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Chair: Sandra G. Hershberg, M.D.
Presenters: Frank M. Lachmann, Ph.D. and Joseph D. Lichtenberg, M.D.
Case Presenter: Hazel R. Ipp, Ph.D.
In the third panel of the conference, we were treated to a rich and
provocative case presentation by Hazel Ipp, and a spontaneous discussion
of the case by Drs. Lachmann and Lichtenberg. Each presenter responded
to the case from his own systems perspective. Reactions to the clinical
material and the application of theory were presented in vivo. The
audience was clearly engaged by the way Dr. Ipp brought us so vividly
into her experience of the clinical encounter and by the dynamic
discussion that ensued—a systems sensibility in action. While the
format was familiar, that is, a case followed by discussion by two well
renowned theorists, the outcome was a level of audience and panel
engagement that was not predictable.
Nell: A Bridge to the Amputated Self
Dr. Ipp poignantly describes her initial encounter with Nell,
recognizing in Nell's first message that she was from her homeland of
South Africa and was an Afrikaner who would have found Dr. Ipp's
background as an English speaking South African to be that of the enemy
in their political struggles. "Suddenly, the thirty years since I had
left my homeland collapsed and I felt catapulted back into the world of
divisiveness, hatred, pain, suffering, horror; a world of angst and
terror." We are thrust, along with Dr. Ipp, as she struggled with her
feelings as her "...past comes crashing unannounced into the present...."
She came to understand that Nell consulted her regarding her
unhappiness at her recent emigration. Having left a homeland ripped
apart and at war, the peaceful existence of her new land seemed without
life, without meaning. This was a feeling that Dr. Ipp had also
struggled with, and she found herself reacting in powerful ways to the
recognition that they, who were on opposite sides of the conflict, had
common struggles. As Nell began to share her traumatic life in detail,
Dr. Ipp was not allowed into her internal world. When Dr. Ipp did
comment, she was commenting from her own reactions, her own experience.
These were politely dismissed by Nell. Nell seemed devoid of feeling;
the feelings were sequestered from her narrative. Dr. Ipp found that
focusing on the details of the narrative, instead of the affect, helped
Nell develop some curiosity about herself and her life. Nell brought in
a dream, ripe with feeling about her mother. This was an entrance into
Nell's inner world, inner experience. Together, they came to understand
what drove Nell to her dangerous political involvement. Both Dr. Ipp and
Nell were freed in this process: Dr. Ipp from her painful feelings
about leaving South Africa and Nell from having to engage in dangerous
political activities.
Dr. Lachmann explained that his perspective involves examining
interactions microscopically. When discussing a case, he asks what the
patient is saying, how do we understand it, how do we feel about it, and
how do we manage it. Turning to the case presentation, Dr. Lachmann
noted that Dr. Ipp engaged the audience by taking them into a conflict
within herself. Through careful tracking of herself, her reactions, and
Nell's, she was able to find a way to emotionally engage Nell. In the
context of the tumult created by the intersection of their pasts, they
developed a system of mutual regulation which benefited them both.
Dr. Lichtenberg began his discussion by referencing the five
motivational systems that he and his colleagues have put forth and
noting which were engaged with Nell. He noted that the attachment
motivation was evident in that the therapeutic connection started with a
smile; an implicit level of communication that engaged Dr. Ipp. He
emphasized that Nell's theme was that of rescuer vs. rescued. He
identified a critical moment, when Nell asks Dr. Ipp a question about
traumatized people. Dr. Ipp was able to bring that back to Nell and her
own experience—a moment of meeting. The dream revealed a sense that
Nell implicitly understood that she needed not to rescue her mother;
that it was she who needed rescuing. In Dr. Lichtenberg's understanding
of the case, Dr. Ipp rescued Nell.
Amy Eldridge, Ph.D., is Dean of the Institute for
Clinical Social in Chicago. She has a private practice seeing adults,
adolescents, and children. She is a member of the governing council of
the IAPSP and is on the editorial board of the Clinical Social Work
Journal.
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