Affective learning after pharmacotherapy

• Welcome to the BOL Forum on Shame and Affect Theory by John Grohol, 2/10/96
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    • Thank you for the quick Bipolar reply! by Kris Evans, 7/28/96
      
      

Another important question! You mention the use of hypnosis to retrieve memories of the past experiences from which current affect management scripts were derived, and compare that strategy to my experience in the 70s doing "uncovering psychotherapy" on recently Lithiumized patients. The question itself caught me off guard and forced me to reconsider my own memory!

I was trained in an institution that stressed (traditional) psychodynamic theory and the value of uncovering therapy in those who were glued together well enough to handle the increase in "anxiety" caused by that group of techniques. As you may know from other material I've written, some of which is posted here, it turns out that the affect involved in that system of "uncovering" really was shame, rather than fear, and as I mentioned in the post above, shame may be the single worst affect to trigger in a manic patient.But a lot else has happened in my "doing" of psychotherapy since then, and I guess I've sort of kept my original language for longer than makes sense. While it is true that I began to work with these patients using the non-directive technique that maximized the output of information from non-manic patients, and while it is also true that they were able to handle that technique much better after Lithium had stabilized their affective reactions, before long I began to develop the techniques I write about nowadays. Basically, I work like a miner following a vein of ore, only for me, any particular affect may be the ore. I encourage memories that fit the Stimulus-Affect-Response sequences present in our work at the moment, and work with the patient to learn new ways of handling similar stimulus situations. I do very little uncovering for the sake of uncovering.

Even though I am fairly well trained in hypnotic technique, I rarely use it to dig for memories with this cohort. I hope Peter Bloom or Rick Kluft catch this post, because both of them are far more experienced than I with this approach. But there is another reason I would not have thought of hypnotic recall for this purpose.

I'm pretty well convinced that the phenomenology of "state-dependent memory" is very very important in the biological disorders of affect. Rather than spend much time looking at past experiences, all of which were accumulated while the patient was forced to live with a pattern of affective responses dictated not by the normal plasticity of the affect system but by the biological glitch of the moment, I try to work with the patient learning completely new ways of handling nearly everything. It is the patients who have taught me this, for they now are capable of reacting so differently from the ways they had known for so long that they themselves begin to search for new responses to situations. At best, then, I find therapy with recovering bipolar patients a matter of new script development rather than the collection of memories about the bad old days.

Your question has forced me to revise the way I talk about these cases. Thank you.

• Hypnosis and Mood Disorders by Peter B. Bloom, 8/3/96
• new script creation what is it? to Nathanson by ginni...fan of Nathanson, 7/11/98
  • Goals and Methods of Therapy by Don Nathanson, 7/19/98