Pathological Accommodation Research Articles

Birds on a Wire: A discussion of Çevrim’s “The Vulture in the room”

ABSTRACT Birds on a Wire is a discussion of Mustafa Çevrim’s, ”The Vulture in the Room”, a beautifully intersubjectively focused clinical paper. This discussion focuses on the bidirectional, self (therapist)regulation and self with “other” (patient and therapist) regulation. Çevrim’s elegant adherence to contemporary Self Psychological/Intersubjective Systems theory is spotlighted, as the emergent self object twinship transference highlights the dyad’s shared understandings through their co-created metaphoric use of bird imagery. Çevrim’s application of a Brandchaftian model of systems of pathological accommodation and his tracking of therapeutic rupture and repair sequences reveals a process of transformation and growth for patient and analyst. Finally, there is a consideration of the impact of what I term, the analyst’s “generative thoughts” on therapeutic process and contextualization.

The vulture in the room

ABSTRACT This case study explores the story of Eva, a 37-year-old woman who has embarked on a journey of psychotherapy to navigate the complexities of her past traumas and their manifestations in her present inability to set boundaries and assert her needs. The narrative unfolds through the intersubjective therapeutic relationship with a novice therapist who is also grappling with personal issues of competence and parallel dynamics of past abuse. The case illuminates the complexities of Eva’s life, from her violent childhood and oppressive family environment that demanded success at all costs to her traumatic experiences in academia and romantic relationships. Through the lens of intersubjective-systems theory and focusing on Brandchaft’s systems of pathological accommodation, the paper explores the patient’s struggle with self-cohesion and the internalized need to accommodate others to maintain a sense of security and attachment. The therapeutic encounter, characterized by a twinship in trauma becomes a site of transformation in which both patient and therapist navigate their vulnerabilities and strengths. The turning point in therapy occurs when the therapist inadvertently assumes the role of an authoritative figure, prompting Eva to express her own experience assertively.

Dancing with the Demons – Making sense of schizophrenia

ABSTRACT This paper explores the empathic nuances of the therapeutic process with a person experiencing ongoing psychosis associated with a diagnosis of schizophrenia, and with a history of severe relational trauma. Incorporating the self psychological principles of working with the therapist’s and client’s forward edge, utilizing experience-near empathic attunement, and the somatic psychotherapy essential for kinaesthetic conversation were essential elements for the ongoing integration of the client’s self. This work demonstrates the development of a nuanced understanding of pathological accommodation with its internal self-organizing dynamics as well as offering examples of forward edge movement. Interweaving vignettes from a two-year period with the subjective and intersubjective somatically animated experiencing of the therapist, the puzzle of how to work with all parts of the client unfolds gently and carefully. This paper outlines how connections were made between the two participants, in a clinical sense and within the client, creating a sense-making structure within the nuclear self experience of the client. Real life clinical experiences of what somatic psychotherapy, undertaken within a relational, intersubjective psychodynamic process, looks and feels like are in short supply. The presentation of this case hopes to remedy that by demonstrating the body mind integration required to work this way.

Struggling To Be Free: Synthesizing Developmental Theory, Clinical Theory, and a Relentless Dyadic, Bidirectional, Interactively Regulated Field

ABSTRACT Interweaving clinical phenomena and dynamics from a developmental perspective is fraught and burdened by the exact complexities one is trying to unravel and re-ravel! While acknowledging those complexities and difficulties Dr. Herzog took on in his paper, I offer an understanding of developmental tasks from relentless, emergent, bidirectional system of influence and being influenced. The focus here is not on either the adult or the child but on the dyad: the adult and child’s individual contributions toward growth and development AND the adult and child’s co-configured, co-created experiences. Brandchaft’s theory, systems of pathological accommodation, is offered an alternative means of clinically understanding the binding attachments or “tethered love.” The case Dr. Herzog shares is reconsidered from Brandchaft’s perspective and from a developmental, dyadic, bidirectional system’s clinical approach.

Transcending Pathological Accommodation: An Intersubjective Self Psychology Approach to Affirmative Therapy

Minority stress, including that experienced by sexual minority (SM) individuals, has been studied extensively in social and developmental contexts. Still, sexual orientation microaggressions (i.e., exposure to frequent heterosexist/homophobic language) can persist within the family structure. The focus of this paper is on the internalization of these experiences and the deleterious impact they could have on identity and developed systems of pathological accommodation, referring to attempts at rejecting one’s sexual identity to achieve acceptance from parents. A composite case is presented to demonstrate the effects of persistent discriminatory events within the family structure; this serves as a set of model scenes, that in aggregate, can lead to internalized homophobia. This paper explores a treatment process that integrates concepts of intersubjective self psychology and affirmative therapy to arrive at a theoretical approach that helps to mitigate internalized homophobia as can be present in gay identifying male clients.

The Long Winding Road to Liberation: The Tales of Two Iranian Immigrants

ABSTRACT In this article, we attempt to illuminate the unique and distinctive experiences of Iranian refugees and immigrants through the lens of our own autobiographical and phenomenological experiences as émigrés in two separate countries, the United States and Austria. We will draw from our own personal experiences of exile, occurring at different periods in Iran’s sociopolitical history, pre- and post-Islamic revolution, to elucidate our separate and different experiences of dislocation, adjustment, and acculturation. We will illustrate that, even with the starkly differentiated patterns of our cultural and religious immersions, we appeared to share elements of experience in adjusting and adapting to our host cultures. Psychoanalytic work offered us an experience of a surrogate motherland that bridged our cultural selfhoods. In particular, analytic work provided us with a tool and a cultural vehicle to accommodate our passage, facilitating our adaptation and acculturation, our senses of selfhood, and relational dimensions. We maintain that psychoanalysis helps by illuminating and loosening patterns of attachments to archaic cultural ties, or cultural pathological accommodation, thereby allowing for the development of an expanded version of cultural horizons.

On The Impact of Psychotherapy on Psychological Growth: The Waning of Defenses

ABSTRACT A discussion of Micheal Reison’s “The Subjective Importance of Accommodation and Non-Accommodation: Expanding Brandchaft’s Ideas of Pathological Accommodation” explicates Dr. Bernard Brandchaft’s signature contribution—the defense of pathological accommodation. The imperative need to maintain attachment is seen as the primary goal of this defense. Pathological Accommodation is seen as a mode of maintaining attachments to caretakers, an unconscious, compulsively self-limiting behavior which occurs when a child experiences threats to his bond with a needed parent. In Kohutian terms, pathological accommodation functions to protect the self a child has been able to construct despite formidable obstacles. The term “accommodation” is traced through writings by Atwood, Stolorow, and Brandchaft. Accommodation, in Brandchaft’s terms, refers to the child’s response to relational trauma suffered when his or her emotional expressions and/or actions regularly evoke profoundly malattuned parental responses which threaten the child’s attachment bond. Dr. Reison’s case is reviewed through the lens of these ideas and Dr. Reison’s emotional attunement and genuine appreciation of his patient is appreciated. His genuine empathic understanding of his patient is seen as the foundation of the considerable psychological development and growth demonstrated in Reison’s very fine case report. Indeed, the genuine psychological growth demonstrated eventually made the defense of pathological accommodation unnecessary.

The Subjective Importance of Accommodation and Non-Accommodation: Expanding Brandchaft’s Idea of Pathological Accommodation

ABSTRACT This paper is an expansion of Brandchaft’s notion of pathological accommodation. In a pathological accommodation a child is exposed to immutable primary caretakers unable to perceive the child’s subjectivity while at the same time demanding that the child meet the needs of the caretakers. As a result, the child abandons much of his desires and striving in order to maintain the needed ties to the caretakers. I am introducing both the idea of pathological non-accommodation and the subjective importance of both accommodation and non-accommodation in their non-pathological forms. In pathological non-accommodation the child attempts a precocious self-sufficiency overplaying their separateness and distinctness at the expense of taking in the emotionally organized help, information and nurturance they need to thrive in the world. Healthy accommodation and non-accommodation entail having good enough caretakers promoting a child’s developing emotionally organized judgments regarding their comforts and discomforts around the vast array of playful and worked on interactions within the child’s emotional surround. Examples of early healthy accommodations are turn taking, imitation and other forms of learning. Examples of early healthy non-accommodation are averting one’s gaze, crying, displaying displeasure, learning to say “no” and more complex oppositional behavior as development proceeds. A case example is given of work with a patient who combines both pathological non-accommodation and pathological accommodation.

Politics, Phantomization and Pathological Cultural Accommodation

ABSTRACT In this article I attempt to illuminate the five themes from Dynamic Systems Theory, that Dr. Gabriel Trop identifies in his compelling investigation of the political context in psychoanalysis and the politics of psychoanalysis (this issue). Drawing from my personal experience as an Iranian émigré and my work with my patients, I elucidate how a complex matrix of cultures, politics, languages and faiths intersect in the very ways Trop applies the dynamic concepts of changeability; disruption; experimentation; particularization; and exposure. The terms “phantom selves” and “phantomization”, are elaborated to describe the type of experiences that relate to the after-effect of traumatic loss. I suggest that rigidly administered religions, cultural ideologies, and unvarying traditions crush people’s souls and take them hostage. The intersection of politics and psychoanalysis (or the politics in psychoanalysis) has the potential to restrict and censor our lens and scope of inquiry. Ultimately, the politicization of psychoanalytic communities can reduce human complexity, collapse social multiplicity, and runs the risk of creating a new binary set of good-versus-evil moral absolutisms by which we—wittingly or unwittingly—measure psychological health.

Self-Regulation and Compulsive Sexual Behavior

Using the critical lens of the Intersubjective Systems perspective, this article focuses on making sense of compulsive sexual behavior. From this perspective, the concretization of sexuality provides an antidote to the unbearable affects being warded off. The sexual addiction framework is reconsidered, and compulsive sexual behavior is reconceptualized as a form of emotional concretization born of developmental trauma. Using clinical material from the treatment of Steven, the phenomenological contexts and underlying dynamics from which his sexualized pattern of behavior derives are illuminated. This article highlights how, through pathological accommodation, Steven adopted from his father the very heteronormative, patriarchal values and oppressive realities that led to his deep sense of shame and humiliation. His unsuccessful quest to overcome his organization of experience—that he was fatally flawed, unmanly, and undesirable—resulted in his compulsively playing out misogynistic hypermasculine tropes that became transformed only upon the development of a new understanding of his developmental history and an attuned relationship in the therapy.

Brandchaft’s Pathological Accommodation—What It Is and What It Isn’t

Pathological accommodation refers to ways of being that function unconsciously to preserve a needed attachment when that bond has been traumatically threatened. In this sense of the word, “accommodation” means that the individual unconsciously adopts the views and feelings of another at the expense of his or her own experience. The role of unconscious organizing principles and affective sequences is detailed, and the issue of pathological accommodation in therapists is briefly addressed. This defense—the dread not to repeat—is distinguished from Anna Ornstein’s description of the dread to repeat. An anecdote emphasizes the crucial role self-awareness and the capacity for self-reflection play in the emancipation from entangling remnants of pathological accommodation.

Two Reciprocal Selfobject Variants in Systems of Pathological Accommodation: Illustrations From the Movies Shine and Black Swan

The devastating descent into psychosis is powerfully illustrated in two movies, Shine and Black Swan. Here, two young prodigies, David Helfgott, the pianist, and Nina, the fictional ballerina, portray a vulnerable idealizing selfobject transference between father and son and a crippling merger/twinship selfobject transference between mother and daughter. Furthermore, the films demonstrate how the two young artists serve as potent stabilizing influences for each of their same sex parents. An intrinsic maturational need in each young artist is vividly thwarted by the bound up nexus of each parent and child dyad. After comparing and contrasting the two films and the psychotic fragmentation which evolves, we postulate what environmental supports and what selfobject experiences are necessary for the child caught in this kind of psychological configuration to survive into adulthood.

When Patient and Analyst Speak the “Same” Language: Exploring the Paradoxes of Belonging and Not Belonging

As the title suggests, this presentation explores the paradoxes found in the subjective experiences of belonging and not belonging when solely English-speaking psychoanalysts, like this author, assume they are speaking the “same” language as their bilingual patients for whom English is a secondary language. Seen through the lens of Brandchaft’s conceptualization of “systems of pathological accommodation,” in-depth, clinical vignettes from the analytic journey with her Italian patient, Antonio, illustrate the process by which the emergence of unspeakable traumas, embedded in his mother-tongue language world, bring into the foreground these unforeseen paradoxes. This awareness creates much turbulence in their analytic relationship. Ultimately, however, long-held convictions about their mutual experiences of belonging and not belonging are redefined, and significantly transform their ways-of-being in the world. In conclusion, the analyst describes the emergence of disavowed words and phrases particular to her own history and subsequent realization that paradoxically, none of us is truly monolingual. This in turn, raises questions about why the psychoanalytic world has privileged English: is this is a manifestation of ethnocentricity, or perhaps a means by which we sustain our ties with our psychoanalytic forebears, who, as survivors of the Holocaust, have disavowed horrific, unspeakable memories by silencing their own as well as their patients’ mother tongue?

Surrender to the Other: Meeting Annette Richard on the Historical, Personal, and Therapeutic Return from Exile

Annette Richard’s reflections on her complex developmental and therapeutic return from historical exile create resonances beyond the Acadian story to reach into the ethical significance of clinical work more generally. This discussion links Ghent’s distinction of masochism from surrender with Brandchaft’s liberation from pathological accommodation in reading Richard’s personal and clinical stories.

Sameness and Difference: Cultivating Cultural Dialogue

This article examines the role that attitudes which originate in a cultural context play in the therapeutic process. Attitudes toward sameness and difference are explored, especially those attitudes that reflect culturally encoded expectations. Assumptions that the analyst and patient are similar to one another may mask culturally embedded biases and attitudes toward difference, particularly unconscious expectations that “others” will assimilate to the dominant group. Such unrecognized attitudes may obscure opportunities for empathic contact and connectedness, play a role in defining the therapeutic dialogue, and perpetuate a larger culturally based system of pathological accommodation. The role that a hermeneutic attitude plays in cultivating cultural dialogue is illustrated clinically.

D.H. Lawrence's The daughter-in-law: Transforming a family system

D.H. Lawrence's play The daughter-in-law, written in 1912, explores underlying, implicit conflict within a family. Set in a small mining town in England, the family consists of Mrs. Gascoyne, her sons Luther and Joe, and her daughter-in-law, Minnie, Luther's wife. The central conflict is between Mrs. Gascoyne and Minnie, who challenges her mother-in-law's control over her sons, who also compete with each other for the love and recognition of their mother. Joe, the youngest son, perturbs the family system and acts as a mediator, functioning as a family therapist. He sets a process in motion through which the rigid family alliances are challenged and ultimately realigned. Mrs. Gascoyne's self-image as a perfect, self-sacrificing, self-righteous mother ultimately is transformed, and she accepts Minnie as a family member. Brandchaft's concept of “pathological accommodation” explicates how enmeshed family members can collide, and thereby stultify their personal development. As Joe plays his role of “family therapist,” the family dynamic changes. Through the process of rupture and repair, each family member begins to recognize the needs of the other, and thereby a path for differentiation, individuation, and autonomy becomes possible for them.

From Pathological Accommodation to an Authentic Self

From Pathological Accommodation to an Authentic Self

Thinking About What We Know and What We Do Not (Yet) Know: Thoughts Stimulated by Anna Ornstein's, “Do Words Still Matter? Further Comments on the Interpretive Process”

While affirming the overall congruence of her clinical approach and Ornstein', the author delineates the distinction between defenses initially described by Kohut and Ornstein and a defense later identified by Brandchaft. Although the former protects a vulnerable self developed in malattuned environments, the latter, structures of pathological accommodation, bears the imprint of the malattuned environment; the defensive behavior carries the mark of the narcissistic injury in some amalgamation with the child's response to it. The author links the tenacity of these defenses to attachment ties, for efforts to eliminate them may threaten patients with annihilation anxiety. Ornstein and Brandchaft agree that both forms of defense may co-exist. The author briefly underlines a similarity between a case described by her and one described by Ornstein, and draws attention to the need to continue the investigation of defensive structures to improve clinical efficacy with such challenging patients. Al afirmar la cong...

Addiction and Pathological Accommodation: An Intersubjective Look at Impediments to the Utilization of Alcoholics Anonymous

This article explores the application of intersubjective systems theory to addiction and, more specifically, to the tenets of Alcoholics Anonymous (AA). Utilizing Bernard Brandchaft's ideas about derailed differentiation processes in early development, the author suggests that for addicts who have developed an adaptive style of pathological accommodation, the compulsive use of substances or sex can reflect a powerful life or death struggle to hold on to one's vital and authentic sense of self. The author shows that AA's implicit demand for compliance and conformity as a condition necessary to free the addict from his or compulsive behaviors reflects early classical psychoanalytic ideas. The implicit pull for conformity of this more traditional perspective may cause an aversive response in the addict/accommodator making it impossible for him or her to tolerate AA. Brief case examples are illustrated. Este artículo explora la aplicación de la teoría de los sistemas intersubjetivos a la adicción, y más específicamente, a los principios de los grupos de Alcohólicos anónimos. Utilizando las ideas de Bernard Brandchaft sobre los trastornos de los procesos de diferenciación en el desarrollo precoz, se sugiere que para los adictos que han desarrollado un estilo adaptativo del tipo ‘acomodación patológica’, el usocompulsivo de substancias o del sexo puede constituir una lucha a vida o muerte para mantener un sentido de sí mismo vital y auténtico. Se señala que la demanda implícita de sumisión y conformidad por parte de los AA como una precondición necesaria para liberar al adicto de sus comportamientos compulsivos, es un reflejo de las primeras ideas del psicoanálisis clásico. La demanda implícita de conformidad en esta perspectiva más tradicional puede causar una respuesta aversiva en el adicto/sobreadaptado haciéndole imposible tolerar los AA. Se ilustra con ejemplos clínicos breves. Cet article explore l'application de la théorie des systèmes intersubjectifs aux dépendances, et plus spécifiquement, aux principes des Alcooliques Anonymes. En utilisant les idées de Bernard Brandchaft au sujet des processus avortés de différenciation dans le développement précoce, l'auteur suggère que, dans le cas des dépendants ayant développé un style adaptatif d'accommodation pathologique, l'utilisation compulsive des substances ou de la sexualité peut manifester une intense lutte à mort pour tenter de maintenir un sens de soi authentique et vigoureux. L'auteur démontre que les exigences implicites de soumission et de conformité chez les AA comme condition nécessaire à la libération du dépendant de ses comportements compulsifs reflètent les idées de la psychanalyse classique antérieure. La poussée implicite vers la conformité dans cette perspective plus traditionnelle peut occasionner une réponse aversive chez le dépendant/accommodateur lui rendant impossible de tolérer les AA. De brefs exemples de cas sont offerts en illustration. Diese Arbeit untersucht die Anwendung der intersubjektiven Systemtheorie auf dem Gebiet der Sucht, spezifischer auf die Grundsätze der „Anonymen Alkoholiker“. Indem der Autor auf Bernard Brandchaft' s Überlegungen zum entgleisten Differenzierungsprozess in der frühen Entwicklung zurückgreift, nimmt er an, dass für Süchtige, die einen pathologischen Anpassungsstil entwickelt haben, die zwanghaft Verwendung von Substanzen oder von Sexualität ein machtvolles Ringen um Leben oder auch Tod widerspiegelt, zum Zweck, ein vitales und authentisches Gefühl des Selbst zu erhalten. Der Autor zeigt, dass die „Anonymen Alkoholiker“ implizit Unterwürfigkeit und Konformität verlangen, als notwendige Bedingung dafür, den Süchtigen von seinem zwanghaften Verhalten zu befreien, was eine frühe Idee der klassischen Psychoanalyse widerspiegelt. Die implizite Forderung nach Konformität, die in dieser mehr traditionellen Perspektive enthalten ist, kann eine aversive Reaktion im Süchtigen auslösen, die es ihm unmöglich macht, die „AA“ zu akzeptieren. Kurze Fallbeispiele werden dargestellt.

Systems of pathological accommodation and change in analysis.

This paper is an attempt to investigate certain structures of subjectivity laid down in development by processes of pathological accommodation. These emerge when the child is required preemptively to adhere to the needs of its primary objects at the expense of its own psychological distinctness. By repetitive patterning of the child’s first reality, an immutable product is created and emerges in the form of fixed belief systems. Systems of pathological accommodation are responses to the trauma of archaic object loss and designed to protect against intolerable pain and existential anxiety. These structures are reactivated in analysis in the context of reciprocal, mutually influencing structures operating unrecognized in both patient and analyst. When they are not addressed, they represent a formidable source of resistance to the analytic process. A review of pathological accommodation in the history of psychoanalysis itself is provided.