Prof. Joseph Levine, M.D. is an emeritus associate professor in the Division of Psychiatry, Faculty of Health Sciences, Ben Gurion University in Israel. Prof. Levine is a certified psychiatrist with clinical experience in controlled trials of adult psychiatric disorders and in psychotherapy. He was awarded a NRSAD independent investigator grant for the study of Creatine Monohydrate in psychiatric disorders -- mainly Schizophrenia. He resides and treats patients in Tel Aviv and all of central Israel.
Internalization in general is related to learning and remembering processes. In psychology and sociology, internalization involves incorporating the attitudes, values, standards, and opinions of others into one's identity or sense of self.
Internalization means the individual's acceptance of a set of norms and values (set by others) which often occurs through socialization. In other words, an idea or an action that moves from outside us to inside us.
Some argue that the internalization process begins: 1] with learning something (attitudes or behavior),
followed by: 2] a process of understanding why the learning is meaningful and/or valuable,
and proceeding up to: 3] accepting learning as the learner's point of view or starting point.
Internalization helps a person define who he is and create his own identity and values.
Internalization is defined by the Oxford American Dictionary as "to make (attitudes or behavior) part of one's nature by unconscious learning or assimilation’.
Lev Vygotsky defined internalization as an internal reproduction of an external action. According to him there are three stages of internalization:
1] Reproducing or imitating an external, specific activity which gradually begins to act internally.
2] An interpersonal process [which is complex and includes a series of activities and reactions] that begins and becomes an internal intrapersonal process.
3] a long series of developmental events that contribute to the transformation of the interpersonal process into a distinctly intrapersonal process.
We will note here that there are also those who distinguish between internalizing knowledge of what [what things are, what their essence is, etc.], and knowledge of how [how things are done, how to act, etc.]
Within the concept of internalization we will specifically discuss the internalization of significant figures.
By significant characters we imply a certain person or a certain group of people who have a significant influence on the set of attitudes, emotional expressions, and behavior of the person who internalized these characters.
The question arises, what is the mechanism of internalizing these characters? That is, how is the significant internalization of the characters carried out and what stages does it undergo.
Our patients are often our teachers for understanding the inner worlds associated with patients and psychopathology.
Thus the "laboratory" for the development of the theoretical method for RGFT was the treatment room or actually the treatment process and its content.
Hence, on the one hand the discourse of a particular patient may have a potential to teach us about the development of a particular illness or mental condition and even ways to deal with them, and on the other hand, the therapist often has a thought or idea about the new ways of doing it within his/her treatment room but also in the wards of a psychiatric hospital.
This was, for example, the way the “Trigger Event Analysis” (TEA) the method analysing triggers or events that contribute to the onset of a mental condition or mental psychopathology, has been developed. The idea of the TEA emerged following the story of a patient in the psychogeriatric ward, a subdivision engineer whose daughter has been killed in a car accident, am event that affected him much less than his transfer to another job position without any change in his working conditions. This last event was perceived by him as a terrible humiliation and he committed a suicide attempt by jumping from the 3rd floor. This unfortunate event demonstrated clearly the individual relevance of traumas and is inconsistent with the accepted scale known as Stress Inventory by Holmes & Rahe.
We would like to bring this time a summary of the long treatment in which a bipolar (manic-depressive) patient was accompanied by one of us [JL] for about two decades.
Here we will refer to three different types of treatments that have similarities with RGFT and we will examine the differences between them.
The first of these is the theory and method of treatment proposed by Roberto Assagioli.
Roberto Assagioli was an Italian psychoanalyst who was influenced by both Freud and Jung in creating the theory and treatment method that he called "psychosynthesis."
Roberto Assagioli
Assagioli expanded the teaching founded by Freud through the expansion of the unconscious so that it could include the collective unconscious and the archetypes.
As he himself stated: “We pay far more attention to the higher unconscious and to the development of the transpersonal self. In one of his letters Freud said, “I am interested only in the basement of the human being.” Psychosynthesis is interested in the whole building. We try to build an elevator which will allow a person access to every level of his personality. After all, a building with only a basement is very limited. We want to open up the terrace where you can sun-bathe or look at the stars. Our concern is the synthesis of all areas of the personality. That means Psychosynthesis is holistic, global and inclusive”.
The 7 core concepts of psychosynthesis are:
disidentification
the personal self
the will
the ideal model
synthesis
the superconscious
the transpesonal Self
Beside “disidentification”, all these concepts can be in this or other way derived from the well known Freudian and Jungian postulates.
We cite Assagioli here because some of his theoretical elaborations sound similar to RGFT and therefore demand clarifications. Specifically, he spoke of “sub-personality” (the same term is used in earlier mentioned by us “Voice dialogue”). This concept resembles in some way a concept of the “secondary self” in RGFT. But, as in the “Voice dialogue”, it represents more a partial “feature” of a person (architypal or otherwise originated) and not a personally significant character that could be traced in the person’s history as in RGFT. Still, the concept of disidentification is identical to that in RGFT and serves analogous purpose – it reveals the true nature of our identity with a specific attitude or behavior and allows us to extend our consious choices. Finally, the key concepts of Assagioli root in some part in the spiritual world, whereas RGFT is based mostly on the theoretical constructs of social psychology.
Hello, this time we will discuss what is between the Jungian treatment and RGFT.
An archetype is a prototype of an idea, an object that stays at the bottom of human memory, as a kind of model or template for images originating from the very early stages of human kind.
Carl Jung
In his book “Man and His Symbols”, psychiatrist Carl Jung explains that archetypes "are the pieces of life themselves – images that are integrally connected to the person living by the bridge of emotions." While we tend to think of our consciousness in a uniform sense of self (or of me), a careful examination of consciousness may show that instead of consciousness being perceived as a unit, it may be a pantheon of archetypal figures existing in our minds.
“Archetypes,” writes psychologist Marie-Louise von Franz in her “Archetypal Dimensions of the Psyche”, are “hereditary tendencies that cause us to respond typically to basic, internal, or external human problems”.
“Archetypes”, she claims, “affect everything a person thinks, feels and does. Therefore, when dealing with archetypes, think of fixed patterns of behavior common to all of humanity”.
Marie-Louise von Franz
Among the common archetypes can be found those of the ‘hero, warrior, teacher, mother, child’, and more. The archetypes appear in a variety of forms, including figures in mythology, art in religion in stories, symbols, and rituals and various myths.
Psychologist Carl Gustav Jung (early 20th century) saw the archetype as a human mental pattern that manifested itself in broad areas.
According to Jung's analytical theory, there are a number of key archetypes:
‘Ego’ – the archetype of adaptation to reality and the source of identity.
The ‘shadow’ – the inferior and undesirable side of our personality, which we are not willing to admit exists. The "dark part", which inhabits the primitive passions and emotions that exist in us.
The ‘persona’ – the mask we wear in accordance with the requirements of the environment and society. The social personality, which hides the "true self" -.
‘Anima’ – the feminine element found in men.
The ‘animus’ – the masculine element in women.
The ‘self’- which gives the personality uniformity, balance and stability.
Other archetypes are:
Ego – the archetype of adaptation to reality and the source of identity.
The shadow – the inferior and undesirable side of our personality, which we are not willing to admit exists. The "dark part", which inhabits the primitive passions and emotions that exist in us.
The persona – the mask we wear in accordance with the requirements of the environment and society. The social personality, which hides the "true self" -.
Anime – the feminine element found in men.
The animus – the masculine element in women ,.
The self – which gives the personality uniformity, balance and stability.
Other archetypes are: ‘mother figure, child, God, mother earth, hero, old man, sage, monk, manipulator, caregiver, king, queen, mentor, prostitute, tyrant’ and more.
Here are two comments in the context of Jungian theory
A] According to Eric Goodwyn, since Jung assumed that the archetype was an a priori structure, previously formed structures within the psyche, he was constantly accused of "marcionism". Recently, with the advent of genetic research and the human genome project, the idea that psychological structures can be innate has come under even more harsh criticism in Jungian thought. There seems to be a growing consensus today that Jung's idea of innate psychological structures was wrong, and that perhaps the archetype as such should be abandoned in favor of more developmental theories of the mind.
B] The concept of Dialogical Self [DS] was added in the 1990s by some authors to the body of Jungian theory.
An exhaustive definition of this was given by Hubert Hermans and his colleagues who defined the "dialogical self" as a dynamic multiplicity of stated positions of an expanded internal discourse of the psyche that includes topical figures in the social world and even imaginary figures closely related to topical figures "
Hubert Hermans' theory of the "dialogical self" sees the self not as one entity, but as "a society of consciousness" composed of "many selves" or in other words of many self-figures. He calls these self-positions I-positions, (the letter I in English from the word "I") that are in constant dialogue. Where each single position of “I” contributes to the way it sees and feels itself and the world.
Hermans used the metaphore of a stage and actors to describe the interactions of I-positions in the "dialogical self." Sometimes in certain circumstances there may represent a confrontation within the "dialogical self" of a person when the I and I-positions criticize and fight each other, these positions may be in some cases of other people – sharing their true or imagined opinions to create negative dialogues that may provoke feelings of doubt and anxiety.
This concept allows for an extension of Jungian treatment not only to archetypes but also to real actual figures and their imaginary aspects where it can happen that sometimes the imaginary figures are derivatives of the archetypal figures and usually the real figures are at the forefront compared to the imaginary figures and their possible archetypal connection.
Hubert Hermans
So what are the differences then between the archetypal figures in psychic life in Jungian therapy compared to RGFT?
Contrary to Jung's conception of archetypes which are regarded as constant representations from generation to generation and identical in all human beings. In RGFT the perception is related to the individual historical past (of just decades) of a particular person, to that person’s internalized figures which are usually related to that past, and to its unique development. On the other hand, RGFT adapts a certain evolutionary conception which relates to the development of different kinds of "self" with similar aspects in all human beings.
Contrary to Jung's conception of archetypes, regardless of the time of their formation or the circumstances that led to their formation, in the RGFT, the different types of dominant "self" originated in the prehistoric period when each of these selves stems from different roles in the tribal system, for example, " the tribe’s leader", "the hunter", "the shaman", "the guardian of the fire", "the plucker", etc.
RGFT refers to the period of the primitive tribal man as a source for the formation of the prototypical features of the dominant self ( that are based upon the real, necessity forced roles within the tribe) as opposed to Jungian not historically associated archetypes. RGFT conception chose the primitive communal system
as a basic referent point since it was the period when the more sophisticated socialization along with the first forerunners of language were formed.
Finally, RGFT revolves entirely around social conception.
And what are the differences between Dialogical Self and RGFT?
In Dialogical Self the central concept is one self where it is perceived in a more complex way and includes a variety of parts resulting from the interactions with the different characters, both realistic and imagined.
In contrast, in RGFT the basic perception is not of one self but of multiple selves where each self exists in its own right with its own creation and history with a number of specific characteristics such as emotional aspects, attitudes, forms of behavior and more.
As everybody knows, we experience the world through five senses. If we evaluate them according to the extent to which they transmit information to our brains, then, no doubt, in most cases the sense of sight will come first.
This sense can contain a good deal of information simultaneously while other senses, such as the sense of hearing contain fairly limited information at a given moment, and only a signal analysis along the time axis allows the transmission of a sufficient amount of information such as communication.
It is interesting to note that the sense of sight is probably more significantly developed in animals inhabiting the land such as mammals with relatively well-developed intelligence, elephants, humans and more. However there are a number of marine animals that also have developed intelligence such as dolphins and whales. In this regard is worth to mention that hypothetically, dolphins and whales were terrestrial animals before they turned to marine life and it is possible that it was on the land where they apparently developed their intelligent ability.
It was earlier hypothesized that the sense of sight developed more in terrestrial animals due to the transparency of the air compared to that of water, which allows the ability to identify same-sex and non-same-sex creatures and creatures that are a source of danger or a source of prey. This sense also allows for planning ability in a variety of situations such as, quick escape, hunting planning, orientation in space, and more. On the other hand, vision in water is limited to much shorter distances and that promoted the development of other senses such as sonar capability for example.
Image signal processing requires a well-developed brain system that allows a great deal of information to be analyzed in a fraction of a second. This rich visual information is translated within the brain into an elaborate system of images and characters.
Due to the fact that the human baby grows in the group belonging to the same species [the same is true for other mammals and even a variety of other species] and the baby has significant interactions with the care giving persons, who satisfy his needs, especially with the mother [caregivers comment on his needs and feelings and interpret the world around him]. People and their faces in particular have a specific representation in the human brain.
In this conversation we will look at the method known as "Voice Dialogue" (VD) and compare it to our method "Reference Group Focused Therapy” (RGFT) while focusing on the similarities and differences between the two methods.
VD (a method developed by American Jungian psychologists Hal and the Sidra Stone) sees the human psyche as naturally composed of many characters which they call 'sub-characters, sub-personalities, plural selves”, and more. Each character has its own distinct sub-personality that includes desires, impulses, needs, abilities, point of view and sensitivities.
According to this approach, all figures exist in all human beings, however in different people, these figures will be expressed in different ways and intensities. In general, this is a method that helps the patient to be aware of his variety of sub-personalities and how to consciously choose between those who will be effective in his development and those who will be counter-productive. The theoretical basis of VD is therefore related to the psychology of the Self and in addition to the “Aware Ego Process” concept that we describe further on.
The authors identified two main types of sub-personalities – “primary selves” and “disowned selves”. Primary selves refer to the dominant group of selves that define the personality of the individual and control the life of that person. This group is called the “operating ego”. The “disowned self” is the group of “sub-personalities” that are equal in some respects and opposite to the primary self. Although there are conflicting values, both the primary selves and the disowned selves are considered to contribute to the individual's survival, social skills and general well-being. The authors of the method emphasize the importance of treating each self with respect during treatment.
“A man is the world in its fullness" – there is nothing like this sentence to emphasize the connection between the environment in which man lives and his inner world. From the moment a person is born until his death he is subject to environmental influence. Like a sponge he absorbs some of the characteristics of the significant people in his life. Each of these characters, known as the Reference Group (RG), actually shapes us, our attitudes, our emotional world, and ultimately our behavior as well.
These groups can influence us directly, with the greater social impact if the related RG is perceived as a more significant one. It can also influence us in a more complex way that is not immediately recognizable: when important reference groups undergo an internalization process and become an integral part of a person and operate within us even when the original reference groups no longer exist. Some of these effects, without permeating the consciousness, make us a kind of a "robot" performing a scenario that is not ours, according to the "software" written by other people who have now become our inner characters and an integral part of our world.
The many conflicts that take place between these inner characters themselves and, then, between these characters and the person’s contemporary reference groups can, at worst, cause a person to go through mental crisis up to the degree of a real mental disorder.
Most mental disorders start or worsen due to the stressful situations. It turned out that a significant proportion of these situations occur in a context of the social groups to which a person belongs.
The Reference Group Focused Therapy – RGFT – ( see previous conversations) – sets as one of its important goals to bring to consciousness the impact of a social influence upon a person most of which a person is unaware of. RGFT allows a patient to better understand the psychic forces at work within him and facilitates a better adaptation to the society in which he lives. The treatment is based on a number of theories that originate in social psychology, in addition to theories of object relations, and some others which are described below.
RGFT can be applied to patients with diverse mental problems, such, for example, as Adjustment Disorder, Phobias, Obsessive-Compulsive Disorder, and others. The method is suitable for different age groups, including also the third age where the collapse of the support system i.e, reference groups, becomes a major problem.
At the end of the previous blog we hinted that the treatment effectiveness in REFERENCE GROUP FOCUSED THERAPY (RGFT) that makes extensive use of internalized figures in our inner world, has contributed to the creation of the model of the Self, the one we metaphorically call the "Fabergé Egg of the Soul". In this conversation or session we will bring therapeutic examples of different types of problems or mental disorders in order to give a taste of what is happening in
.this type of a treatment
Here are some examples:
A] Fainting perceived as death
Fear belongs to the range of our basic emotions, just like sadness, joy, anger. But some of us are attacked by extreme fear whenever we encounter certain objects or situations. This is called phobia. Phobia is very common among us – it is estimated that between 9-18% of Americans suffer from various phobias, with the similar number in Israel’ while women are reported to suffer from phobias more than from any other mental disorder. Examples of phobias are countless – fear of flying, fear of traveling in an elevator, fear of enclosed spaces, fear of elevated places, fear of dental care, fear of crowds and more. Agoraphobia – fear of leaving home or another familiar place – can limit us to quite a marginal functioning.
There are a number of treatments that help people in these situations – among others we have different types of behavioral therapies and psychopharmacological treatment with antidepressants and antianxiety medications.
Here we discuss the treatment of REFERENCE GROUP FOCUSED THERAPY (RGFT) in a patient with particularly severe agoraphobia. Of course, the details of the patient's life were changed in a way that prevents any identification.
The first Fabergé egg, known as the "chicken" was created by the artist and jeweler Carl Fabergé in 1885, at the request of the Russian Tsar Alexander III. The egg was a golden egg coated with enamel, inside it there was a golden yolk, that was inside a golden chicken, and surrounded by a crown of rubies. Fabergé created later additional eggs that express a diverse symbolic world. For us, the egg will symbolize the " Self," and, as a part of it, the “Social Self”, an essential component of the “Self” or "Me" that defines our being human. In this session we will try to open the egg and characterize our perception of its unique components in the hope of providing new insights into this social self and will be later outlining new ways to empower it.
There exist a large number of psychological theories that try to provide a proper explanation of a person's subjective inner life. The very fact that the number is so large. indicates that it is very difficult to explain and encompass the whole essence of the human mind through just one theory. Some of these theories attempt to encompass broad areas of psychic life while others are concerned with partial explanations for the variety of psychic phenomena.
Igor Salganik, Ph.D, Dr. Med.Joseph Levine, Prof. Med.
This is an introduction to the new blog on our ongoing research in psychiatry and psychology.
We, Igor Salganik and Joseph Levine, are senior psychiatrists and researchers with accumulated and extensive experience in psychiatry, neuroscience, and a variety of psycho-therapeutic treatment approaches.
Over time we have come to an inevitable conclusion that the field of psychiatry, unlike most other fields of medicine, has undergone relatively few changes in recent decades and in many ways seems to be on the spot.
There seem to be several reasons for this: one is the sheer complexity of the subject which is based not only on the processes related to the human body but also on mental processes like thought, behavior, and emotions. Another reason stems from the very definition of the psyche which is essentially metaphysical and cannot be easily or at all translated into materialistic concepts or, in other words, the body-mind connection is anything but trivial. Another reason is the paucity of the appropriate tools for the profound scientific analysis of mental processes. And finally, due to the stigma still associated with psychiatry, the funds invested into this field are sadly far away from those invested in the research of physical illnesses.
Let us also note that psychiatry is generally based on the phenomenological expressions of the mind and is, in many aspects, combined and intimately merged with psychology, the science whose roots stem from philosophy and other humanities, although, in recent decades, psychological research widely uses brain imaging tools.
All this led us to the decision to try and develop a new theory with the goal to merge between the well established knowledge in neurosciences on one hand and psychological processes of an individual and social nature on the other hand. The conceptualization of this theory should be held as simple as possible in order to facilitate both the understanding of intra-psychic processes as well as the treatment of psychological disorders. It will attempt to avoid psychiatric “slang” as much as it goes and use the model of internalized images and their development along the time axis as representing the “Social Self” of an individual.
Prof. Joseph Levine, M.D. is an emeritus associate professor in the Division of Psychiatry, Faculty of Health Sciences, Ben Gurion University in Israel. Prof. Levine is a certified psychiatrist with clinical experience in controlled trials of adult psychiatric disorders and in psychotherapy. He was awarded a NRSAD independent investigator grant for the study of Creatine Monohydrate in psychiatric disorders -- mainly Schizophrenia. He resides and treats patients in Tel Aviv and all of central Israel.
