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From Cincinnati WG you see the University of Cincinnati station presents the third in the series of Frank L. Weill Institute lectures by Dr. Mani Slitheen professor and director of the Department of Psychiatry at the University of Cincinnati College of Medicine. Dr. Levine is the author of psychotherapy and medical practice a book which has gone through 18 editions and has been translated into three foreign languages. He was also president of the American delegation to the First International Congress of psychiatry rest in Paris. These wild institute like yours were given at the Hebrew Union College Jewish Institute of religion under the title psychiatry and ethics. The topic of this lecture is the therapeutic alliance. Here now is Dr. Maurice Levine. Last time I talked about defensive ethics I want gradually now to develop the concept of creating about us extreme attitudes may interfere with
both defensive ethics as I just indicated may go off the track because of expressing words or extreme feelings or attitudes. But also the transition from the defensive I think to create about thinks can be blocked by extreme words or extreme attitude was in fact created ethics in a number of ways must be based on concepts which give the highest armorer the place of highest importance to words in attitude which are not extreme. The concept for example of a good human relation or a butler or our the and the lion acts a concept which is useful in describing one form of creative ethics such concepts are difficult to you if one thinks of human responses only in terms of extreme alliance and extreme are more or less in missable and we come to that and see they way out in a moment. One of the best
phrases to use in developing the concept of creative ethics is the tension between the opposite side or the creative tension between opposites. Phrases that in this building I think very well know. But this phrase good as it is has a built in problem in one of its words the word opposite. That word is one of the extreme words in could block a simply used it without indicating that it is used only for sweet clarity's sake or for the dramatic effect. It is a dramatic idea to think that there are two opposite ideas or patent news that one can have a dramatic tension between between them and that out of that tension will come a new creation a new integration but the drama the fact of the two being opposites or phrased as opposites may slow the process make it
less probable that is the integration less probable simply because opposites seem to call for opposition for struggle for continuing conflict rather than for working together for an alliance for an integration to improve the chance of the tension the tension of opposites really being created here. One must know that the tension is between forces that are not altogether opposite us. For example the Geneva Convention for the better treatment of prisoners of war are. Has had some value because it was based on the idea that even enemies or war did not have only the opposite attitudes or opposing action. These booths were opponents but still were in agreement in wanting to provide better conditions for their men captured by the other side and a better example of the European common market has had its resounding
success threatened now by the goal by taking the route of emphasizing the fact that countries which opposed each other in many ways had opposite interests in many ways still were not totally opposite. A creative tension between countries which in good part were separate and antagonistic but not at opposite extremes not opposites really can lead. Could they did they to a plan an integration which was of high value to all who join. The Theory and Practice of the rearing of the young of the human species the process of child raising has been made without unduly unnecessarily confused and different product by the use of extreme words an extreme attitude such as breaking the child's stubborn Where are the opposite setting the children free. The tension between such opposites or extremes is not usually resolved in a
productive way. The resolution problems best by taking each extreme several steps in the direction of being last six Raima and then putting them together see that one can see what can happen when we do this in the field of child raising. We see that we have good valuable one being a selective permissiveness and approval instead of setting the child free selective permissiveness and approval and the other a select few limits setting our disapproval instead of breaking the child's government will rather punish selective limit setting or disapproval. It is not just not too difficult to work out a flexible combination of permissiveness and limit setting for a child but if permissiveness has become its own extreme if the parent has become the doormat for the child who is the master. If anything he
does is OK and almost unlimited permissiveness or sparring is the rule. That's no longer good but bad. And if limit setting has become its own extreme of a death of a destructive punishment or a destructive forcing of the child to be deeply guilty or deeply ashamed of that Oso is no longer good but bad. Now it's true that the less extreme pair perhaps the original pair of selective permissiveness in a realistic limit set a point somewhat in a different direction. They have different functions so permissiveness and limit setting point somewhat in different directions but they are not the extra they can be integrated in a way into a way of being a parent or a teacher that is about as good as we can do. Most important this integration lays the groundwork for a fairly effective conscience in the child for the development of his
own standards for himself. He has a good chance of developing a conscience which uses both selective permissiveness and selective limits citing this kind of conscience can give valid and workable bits of advice when it appears as the voice of conscience. But it is next to impossible to integrate the two extremes of severe sporting into destructive punishment with its excessive Puritan shame. The pattern of unlimited permissiveness tempts a child to feel all powerful all the master of the god. The second pattern of destructive punishment attempts the child to feel excessively guilty and to shame. And when this to a serious degree is the pattern of the child raising the child may later have two voices of conscience. One which tells him to get away with whatever it can and the other which says he deserves terrible punishment for even thinking of having something that he wants. Now this leads me to
present at this point my first suggestion for the process of developing a technology of ethics and instead of waiting for the six letters in a way this is a kind of mathematics that goes this way it goes this way. Whenever there is a tension between opposites or between X brain divide each one by two or by one half. That is reduce each one to 50 percent or 66 percent of what it was or what it seemed to be then find a good word for each one which has been reduced. Then put the two together and see if they join if they integrate. See if the tension can become create here. The phrase could be that there often can be creative tension between opposites when the opposites are changed into kind of the razor on prairie's or just some others rather than opposite the opposites no longer have a negative magnetic force but a positive magnetic force.
The difference no longer is extreme and unworkable. The difference has become workable one about which one might say again Vive la de France now to give examples of this. This is even a newer kind of mass. The other was the new math as the newer kind of math. The first first example is one that we mention severe punishment severe sporting regs. Green Card to be integrated by each bank to reduce them the selective limit setting and selective permissiveness and an integration take place which is a high dive. Second example severe rebellion and this lead on to our discussion next time of the conflict between the generations. Severe rebellion and defiance cannot be integrated with submission and obedience as in the same person severe rebellion defiance cannot be integrated with submission and obedience. But now divide by one and I have to reduce the first to independent wishes to
be heard and to play a role in directing one's own life. And reduce the second which had been submission obedience for obedience. Reduce the second to the attitude of wanting to be advised or to be supervised and helped and to learn what experienced people have to say. Then these two are not explain and can be integrated into a most productive combination within the individual. Third example it is this type of resolution that has led to our having a pluralistic society in America in which there are two interacting. One is the pattern of having separate distinct productive and creative groups and cultures which are related and linked in many ways. The other pattern is of having an overall American culture in which all of the choral groups are involved. The extremes of
assimilation and of separation are the extremes of total integration vs. total separation. The extremes of complete unity of the whole country or complete diversity and separations need not remain as. One solution has been the development of a society. One solution for the future would be the further development of a society based on a decrease in each of the opposing extreme attitudes or principles. Leading to a pluralistic society even further which combines highly important components of each of the important differences into one part while each of the sub cultures continue somewhat independently its productive development. If these were to be extremes would be unworkable of course but need not be. Now this discussion of the kind of mathematics for the resolution of the creative tension between opposites can be used to explain the process of sublimation which I skipped over last
time. It is one variety of defensive it out there. Yes it can appear as one of the resolutions of the exhibition as a modesty conflict or of many other kind and if the extreme demand to be exhibitionistic. Process is the demand for the direct gratification at any time of the exhibitionism or if the modesty insisted on the extreme or complete suppression of the HGs exhibitionistic impulses. There is no resolution of much about but the exhibitionism can make milder demands and be somewhat domesticated and the modesty can be less extreme then the exhibitionism may appear in minor or minimal form in a socially acceptable channel such as lecturing or I want to get approval for winning in a competition. The point becomes clear when one thinks of a lecture which is totally devoid of any wish to have it be a fact given well regarded
such a lecture is likely to be dull and boring or much more dull and boring in the sublimation. The impulse is gratified in a minimal or minor form and is in the service of an acceptable activity subordinated to that goal such as becoming known or respected for one's achievement. This goal is in keeping with the standards of the individual himself and sufficiently in keeping with the needs and standards of the culture. To make can make it an acceptable resolution all round. And yet it makes use of the energy of an unacceptable impulse. This is defensive ethics in the sense defense of ethics at its best and in part perhaps can be thought of as being on the continuum toward a creative ethics. This leads me close to a definition of ethical behavior of ethics which I have been fighting against giving for these three lectures this tentative or they would be phrased as being behavior in which the interests of the
individual in the interests of the culture or the society are not were guarded as contradictory are conflicting to an unworkable degree are not regarded as adversaries locked in mortal combat. Rather they can be regarded as having somewhat different goals than the individual and the culture of the system. A somewhat different goals or values or as pressing in different directions inevitably this produces some tension or conflict. But the interests of the individual in the interests of the culture or the society can be and integrated successfully in a variety of acceptable and good solutions which were both workable and creative. There may be solutions in which the interests of one are paramount. Hopefully without damage to the interests of the other then there may be solution is the most creative forms of ethics in which the interests of both the individual and of others and of society are all forward. And we come tonight to one in which it is in the
therapeutic alliance. And there is the kind of creative ethics we have talked about in which at one in the same time the wrists of both parties both involved are and there are many other patterns in which which we can in that sense call creative ethics. But I do want to avoid a further discussion for the definition of ethics since pre-mature definitions can limit some of the freedom of our thinking. Open mindedness and open ended ness of the stage of our discussion are far more important than definitions. Now the material so for this lecture has been given in good part to prepare the way for a discussion of the therapeutic alliance but the material so far has been important in its own right. Particularly the concept of a kind of mathematics of ethics as a part of the technology of that day I have a second now the first mathematical formula was that of dividing two opposites or extremes to bite each one by to lure about one eye. And then putting them together to see whether what happens is
a mathematical combination of a chemical bond or something more human. But now I want to suggest a second kind of mathematical approach to developing a technology about I think. It would start with one of the very good maxims or statements of that I like this one. It need not be an extreme and I will pick one choose one that has no opposite or contradictory match are only minor versions of one. One example is one the one of the Ten Commandments of honoring one's father and mother. Surely this is a most acceptable pattern of behavior although parents who batter their children or in other ways behave destructively would have difficulty mixed back on or without other reaction. Should we say at the same time. But surely the honoring of the father and mother stands as a highlight. It's a high level goal. You know then in this technology of ethics I
suggest one thing that might be done is to reverse the numbers or to reverse subject and object and you come with this. The parents and one of the most important commandments could be parents must honor their children as well. All of the work in the field of psychiatry indicates that a further development of respect and trust and empathic from a feeling for children would be of the highest value. After the my African maxim then it has been tried out and reversions and crew seem to produce a second good maxim the next step is to bring the two together to see if an integration can result in the instance of Honor thy parents in honor of their children the value of integrating is clear that one of the most important steps forward could be must be a joint working together are parents and children in a mutual you respect thing and honoring our relationship.
I have another example but I see that I am less than expected to be along the lector an example about the law of parsimony of the Ockham's law in philosophy and in science I devise the opposite which I call them Ockham's law which would be the law of. We have a problem here extravagance instead of law of parsimony and point out the enormous value of being extravagant at times and is it in one's thinking one's generalizations. Some of the horrible failures of the parsimonious m law approach and then put the question of whether we might have an Octomom law which might have about some guy. But now on those a few years I don't have to be too careful about getting in every paragraph because the arrangements made in Vance thank goodness for the publication of the book. So you'd be able to see it there. And
now we turn to another extraordinary issue the unexplained and expected finding about him but about the fact that one thing may have two meaning two implications to function. Now we turn to the issue of the ambiguity which contemporary art in music in sculpturing and the rest is making so much of and so productively and to the fact that ambiguity raises great problems which we can relate to our focus today of the therapeutic alliance the work of Einstein Neos Bohr and many others. Shred here and others indicates that one of the fundamental ways of thinking about the universe is to say that certain of the smallest elements are to be regarded as physical particles and simultaneously are to be regarded as wave like. This is were guarded as a most important concept by many. Even though it's ambiguous almost
shocking in its stark and the goody a physical parting and a wavy line bowed. And it seems to indicate that ambiguity as well as simplicity may be one of the basic facts of life. Now simplicity surely is of enormous importance and ambiguity most often represents a lack of facts or a lack of knowledge or a lack of clarity or of understanding. Most of the time one has an obligation not to rest content with ambiguity but after one has struggled with the ambiguity and finds that it proves this is was in this instance one can say that also there may be situations in which ambiguity can be thought of not only as an evil a necessary or an unnecessary form but also as being a more positive and productive formulation or starting point. So I will link this now with today's topic the therapeutic alliance. That is between the psychiatrist and the patient and
that alliance or so or there is a very valuable ambiguity the psychiatrist is a participant in the process of therapy. He joins with a patient in trying to work on that part of the patient's life and personality which is causing trouble for the patient and for others whom he does not want to hurt. But also the psychiatrist is in part an observer as well as a protest a bunt and Harry stack Sullivan coined the phrase of the participant observer. Also this characteristic is in part an observer who must not be involved too closely so that he can make clear headed observations with adequate objectivity. To use is the basis of his further thinking which is then basic to his further attempts to help this double the roll up or to spank and observer as essential in many of the important relations in light most vividly in the therapeutic alliance but also in others in the non job alliance that I'll talk about next time and the conflict
between the generations also in the supervisory alliance. Ambiguity is there in all of them. There it may be for those who are interested in some synonyms in this. The voters material on the multiple functions of the ego may correspond in part to what we're talking about here as ambiguity. There are other ambiguities in life to consider in addition to that of being pretty spent an observer. And yes one can say it is more difficult to deal with ambiguity than with simplicity but if one wants to have depth and foremost in one's life when one's profession or in many other work areas of life one cannot expect simplicity on the way there will be potentially conflicting attitudes and approaches that will be necessary and necessary to lead them. And with a little care one can keep one function from interfering with the other. Now throughout these sessions I have tried
occasionally to go outside or beyond the root teen. I try to keep you with me and by the content of the discussion by doing the unusual at times by having a change of pace by throwing a forward pass when you expect me to run with the ball. So when we focus now on the therapeutic alliance I want to use an approach which I have never used in the past and which has the positive qualities of immediacy and relevance about which we hear occasionally these days. It goes this way. In these three days when we've been together something new has been born and has developed in addition to the substance of the letters. Some kind of a relation between you and me between the audience and Electra has developed as well as between members of the audience. This relation has nothing to do with treatment with therapy of course and so it's not a therapeutic relation not a therapeutic alliance which is my focus in this part of the Third Doctor. But in the
relation which develops between an audience and a speaker or between a seminar group and a seminar chairman a pattern and interaction grows and develops which has many points in common with any other positive interaction in life. So there is a proud hour between the interaction between you and me and the interaction in therapy. There are basic differences of course ways in which there is no parallel. For example in this situation a relationship with a relation is between the group and myself. But in a therapeutic relation the relation is usually between. I should say in this situation the relation is between a large group myself but in the therapeutic relation the relation is usually one between patient between one patient and one therapist or at the most as in group psychotherapy as the relation between a group of five or ten individuals and one and perhaps two separate there. I mentioned some of the points of similarity between the relation between you and me and the relation between psychiatrist and patient. This way I will be
describing by inference some points of what we mean by a therapeutic relation the therapeutic alliance in the parallel then I will be talking about you and me and so it may seem quite alive and real. The reason that I want to emphasize the therapeutic alliance is that I think that to a large degree it is the paradigm. It is the exam. It is the open door to some of the opening of the door or one of the opening of doors toward our future development of ethics to further thinking about ethics. Is this is an alliance which has some specific qualities which Well I've been building up to and the rest of this section. So the emphasis will be on the therapeutic alliance as the paradigm as the opening kind of a development toward creating that they and then I'll be presenting it in terms of how it powers with some of the
Frank Weil lectures
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#3 (Reel 1)
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