Considerations on Developing Agency and Autonomy

In recent weeks, I have experienced a curious collision between some things I have been trying to wrap my head around vis-a-vis the therapeutic process and something that has come into consideration in watching my daughter and contemplating the process of parenting a toddler experiencing their first real bouts with feelings like anger/rage, despair, willfulness, fear, and disappointment.  The question, in both instances, has involved reflecting on the never fully resolved position of what to do and when to do it.  How do we know what kind of container the other needs at any given moment?  What do we demand of ourselves with what is showing up in a relational dynamic?  How can we ascertain when we should, in the words of Heidegger, leaping-in and take over rather than leap forth and liberate?

This is a question which comes up often in my reflections on a session.  Occasionally it is in the realm of what I suppose we would call intense emotional processing, but which we might existentially call something more like a client’s willingness to confront themselves.  It is often reasonable to ask oneself the question: “What is this person ready for?  Should we go towards making space for some of the more traumatic origins of what is bringing them into a therapeutic relationship or do we need to continue to build up self-esteem, emotional resources, and orient ourselves towards (re)constructing the ego?”  And this can be true from the most profound to the subtlest of developmentally arrested positions.  I am not merely talking about moments where we are trying to determine how much to bring a client into tension with some palpably traumatic episode which we would classify as an acute trauma.  But also, for example, with someone who struggles with something like empathy and emotional attunement, when to help them develop that faculty by describing some of what you think another might be thinking, as opposed to putting them in the position of “sink or swim” and holding them through the uncomfortable experience of attempting to do it themselves.

Generally the accepted wisdom is to make some consideration along developmental lines (this is probably true of both the developmental position of the client as well as where we are in the development of the therapeutic relationship).  This is the value, oftentimes, of psychoanalytic theories and principles.  They provide a rich—and to my mind fairly accurate—repository of concepts and frameworks for how certain interpersonal activities and affective regulation components develop.  As the relational theorists often talk about, it is not that there is some obvious developmental arrest that has occurred leaving a person infantile and incapable before us.  Rather, we are confronted repeatedly with the idea that, as Ghent puts it in his paper on paradox and process, there both “is a baby and is not a baby”.  In this developmental model, “object relations” theories and the need for containment and holding functions in therapy are the driving factor, seen as the earliest developmental position, we find ourselves compelled to satisfy urges and desires of the client, while recognizing the limitations of interpretation at that level.  More up the developmental ladder is self psychology and the beginning of giving the client something to model, mirror, or idealize in order to create their own internal structures of what it is they need from an intrapsychic position.   We then arrive at the conflict model, which is the position at which most psychic functions are relatively well developed and ego functions can contain disruption well enough, but there's some misalignment of, say, values and needs.  This is the level at which more subtle defenses like repression play out and clients need to be gently challenged to see what it is they are repressing, but would also do well to be allowed the frustration of not simply being given someone else’s set of answers about what the so-called “problem” is and what they ought to do about it.

Of course, this all sounds very wonderful and clean when laid out in this manner, but as Ghent (among many others) is quick to remind us, there is never any one way in which a client “is”.  Nearly everyone we work with will be plotted in multiple positions along this developmental continuum, often simultaneously.  This complicates the “what to do” and “when” questions.  Clients come in and out of various aspects of these phases, at times using language that seems to seek merger, at others using language that seems to be seeking some kind of self-object identification.  Clients can simultaneously demonstrate aspects of the deficit and conflict model.  At times it can make one feel, perhaps hopelessly, that we need to be doing everything, all the time, and all at once.

It’s been an edifying, though difficult, experience watching my daughter grow up and have to navigate similar (though often far more extreme) oscillations between states of being.  I remember learning Erikson’s developmental psychosocial stages as a graduate student and having some intuitive sense, later confirmed by a professor, that though linear, the phenomenological truth of it was that each developmental stage was always occurring simultaneously.  I am now seeing it in action.  As my daughter’s ability to influence and manipulate her environment has become increasingly sophisticated and language has developed and adapted to more effectively symbolize her world, it is easy to get a sense of the modes of conflict and dialectical tension between developmental needs that arise at various points as she explores what it is to be present to and in relationship with her surroundings.

You can see this most acutely as tantrums are beginning to mount and questions about frustration tolerance are becoming a household concern.  To what extent is there some responsibility to sooth and to pacify and to what extent is she entering a developmental phase where some of that responsibility should be hers to bear (with some support from her caretakers).  It would be far too easy to get lost in the binary of “she’s too young therefore sooth” or “she’s old enough, let her work it out”.  It is my sense this tends to be the direction of most parenting “manuals”.  Pick a side and stick to it, when the reality of interpersonal dynamics are far more fluid than that.  If we think about what it is we are trying to achieve developmentally, the task is really one of engendering the capacity for contained frustration.  The child needs to be able to develop the capacity to engage in the contradiction.  This is different from the more developed position of being able to reflect on one's capacity to hold contradiction, but we would suspect living in contradiction and holding conflict is an important precursor to naming contradiction and conflict.  Unsurprisingly, our capacity for doing this exists in some nebulous space where neither our ability to be nor to do takes any obvious precedence, but where the two develop alongside one another on unpredictable, asynchronous, and arhythmically parallel tracks.  The child becomes what they need to become by doing what they need to do.  But they can only do what they need to do by stretching their ability to be something outside the realm of that which they already understand themselves to be.

This process similarly plays with notions of inside-outside as well as with the spectrum of being-doing that we describe.  In order for the child to learn this process of being able to contain while being frustrated, they need to engage in a complex set of interpersonal functions.  Daniel Siegel once described the process of learning how to self-regulate as “other-regulated self-regulation”.  When children are much younger, this process is quite obvious, but they have so little capacity to do for themselves.  As they get older, the challenge becomes how to thread a particular kind of needle, which I would describe as engaging in soothing on a meta-operative level, wherein we are no longer soothing the immediate need, but are providing assistance in soothing the secondary need of the child’s not quite yet knowing how to satisfy the primary need on their own, whilst also having some sense of when that frustration might boil over into something unproductive and disruptive towards building a sense of self-efficacy/-competency.  What they don’t tell you is these processes also require a considerable amount of self-soothing be done on the part of the parent, particularly (I think) in the instances where we are engaged in the more delicate dance of moving in and holding back which is the secondary containment process.

So how do we sort this out in the context of therapy?  The good news is we both have to and also sort of don’t.  When we are working primarily with primary process type dysregulation in the therapeutic process, the mode of listening and reacting is almost always one of containment.  The therapeutic instrument need not be particularly well-honed to sense this, it will be palpable.  You will feel the sense that the client needs you to sooth and knows they cannot provide that function on their own just yet.  Usually these experiences will be affectively dense, with emotional states like rage, shame, sorrow, or paranoia taking center stage.  At this level, there is no need to do anything other than help the client to contain and through that container hopefully provide them the “other-regulated self-regulation” we described to be able to tolerate these emotions well enough to eventually feel capable of exploring them further.  The trick is to be sensitive enough to know when they are ready for you to pull back, which will inevitably lead to at least some regressing back into these states of rage, shame, sorrow, etc., but this time as a means to defend against the feelings of shame and guilt that might be arising in the more immediate therapeutic relationship with regards to the client’s sense they are not doing something they are “supposed” to be able to do.

What changes is, as the relationship deepens, we are rewarded with the possibility of moving further into the interaction with the client and offering some response on what we are feeling/thinking/sensing/understanding about what is happening.  This response can be in the form of commentary on the process, it can be something we offer the client in the form of mirroring some sense of what we are picking up in the exchange, or it could be using reflective statements to help the client see something they are already expressing anew.  All while recognizing some responsibility to use ourselves and the relationship to simultaneously evoke and contain the secondary process challenges that arise in the relationship.  It makes for a more dynamic (and therefore I think more accurate) way of understanding our responsibility in the caretaker role, regardless of whatever the specific responsibilities of that role may be.  It also seems to me that rewards, though perhaps slower to come, can be far more fruitful, as it invites the other to do more than simply correct some set of unwanted behaviors, but to confront the existential condition, the responsibility, agency, and limitations of what it means to engage with the world, authentically, with true determination and humility.