"Good Vibrations": Complexity Theory and Dynamic TreatmentGood Vibrations": Complexity Theory and Dynamic Treatment
By Carol Levin, M.D.
In a talk on complexity theory that Robert Galatzer-Levy gave at APsaA's winter meeting, he used the phrase "good vibrations" to capture the essence of his emerging view of the therapeutic action of dynamic treatment. He quoted a patient's dream of being attacked, barely escaping and then being told by a manager to sit down and wait. The patient protested in his dream: "Don't you understand how serious this is? There are attackers outside!" But the manager giggled and the patient sighed and they "giggled and sighed together until [the patient's] fears slowly melted away." Galatzer-Levy noted that he is prone to giggle, and thinks that his patient got better not from understanding or working through terrifying fantasies, but from their "giggling and sighing together-coming into a peaceful state that somehow made the terrifying fantasies melt away". In his view, the usual foreground of dynamic treatment-content, insight and interpretation-becomes the playground through which the dynamic therapist and his/her patient are connected and function as markers of transformative deep resonance in a therapeutic situation. A time worn idea, we might say, evoking the "corrective emotional experience" we are all so familiar with, but Galatzer-Levy, the Boston Change Study Group, Stephen Seligman and William Coburn, just to name a few, are formulating explanatory theory that supports this old idea that has become embedded in the relational theories of therapeutic action. Complexity theory involves a paradigm shift from an older, objectivist isolated mind perspective to a perspectival, constructivist point of view in which emotional experience is inherently relational. It gives us a language that captures the rich texture of what we do and what we offer our patients, helping us loosen our rigidities and understand how we create optimal therapeutic systems.
Complexity theory is a theory of explanation, not prescription or proscription. While in linear systems cause and effect are predictable and proportional, like when a stone travel a distance that is proportional to the force with which it is thrown, in non-linear dynamic systems different processes are in play: more is possible than can ever be actualized. Complexity theory studies the processes by which complex systems come into being, are ordered and change. We are all familiar with the butterfly effect: a flap of a butterfly's wings in Rio can create a hurricane in, say, Louisiana. This is popularly known as the theory of "tipping points": that at some particular point in a non-linear dynamic system, when conditions are in a particularly sensitive state, a small change in a particular input can produce dramatic changes the dynamic of the system. Thus cause and effect in complex systems are not proportional or predictable and are transformed into one another as the system reorganizes, as it is propelled to do. Simple rules lead to complex yet ordered structures.
Further, coupled systems of oscillators are particularly rich generators of emergent phenomena with properties and processes that are qualitatively different from those of each oscillator functioning alone (take, for example, our legs, which can perform qualitatively different actions singly-hopping-versus when working together-walking or running). Systems are called chaotic when small changes lead to major changes in the system's evolution. Complexity and creativity emerge on the border of chaos, and to facilitate their emergence there is an inevitable compromise between the need for familiarity and stability and the need for novelty, with different risks inherent in being skewed in either direction (for example, stagnation or fragmentation).
Complex systems theorists view a dynamic treatment as creating a new, complex system made up of two interpenetrating experiential worlds. The whole treatment setup couples two complex oscillators-two whole people-and creates a new system in which they are together often enough, and long enough, to rework patterns of psychological action that have not worked well for the patient, who has lived in attractor states (patterns) that have been too rigid (not permitting adaptation or creativity in the face of new experience) or too loose (leading to fragmentation in the face of challenges). People enter this new complex dynamic system in some sort of disequilibrium, fertile ground for new solutions to life problems to emerge. Things get shaken up, and perturbations of all sorts (for example, interventions, empathic failures, outside experiences) introduce novelty into the relatively stable setup of the dyad. The aim of dynamic treatment is thus to facilitate the emergence of new and more useful configurations of experiencing and behaving which are then sustained by reiteration (as opposed to repetition) in the treatment and in the interpenetrating systems in the patient's outside life. Each treatment is self organizing and complex, developing its own way without explicitly planning how things should go, and technique thus is dependent on the properties of the system at a given moment.
The Boston Change Study Group has moved away from their initial position that only "lit up" moments of heightened affectivity move the process along, and joins Galatzer-Levy in thinking that the "hours of struggle, jostling, chatting and speculating are just as central to [therapeutic] change as dramatic, apparently transformational moments," and that both participants in the dyad are deeply affected and changed by the process. Usual guidelines for the therapeutic setup and our participation in it enable us to provide enough stability to allow newness to emerge while helping to protect the therapeutic process from falling into chaos. A lot of what dynamic clinicians do explicitly and implicitly involves creating interventions that move the process along by titrating novelty within familiarity. What seems to matter for moving the process forward is that the dyad works together to discover and create meaning rather than the particular content of that meaning. Complexity theorists view the goal of a therapeutic process as restoring a person's derailed capacity for ongoing development and change, and view training as learning how to become part of the solution rather than part of the problem.
In conclusion, then, I hope that this overview of complex systems theory piques your interest so that you will want to read some of the rich clinical papers emerging in our literature on this new paradigm in dynamic thinking.
Note: I am viewing the dynamic treatments along a continuum in which each treatment varies in the details of the setup (depending on what is possible for patient and therapist) but is grounded in these ideas. Galatzer-Levy gave his talk at an ongoing Discussion Group at the winter meeting of APsaA called "Complex Models of Mind in Relation to Psychoanalysis," chaired by David Olds, M.D. If you would like an annotated bibliography on these ideas, please contact me .