HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • coherence
  • gaze
  • reflecting team
  • mirroring
  • safe place
  • reflective function
  • intersubjective encounter
  • mentalization
  • shame
  • meaning

Part of this text is based on a presentation in a Symposium titled “Narcissism 100 years later” held by the Hellenic Association of Psychoanalytic Psychotherapy on March 27-29, 2015.

Translation: Pepy Scordeli,  psychologist-psychotherapist, MSc

The soul, like the body, needs a safe haven/place
_ to recuperate or heal._
Havens, 2012


The first mirror one faces in life is the mother’s gaze, through which one establishes a sense of self. An inadequate mirroring through the mother’s eyes instills in a child feelings of rejection, abandonment and shame, thus transferring narcissistic and identity deficits that imprint as trauma, void, deadness, lack of meaning. Through clinical material we will be looking into the sense of shame, both as a painful emotion that often shatters identity cohesion, and as an attempt to recreate and symbolize one’s traumatic story. The therapist’s emotional mirroring and the therapeutic relation will provide the patient with a facilitating environment –a safe place– that will allow him to explore and process sensitive emotional issues of his history, in order to give meaning and gradually recuperate a more cohesive sense of self and relations. Under these circumstances, psychotherapy could be seen as an intersubjective encounter, through which the therapist aims to create a safe and transitional intermediate space that will give the patient the capacity to develop reflective function; that is, the ability to observe and think about oneself, one’s life and relations with cohesion and meaning.

Key Words : gaze, mirroring, reflective function, mentalization, shame, meaning, coherence, reflecting team, safe place, intersubjective encounter


No place can be as hospitable and safe as our childhood, if we have had the chance to grow in families with warm and genuine emotional ties. A positive connection to people we love forms a protective shield, a safe haven that gives a sense of containment, protects from adversities and uncertainties of life, while providing a context for maturation and growth of self.

In the opposite case, lack of emotional response from parents to a child’s needs leaves the latter exposed to emotions of unbearable loneliness and despair. The child lives abandoned, in a state of total solitude, without a mentalized presence of his parents’ love, since the parents have not invested in his emotional and symbolic growth. The child’s psychic apparatus, developing in such an inadequate environment is severely traumatized, resulting in a deficient structure of the self, difficulties to connect emotionally to others and a compromised capacity to represent his own thoughts and feelings. Trauma invades the child’s psychic world and makes existence a non-existence, leading to an encounter with psychic death. Symbol formation is substituted by “reality”, and that means an arrest of the representational capacity (Erlich, 2010). Eventually, the child internalizes the negative as real and in a way learns to expect solitude, rejection and unmet needs.

From therapeutic practice we know that working with adults with primary trauma can be very arduous and may demand a great deal of tolerance from the therapist’s side. Often these people have severe narcissistic and identity deficits, they have difficulties to tolerate frustration and accept boundaries, they tend to confuse internal and external reality and resort to acting-out. In the therapeutic process we are often invited to replicate primary interactional models that are more resistant to change according to the level of traumatization. Thus, a key question that arises is how psychotherapy and the therapeutic relation could provide that safe place, which will allow the patient to internalize an experience of understanding, acceptance and attribution of meaning to his experiences, in a way that will balance out the inadequacy of his primary experiences.

Gaze, mirroring and reflective function

The precursor of a mirror is a mother’s face.

Maybe then our only homeland is the face
of the other.
Kiourtsakis, 2015

The first mirror one faces is a mother’s gaze that reflects her emotions towards the baby, her expectations, wishes and phantasies. Mother, through visual communication with the baby, reveals her psychic content that intertwines with the developing psyche of the infant (Zacharakopoulou, 2011). Through a mother’s mirroring the child will construct his first representations of the self and  will gradually learn to identify and manage his internal world and his emotions; in other words, he will establish a sense of self.

The emotional echoing and the mother’s response to any spontaneous gesture of the infant; this amazing dance of mutual emotional co-ordination through facial expressions, looks, hand movements and tone of voice as described eloquently by Threvarthen (1979), is a kind of primary dialogue between mother and baby; it gradually introduces the baby to a world of meaning, thought and intersubjective communication. Paraphrasing Kiourtsakis, one could say that a mother’s face and gaze is the infant’s place of origin: the first homeland where the self resides. The mother is the one to accommodate and transform a baby’s painful experiences into tolerable feelings, ensuring a sense of continuity of his existence. The child absorbs the mother’s response, internalizes it and creates a psychic space; that is, he learns to encompass his experience as a subject and to attribute meaning to the world around and inside him. Through symbolic function the child discovers that he has a separate mind and others have their own separate minds, but he can share aspects of his subjective experience with others, thus creating possible ways for the self to exist with others (Stern, 1985).

Mirroring acts as a boundary between the outer and the inner world. It introduces the infant to a discovery of reality and to differentiation from others, as he gradually learns to distinguish between his own experience from another’s, by recognizing similarities and differences between him and the others.

One essential condition of adequate mirroring is a mother’s ability to return to the infant a gaze that contains something of his own (Winnicott, 1971) and not distort the baby’s signals with her needs and projections. This could lead to a sense of emptiness and absence of meaning or the formation of a false self. Actually, an adequate mirroring assumes a relatively successful congruency of a mother in order to identify with the baby’s feelings; that is, the mother recognizes the infant’s feelings and responds accordingly by following them, not imposing her own emotions. Also, this is achieved by a markedness of emotion through excessiveness in expression, in a way that the mother expresses her child’s emotion, at the same time she making it clear that she is not expressing her own emotions (Gergely & Watson, 1996).

Mirroring congruency instills in a child the feeling he is being understood, while through markedness a mother introduces him to the ’as if position’, to a pretend mode, in other words to the world of symbolization (Gergely & Watson, 1999). It is as if she told the baby that this is a small game for you and your emotions (Holmes, 2001) and through this process she helps him metabolize his feelings, in order to avoid experiencing them as real and scary. In effect, symbolic function discerns between real/lived and representational experience. Through this process, as previously mentioned, we realize that our mind mediates between the self and the experience.

The development of a reflective self starts from the infant’s mirroring experience through his mothers gaze. A mother’s ability to mirror the baby helps him develop a symbolic representation of his own state of mind and that of others. The infant will gradually internalize his mother’s responsiveness as reflective function (Fonagy et al, 1991). This is a person’s ability to think of himself in relation to others. As the others respond to this and understand him, he, in turn, will be able to understand others, accept the others’ opinion as an “aspect of the other” and thus be able to cope with himself and his relations.

Reflective function relates to mentalization. Mentalization is a fundamental human ability that allows one’s mind to carry the other’s mind. Through mentalization a person understands human behavior in terms of needs, emotions, convictions, aims, goals and reasons (Allen et al, 2008). In other words, mentalization refers to our ability to observe ourselves from an external perspective and others through an internal perspective. It helps us distinguish inner from outer reality, intrasubjective from intersubjective processes and allows us to attribute meaning and manage reality. By developing this ability a person acquires the sense of a predictable and understandable world, while others’ behavior carries meaning. Through reflective function and mentalization, an individual acquires the potential to turn and look inside himself; he becomes the subject of reflection, just like his relations, he processes experience while giving out a sense of cohesion, he contemplates his emotions and feels about his thoughts, instead of acting- out on them ; he realizes the multiplicity of aspects he can perceive and interpret reality and consequently he comes in touch with his ability to change and improve.

When the gaze becomes traumatic: The feeling of shame through the eyes of important others.

Mirrors can kill and talk , they are terrible rooms.
In which a torture goes on one can only watch.
The face that lived in this mirror is the face of a dead man.
Sylvia Plath

When the important other does not acknowledge and value us through his gaze, then the psychic apparatus is not structured adequately, and this deficiency is imprinted as trauma, void, deadness, lack of meaning. Our place of descent appears inhospitable and deserted. Winnicott claims that if an infant sees in the face of the mother her own feelings or the rigidity of her defenses instead of himself, then the mirror becomes an object one can look at but cannot see himself in it (Winnicott, 1971). The inadequate mirroring eyes of a mother instill in the infant feelings of rejection, abandonment and shame, while transmitting a vulnerable narcissistic identity.

Morrison (1989) studied the connection between shame and narcissism and claimed that behind narcissism lies a feeling of shame, as it reflects a failure to live up to an ideal. It is a kind of narcissistic trauma that comes from a comparison of what one actually is and what he ought to be. Deep inside the narcissistic individual feels ashamed, as he carries the conviction of a deficient, inferior self, while trying to overcome this gap through a narcissistic declaration of the self.

Shame is physically demonstrated through blushing, lowering of the eyes or avoiding eye contact and is an unbearable emotion created always from the gaze of an important other. When ashamed we want to hide, to become invisible in order to avoid feeling exposed (Rizzuto, 1991, Warmser, 1981). In the core of shame lies the element of exposure. Shame emerges when something intended to stay concealed is suddenly visible to others. Privacy is hindered and we are left naked in front of another’s eyes, be it an actual or an internalized person. The individual is ashamed of how he appears in front of others, and the other makes him feel weak, inadequate and unimportant. The shamed individual identifies with that stare as if it resided inside himself, and shares this contempt. The other’s stare is experienced as potent, overwhelming, judgmental and infallible. It reveals the terrifying distance between the ideal image of the self, to which he ought to correspond, and the deficits of his image as identified in the stare of the other. Shame is usually a mute emotion; a shamed person would rather vanish instead of acknowledging and talking openly about it, or trying to repair the relation with the person who causes it: confessing the reason of shame would mean surrendering oneself again to the other’s power to judge (Cyrulnic, 2012).

Lacan (1991) locates shame in the field of reality, of the non-symbolic that exists in the gaze of the other. According to Tisseron (1992), shame is born when a catastrophe crushes an individual’s feeling of internal continuity. If this shame is not processed, it can lead to a destructive aggression towards either the self or the others.

Through infant observation Thompkins (1962) claims that shame is created within the mother-infant dyad, as a protective response, when the mother fails to emotionally be attuned to her infant’s needs. She is then being experienced as unavailable and finally estranged from her child (Broucek, 1982).

Shore (2003) defined shame as a primary social emotion that emerges between the 14th and 16th month in an infant’s life, through his relation to a caregiver. He describes how the infant looks interestingly and excitedly at the parent, in order to share his enthusiasm and have it mirrored back to him. If a parent is not emotionally attuned, the baby experiences shame. A parent’s failure to provide attunement and mirroring leads the infant to perceive his genuine self as unwanted/unaccepted, unimportant, in a way that disrupts his sense of continuity. The infant is ashamed, feels denigrated and finally disconnects from his own needs and wishes.

Ayers (2003) explored shame caused through visual communication between mother and baby. Shame was not an instant response but evolved into a perception of the self that on a very deep level inhibited the individual’s capacity to present himself, resulting in a feeling of non- existence and annihilation. A mother of this disposition is unable to recognize the emotional world of her infant and ends up denying and denigrating his existence. The infant gradually feels hated, bad, as if he shouldn’t have been born, should not have existed. The baby actually introjects his mother’s eyes as partial objects, and shame protects the connection to the internalized bad object, leaving the mother flawless and perfect (Zacharakopoulou, 2011).

The source of shame may thus affect one aspect of the self or the entire existence. In this case, shame may be a threat to three essential milestones upon which an individual’s sense of cohesion is built: self-esteem, the emotional bond to one’s own people and the feeling of belonging to a human community (Matsa, 2013). Through shame, communication to the important other is disrupted. However, apart from a pathological aspect shame may have a protective function. It acts like an impenetrable wall that separates and protects a fragile, genuine part of the self from the mother’s gaze that intrudes fiercely and keeps the child imprisoned (Zacharakopoulou, 2011). Similarly, Campbell (1994) suggests that shame could be a useful and essential emotion. Concealment due to shame prevents further exposure of a person’s weakness, in order to recuperate in a safe, hidden, private space where he can pursue psychic reconstruction away from the domineering stare of the important other. In this sense, shame functions as a protective shield; the destruction of this shield, as in cases of abuse, can lead to perverse choices.

Paradoxically, threrefore, shame can be seen as an individual’s attempt to preserve the bond with the person that causes it. As Matsa (2013) suggests, the individual who receives the other’s gaze and contempt becomes a subject of shame through the intersubjective relation that secures his existential affirmation. As a result, though ashamed, through this relation he feels a sense of belonging in a community. and shame confirms his dedication to the values and moral precepts of the community that rejects him. Therefore shame essentially is the individual’s attempt to represent (as shown in the clinical vignette), to symbolize trauma and attribute meaning to the experiences of shame, to connect them to his history and regain appreciation and dignity by reconstructing his identity.

Orestis’s story

What more horrible act of violence than not be loved.
_ M. Karapanou_
Orestis is a 35-year-old, homosexual man, former drug abuser that comes to therapy after completing a rehabilitation program. He carries a very raw and violent history and a “loose identity” . He feels like an empty garment, flooded with things he does not understand. Orestis’s life has unraveled in deficit, lack of presence, absence, and void.

His father is presented as psychopathic, brutal, violent, rejecting and abusive to his son, sexual abusive to his daughter. He was never a role model for identification but a source of fear and terror. Orestis’ mother is depicted as depressive and dependent on her husband, although occasionally she would seek comfort in other men. When her husband died she left Orestis, then aged 12, to her mother and went away for two years to live with a man who was a drug addict. When she returned she began soliciting. Orestis has intense memories of his mother, when he was 14 years old bringing men at home and having paid sex in the same room where her teenage son slept. He remembers himself hiding under the blankets, holding his breath, wishing to disappear from shame. In retribution, as he grew up he would ask her for money and various goods.

Orestis’s identity was built upon shame. As a boy he experienced terrible stigmatization, exclusion and he was being mocked out in the street. At school he was a black sheep, he was called “fag”, “sissy” etc. At home his father would call him vulgar names and he, afraid and ashamed, would hide under the furniture. He was the son of a prostitute and a rapist. At age 10 he was sexually molested by a cousin on his mother’s side of the family. His aunt (his mother’s sister, who also solicited) caught them naked in the bed. She neither said or did anything. The incident was kept quiet. Orestis felt great shame.

Orestis indulges in one-night stands; he often has unprotected sex and has no sense of peril. In his romantic relationships he complies with the other’s lifestyle. He claims to do that out of fear of abandonment; but in this manner he loses his self. In the end he acts out on his annoyance by lying, sleeping with other men, not revealing his more vulnerable sides.

Initially, at our sessions Orestis brings scattered facts and talks in a disconnected and fragmented manner. He seems unable to define his feelings and afraid to let himself experience emotions. He has learnt to seek excitement in artificial ways such as intense sexuality and risky behaviors (like drug abuse), as a reaction to compensate for his mother’s lack of response to his primary needs.

The sexual act becomes an automatic getaway/antidote to any difficulty (he goes for solicitation to the park or to sex cinemas).He has always lived in a state of permanent alertness and tension. He has great difficulties in remembering or containing what happens in therapy. He seems disconnected. He constantly releases tension and often he attacks me by protesting that I don’t listen, that I am bored, that I keep looking at my watch. At such times I feel he is provoking me, he is afraid to relate and trust me and he tries to maintain an omnipotent control as a defense. Overwhelmed by narcissistic needs, he attacks the therapeutic context and the therapist, forgets our appointment or comes late. I feel exhausted and drained, genuinely wondering if I can really help him, so I decide to speak openly. That was an important moment that brought a more genuine connection between us.

I think initially the role attributed to me in Orestis’ therapy was to accommodate and receive his feelings, and that helped him to feel them. At first, when my gaze reflected care, compassion or affection for his traumatic experiences, he started feeling that someone could care for him and gradually he began to feel more warmly and compassionately towards himself.

A very special moment was when he described a shut, empty room (the space within) and how he felt me (as a therapist) close to him through my gaze. He detected emotion in my gaze and that made him feel secure. I mirrored his pain and loneliness, and by experiencing emotion he came to tears and felt compassion towards himself. It was as if the room had become warmer, as if someone reciprocated his feeling and held him; he felt he wasn’t alone; someone shared his feelings and showed understanding. Gradually he became stronger inside. As he says: “the therapist’s gaze softens him, brings him into contact with his needs”. He claims: “I was afraid to bond emotionally”, “the people I loved fucked me up”.

When we talked about the initial phase of the therapy he said in all sincerity “I didn’t know what to expect from people. I wanted you to be perfect so I could make sure you didn’t exist, to reject your presence. If I accepted that you weren’t perfect, then I would be at risk of bonding with you. As a perfect, not existent person you wouldn’t hurt me, nor would I risk being abandoned”.

Fear of intimacy leads him to the false security of the park or the cinema where response wouldn’t matter, where he took no risks; where relations are temporary, transient, seemingly harmless, mere bodies in arousal.

Orestis’s only positive experience during his teenage years was his involvement with dance due to the support from a professional dancer who saw some talent in him and gave him free dancing lessons. Dance essentially was the first look of admiration and acknowledgement that he yearned for all his life. It built up his bodily ego, gave him discipline and structure since he lived in a chaotic environment with no boundaries. Movement, through dance, gave flow to his fragmented life. Moreover, to be able to belong somewhere was a great relief. However, very soon he started using drugs out of the urge to fill the void and the loneliness within. Drug use was also an effort to draw his mother’s gaze, a cry for help and care, to activate a motherly function in her, but at the same time a way to lash out his anger, to hurt and embarrass her. He says: “I was glad to watch her pain as she saw her child melting away; she became the mother of a junkie, apart from my being the son of a whore”. The tragic outcome was that very soon she fell ill with breast and bone cancer, so she couldn’t respond much to his needs. A positive memory he holds from her as a mother is when he overdosed and passed out and she, although sick and weak, tried to pull him up from the floor.

His legs where the first place he hurt through drug abuse. He had vein deficiency. He has no veins on his right leg, and at times he gets open wounds, swelling, his skin cracks and fluids run. He is embarrassed to show his wound. He doesn’t let anyone see it. As he says, he could never stand to see disgust in others’ eyes. He has always made a great effort with his appearance in order to gain the others’ attention. Sometimes he would push his own boundaries to become accepted. At some point I ask him: “What would happen if you were to show your wound”? He responds that it would remind him of the image of his mother soliciting right in front of him. This was never discussed, he was never protected. It is a wound in his heart; or then again he remembers his father’s violence. He remembers intensely one time his father tied him to a tree and whipped him with a belt.

The wound in Orestis’s leg symbolizes the traumatic events in his life. Essentially, through drug abuse he acted out what he couldn’t put into words. His wounded leg gave him the chance, after leaving behind the danger of drug use, to connect to his psychic pain and give voice to experiences of shame and hurt.

Another momentum in therapy was when he showed me his wounded leg, after which he decided to expose himself more. Having acquired some trust in the relation between us, he starts bringing in therapy aspects of himself he considers dirty/filthy, that he feels ashamed.

He mentions stealing small amounts of money from his workplace and usually it has to do with unexpressed anger, which is acted out by taking what is not offered. He is afraid of his anger, usually acted out instead of spoken. He identifies anger with a senseless, primitive, destructive aggression. It represents the other’s annihilation. In his family of origin there was much violence; his father was violent towards him, his maternal grandmother had attempted to kill her child (his mother’s sister), and his grandfather said about Orestis, when he was a baby, ‘let him die’.

Another important issue he brings to therapy and on which I will focus is his resorting to the park and the sex movie theater in order to seek sexual partners. Sex is identified with something dark, filthy, lacking intimacy, disconnected from relation. The sexual element is like a discharge, animalistic, as if discharging an inner tension. It is sex connected to danger, pleasure, shame, a knot in the stomach, the fear of being revealed, racing heart, freezing, being a preying bird, looking for something, a wandering piece of meat. Sex was the connecting thread in his family, his father having extramarital affairs, as did his mother later on for money, his aunt also soliciting, his sister being sexually abused by their father and he being sexually abused by his cousin.

The park and the sex cinema point to his family. It’s like his relations to his mother and father. He feels, as he says: “a body being fucked, my whore of a mother, myself a little kid wandering in agony, anxiousness and tension”. It is a kind of devotion to his family’s “culture”, devotion to those who betrayed him. He brings back to life a family scene, he resurrects his parents as the unmourned living dead thus not letting them go. It is like a shrine to trauma, the compulsion to repeat the trauma

Another time during therapy he mentions going to a sex cinema and having a memory. He remembered, as a child, listening to his parents having sex and him understanding it as abuse. Pleasure was linked to abuse. He thought his mother was suffering, that she was abused by the father. That was all arousal. His parents didn’t protect him from their relationship. There were no closed doors, everything exposed, their sexuality in plain sight, no boundaries or rules.

Orestis says that if there is no violence, there is no arousal. During sex he wants to be dominant, aggressive, insulting the other and making him submissive, humiliating him; in that way he is aroused. He never kisses his boyfriend in the mouth while having sex. He doesn’t want tenderness during sex.

Another connection we make is his father disappearing from home through sexuality (he was seeing other women). It is as if he’s following his trail, like keeping a sort of identification. In these places he expresses his violent/ side, the stallion that chooses, rejects, as if identifying with the aggressor, coming in touch with a part of his father that hurt him, and through that he retains control. But now he is not as helpless as when he was a child.

He says about his father “How can you hurt for something you never had”? He never allowed us to be together. I never had his gaze, his word. He never related to me, he abused me”. In the park, in the sex movie theater, he repeats what he did not have, he is afraid to let go of the “negative”, the absence of relationship. He feels torn, a side of him wants to abort this dark habit that makes him feel ashamed, makes him want to hide or lie so as not to be revealed. This side knows that it undermines his relationship with his partner; he is cheating on him and maybe he avoids acknowledging the fear of abandonment from his partner. Another side of him is like needing to be there, in the sex cinema, re-experiencing anxiousness, shame, tachycardia, loneliness, reliving the way he was as an abused and traumatized child. He retains images, but he doesn’t remember how he felt. It is like reliving an anxiety of being annihilated and then feeling reassured that he will not vanish. How ready is he to let go of his abusive parents? It is common knowledge that mourning is more difficult when one has to let go of something one never really had.

In one of our last meetings Orestis mentions a moment he experienced in the sex theater that really troubled him. He was about to engage sexually with a married man, when he saw his wedding ring; he froze and thought for a moment “what if he’s my therapist’s husband?“; “I wouldn’t want to hurt her, she is an important person in my life who helped me stand on my feet again”. He was upset, he lost his desire to have sex. He left the premises filled with guilt. It is worth noting as indicative of his destructiveness and envy that in the past he had had intercourse with his ex-brother in law. In this phase guilt is being internalized. Maybe for the first time he experiences that there are rules, prohibitions that protect people from their own instincts and destructive impulses. At home he never had boundaries and rules. Anything could happen, so reality would become traumatic, overwhelming, unbearable.

In a way, the therapeutic relation between Orestis and me became a substitute for the emotional support he was deprived of. Almost seven years after our first meeting, Orestis acknowledges some good and stable parts in his life compared to the past, where everything was fluid and discontinued and he had a “loose” identity. The way he felt about our meetings has changed. He takes with him what we say and reflects on them, whereas earlier he couldn’t internalize them and forgot what we talked about. He feels more peaceful within and dares to be more genuine emotionally. He has been in a stable relationship for the last four years, has a job that gives him recognition and acceptance, a house where he feels welcome and safe (he had to move several times during therapy). Eventually he stopped going to the park, realizing how dangerous it had been, but still goes to the sex cinema, slightly less often. Not going there is a kind of liberation from the dark and shameful part of himself. As long as he goes to the sex movies he keeps an element of shame inside a new identity where he can now feel proud for everything he has accomplished despite the deprivations and abandonment he had experienced in his life.

Reflection and therapy

Influenced by postmodern ideas, systemic therapy was enriched by concepts like individual and social construction of reality, meanings, convictions, narratives, language, dialogue, reflection. There has been a move from behavior and interaction to language, meanings and narratives. Hoffman (1985, 1992) describes this turn of therapy to the second cybernetics more like a different therapeutic stance, rather than a different therapeutic method, a move towards reflectiveness.

The mirror, a basic interventive tool in first cybernetics family therapy, goes from being one-way (where the team behind the mirror secretly confers, delivering messages, suggesting interventions) to a two-way mirror with the so-called reflecting team (Αndersen, 1991). The team mirrors and reflects while listening to the family and the therapist, brings forward different perspectives and alternative ways of understanding reality. The team dialogue takes place in front of the family and the therapist, and the language used is co-operational, coherent, positive, respecting and enhancing diversity and polyphony. Through that process new meanings and actions may come up. In effect this dialogue of the reflecting team as participants in a mutual process of expression and reciprocity gives family members the potential to internalize a different manner of interaction, leaving room for new meanings that weren’t spoken out previously. Bakhtin (1986) claims that understanding is an active process of response that comes from participating in conversations. Meaning emerges through the special nature of the dialectical interchange among the members at this particular moment, and not inside each participant’s mind but in the interpersonal space among them (Βakhtin, 1984). As this polyphony is fully internalized, it sets the foundations for an internal dialogue that is key to regulating action and emotion (Seikkula and Trimble, 2005). This idea fits in with a mother’s mirroring, through which the infant gradually acquires the ability for affective regulation and impulse control (Allen & Fonagy, 2002) as well the ability for a reflective function (Fonagy et al., 1991).

Creating a reflecting team marks the passage from monologue and a unilateral, directive way of exploring to a co-operational, dialogical, polyphonic, non-directive process based on a subjective and pluralistic approach to knowledge influenced by the ideas of constructivism and constructionism.

Reflective exploration could be facilitated when a therapist works with a team, but also when working alone with a family or an individual. Tomm (1987, 1988) developed what he called reflecting questioning through which he explored alternative or different possibilities, seeking connections between different levels of meaning in a family system and gradually guiding the individual or the family towards self healing. Similarly, Byng-Hall (1995) underlined the importance of the therapist who works alone communicating and sharing with family members the feelings he might get during the session, so that the family becomes his reflecting team in a way.

Furthermore, a series of reflecting practices have emerged in the context of narrative and dialogical therapy (White, 2000, 2007; White and Epston, 1990, Anderson, 1997, Seikkula, 1993, 2008; Seikkula & Olson, 2003,Seikkula and Arnkil, 2006; Seikkula and Trimble, 2005, Βertrando, 2007, Rober, 2002, 2005, Andersen, 1995; etc).

Through these theoretical developments there emerges the image of a therapist as a non objective observer who participates in the observed system through his self-references, thoughts and feelings, co-constructing meanings with the patients that open possibilities for new, expanded options. The therapist is less interventive and rather reflective, in touch with his inner voices, involved in an internal dialogue (Rober, 1999), contemplating on the feelings evoked in relation to the issues brought by patients and trying to respond in a fashion that creates space to new meanings and stories untold (Rober, 2011).

The reflective method is a dynamic process that starts from challenging standard practices, from critical thought and participation in dialogue, from seeking creative connections and understanding. It is a process during which we take back something we have heard and observed and we think upon it before we respond (Burnham, 2005). Through this process we are able to observe and think about actions and reactions, so we can better understand and attribute meaning to our actions in any given context. Burnham (2005) referred to relational reflection as a process and practice through which therapist and patient experiment, develop, and process ways to relate that have a therapeutic potential. The moment a therapist starts to reflect upon the effect of his stance and his hypothesizing, he assumes a position both moral and therapeutic (Cecchin et al., 2009). Moreover, the patient gradually internalizes a similar reflective position towards himself and his relations.

In this context, psychotherapy can be seen as an attempt to develop a person’s reflexivity, the ability to observe and think with coherence and meaning about himself, his life, his relations. Through the therapeutic process and relation the patient should feel safe enough to explore his internal world and express it in stories and narratives that will reflect his experience.

Reflective function and mentalization in a way becomes a connecting bridge between systemic, psychoanalytic and attachment therapy. Insights around these concepts were created through empirical research by the psychoanalyst Fonagy and his associates (Fonagy, 2001; Fonagy et al., 1991, Bateman and Fonagy, 2006), and through research by Main and her partners (Main et al.,1985, Main, 1991). An interesting finding is that the type of attachment of an infant to each parent could be safely predicted not only from the parent’s attachment type, as measured during pregnancy (Fonagy et al.1991b) but even more by the parents’ ability to understand their relation to their own parents (Fonagy et al., 1991a). Similarly, Main linked a child’s safe attachment to his parents with the parents’ capacity to speak cohesively about their own childhood and their relation to their parents, regardless of any traumatic experiences.

As all this research has shown, a person’s capacity to process emotionally and give meaning to painful events of life is essential for his sense of safety. When a person is able to talk cohesively and clearly about life experiences and the past, no matter how painful they are, without denial or excessive emotion, it is an indicator of security and a reflective function which prevent the transmission of insecure attachment across generations (Main et al.,1984). These findings support the value of the psychotherapeutic process and can promote our effort to help our patients break vicious circles of unhelpful transgenerational motifs and be liberated from the adverse effects of their past (see also Thanopoulou, 2013).

Therapy as a safe place

Where there had been only fearful emptiness […], an unexpected wealth of vitality is now discovered. This is not a homecoming, since this home has never before existed. It is the creation of home…
Arthur Miller, 1983

Therapy is a potentially reparative, emotional experience that is co-created and co-constructed through the relation established between therapist and patient. An effective therapy, like adequate parental care, provides a safe place in which the patient will process sensitive, emotional issues of his past in a way that enhances and expands his perception of reality and leads him to a more coherent sense of his history.

It is common knowledge that building a safe place is assisted by providing the patient with an experience that the therapist is able to acknowledge and understand what is going on inside the patient’s psyche; it is also helped by the experience of a capacity for emotional reparation that balances out any primary traumatic relations.

Gaze, availability, emotional response and the therapist’s interventions provide a way to experience and interact that is internalized and reconstructs the patient’s internal world; through this process, he gradually learns to observe and reflect on himself and his relationships, giving space to autonomy and self-determination.

As Havens (2012) aptly points out, psychotherapy is the name we give to the efforts to study and improve how one experiences and sees things –one’s subjectivity- with the help of the therapist’s subjectivity. Through this intersubjective perspective he understands how the therapist contributes to the way the relationship is experienced and evolves, how the patient is affected and how the therapist is affected by the patient.

In conclusion, therapy is an intersubjective meeting through which the therapist aims to create a transitional, safe in-between space that will allow the patient to explore and process aspects of his experience, that trauma kept disconnected and without meaning, so that he achieves integration and cohesion.

The therapist as an adequate mother welcomes and contains the patient’s non-metabolized pain and helps him create space to talk about the experiences he hadn’t been able to put into words, in order to represent them, as well as recognize and express feelings that might be too scary to think on his own. Under these circumstances, therapy could well be another homeland more hospitable and warm than his place of origin, a mental space where the patient can finally create what was never offered by the important people in his life.


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ARTICLE 3/ ISSUE 7, October 2015

Making sense of and coping with voices through the use of Romme & Escher’s therapeutic model: A clinical case study

Eugenie Georgaca, Vassiliki Fenekou
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