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Friday, 18 April 2008
Extractive identification
I attended a workshop last week where the concept of extractive identification was discussed. This is a common process done by many psychotherapists. The therapist identifies with the client and then extracts that identification.
I did it today. A client reported that he lost his mother to cancer when he was seven years old. So we dealt with the various psychological ramifications of that. In the discussions however I discovered that after she died his father moved interstate for a time as he was so desperately ill with grief. Also he was placed in a house with good family friends and his brother and sister were moved to another family.
I then brought to his awareness that not only did he loose his mother, but that 7 year old boy also lost his father, two siblings, his home and bedroom and so forth all at once and that must have been quite devastating. His whole world of security had disappeared all at once.
This is an example of extractive identification. As a therapist my own Child ego state had identified with him and the pain I assumed he felt. Then I had ‘extracted’ that aspect of his experience by reporting it to him. In essence I had stolen from him. Extractive identification is literally theft form the client by the therapist.
Identification
By me reporting my identification to him I had made it impossible for him to ever achieve that by himself. I had stolen it from him for ever. The theft metaphor is an interesting one. Of course it rests on the assumption that if I report something to a client about their experience like I did above, then that results in less ‘gain’ to the client than if they achieved that awareness of their experience by them self. I think it is safe to say that many would agree that this assumption has some merit.
It has interesting implications for the therapeutic or transference relationship. It almost gives it an adversarial quality. The therapist can steal things from the client. Making prophetic and insightful type statements like I did may make me feel good but it is at the cost of the client having something stolen from them forever. The clients rights are violated when they have something stolen from them.
Can you steal their insights?
With the idea of the violation of the client’s rights and indeed in one form their ‘property’, then one immediately gets a stronger sense of boundary. What belongs to the client is more clearly defined when one considers extractive identification. In the medical field we hear about intrusive and nonintrusive medical procedures. Surgery to remove a persons appendix or gall stones is an intrusive medical procedure. It is intrusive because the doctor intrudes though the clients physical boundary (their skin, muscle and so forth). Of course nonintrusive medical procedures do not do this. Here they use other methods to treat the problem that do not involve intruding across the clients primary boundary of their skin.
Intrusive surgery?
With extractive identification one arrives at the same scenario. There can be both intrusive psychotherapeutic procedures and nonintrusive psychotherapeutic procedures. Extractive identification of course is an intrusive psychotherapeutic procedure. The therapist has sought to observe inside the client’s own psyche and then makes a comment about that observation to the client. Metaphorically the comment of the observation is the equivalent of the surgeon cutting into the patient’s skin with the scalpel.
So the client then has a sense of being intruded upon. “He’s reading my mind” maybe the kind of experience. Another good example of this would be hypnosis.
So in this way one can see extractive identification as not only theft from the client but also as an intrusion by the therapist into the private and intimate world of the client’s mind. This then begs two questions:
1. What are the psychological implications of this intrusion for the client (and therapist)
2. What is the fallout of this intrusion on the relational or the relationship between the client and the therapist.
Graffiti
19:50 Permalink | Comments (17) | Email this
Comments
If you don't know the answers to those questions, then why did you use that procedure on the client?
Posted by: roses | Friday, 18 April 2008
I guess if the relationship is good the intrusion will be more effective in the long run. The therapist may be confused especially if they have a solid belief in the Power is in the Patient concept.
Some may see it as rescuing and others might say its proactive-working psychotherapy. At this stage, it seems like a confronting style of reflection or mirroring to me Grafitti. The robbing-theft bit might feel like NIGYSOB depending on how the therapist shows the "stealing" in non verbal ways.
Sounds interesting and as you say nothing new or different for counselling, however perhaps it sheds more light on an interesting therapeutic intervention.
kenoath
Posted by: kenoath | Friday, 18 April 2008
Ken, it just sounds like conversation to me. That's what we do when we're just talking. If we're really listening we'd have understood that he had lost everything and not just his mum.
But what i want to know is... if the questions asked have no answers then why use it in therapy? There's one thing being shown in a suppressed way what the person actually went through just in conversation or relating but a whole other thing if it's used as a tool in therapy.
Stealing is stealing. It's not nice if you see it that way.
roses
Posted by: roses | Friday, 18 April 2008
Interesting.
Personally in situations like that I don't feel robbed. But it can end up kindof risky. Because I end up thinking either
!yeh, you really get me'
Or I think
'You really don't know me at all' which is fine at the beginning of a relationship but not after you have known eachother a while. So then it can create a wedge.
Mostly I am grateful for the insight and it creates a building block to understand further.
Posted by: kahless | Friday, 18 April 2008
I like what Ken says - its all in the delivery!
After I wote the above comment I wondered whether I am a bloody awkward client! I guess I hate people assuming they know me. People think I am a piece of cake to read because of my expressive body language but I am not!
Lol!
Posted by: kahless | Friday, 18 April 2008
The answer to those two questions is not easy Roses,
Indeed they are really rhetorical questions. Extractive identification really represents a whole different approach to those who will make such interventions. It is treating the client with much more care and a softly, softly approach.
It is moving towards the position where one insults the client by seeing them as ill. There is no way such an approach would ever consider a client is playing a game or in a racket feeling. The client in this sense can never do anything wrong. There is in this way no psychopathology.
Tony
Posted by: Tony | Friday, 18 April 2008
I hope you write more about the technique Graftti.
kenoath
Posted by: kenoath | Friday, 18 April 2008
I don't understand, Tony. In one sentence you say "Extractive identification is literally theft form the client by the therapist." and then in your comment you say "It is treating the client with much more care and a softly, softly approach.'
They just don't seem to fit together. How can stealing from your client be seen as more softly softly approach.
then you say "It is moving towards the position where one insults the client by seeing them as ill." Again, a negative.
"There is no way such an approach would ever consider a client is playing a game or in a racket feeling. The client in this sense can never do anything wrong. There is in this way no psychopathology." I guess I see this as heading towards a positive.
I'm totally confused. Is this "extractive identification" a good thing, a bad thing, or just another possible technique and neither good nor bad.
Posted by: Madeleine | Friday, 18 April 2008
I think it was in relation to my mention of NIGYSOB Madeleine. If I said it might be like a game, then that also infers that the therapist and client are in a game. From the clients perspective the may feel "had", which isn't really a Niggysobber. Good points you make Madeleine.
kenoath
Posted by: kenoath | Friday, 18 April 2008
Hey Kenoath, I guess I hear Tony's initial response
"I then brought to his awareness that not only did he loose his mother, but that 7 year old boy also lost his father, two siblings, his home and bedroom and so forth all at once and that must have been quite devastating. His whole world of security had disappeared all at once."
as a simple reflection from therapist to client, awareness for the client that he had lost more than he realised, acknowledgement from therapist of all the losses etc. rather than an intrusion or "stealing" something from the client.
Posted by: Madeleine | Friday, 18 April 2008
Tony,
So you put yourself in the 7 year old boys shoes and said what that might have been like for you back when you were 7? Using that in therapy is using a whole lot of assumption. Though at the age of 7 we're still early in our development. We've already grabbed a whole lot of stuff and learned a heap of things yes - but at age 7 we'd still be forming. Gosh - at 45 i'm still forming - or is it, reforming?
A therapist using what s/he knows, added with compassion and honesty, would help to mirror to the client, what a grown up is feeling if that happened to her/him as a 7 year old child. It may not be exactly what the client felt or how it is remembered, but the empathy and connectedness a realisation like this between them both could be dramatically changed. Oh, yes - and that change could happen any number of ways i guess.
Assumptions like that could be like throwing a number of dice. The variables - WOW - are so numerous! Oooo, no room for games in that one. That's jumping and hoping that the bungy string is in tact Tony. Such assumptions should only be stated with close friends. So i guess it would only flow with a client who has been a client for some time? Once you're both familiar with each other and less easily offended and you have learned their communicative thought style?
For some reason while i'm writing this it's making sense but i'm afraid that when i come back here it's going to be gobbily goop. Pretty much what i'm saying is how i relate to people. I just realised how hazzardous it is.
Mind you - about the dice? There are certain amounts of times the dice fall on each face. How to say this... living in this town for the last 30 years, when i'm talking to someone who i've known all that time (not necessarily a friend) I'm going to be talking with them knowing alot the same as they know. Lots of events have happened the chances are, both of us have witnessed those events. Umm, lots of similar memories or relatable items in our memories i guess. So the number of dice we're throwing are less (so to speak) so the outcomes fall less randomly. You know what i mean? My assumptions while conversing are going to match theirs?
By the way - anyone visiting this blog NIGYSOB stands for *Now i've got you, you son of a Bi***. It's called a game. You can read about it in Eric Berne's book "Games people play".
We've got rain Tony. It's lovely
Posted by: roses | Saturday, 19 April 2008
Hi Tony,
I don't see anything wrong with that. I agree with Madeleine that it is reflecting back to the client how much they would have lost. The client can then say, well, no I didn't feel it was like that at the time for such and such reasons........or he can say, yes, I feel you've really hit the nail on the head.
KazzaB
Posted by: KazzaB | Saturday, 19 April 2008
Often the teenager client shows resistance to the whole counselling thing. In their minds perhaps the counsellor is going to take something away from them. Their Mojo-survival anger perhaps?
In that way the counsellor may utilise Motivational Interview or some reflective summaries perhaps. The teenager seems to place a great of importance on surviving. Their resistance to the counsellor unlocking matters that may evoke 'bad' feelings and create self reflection is like voodoo to them.
I can imagine that in the moment the counsellor seems to get some 'points' via this Extractive Identification the teenager is gonna hate you but like you for that. Perhaps in some cases there is not much else the counselor can do within the realms of respecting the client? The counselor is being paid to achieve results why would the client not want that?
kenoath
Posted by: kenoath | Saturday, 19 April 2008
Geez, maybe I have not been respecting my clients for years Grafitti and been ripping them off blind according to some theories. Some of my clients don't want to hang around for years of work. In some cases they only get 6-10 weeks of funding and they probably won't continue after that.
In the end its gonna have to come down to the clients "contract". I mean, what the hell is the issue? Will it be about being liked, honoured, respected and rebuilding a core trust for them or will the issue be the anxiety, anger or sadness? Either way, the Power is still in the Patient even if the self reflective process is expediated by Extractive Identification methods. The client still makes their redicisons in the end.
kenoath
Posted by: kenoath | Saturday, 19 April 2008
Well that is correct Kenoath,
You have been engaged in theft from your clients if you do the process of extractive identification.
I plan to write a second part to extractive identification on further discussions from the week long workshop.
But I am at the moment trying to find some good stone for my back step!
Hope you are enjoying your sunny Saturday afternoon Kenoath
Graffiti
Posted by: Tony | Saturday, 19 April 2008
So your back step is wobbly Grafitti and you are looking for some stone to rectify that?
the footbal is just about to begin which is good
k
Posted by: kenoath | Saturday, 19 April 2008
Ken said:
"So your back step is wobbly Grafitti and you are looking for some stone to rectify that?"
Human beings are searching ernestly for good stone to help rectify their wobbly life. So - like you, they can step out of their back door with confidence and face the world with dignity.
I hope you find some good stone Tony and you don't get too ripped off while you're at it.
roses
Posted by: roses | Saturday, 19 April 2008