolic something is the more delicate the satisfaction. Like eating in a French restaurant or eating a wholesome meal in a workers restaurant. Or sipping Schnapps vs. gulping down coke. Schnapps is more delicate and symbolic. In the metaphor there is more essence, while the metonym is more concrete. Maturity is learning to life on little or on essence. Having sex with one partner vs. have multiple partners.

Lesson 5: 17/12/2008

Patients present us with metaphors and we need to know what to do with them. A patient brings a metaphor and said «I feel as if I have an air hammer in head even though I have not said anything». Or an immigrant saying «I feel like I'm in Saudi Arabia and everyone is speaking Arabic». His mother pulled him out by his roots as a dentist would pull teeth out. Why did he use a metaphor and not say that he feels that he is not understood and others don’t understand him. By means of the metaphor he is expressing more than that. If we communicated just through words like would be boring. How long can a relationship last with banal words and technical conversation. Therapy doesn’t progress maybe because people speak only with words and not more than that. There is no energy in what he says or no feeling. Otherwise a person repeats the same things over and over again. He feels not only that he is in a different place but also that the language and country is that of the enemy. Maybe the therapist is also a stranger and does not speak his mother tongue. Saudi Arabia is a desert and is huge so the distance between therapist and patient may be vast and there is no intimacy. There is oil and hierarchy - who is rich or poor. These are other things he may be saying. All the «like this, like that» enrich the conversation. But if the language is littered with the word «like» then nothing is actually said or real.

The air hammer: the person could have said «I have a headache». Metaphors bring the person's internal world into the room. He is speaking about phallic symbols, about pressure. Is this a phallic narcissistic fantasy? Is he the victim or does he also have fantasies about hammering someone else.

«We are like two empty glasses passing air from one another and there is nothing». This is very oral, common to drug addicts. It could be connected to lips or kissing. Or a breast from which an infant suck only air and chocks. She wants to be full but gets nothing. With drugs they are also passed on from one mouth to another. There is something very erotic in kissing and in sex. This could also be sexual, one thing not being able to fill another.

A metaphor enriches transference. The metaphor broadens our horizons and the object relations that are in the room. A metaphor is another aspect of transference the dimensions on patient and therapist are broadened. Additionally, once the therapist hears the metaphor he is also enriched and got a contribution. If the patient is stuck then also the therapist is stuck. Lecan claims that resistance belongs to the therapist and not to the patient because the therapist has limitation and the patient does what he can.

The therapist may also use metaphors and then the patient can learn about him from this and can make various inferences. The therapist must then be ready to deal with the patients reaction.

Lesson 6: 24/12/2008

Norbert Freedman & Gered Russel: «Symbolization of the analytic discourse»

This refers to the level of symbolization. If the therapist talks in therapy then there are fewer places for free associations. Ping pong talk disturbs this process. When two people talk and one nurtures the other and needs are fulfilled. If needs are fulfilled then there is no lack and no need to sweat and work hard. I our lives there are problems and issues so everything is not fine. In therapy there should be less conversation. There is discourse but it should not be dual. Like telling a dream and wanting it to be interpreted. Pharaoh had a problem telling the dream but Joseph did not immediately interpret the dream. Maybe Pharaoh first had to tell his dream and then wanted to hear his own thoughts about the dream. The patient has to first talk. Freedman was blind and used this disability in therapy. They describe the word symbolism in the article. We want to see that there is more and more symbolism in therapy and that the patient is more aware that he is talking symbolically and understand more and deals better with conflicts that have brought him to therapy in the first place.

A case study:

A patient is dealing with feelings toward her pregnancy. She is ambivalent. She is happy but also worried. Why do people get pregnant and want babies. She says she is full of feeling and various feeling and this stops her rationality. She is drowning in feelings. There are few thoughts. She is pregnant 2 weeks and already wants an ultrasound because she cannot feel heartbeat. She wants to be pregnant but also has enough reasons not to want to be pregnant. Maybe she is pregnant because she has had enough of «being a leaf blowing in the wind without responsibility for anything». She is committed to therapy and to her family. She revealed her secret that a lot of her stress (personal and in therapy) is due to the fact that she knows that there can be an abortion therefore there is a chance that it can be ended. She wanted pregnancy so that she can commit herself but this is not final because she can abort. She says she is full of feelings and therefore she cannot be ambivalent because there is not enough symbolism here. We cannot always be full of emotions because then there is no thinking. She is not yet ambivalent. She wants to be pregnant but thinks of how much time she will have left to abort. Who gets pregnant in this way? There is too much contemplation and this means there is too little symbolism. There is too much emotion and therefore lack of symbolism. Symbols limit our horizons. This is the price we pay for maturity. When there is too much discourse or too much non-symbolic discourse or too many monologues this means that there is too little mental maturity in the patient.

Ambivalence is a developmental level that has been acquired. A child who wants to touch the candles but knows that she cannot. This is on the process of internalization and the child has not yet fully internalized it. She is talking to herself in the third person «Nava, don’t touch the candles» because this is not yet fully internalized. Ambivalence is the adult who says why should I light candles again and again each Hanukka….? In the end the adult with light or will not light the candles. But the little girl is yet not ambivalent.

The patient is full of feelings and has the wrong reasons to be pregnant and this disturbs her unconsciously. She is not in touch with her ambivalence.

Incipient symbolization (æëééðé) - Incipient - it is starting to occur. The symbolism is starting to be created but it is above 0 but is developing. There are developments or regressions in symbolization.

Discursive symbolism - There is symbolization on a certain level but the relationship is dyadic (give and take). Like a transitional object, which is partially symbolized; it is between full symbolization and total lack of symbolization. The transitional object is discursive because there is transition. Each metaphor enables some form of transition or movement. In adults who use metaphors they are already in a more symbolic stage due to their development. An infant in the transitional stage with a transitional object is in this stage and does not use metaphors. The infant has made some sort of progress towards symbolism. Adults travel in and out of symbolism.

Dynamic symbols - These are more mature symbols, the world of stable symbols, the symbol itself says it all. This is the world of symbols but there are also conflicts. Using symbols and not running from or leaving therapy. The world of art and reality. There are existential issues in the high symbolic world.

Desymbolization - We can remove all symbolization from the symbol. This is what psychotics do - they take a symbolic object and see it without the object. A psychotic patient who did not want to play his violin in public because he felt that he is masturbating in front of people. He instantaneously desymbolized.

What about coming late to therapy and has a justifiable reason. He needs to understand why he was not in therapy on time and what his thoughts about it are. Therefore facts are not important. Saying, I was just late for no reason is desymbolization. This is also a state in which a person intentionally stays on the concrete level. Almost everything we do is symbolic - even eating (we buy food, there are eating ethics, rituals etc). This is all symbolic.

Lesson 7: 31/12/2008

Norbert Freedman & Gered Russel: «Symbolization of the Analytic Discourse»

UN - means there is lack of symbolization and there never was symbolization.

DE - means that there was symbolism but it is no longer in use. It is a state of regression.

Differences in places where there is symbolism (rich text) there is a world in which there is space, symbolic space.

If patients don’t want to hear something else they get stuck on a word and may even argue about it. Symbolism allows virtual space. When we use metaphors we have more space which we feel but do not see.

The case study of the older patient with schizophrenic mother: Spero said that she has imprisoned herself in a frame of mind and way of thought, perception and she cannot see outside of this imprisonment. She related to this in a concrete way that she was never in prison. Spero did not relate to the patient response because he feels this will not help. She is a patient who is able to symbolize but here she desymbolized. How can people be symbolic and desymbolic at the same time. What about all the poets who are symbolic and commit suicide. Why is this symbolism not accessible in therapy. From too many symbols holes can be created. When we build holes are created as a side-effect. Maybe there is development and symbolism and simultaneously there are holes (which may also be creative). Some people are able to symbolized holes. In future it is possible to build on these holes. Sometimes in develop these holes may be created and are left as untreated holes. Poets may write about them but cannot always solve them. Meir Ariel - Terminal Luminal -medication used for crying children. He had symbolic ability and lots of mental pain. He expresses his pain (hole) in the only way he can - through lyrics. He says the same thing through a number of songs. Or artists who draw the same theme over and over again obsessively, like Munch - The Scream. If we see this theme repeated over and over again we can conclude that there is a problem in the system of symbolization. Sometimes this can be dealt with by painting and writing and still feeling pain, but one does not have to commit suicide.

Level of symbolism can be gradual and represent different levels. There are not only 4 levels. Mental illnesses are also expressed in different levels of symbolism. People change from one developmental stage to another as they mature and throughout life. We don’t need new diagnoses to describe these changes. Fashion changes and people dress differently throughout these generations, but diagnoses don’t change.

What happens when a person was symbolic and falls into a hole and is no longer symbolic? How do we explain this?

There are triangles that explain symbolism D> - ñîì, äîñîì, äîñåîì.

Symbol, symbolizer, symbolized

The one who symbolizes - Adam called the woman Hava, mother of all living things. The symbolizer creates symbols from signs that exist. Words are the highest symbols. And then there is the object that is being symbolized. A person who is on a symbolic level has internalized these three components.

What about borderline? What about those who have symbols and then loose them suddenly? Or don’t have enough? Or suddenly become concrete? The patient before the imprisonment incident quoted something from George Eliot. She appreciates him when means she is symbol and Spero replied symbolically and then all of a sudden the patient didn’t understand and became concrete.

There are deformed/degenerate triangles or symbols. There is a triangle but it is deformed or crippled. We do not return to dyads because there is symbolism and it is more complex than dyads. These people have symbols but sometimes don’t use them. Degenerate triangles help us to explain complex cases. What is the characteristic of deformed triangles? One of the three components plays two roles. The îñîì may also be the symbol or the îñåîì and visa versa (3x3 options). For symbols to be pure and to be able to be used symbolically they need to have three components and triangles. One of the corners needs to serve two components and this is pressure. The person cannot be in both places at one time. A person cannot be both the îñîì and the symbol. A person is not a flag, but a soldier. Therefore for these people with dysfunctional triangles a hole is a hole and the prison is a real prison and not a symbol. Munch's pictures of the scream = he himself is the scream and not another component.

Lesson 8: 7/1/2009

We spoke about various types of symbolization.

Is incipient symbolization (ñéîåì æçìðé) like transitional objects? No! In symbolization a person has already acquired symbolization. The transitional stage is one of symbolization. A child starts to see symbolization the moment he is in the transitional stage. In transitional stage we are just starting to start to symbolize - it is a primary stage with which we have to begin. A blanky enables a space from mother and is not the concrete mother. The blanky enable a fantastic illusion. Transitional stage is not the end of the symbolization stage. This stage represents our entire life - fata morgana and fantasy - a non real stage. We live our life with fantasy. There is also perception and objectivity. If we are in the fantasy world we can decide when we want to fantasize, when to be concrete and perceptive. But a child who is transitional is still developing symbolism and concrete and symbolic is not yet clearly defined. He can only be in this stage. If symbolization is acquired there is space to maneuver between these worlds. We can choose to be transitional or symbolic or concrete.

With the development of symbolism we develop more psychic space. The mind is not a bag - we cannot physically enlarge or decrease it. So how do we create more space? Through symbolization! It enables broadening psychic space. We do not know how a symbol does this. We begin in a concrete state and the more we have symbols the less concrete there is and what remains is psychic space. As the concrete is digested, as the mind becomes unsaturated there is more psychic space. From density we can see a clearer picture.

We need both the symbolic and concrete world in life. The more creative, bigger our symbols are the better…. But we also need a measure of concrete in life - flesh and blood. Maximum symbolization does not necessarily mean it is better.

Some rabbi said: To know God you have to be him.

Lecane «God is dead and thank God» - God cannot be a concrete object and this is the dead part. God needs to be a concept that we can kill, fantasies about, symbolize etc. He is with us at all times, we can choose to believe and choose not to. The lack of his physical existence is actually his existence.

Article which we will read about a woman with bulimia and anorexia «She eats her own words». An anorexic does not speak because words are too big for her. We could say that an Anorexic is in total symbolization - is this true? No, she is not symbolic. She has no physiological needs. Returns to pre-menstrual stage. She is using de-symbolization. For her, food is not food so she eats nothing. There are conflictual needs simultaneously. She does not want to exist. This does not help her.

Henrey Rey speaks of the anorexics paradox: the anorectic says «look at me I don’t want anything from my parents, not even food. I am a walking example that I don’t need anything. I don’t exist, I sacrifice myself because I invest in my mother. She says I have no needs and I take care of myself. In anorexia we do not see a symbolic act. When a person is in a symbolic stage he does not need to reach a stage of self destruction. An Indian fakir yogi who abstains will have a different Rorschach than an anorexic. Anorexia Rorschach had a perfectionist vision, dependence, notices voids, clear boundaries, seeing minor details and thinks they are errors in print, didn’t refer to colour. There were 4 symbiotic reactions. The Indian who wants to be a part of the cosmos should not have dependent symbiotic relations. He thinks that this will strengthen him and not destroy him.

A child is asymbolic till he becomes symbolic though incipient symbolization which is similar the transitional stage, where there are concrete objects but I have a symbolic relationship with the object. We fuse with the concrete world in this stage. The Indian is also symbiotic but on another level which is much higher and meaningful. Once we have passed the stage of incipient symbolization and have progressed we can choose when we want to be symbolic and to what extent.

The deeper and more dimensional our symbols the more reflective they are. A patient is angry and after 10 min of angry expression and therapist says «you're angry» which is so obvious. The patient may deny it. The patient lost his ability to reflect on his behaviour. The therapist is a mirror, is empathic etc. The therapist wanted the patient to reflect, to look at himself. Many references from medial institutions don’t always come for the right reason - the reason is medical.

The more symbolization we have the better our ability to reflect because we have more psychic space. When we speak of de-symbolization there will we less reflection.

Lesson 9: 14/1/09

Victoria Shahly: «Eating her Words: Food Metaphor as Transitional Symptom in the Recovery of a Bulimic Patient»

She presents a good review of literature. Sharpe: «The metaphor is a subterranean passage between mind and body». Metaphors are heavy, acknowledge laws of symbolism. Psychotics can't appreciate metaphors. The metaphor has its own structure and if we have both body and mind we can appreciate the metaphor. She cites «I've wondered off the point and can't find it again». Words are here to give weight to the affect.

Pg 404: Rudulf Ekstein: «Like the dream the metaphor enables the patient to maintain a distance from the content and the metaphor is a little bit ego-dystonic (not me and something I dislike)». The hidden wish is dangerous therefore I need to dream it or distort it. Ego-dystonic enables because at least then the patient can hold it in this latent deformed way and does not have to repress it totally.

They suggest that «the therapist needs to use the metaphors that the patient presents» and not to use their own metaphors. The patient's metaphor passed a certain test and the patient confirmed it and is prepared to use them. It is ego-dystonic enough. They «observed that fluctuations in the patient's metaphoric competence were diagnostic of changes in the ego function».

Alexandrowicz: She prefers to treat the emotional content of the metaphor and less emphasis for words and puns.

Poland: claims that when the therapist «limits himself to the patient's words, he may make new connections, yet he seriously risks a mirroring that promotes disappointment/ the obvious…» When he modifies the patient's words he suggests new possibilities of understanding. The therapist can put him own input in including interpretations and therapist metaphors in accordance to respecting the patients level of symbolism and emotion.

Lesson 10: 28/1/09

Victoria Shahly: «Eating her Words: Food Metaphor as Transitional Symptom in the Recovery of a Bulimic Patient»

The author made an effort to push her terms and concepts in the article. She wrote the word bullimic with two l's.

Voth «observed that patients increase their metaphor use when the transference relationship is particularly intense. Although such metaphors are symptom-equivalents, they are especially amenable to interpretation because resistance is low at these times».

Spero's patient says she wants to be different and not to feel different. The patient feels that she is in jail and wants to be free, but Spero says that she won't know what to do if she is free. She first needs to feel different and then she will know what to do with it when she gets out. There was strong transference from the patient. Like the inmate who committed suicide once he was pardoned because he did into know what to do with freedom.

Voth says that when transference is more intense and more active then metaphors are fuel by this transference. Transference enables me to use metaphors. When transference has a shade of love, hate etc. in the therapy then the metaphor are able to be used. Metaphors can be similar to symptoms because in therapy there are symptoms until he really expressed what he wants to say and to who he wants to say it. The symptoms that he speaks are substitutes for the time being until he is able to express himself and to say what he really wants. We always express symptoms- we don’t want to be in therapy, or waste money there. Everything is a symptom - our clothes, our hairstyle etc. Each metaphor is symptomatic. «…..resistance is low in these times when transference is high» and thus the patient is more open to hear and is more reflective.

Freud says that transference is always resistance.

Earnest Becker: Transference is the way of making that which is unknown very familiar.

Carveth (pg 407): «The neurotic's problem is no that his thinking is metaphorical rather that he is possessed by his metaphor….; that he is used by it rather than using it critically in his thinking and acting…». Spero thinks this is more characteristic of borderlines. The patient does not use her metaphors so that we can understand her better or to transfer a message, though she would like. She is controlled by them. Through analysis we can help a patient enter his internal world and to life with his metaphors and to know which metaphors assist them and by which they can live.

Case study:

Sara, has bulimia. She uses expressions of food and slimness. «I felt that the patient hungrily drank in my every word». To soak up or absorb words of the lecturer. For the patient words were not words, so what were they? Maybe fantasies. She has fantasies to eat the therapist, or to be eaten by her. She is saying more than words, she is expressing fantasies. Fantasies are supposed to act as fantasies which should be expressed and there are many fantasies. With fantasies we need to have many expressions and to do many different things in life. But things may be too concrete - Sara eats her own fantasy and does not express it in words. She is her fantasies. The therapist must slowly guide the patient to the understanding that words are food and objects that are eaten and not fantasies. She is eating her words. Almost every word that she says is connected to food. She understood the symptom is dystonic but also said it's neurological - drugs can control the obsession. Which fantasy enables a person to get confused between words and desire? There is always a fantasy at the core. She may believe that her body and her mother's body are the same. When she eats her words she may be living a fantasy that the words are similar to the mother or the breast. What is the patient's problem? When she is bulimic she ate her words or was eaten by them or would vomit. Only when she sees the words as fantasy then she can progress in therapy. For Sara, the words are not metaphors they are real. Her metaphors are very narrow and there is no space for any other understanding than the words itself… literal meaning.