On Coming Into Possession of Oneself: Witnessing and the Formulation of Experience

My Bad, You Got This: witnessing, therapist attitude and the synergy between psychedelics and inner healing intelligence in the treatment of trauma

The MAPS (Multidisciplinary Association for Psychedelic Studies) sponsored MDMA-assisted therapy protocol has had greater success in treating trauma in preliminary clinical trials than any prior psychotherapeutic, pharmacologic, or combined approach. It is predicated on a synergy between drug action and the participant's inner healing intelligence. The latter is described mainly by analogy with the body's capacity to heal itself, and the treatment is characterized as a means of activating or accessing this capacity. How is this rather mysterious-sounding process so effective? I suggest that the therapist's full commitment to, and trust in this treatment framework, along with the medication's subjective enhancement of trust, encourages individuals who have suffered trauma and have difficulty trusting others to engage the therapist as a kind of witness. I discuss parallels between the therapeutic attitude implied in the inner healing intelligence model and the way a therapist can act as witness in the resolution of dissociative enactment in relational psychoanalysis. Trusting the healing capacity of one's inner healing intelligence is dynamically equivalent to trusting the relational process. This makes trusting one's inner healing intelligence a process of feeling witnessed. In both settings, the therapist's willingness to acknowledge her technical limitations or failings, coupled with a conviction that the participant/patient's primary need in processing trauma is to feel witnessed, facilitates the integration of dissociated experience.

Grace, too: the sense of agency and Jeremy Safran's relational vision

The sense of agency, our felt sense of authorship for our actions, is a difficult concept to define, yet its faltering stands at the heart of psychopathology. Historically undertheorized by psychoanalysis and typically positioned opposite relatedness by clinical psychology, Jeremy Safran conceived of agency and relatedness as paradoxically related. This paper pays tribute to Safran's ideas by taking his writings on agency as a starting point to elaborate how agency forms, and goes awry, in the relational crucible of early life. In doing so, the paper draws on the developmental theory of Winnicott, empirical research on embodied agency from adjacent fields of study, and Safran's clinical phenomenology.

Interpretation: Voice of the Field

To patients, the most memorable moments in psychoanalytic treatment are seldom the contents of the analyst's interpretations, but the feeling of being understood. Interpretations are most meaningful not because of what they say but because each one is evidence that the analyst, who generally becomes someone of great significance to the patient, knows the patient more than before the interpretation was made. As a result of this process of "witnessing" patients not only know and feel-they also "know and feel that they know and feel." They can feel their roles in authoring their own experience. Therapeutic action results: patients "come into possession of themselves." Interpretations are the outcome of shifts in the interpersonal field, which reveal this new freedom to think and feel. This new freedom allows the creation of the analyst's interpretations, which therefore serve as a sign of a new way of being in one another's presence that has now become possible between analyst and patient. Field shifts are jointly created, without conscious intention, and interpretations arise from these shifts. Thus, interpretations are not really created independently by the mind of the analyst, but are instead the voice of the field. A clinical vignette illustrates these ideas.

Distance And Relation: Emerging From Embeddedness In The Other

Inspired by an essay by Martin Buber (1950), and then by the work of Ernest Schachtel (1959) on the idea of "embeddedness" and emergence from it, this essay is an account of the role of "distance" or "separateness" in clinical psychoanalytic work. We tend to assume that the capacity to appreciate otherness is always already present. We often lose track of the necessity to "set the other at a distance" (Buber), the prerequisite for emergence from embeddedness in the other. The entire process-i.e., setting the other at a distance and then emerging from embeddedness in the other-must take place over and over again in any treatment, and in both directions: patients must disembed from analysts, but it is just as necessary for analysts to disembed from patients. It is the emergence from embeddedness that allows the analyst's appreciation of the patient's otherness. Embeddedness in the other is discussed as mutual enactment. This use of these phenomena in treatment is articulated in the theory of witnessing presented elsewhere in recent years (Stern 2009, 2012, 2022b, in press). A detailed clinical illustration is presented.