Psychodynamics of Spirituality:
The Higher Power and the Personal Unconscious
Gibbs A. Williams, Ph.D.

What do you think of yourself? What do you think of the world? These are questions with which all must deal as is seems good to them. They are riddles of the Sphinx, and in some way or other we must deal with them. In all-important transactions of life we have to take a leap in the dark. If we decide to leave the riddles unanswered, that is a choice; if we waver in our answer, that too is a choice: but whatever choice we make, we make it at our peril. If a man chooses to turn his back altogether on God and the future, no one can prevent him; no one can show beyond reasonable doubt that he is mistaken. If a man thinks otherwise and acts as he thinks, I do not see that any one can prove that he is mistaken. Each must act as he thinks best; and if he is wrong, so much the worse for him. We stand on a mountain pass in the midst of whirling snow and blinding mist, through which we get glimpses now and then of paths which may be deceptive. If we stand still we shall be frozen to death. If we take the wrong road we shall be dashed to pieces. We do not certainly know whether there is any right one. What must we do? 'Be strong and of good courage.' Act for the best, hope for the best, and take what comes. If death ends all, we cannot meet death better.

~ Anonymous ~

Aim
The purpose of this paper is to shed light on the nature of spirituality as a core issue underlying alcohol addiction {possibly other addictions as well} and the resulting implications for treatment. For the purposes of this paper, treatment will be limited to The Twelve Steps Program of Alcoholics Anonymous and, or Psychoanalytic Psychotherapy.

Spirituality as a Core Issue: Symptoms and Location
Alcoholics Anonymous (A.A.) assumes that spirituality is the core issue underlying alcohol addiction. But it is core more in the sense of something vitally missing than is functionally existing. The major symptoms associated with missing spirituality are: feeling lost, pan confusion, empty, and out of control. Associated with this cluster of feelings is a state of consciousness experienced as an unbearable deflation of personal power. The common description of this state of consciousness is called "hitting the bottom." A major purpose of alcohol (and other addictive substances) is to convert this unbearable state of consciousness into one that is pleasurable and if not attainable at least one that numbs the pain. "Hitting the bottom" implies falling from the top. For A. A. the 'top' is consciousness of God thus defining the core issue underlying alcoholism as a falling away from God consciousness or a lack of meaningful connectedness with spirituality.

AA believes the heart of the spiritual problem to be a self that is out of spiritual alignment with Absolute Reality assumed to be synonymous with divinity. It is further assumed by AA that this straying from God consciousness is due to the alcoholic's negative attitude of dissent. The essence of this position is set forth in the Twelve Steps And The Twelve Traditions.

A basic problem of alcoholism is a defiance of God instead of a reliance. A major problem is straying from God's Will. A major symptom of the problem is a lack of faith, hope, trust, and love of God.

Additionally, this disconnection of the self from God is also reflected in a preoccupation with conflicts concerning such concepts as meaning, purpose, and values. Together these concepts comprise the territory of what is commonly referred to as spirituality operationally defined as a concern with ultimates and essences. Note that these concepts may also be conceived of as the territory of primary motivation {the first year of life}.

A Theory of Symptom Formation and Implications for Treatment AA assumes that the alcoholic is suffering from a type of spiritual/psychological 'dis-ease'. The core symptom associated with this hybrid illness is a chronic state of frustration. The assumed etiology of the chronic frustration is the alcoholic's defiant straying from God's Will. From this perspective, chronic frustration results from an over estimation of the power of individual's Will leaving him continually disappointed in his inability to match his and others expectations. In the alcoholic's case, accumulated disappointment leads to attitudes of helplessness, hopelessness, and eventually paralyzing passivity. This confluence of 'negative attitudes' results in a lack of self-discipline further depressing the already depressed alcoholic.

In an accurate statement of a problem lies an embedded solution. Thus for AA the major problem requires a two fold intervention - one which is spiritual, the other being psychological. The spiritual antidote is motivating the alcoholic to realign {reconnect} himself with God's Will. The psychological intervention is teaching the alcoholic to learn the habit of self-restraint (i.e. learning to bear frustration and other so called negative affects.)

When An Alcoholic Becomes A Patient An alcoholic becomes a patient when he recognizes and accepts the fact that he feels powerless to function in his own normal way. He feels like a dead battery in need of a jump start. This felt lack of power generates an all-consuming conscious and unconscious need to connect with some substitute external source of power. AA names this external source of power the Higher Power.

Treatment in the Twelve Steps Program Traditional treatment for alcoholics in AA has followed the structure referred to as The Twelve Steps Program. This program aims in creating the optimum conditions for making it possible for the alcoholic patient to connect {reconnect} with God thereby attaining spiritual consciousness thought to resolve the alcoholic's core issue. Obtaining spiritual consciousness referred to as a connection with The Higher Power is often experienced as a transformation. AA contends that to accomplish this central task of treatment, the alcoholic patient has to open himself up to be a clear channel to receive an assumed inflow of divine energy issuing from The Higher Power.

Specifically, connecting to one's Higher Power is incrementally accomplished as the alcoholic patient successfully works through twelve steps (tasks). The outcome of negotiating these twelve steps is thought by AA to lead directly to an experience of God (spiritual consciousness). A central feature of the Twelve Steps program is thought to cleanse the alcoholic of his 'negativity' thereby inducing a switch to being 'positive'. Thus the Twelve Steps program may be conceptualized as a graduated process which aims at providing a transitional experience for the alcoholic patient ranging from deflation consciousness (characterized by emptiness, powerlessness and despair) to unity consciousness (characterized as fullness, kinetic energy and salvation) with God. The primary techniques utilized in negotiating the steps are meditation, sharing feelings, thoughts and experiences with other AA members in meetings, and prayer.

Basic Assumptions and Organizing Concepts of The Twelve Step Program

(l) Reality is spiritualized which means that an absolute perfect reality is thought to exist in fact and may be thought of as a Higher Power.

(2) What we refer to as a self is assumed to be pre-formed and has the capacity to have knowledge of the Higher Power.

(3) Knowledge of the Higher Power happens by means of intuition which is by definition assumed to be unmediated direct knowledge {by passing the five sense receptors).

Alcoholics in Treatment and their Attitudes towards Spirituality For many alcoholics, working the twelve steps resulting in connecting with one's Higher Power works quite satisfactorily. However, for many others, it fails. In this connection, a continuum of alcoholics in various forms of treatment has been observed with respect to differing attitudes towards spirituality. This continuum is comprised of true believers, atheists, and agnostics. This paper will focus exclusively on the agnostic alcoholic group's attitudes towards spirituality.

The agnostic group members all wish to meaningfully connect with 'divinity' but are skeptical of the Higher Power concept as conceptualized by AA It is noted, that despite their professed skepticism each and all the agnostics studied by this researcher might be validly thought of as preoccupied if not obsessed with spiritual concerns.

Six patients have been identified as representative of this agnostic group of alcoholics. While feeling somewhat helped in AA and/or in other forms of treatment, each one eventually entered psychoanalytic psychotherapy complaining of being stuck in a seemingly intractable therapeutic impasse.

What follows is an account of how each of these six patients tried and failed to effectively utilize the Higher Power concept as conceptualized by AA Each of their core problems is diagnosed from the perspective of a combination of Psychoanalytic and Self theory.

Characteristics of the Six Representative Agnostic Patients
Peter: is thirty-four years old who despite ten years in psychoanalysis and concurrently the last three years in AA "still feels basically lost, empty and confused." Although he is a talented actor he isn't sure he can " show up for himself." He experiences his struggle on a spiritual level. " I put myself in a hole and cover myself with a blanket of lethargy, my brain shuts down, and I'm tired of fighting. It's hard to get going and sustain positive momentum." He feels overwhelmed by smother - love and 'under- whelmed' by his absent father. "I feel I'm acting out my parent's life so that whatever I do is never enough." He understands his basic problem to be an inability to keep connected to his basic self. He feels in need of "an inner voice experience" but finds instead nothing substantial to hold onto. He may be said to have a problem of emptiness.

Eric: thirty-four years old. Despite six years in AA feels as if "he's a program zombie." Following the program principles he expected his negative feelings to be resolved by a 'passive transformation; but, as that has not occurred, he feels stuck. He feels there is a passive message being sent by AA "When you feel stuck or tempted to lose control, just go to a meeting, pray and believe in the program. It's all part of God's plan. It's ok to underachieve today. The emphasis of the program is on just Being as contrasted with Being and applied doing.

He is unable to utilize the Higher Power as he feels betrayed by God who he refers to as "a cosmic joker who teases." He feels he has to take a more active role in his recovery but is stuck at the fourth step unable to make a fearless inventory of his character defects. He experiences the fourth step as "scorching and fearful." He believes his problem be deep seated but too afraid to find out what it is. Thus he is caught up in a circular process unable to change. His core problem may be described as an inability to tolerate negative affect coupled with a problem of emptiness. He describes his problems as '' developmental disability i.e. something basic is missing."

Mills is forty years old, and an AA member for three years. He describes his basic problem as "Im not the person I should he." His {accurate} self diagnosis is "an intense motivational and personality confusion" He has a difficulty in keeping himself organized and focused due to the ordinary stresses and strains of inner and outer reality. Thus he has a problem in sustaining positive momentum.

He went to AA to ' break' his feelings of isolation. He found it to be a place where he was unconditionally accepted. He also gets exercises to help him reduce his negative perspective. But despite his best efforts to use his Higher Power he is unable to give up the expectation that he is supposed to be in absolute control all the time. He hates the feeling of weakness. When this state overtakes him it evokes a feeling that "no matter how spiritual I feel, sooner or later I get messed up." Mill's suffers from an inability to regulate his self - esteem.

Norman, forty-eight years old, has been a member of AA for five years. He has found the steps to be helpful but now feels stuck. "I don't get it." By 'it' he means "cutting off from true feelings." He used drugs and alcohol to seek 'a spiritual solace.' He has a strong wish to fit in. He has never felt comfortable with himself. He feels empty and missing something. He experiences a gigantic gap between who he is and who he wishes he could and should be. He is disappointed with all of the struggling he has put in with so little to show for it. He has been searching for an instant transformation to cure the "something missing at the core." His problem may be described as the lack of a cohesive self due to an intolerance of frustration.

Larry, forty years old, has been a member of AA for five years. He is consumed with resentment and discontinuities in his experience. He feels his name should have been 'But Wait' as he has always felt neglected by his father. He feels obsessed by a wheel of negative fantasies and death wishes towards his father. He describes his core problem as a lack of basic trust of both his family and himself. He judges the negativity completely unacceptable as is believes he should be able to transcend such lowly feelings.

He attempted but failed to put his anger to rest trying to use the Higher Power. However he always gets stuck at the eigth step, unable to forgive others. This glitch is predictable as he is unable to resolve the conflict that if God is all knowing and all good then how could he permit such a travesty of justice to happen to him. This problem may be seen as a lack of self and object constancy. (Object constancy is the capacity to maintain a continuous tie with a loved object even when disappointed by the object. Self-constancy is the capacity to maintain a solid tie with the self even when the self is disappointed with itself).

Wynn, fifty-three years old is the only one of the group who has not been a member in AA However while not a member of AA never the less has been on a life long spiritual journey seeking to discover his authentic self. Two different therapy experiences lasting a total of six years substantially failed to aid in this quest. Wynn describes his major problem as being passively motivated, lacking focus, unable to concentrate, allergic to conflict, and having an obsessive wish to be whole and integrated but exceedingly pessimistic about ever achieving this sought out union.

He became 'addicted' to occult theories and phenomena but eventually found them wanting. In his words "despite lofty promises of perfection and good guidance preached by the authorities it soon turned out to be politics as usual." Thus no matter what paths he took to find "absolute answers to ultimate questions" he sooner or latter began to experience "a repetition of meaninglessness once again drowning my soul." A frustrated wish for union with a Higher Power was unsustainable as he oscillated between states of agony and ecstasy. He clearly lacked the capacity to remain steady, balanced and in proportion.

At the beginning of psychoanalytic psychotherapy he felt he was experiencing a spiritual crisis. He described it as "being caught up in a titanic struggle for my soul." In steps language he was stuck at step One - unable to resolve the problem of to be or not to be. Nothing real seemed important to him. He was obsessed with trying to answer the abstract question of what is the nature of reality. His obsessing about this issue left him in a chronic state of frustration. Quoting Plato he said " The unexamined life is not worth living. But added the qualification: " The overly examined life is incapable of being lived." His problem may be described as a missing cohesive self.

Summary and Parallels of the Six Agnostic Patients
Each of the patients is analytic and psychologically minded. Each feels that something fundamental concerning the self is either missing or is defective. Further, that what is missing or defective is related to issues thought of as spiritual. One of the patients captured the essence of spiritual problem as "a hole in my soul." Each was searching consciously or unconsciously for absolute answers to ultimate questions such as who am I, what do I want, and what is my purpose. Each tried but ultimately failed to utilize the Higher Power to break free of what seemed to be an intractable therapeutic impasse. Nevertheless, despite their overt rejection of the Higher Power as conceptualized by A.A., they each retained an almost obsessive preoccupation with spiritual matters. Clearly these agnostic patients have been searching for an effective spiritual psychology to transform them selves.

Four Problems Associated with Psychological/Spiritual Impasses
Four problems associated with the above psychological/spiritual impasses are: (1) The problem of empty expressed by the patient who felt there was something missing at his core- with nothing substantial to hold onto and if by chance there occasionally was, he couldn't sustain it.(2) The problem of negativity expressed as an allergy to intense negative and sometimes positive affects including those of frustration, anxiety, fear, depression, shame, guilt, rage, revenge, excitement and pleasure. (3) The problem of self esteem deregulation expressed as an inability to cope with internal and/or external stressors (realistic limitations) which results in a deflation of self esteem. (4) The problem of final authority expressed as the patient's inability to trust others or himself as the final authority for his experiences.

As the Higher Power was ineffective in helping these particular patients break out of their therapeutic impasse, a need was created to revise the theory to account for this failure.

The theoretical assumptions of The Twelve Steps Program assumes that by successfully negotiating the Twelve Steps resulting in a solid connection with one's Higher Power is indeed 'spiritually transforming." If, as is the case of these six patients, the Twelve Steps process failed to accomplish this sought for transformation, the question arises is there any additional way to attain this transformational goal?

To answer this question, we need to look at the structure of any process that has as its aim a transformation of the self.

Transformation as the Result of a Transitional Process
Two questions arise. If one wishes to be transformed, where does one go and how is it done. In this perspective, imagine that you are a reflective caterpillar who hears that it is possible to be transformed into a butterfly. You learn that you have to allow yourself adequate time to submit to a process, wherein you are passively enclosed in a chrysalis. Eventually, when ready, you will obtain your wish being transformed into a butterfly.

In this light, The Twelve Steps Program is the equivalent of the chrysalis. Working the steps is the process assumed to lead to a union with God consciousness utilizing the Higher Power as the chief guide on this way to salvation.

It is important to note that a great deal of the work in the Twelve Steps program is an opening one up so to speak so that one's Higher Power can flow into one's self. It is fruitful to consider the logic behind this conception of transformation.

Whitfield (1984) in a paper called Stress Management and Spirituality During Recovery: A Transpersonal Approach, (Part I. Becoming) underscores the central importance of spirituality and stress in both understanding the alcoholic's core difficulty and in treating him effectively.

Whitfield defines stress as " the experience of frustration with no relief so that it creates unbearable tension.'' He further states that the antidote to this painful state of affairs is spirituality. "Spirituality defined as the self connected by consciousness to The Higher Power is the best stress reducer. Therefore it should be the best frustration reducer."

Using spirituality as a stress reducer is the primary aim of working the twelve steps. Theoretically, utilizing this process the alcoholic patient can look forward to gradually experiencing his fragmented consciousness into one which is felt to be unitary. In Whitfield's view the progression of consciousness is seen to consist of a process of "struggle, confusion, surrender, and seeing the light."

It is important to note that Whitfield's solution to the problem of stress (frustration intolerance) in the recovering alcoholic is exclusively a 'spiritual' solution. He actively discounts even the remotest possibility of an adequate psychological solution. He bases this militant assertion on the assumption that: "None of the traditional Western psychological frameworks or theories adequately relates the mind/ego and the self."

Whitfield reasons that because Western psychological frameworks only deal with the mind equals the ego, the self is only thought of in linear rational ways. This equation of mind = ego = self are relevant to issues of doing (action). For Whitfield this too narrow conception of self leaves out the crucial dimension of spiritual experience which for him is the essence of the self. Further, says Whitfield, "our spirit in not knowable by our intellect – it is only Be –Able. It is known through contradiction and paradox."

Thus for Whitfield, the self is a state of pure being that is a " a sanctuary from stress." This 'place' is described by him as "spirit, essence, true nature, soul, higher self, The Self {all of it describing the territory of spirituality.}

It is this researcher's experience that there is at least one Western psychological framework which does adequately relate the mind/ego and the self. This framework is a combination of
(A) two of Freud's metapsychological organizing constructs-two cornerstones of classical psychoanalytic theory.

These are: (l) the topographic model assuming that the psyche is structured vertically like an iceberg with the unseen unconscious being the major part, the conscious being the visible part of the ice berg defined as "awake and aware",and the preconscious which connects the unconscious to the conscious} and
(2) the structural model based on the assumption that the psyche is horizontally structured in three parts consisting of the id, the ego and the super ego) and,
(B) the constructs of self theory expounded by Kohut, Winnicott, Jacobson etc.

Representative of self psychologists who conceptualize the self intimately connected with the realm of being is Guntrip who states:

Science never knows ''the person''; it only has information about the person. There cannot be a whole complete human being without an integration of feeling with thinking and acting, provided by 'doing', arising out of the fundamental experience of 'being'.

Psychoanalytic Psychotherapy and Self Theory
It is this researcher's experience that there is at least one Historically, psychoanalytic psychotherapy has not had much success in treating substance abusers. With respect to their spiritual concerns it is a cliche that such issues be directed to AA However with the advent of psychoanalytic theories of the self, there is now a way to effectively respond to the recovering alcoholic's spiritual concerns from a depth psychological perspective.

A combination of psychoanalytic theory and self theory has been highly effective in helping each of the six agnostic patients described above to break out of their seemingly intractable treatment impasses.

Assuming these salutary results are valid it remains to be shown what the psychological approach has that the spiritual approach of The Twelve Steps apparently does not for these particular patients.

Review: Comparison of Diagnoses of the Alcoholic's Core Problem - The Twelve Steps Versus Psychoanalytic Psychotherapy

AA assumes that the core problem of the alcoholic is mainly spiritual - namely a falling away from a union with God consciousness. This dis-connection results in an unrealistic over estimation of human powers destined to take the form of a state of chronic frustration. Chronic states of frustration are experienced by the alcoholic as division, emptiness, confusion, powerlessness, deficiency, and weakness. Alcohol is used for the purpose of self -medication to narcotize the accompanying psychic pain

Psychoanalytic Psychotherapy utilizing self theory assumes that the core problem of the alcoholic is mainly psychological - a substitution for a missing self structure resulting in an allergy to frustration and other so negative affects including anxiety, depression, ambiguity, not knowing, complexity, shame, guilt, doubt, weakness, and the likes. The function of alcohol is thought to narcotize the psychic pain experienced as over whelming to the alcoholic.

Both The Twelve Steps Model and The Self Psychological Model focus on the alcoholic's experience of frustration as central to their understanding as to what really ails the alcoholic. However they differ as to the implications for diagnosis and treatment.

In the Twelve Steps Model, frustration is viewed as a derivative of the alcoholics over estimation of his realistic powers causing him great distress when he fails to achieve his objectives. In this model he has to get rid of the frustration by opening himself up to His Higher Power thus regaining a realistic sense of balance between autonomy and submission to spiritual authority.

In the Self Psychological Model frustration is the result of an inability to master inevitable 'negative' affects the chief one being frustration itself. The hypothesized reason for this lack of mastery is (l) a lack of a cohesive self structure resulting in an incapacity to contain the negative affects; and (2) an attitude about frustration and other negative affects that they shouldn't have to be experienced in the first place. In place of accepting and tolerating a certain amount of negative affect as inevitable, there is, instead, a fantasy of perfection characterized by a state of unending perfesion - perfect ease. In this model, effective intervention acts to (l) change the alcoholic's negative attitude about negativity, converting getting rid of frustration to learning to tolerate increasing dosages of it spontaneously leading to (2) growing a cohesive self structure.

Summary:
From a Twelve Steps perspective the fragmented self is made whole by opening itself to the infusion of Higher Power eventually leading to a union (reunion) with God consciousness thereby creating or restoring a sense of wholeness, fullness, worthiness, adequacy and the likes to the spiritually deficient self.

From a Self Psychological perspective the fragmented self is made eventually whole to the degree that the alcoholic learns to accept frustration as an inevitable fact of this life and to learn how to master it by choosing to bear it and other negative affects. Adopting this attitude inevitably results in the formation of a solid self structure which enables the alcoholic to experience himself as increasing more whole, full, worthy, adequate and the likes.

A Discussion of the Self Psychological Model in Greater Depth

The lack of meaningful connectedness with the whole self is experienced as either a lack of self feeling {depersonalization and derealization: ''I feel as if I don't exist and or I don't feel real - I just go through the motions''); and, or as an inability or unwillingness to tolerate inevitable 'negative' affects such as frustration: (Since I demand instant gratification, I hate waiting for anything.}

This combination of a lack of self feeling coupled with an inability and or unwillingness to tolerate inevitable frustration is a way of describing the psychological components associated with the psychodynamics of faith.

Klauber, quoting Tolstoy describes faith as 'the force whereby we live' - that sense by virtue of which man does not destroy himself, but continues to live on.' Says Klauber:

This description of faith does not refer, however, to belief in any religious myth or formulation. It refers to the inner consciousness of a force that, whatever its origins, is now experienced as acting from within. It may, I think, be translated into psychoanalytical terms as the force which ensures that the individual will withstand instinctual frustration and tolerate tension between ego and ego-ideal without the danger of a murderous attack upon the ego by the superego. Put another way, it is the faith in the indestructibility of good internalized objects.

A major task associated with success or failure in cathecting {establishing meaningful connections}between the whole self and in tolerating increasing dosages of frustration is reconciling psychological dichotomies. Representative of these dichotomies are: trust/mistrust; love/hate; faith/lack of faith; meaningfulness/ meaninglessness; and.-the primary experience of aliveness/deadness. Note that each of these dichotomies of experience are related by the common theme of 'essences'. It is important to note that these essences are the subjective contents of what AA refers to as spirituality.

Implications for Treatment
What AA refers to as spiritual, in the perspective of self - psychoanalytic theory is primarily involved with identifying and resolving essential {basic, primary} psychological dichotomies. This equation gives the therapist a new scientific/ philosophical/psychological approach in dealing with spiritual issues.

In this light note Guntrip's following assertion.
Insight, integration, individuation, and personal relationships are are but distinguishable aspects of one and the same thing, which is called mental health from the psychiatric point of view and peace or salvation from the religious point of view.

Basic Assumptions and Organizing Concepts of Psychoanalytic Psychotherapy and Self Theory.

(1) Reality is not absolute, therefore not intrinsically meaningful. Rather, reality is initially neutral accruing meaning relative to the context of an individual observer. The child's task like the adult is to create order and meaning out of the chaos of his raw data of experience. He does this mainly unconsciously by selecting relevant data out of the flow of experience for the purpose of satisfying inner needs. In this view, knowledge of external reality {the object world} always adds something of the stamp of an individual self constructing and interpreting the flow of personal experience.

(2) The self from a psychoanalytic - self psychological framework is significantly different from the self conceptualized by AA The AA concept of the self is already a complete structure at birth considered to be full, alive, and worthy as it is considered to be initially connected with God consciousness. Whereas the concept of the self- psychoanalytic model is not considered to be pre formed at birth, rather, it is thought to developed out of an 'undifferentiated matrix.' The self spontaneously becomes more cohesive to the degree to which is learns to bear increasing dosages of frustration. The cohesive self is operationally defined as something solid at the core which endures in the midst of internal or external confusion.''

A pre-condition for the formation of the cohesive self is that the child must have an experience of unconditional acceptance. Since no parent is perfect, the child will experience inevitable frustration due to missed expectations. If there is enough of an experience of feeling loved, the child will gradually learn to bear increasing dosages of frustration. The parent's task is to provide a balance between too much and too little gratification. Success is reflected in the child's increasing capacity to delay action (to wait). Delaying action is the critical pre condition for the spontaneous development of a cohesive self and a strong ego. Failure to provide this balance results in feelings of deprivation experienced as emptiness and powerlessness.

(3) The locus of power and of final authority is assumed to reside in the self and not in some external authority real or imagined, seen or unseen. The true self is assumed to be the authentic core of the person that is thought to naturally emerge if the person is given an experience of unconditional acceptance.

(4) All behavior is assumed to be motivated or caused and that much of it is done so below the level of awareness hence unconscious.

(5) It follows from the above that what AA refers to as the Higher Power and locates as something external and outside of the alcoholic patient might reasonably be referred to by a psychoanalytic psychotherapist as basic instincts located in the core of the self . It follows from the above that the Higher Power may well be thought of as located in the depths of the psyche and be equated with the personal unconscious.

It remains to be shown how the equation Higher Power = the Personal Unconscious was able to be utilized by the therapist to effectively help the six patients to break out of their seemingly intractable therapeutic impasses. Thus it is necessary to demonstrate how this alternative formulation of the Higher Power as the Personal Unconscious dealt with the problems referred to as empty, negativity, self esteem deregulation, and final authority.

The Problem of Empty and the Personal Unconscious
If the Higher Power be thought of as the Personal Unconscious, the problem of empty may be understood in one of two ways: (l) either as a by product of insufficient structural development of the self, or (2) as motivated emptiness.

Peter was unable to connect with and therefore unable to use his personal unconscious due to early unintentional 'brain washing'. His overly protective parents gave him the message not to separate but to stay home and take care of them. Thus because he learned that urges and actions towards the direction of autonomy were experienced as forbidden experienced as unconscious guilt, he lacked permission and encouragement to grow a cohesive self. Quite predictably, he developed a habit of systematically overriding his truest instincts that issue from his personal unconscious. Disowning his most authentic natural desires was experienced as emptying himself out. Thus his issue of empty was understood by his therapist as motivated emptiness.

As this automatic self sabotaging process was gradually made increasingly more conscious, Peter, had, for the first time in his life a rational framework for clarifying the battle yet to be fought for the control of his soul. This was accomplished in eight months.

The Problem of Negativity and the Personal Unconscious

The problem of negativity is expressed in various forms. For example: In Norman's case marked negativity was reflected as an allergy to frustration; in Eric's case it took the form of a more wide spread intolerance for all intense negative and or positive affects; while in Larry's case negativity was expressed in his inability to transcend seemingly intractable rage and subsequent guilt generating fantasies of revenge.

Norman was unable to value his personal unconscious {trust his basic instincts} as he was caught up in a dependency/autonomy conflict. Although he longed for a meaningful connection with divinity; at the same time, he feared losing the small amount of hard won autonomy he had been able to muster throughout the years. Additionally, he expected instant success with predictable disappointment and frustration when he inevitably fell short of his mark. This cumulatively led to a generalized sense of discouragement with a near psychic shut down. When Peter came to except frustration as an objective given rather than as personally directed towards him, he shifted his attitude from one of being burdened to an opportunity to master his feelings. This radical shift in his primary attitude towards frustration initiated a positive attitude in struggling with his problems, and in two months of psychoanalytic psychotherapy, he finally was able to break out of the stranglehold of his debilitating impasse.

Erich was stuck at the forth step {make a fearless inventory of your weaknesses). To negotiate this step, it is assumed that the person in question is capable of being fearless. As Erich had a pronounced fear of fear this resulted in a major impasse. To make matters more complicated, his fear of fear was also connected to a fear of loss of control which further immobilized him. The key to breaking Eric's impasse was helping him to tolerate these negative affects thus reducing their intensity. Part of the therapeutic work also consisted of helping him accept the inevitability of intense affects, also giving himself permission to be weak and overwhelmed without a fear of losing himself. This took twelve months of psychoanalytic psychotherapy.;

Larry was stuck at step Eight. Hating himself for hating God meant that he had no access to his personal unconscious consumed as it was with generalized rage. Doing so would only have stirred additional guilt. Therapeutic work was directed towards helping him identify and gradually learn to tolerate his primary ambivalent feelings coupled with permission not to have to forgive his father or God for perceived indignities. He was further encouraged to ventilate his rage in the safety of the therapy room. Additionally he was encouraged to analyze the historical origins of his rage as the logical by product of an extraordinarily complicated love/hate relationship with his disturbed father. This approach resulted in a major attitudinal shift towards his basic instincts from that of hating them and wishing to destroy them to accepting them as normal and useful. This shift enabled him to break the emotionally crippling cycle of denied natural rage experienced as self-hatred, generating feelings of powerlessness, helplessness, and hopelessness in turn generating even more unacceptable rage towards God. Larry's impasse was successfully broken up after approximately six months of psychoanalytic psychotherapy.

Summary:
The problem of negativity understood from a self - psychological perspective is viewed as a marked inability to tolerate frustration and other intense negative and positive affects. Therapy is directed towards teaching the patient about the inevitability of ambivalence and other unpleasant but existential realistic limitations and imperfections of being human. Additionally, the patient is taught to ventilate his intense feelings, to understand and to utilize the concept of ego boundaries in space, time, and in contents of consciousness. {Boundaries in space is the capacity to separate all that is inside one from that which is outside the skin; boundaries in time separate linear past, present and future time from durational childhood time; boundaries in contents of consciousness distinguish between feelings, thoughts, judgments, and actions.}

The Problem of Self Esteem Regulation and the Personal Unconscious

Mills began Psychoanalytic Psychotherapy with hyper sensitive to his feelings of frustrated unrealistic expectations {a disappointment allergy} unaware that he was convinced that perfection is a fact and that he should be able to both attain and sustain it. Predictably falling short of his goal evoked a periodic despised feelings of weakness, confusion, fear, depression, accompanied by a precipitous drop in his self-esteem. His therapy consisted of (1) of continually challenging his first assumptions about his fantasies of perfection (making him consciously aware of what up to that point was largely unconscious}. (2) He was taught how to identify and to tolerate increasing dosages of the dreaded intensely painful 'negative' and 'positive' affects. This led to a spontaneous strengthening of his ego and the formation of a cohesive self. As a result of his gradual shifting of unrealistic to realistic attitudes about his goals coupled with a guided effort in working towards them he began to get in touch with his considerable 'middle level' powers and began effectively utilizing them. This therapeutic intervention broke a life long self-esteem deregulation impasse in only three months, three times a week psychoanalytic psychotherapy.

The Problem of Final Authority and the Personal Unconscious The Twelve Step Program explicitly states that the final authority in a person's life is ''God. "Thy Will, not mine be done'' is the essence of their belief concerning the self's assumed fundamental relationship to external Reality {Higher Power}.

For patients like Wynn, the idea of merging with a final authority transcending himself is seductive but ultimately unacceptable. This is so because, traumatic childhood and adult experiences with hostile authority figures resulted in a basic distrust and pan suspiciousness of all authority figures outside himself even those abstract such as God or spirit. Further, this distrust includes an inability to trust one's own instincts as well. Thus unable to trust either one's own authority nor to trust any external authority makes patients like Wynn experience themselves as trapped in an existential limbo with a sense there is nothing solid to hold onto and the fear they maybe stuck in that dreaded state forever. The distrust in either the self or in some substitute external final authority intensifies the primary need to seek and experience a fantasized perfect state of perfesion {perfect ease}. Thus there is a rejection of limitations and conflict in the service of protecting the fantasy of perfection. {While professing a wish for wholeness there is at the same time a wish to be in a state of endless sleepiness and/or no pain frequently described by addicts when under the influence of their substance of choice.}

Treatment for Wynn consisted in providing a framework for understanding the chaos of his inner experience. The attitude of the therapist was to be a true ally,consistently engaged in a mutually collaborative effort to understand Wynn's experience. The atmosphere of working together encourages the patient to increasingly use his own experience as a final guide to decision making. Emphasis is placed on having the patient see his core problem as less one of content (eg. a problem with his feelings) than one of a lack of a cohesive self structure rendering him a victim to internal and external feelings beyond his control.

In a climate of unconditional acceptance coupled with slow systematic work on the self, Wynn began for the first time in his life to connect with; believe in, and to effectively utilize his personal unconscious in confronting and resolving his now welcomed problems of daily living.

Summary:
Both The Twelve Steps Program and Psychoanalytic Psychotherapy may be viewed as alternative transitional processes which aim in effecting transformations in the patient's consciousness of his core self.

In this frame of reference, both treatment programs are each forms of consciousness expansion. Agnostic alcoholics initially enter either program in a state of symbiotic consciousness characterized by an all pervasive wish to merge with an alternate source of perfect power. What distinguishes the two programs is that the Twelve Steps emphasizes a passive surrender to the Higher Power to obtain the sought out union with God consciousness; whereas, psychoanalytic psychotherapy promotes an active process of teaching the patient how, by identifying and bearing his painful affects and making psychological boundaries, he will predictably grow a cohesive self.

The result of transitional success in the Twelve Steps program is the attainment of a state of spiritual consciousness. This is has been described as being reborn. The patient feels like an authority but is allied with the final authority in his life – God.

The result of transitional success in Psychoanalytic Psychotherapy is the attainment of psychodynamic consciousness. This has been described as being not reborn but born. Said a patient: '' I feel as if I have had to create myself all over again for the first time.'' The patient, while often experiencing some identified state of spirituality, nevertheless experiences himself as his own final authority.
Gibbs A. Williams, Ph.D. © 1999-2000