Adult psychotherapy objects : report on an application of psychoanalytic thinking to physical psychotherapy objects in Leipzig

 

Adult psychotherapy objects : report on an application of psychoanalytic thinking to physical psychotherapy objects in Leipzig

Written by Valerie Sinason

From ESTD Newsletter Volume 3 Number 9, December 2014 > read the original article in our newsletter

On May 14th 2014 I had the opportunity to visit the Trauma Institute Leipzig founded by Ralf Vogt where he works with his wife Irina and other colleagues. The opportunity came to both attend the conference, with fast translation from Winja, and to hear firsthand about the development of the Vogts’ methods with perpetrator introjects. Identification with the aggressor and ethical issues around obedience are practical real issues for those in East Germany who had to deal with the Stasi and its inheritance as well as the 2nd world war. Ralf had to face the communist suspicion of psychoanalysis that generationally followed close on the Nazi distrust of the “Jewish Science”. As a pioneer in his field he and his team not only held the great responsibility of gaining the tools needed for this work but to tread the careful path of gathering research, theory and science to allow the trauma work to be accepted.

He designed his beautiful wooden family home to house both his family, the Trauma Institute and his working practice. Containment is physical as well as mental. The same applies to the large airy rooms for group therapy and physical applications and the cosier small rooms. I was reminded of the child I saw when working at the Anna Freud Clinic who picked up a piece of paper he had dropped on the stairs saying “Anna Freud has a lovely house. She would not want tissues on the floor”! There is no institutional feeling to the house although a very clear division between private and public areas.

It is in the large airy group room that the observer sees the important new therapy objects. These were conceived of by Ralf and Irina, tested and manufactured until they were absolutely right for the purpose. Combining their psychoanalytic understanding with an awareness of physical impact they wanted to find a way of allowing a patient to experience the transference as emanating from within his own psyche as a first stage of treatment. In other words, when an adult senses hostile feelings towards a big red plastic rectangular block which is too big to be pushed over and dwarfs them, they learn about transference without it all having to be initially directed to the therapist. Ralf and Irina work with the objects to process anger/rage issues, a lack of parental care (neglect), depression, smallness, as well as re-nurturing when the therapist is there with the client.

For example there is a large orange barrel and when you place it on the floor and a client lies on it it can feel a little like it feels for a baby lying on the mother’s breast because, within the walls of the barrel, are some wiremesh and, together with the hollow space, it reverberates the client’s hea rtbeat... another large living sculpture allowed a womblike enclosure. However, the piece de resistance for me was the horse. One long tube of horizontal plastic (the horse’s body) was linked to another at an angle (the mane) and this geometric piece was suspended by chains to the ceiling so that sitting astride and leaning forward the heaviest adult has the sense of being safely ensconced on something larger that can lift the adult, allowing, as all these therapy objects do, a sense of being small against something larger.

A large black sack can provide an actualisation of a depressed mother. However deep you try and burrow or dent the depression it rises up again. Besides its depressed-like quality the big black sack is also used for processing anger and rage. Clients can hit it with a special club while directing accusations at another object standing behind the black sack representing the accused - this is important as it’s not the accused that is being hit. The client is also instructed and learns to not just dive into murderous rage but to stay focused and verbal and co-conscious while delivering important accusatory messages.

Ralf and Irina were deeply aware of the way such objects could stir up complex memories but given the choice available and the range of soft toys and blankets there was no atmosphere of compulsion. Rather, these were aids to understanding. The therapist was outside of the physical experience but a co-observer of it which aids the therapy. It is, in many cases, the patient who touches the objects and not the therapist touching the patient. At appropriate moments there is some touch, for example when they are sitting/leaning on the horse, the therapist might lay a hand on their shoulder. He might offer a hand to hold or squeeze at a key moment. It is important to note that whilst touch is minimal the Vogts are not opposed to implementing touch in therapy. This seemed a really significant application of psychoanalytic thought to physical objects. I found myself wishing Frances Tustin could have been alive to see it.

I was extremely grateful for the way Ralf allowed me to try out the different objects and experience their actuality myself. It is hard to convey the all-round skills and talents of the Vogts as each effective object has been tested at all levels to be suitable for its task. Ralf does have a car capable of carrying large items for demonstration and I intend to order a “toy” tiger. These “soft toys” in fact have metal inside so that a large adult can sit on them comfortably and safely.

The Vogts and the ir team are, of course, especially distinguished for their work with Perpetrator Introjects and their new work on Slander and Betrayal also has political, cultural as well as clinical meaning.

 

References

Vogt, R. (2012). Perpetrator Introjects: Psychotherapeutics Diacnostic and Treatment Models. Kröning: Asanger.

Vogt, R. (2008). Psychotrauma, State, Setting Psychoanalytical-Action-Related Model for a Treatment of Complexly Traumatized Patients (SPIM-20-CTP). Gießen: Psychosozial.

Vogt, R. (2014). Verleumdung und Verrat: Dissoziative Störungen bei schwer traumatisierten Menschen als Folge von Vertrauensbrüchen. Kröning: Asanger.

Vogt, R. (2013). SPIM 30. Behandlungsmodell dissoziativer Psychotraumastörungen.: Konzeptbegriffe - Materialien - Langzeitfallbeispiele.