Anthroposophic psychotherapy treatment as an essential support for anthroposophic medical treatment in a case of serious childhood trauma

Introduction

This single case study addresses the way in which anthroposophic psychotherapy treatment worked closely with Anthroposophic Medicine (AM) in a case of serious childhood trauma. Anthroposophic psychotherapy follows the same principles of AM in that it is integrative in orientation, thereby building on existing psychotherapeutic methods as a result of adding ‘further knowledge’ to them as a result of making discoveries ‘by different methods’ (1). Each anthroposophic psychotherapist will approach their work from a different perspective depending on their previous training and personal predisposition. So my approach to anthroposophic psychotherapy is not meant as a model for others. It is my own idiosyncratic way of undertaking anthroposophic psychotherapy.

The case

Overview
The client whom I will call Andrea had an aggressive abusive father and, from birth, witnessed repeated rape and beating of her mother and beating of her sisters. She was also beaten herself. This resulted in generalized anxiety disorder plus a fear of ‘something bigger’ than herself, and frequent panic attacks, and depression. She had little direction in her life with a regressive biographical development creating an adolescent lifestyle at the age of 33. Her life was chaotic with little direction and structure (for instance, no consistent sleep-waking rhythm and constantly late for sessions). She was below medium height, her eyes reminded me of a Botticelli painting, dark brown reddish hair and a playful smile. She suffered from emotional dysregulation and an out-of-control thought life: ‘I find it difficult to manage my thoughts, more and more I’m tired to listen to them as for me they could tell anything so I don’t trust them. They just come out and is a continuous and stressful work to value them. It’s like having dogs in your brain, biting each other and I’m scared to get lost in this battle’. Her anxiety would frequently trigger her attempts to solve unsolvable life events as they occurred, thus over-activating her central nervous system and flooding her consciousness in a haphazard way. Even relatively insignificant events such as being offered a ticket to a concert on her day off could create chaos: ‘I didn’t want to think … I was thinking I am dangerous … that I don’t trust myself … the problem just grew up and I couldn’t make a straight decision’.

The creation of a trusting working alliance

Initially the therapy explored the complex symptoms and built a trusting psychotherapeutic working alliance to address Andrea’s disorganised attachment style. But, as in all cases of early life trauma, Andrea experienced the impact of the trauma on her body as well as her psyche. Not only was her autonomic nervous system activated (2) but the problems extended to her internal organs as described by the notion of allostatic load (3). She experienced a variety of physical sensations when she was agitated: a bitter taste in her mouth, rapidly beating heart, shaking, a high level of focus on her brain as a result of struggling to get her thoughts under control, an inability to swallow and burning in her hands. So I referred her to an anthroposophic doctor to provide internal medical treatment. One early medicine was Conchae which aimed to protect her thinking from her out of control feelings. 

Interaction of Anthroposophic Medicine and anthroposophic psychotherapy

Rather than focusing on the medicines, I will focus on the psychotherapy and the way in which I responded psychotherapeutically to Andrea as the medicines addressed the problems and began to take effect. Her body began to develop warmth inducing illnesses but these illnesses also had a positive effect since they enabled buried emotions to enter her conscious soul life. The medicines freed up Andrea’s body which had become cold and rigid because of the trauma and this then brought traumatic memories into her conscious soul life which enabled me to hold a psychotherapeutic healing space where a transition could be made from illness to health.

Memory, cohesion, musicality as a sign of emerging life forces

The anthroposophic psychotherapeutic space gave Andrea the opportunity to share the changes she was experiencing. She began to describe experiences that she had never described before. For instance she told me how one day she woke up at noon looking forward to the day, smoked some marijuana and played Tom Waits on her guitar. She was in a sad and ‘blue’ mood and the music reflected this and so she played a Bach chaconne on her violin which was ‘clean’ and made her feel ‘calm’. Then an image of her father singing a Demis Roussos song appeared in her mind. He was crying. Initially she had not been hungry. But now her mouth felt bitter and she went to the fridge in the kitchen to see what she could eat. She could not decide and then went back to bed crying. This was the first time she had made a direct link between a current experience and a memory of a previous experience. The experience demonstrated how easily her emotional instability was triggered – in this case by the memory of her abusive father – and how this affected her actions. 

Other difficult childhood memories then appeared – her father complaining about the ‘noise’ of her violin when she was practising, her father generally ‘saying critical things’ and putting her down and attacking her femininity as a teenager when she put on a dress and a big shirt and combed her hair and he called her ‘a whore and a bitch’ and kicked her and mentioned ‘sexual things as well’: ‘even good memories become dirty ... I was sleeping with my parents when I was little; I clearly remember my father raping my mother; she was saying “please no” … my older sister can remember him shouting at me because I was crying uninterruptedly’. 

Initially Andrea’s out-of-control feelings intensified. In one session (by now on the phone rather than in-person because to the first United Kingdom (UK) lockdown in 2020) she was speaking rapidly, crying and screaming about a scenario in which there was a dispute with one of her friends. She spoke for about thirty minutes at great speed, loudly without interruption.

At a certain point in the therapy there was a new element. For the first time she had some good memories. For instance, ‘On Sundays we went to church; I remember the incense and a painting on the wall church; mass and the Holy Water and making the cross; I had the feeling of wanting to stay in the church; something in me was telling me to stay there’.

Results: holding the past and future in the present with compassion and forgiveness.

There were five primary aspects to Andrea’s recovery. First, the emergence of a more structured life with less thought disturbance along with a more organized everyday life and regularly attending sessions on time. Second, a clear future orientated direction as a teacher which involved studying at university and also doing supply teaching when needed. Third, the memory recollections as discussed giving a more conscious and complete life narrative: ‘We can really only experience our own identity when we have worked out our memories and those memories are openly accessible to us’ (4). Fourth, a change in her attitude to her father. At a certain point in the therapy she asked me if she should visit her sick and dying father in a home as most of the family except a much older sister refused to visit him. I suggested she held him in mind in a meditative manner before going to sleep for three nights and then make the decision (5). She decided to go to see him. She then began caring for him. She changed his ‘nappies’ and also took an interest in his biography. He was born in Libya in 1930 and came to Italy in 1941 or 1942 when Libya had become a war zone. After this session she sent me a message to say that her father was dying, along with a delightful picture of her father holding her at about the age of five. She had been able to forgive and adopt a moral caring stance towards him in spite of the abuse which is an important spiritual gesture.  Fifth, taking a greater responsibility towards world events (I). This involved reversing the biographical regression and allowing her eternal spiritual I to subordinate ‘psychological forces to itself … This can lead both to what we have called foresight and to the realization of consciously grasped spiritual aims’ (6). This was demonstrated by the way she accompanied her father’s dying process, forgiveness of his abusive behaviour and a clear future orientated direction in her life. She was developing a greater sense of responsibility to others and the world, evidenced by her decision to become a teacher, care for her father and placing her father’s life and illness within a historical context.

Psychotherapeutic interventions

To further the medical treatment frequent psychotherapy sessions were required to monitor and align Andrea’s life with the changes brought about by the medical treatment. This involved stabilizing her soul life as recovery can be stormy since it involves a step into the unknown as a result of leaving the ‘illness comfort zone’: ‘Somebody with a psychological abnormality gains a certain satisfaction from his abnormal soul activity and is therefore loath to depart from it’ (7).  

In addition an overriding principle of anthroposophic psychotherapeutic interventions is to integrate the interconnecting narratives of the patient in a coherent way, be an alert participant observer and notice significant phenomena being shared or demonstrated by the client in the clinical process, hold in mind what is happening from the point of view of the anthroposophical image of the human being, bring the phenomena to the attention of the client and, in so doing and if appropriate, include conceptual explanation although this may not always be necessary or helpful.

In Andrea’s case there were many such phenomena of which a few have been mentioned here – the insightful description of her thought life, the emergence of disturbing memories and especially her ability to demonstrate how her present experience was influenced by memories below the level of consciousness which could break into consciousness at unexpected moments and have a powerful effect on her present state of mind, the emergence of good memories and dealing with her abusive father’s death with love and forgiveness. I commented on these phenomena in various ways to make it clear that the vital body which underpinned her soul life was getting stronger, thereby strengthening her memories and giving her inner self the ability to take command of her life.

This leads on to the next point; namely, the recognition, acknowledgement and implementation of Andrea’s spiritual essence or I organization. Working with this is a key aspect of anthroposophic psychotherapy.  From early sessions it was apparent that Andrea was a very talented and insightful person. In the first session she had mentioned her attempts to ‘create a different kind of project using a different kind of language’. Later on she gave me a beautiful example. Her younger Down’s syndrome sister was not able to lift her arms and nobody could help her but Andrea helped her within ten minutes by putting small stars on her finger nails and encouraging her to stretch her arms upwards. Another example occurred during 2020 when, instead of giving children instructions about how to wear masks as she was told on a course, she created mask games for them. These examples showed that, in spite of the trauma, her spiritual self-had always been capable of taking command of her life in a most creative way.

In accordance with Andrea’s biographical age I took responsibility for temporarily but frequently substituting for undeveloped aspects of her soul life in order to give her narrative more cohesion and understanding by spending time (sometimes more than one session) asking her to recall situations and events from her life, including an array of sense impressions, until I had a clear mental picture of what she was referring to as though I was ‘a fly on the wall’ (II). This incorporates the importance of developing pictorial images in therapeutic work. Whilst introducing this principle Dekkers (8) cites Rudolf Steiner who encourages us to ‘educate ourselves in phenomenology, to reach a “growing together with” the phenomena of the world around us. There comes a moment when we should not be dependent on verbal images. With this strengthened remembering, we grow increasingly interested in the outer world. Spending such time on situations and events was also necessary since when I first started seeing her the communication was often unclear because of the chaos, confusion, the fact that English was her second language and she became incoherent when she was emotionally aroused. Examples of this were the concert ticket event and the morning when she was playing Tom Waits and Bach (4).

Finally the therapeutic relationship had three major elements throughout the treatment. First, It adopted the general therapeutic principle of containment which attempted to substitute for the lack of the maternal holding, congruent mirroring and understanding (due to her mother’s traumatization) during the first seven years of her life. Andrea wisely also took action to provide containment for herself by deciding to live with her family of origin in Italy at the time of the first lockdown in the UK in 2020. Second, often taking the lead in sessions to stabilize Andrea’s emotional and soul instability and attachment arousal. An example of this was the time when she spoke loudly for about thirty minutes at the beginning of a session. I intervened and spoke with a strong but calm voice and when I did this she would invariably calm down and listen intently. This is referred to as the pedagogical law by which my I offered direction to Andrea’s psychologically distressed behaviour (9). Third, I frequently summed up sessions, evaluated progress and linked sessions as she was often consumed by events in order to construct a strong biographical narrative (4). This had the aim of creating salutogenic coherence as a result of understanding the scope of her biography, seeing its meaning and, as a result of this, being able to manage it more easily (10). This involves seeing the coherence in life events as a result of understanding, giving meaning to and managing them.

Conclusion

As indicated earlier this account is not intended to provide a protocolized general way of undertaking anthroposophic psychotherapy but just to demonstrate my way of doing it. Although there are common elements used by all anthroposophic psychotherapists – an understanding of the threefold and fourfold human being and an understanding of biography – each therapist will adapt these principles to their own unique style.

Notes

I. In terms of anthroposophical development this is a quality that develops in particular between the ages of 35 and 42 and is called the consciousness soul.  Andrea had now reached the age of 35.

II. These aspects of the soul life are called the sentient soul and the intellectual mind soul. 

1 Steiner R, Wegman I. The Fundamentals of Therapy. London: Rudolf Steiner Press; 1983, p. 1.

2 Levine PA. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books; 2010.

3 McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology 2000;22(2):108-124. DOI: https://doi.org/10.1016/S0893-133X(99)00129-3. [Crossref]

4 Dekkers A. A Psychology of Human Dignity. Great Barrington, MA: Steiner Books; 2015, p. 15.

5 Steiner R. Karmic relationships Vol. II. London: Rudolf Steiner Press; 1974, p. 106.

6 Treichler R. Psychiatry. In: Husemann F, Wolff O (Eds.) The Anthroposophical Approach to Medicine. Vol. 3. New York: Anthroposophic Press; 1989, p. 255-379.

7 Steiner R. The Karma of Untruthfulness. Vol 2. London: Rudolf Steiner Press; 1992, p. 101.

8 Dekkers A. The journey from word images to pictorial images. Article in preparation (2022, p. 2-3).

9 Steiner R. Curative Education. London: Rudolf Steiner Press; 1972.

10 Antonovsky A. Health, Stress and Coping. San Francisco: Jossey-Bass Publishers; 1979.


Research news

Study confirms correlation between high screen time exposure and autism in infant boys   
A cohort study in Japan examined data from 84,030 mother-child dyads regarding the association between high screen media use by infants at age one and a diagnosis of autism spectrum disorder at age three. Data collection proceeded via a survey of children´s daily screen time exposure at one and three years of age and a survey of autism spectrum disorder diagnosis by a health care professional at three years of age. The study finds significant evidence: extended electronic screen media use at age one triples the diagnosis of autism at age three in boys. This effect is dose dependent (https://doi.org/10.1001/jamapediatrics.2021.5778). Therefore "Screen free until three!": 
https://bilhttps://bildschirmfrei-bis-3.de/


Further information on Anthroposophic Medicine