Psychoanalysis, Self and Context, 13:119–131, 2018

Copyright © Taylor & Francis Group, LLC

ISSN: 2472-0038 print / 2472-0046 online
DOI: https://doi.org/10.1080/24720038.2018.1427968

Integrating Contemplative
Practice and Embodied Awareness
in the Treatment of Dissociative
Anxiety
Shoshana Ringel, Ph.D.

This article presents the psychoanalytic treatment of dissociative anxiety, incorporating a

mindfulness-based, meditative process. This contemplative approach includes moment-to-
moment awareness, the investigation of embodied and affective states, and a view of subjectivity
as fluid and comprised of transitory and changing subjective states. The author addresses shared
elements between Buddhism, self, and relational psychoanalysis, including mutual inquiry and
empathic awareness, as well as a focus on the intersubjective process between patient and
therapist. A treatment process is described where these models are complementary.

Keywords: dissociation; embodied awareness; implicit processes; meditation; mindfulness

I n this article, I describe the principles of contemplative mindfulness practice,

which is based in Buddhist psychology. These principles include the moment to
moment attention to and awareness of somatic, affective, and cognitive pro-
cesses, as well as a stance of observation, inquiry, and non-identification. This offers the
possibility of a reflective vantage point and helps create an internal space in which
patient and analyst hold and regulate traumatic experience. I will show how a mutual
contemplative engagement may complement the psychoanalytic focus on the therapist’s
personal reverie, enacted modes of engagement, and affect sharing between patient and
therapist.
Contemporary psychoanalytic approaches such as relational theory and self psy-
chology investigate implicit processes in the patient/analyst relationship, which are often
expressed outside the domain of words, interpretation, and insight (Stern et al., 1998).
These implicit pathways include affective, somatic, and even transcendent states that

Shoshana Ringel, Ph.D., is an associate professor at the University of Maryland, and a psychoanalyst in
private practice in Baltimore. She is affiliated with ICP&P in Washington, DC.
A shorter version of this paper was presented at the 2015 IAPSP conference in LA.

119
120 Shoshana Ringel

are not readily accessible to symbolization and cognitive processing. The analyst’s
participation through contemplative listening, personal reverie, and disruption and
repair in the domain of self/other engagement provides a relational matrix through
which implicit aspects of the patient’s experience, held in the analyst’s empathic
awareness, can lead to significant change and transformation (Bass, 2009, 2014;
Bromberg, 2011; Kulka, 2012; Cooper, 2014). A meditative mindfulness investigation
deepens this therapeutic process through attention to the sensory aspects of experience,
which the therapist can facilitate through sustained inquiry that often shifts the focus
from narrative and interpretation to visceral experiences and insights embedded in the
patient’s somatic life (Epstein, 1995; 2007; Engler, 2002; Jennings, 2003). Mindful
inquiry may therefore help interrupt the patient’s habitual patterns of negative self
identifications and thought loops rooted in early attachment trauma, fear, and shame
(van der Hart, Nijenhuis, and Steele, 2006).

Buddhism, Mindfulness, and Psychoanalytic Treatment

The Buddhist tradition, on which mindfulness meditation is based, asserts that there is
no solid, unified self, and views sensory, affective, and cognitive experiences as fluid and
transitory. According to Epstein (2007), a mindfulness meditation practice alters one’s
relationship to self-fragmentation, in that it helps deepen one’s awareness and the
subsequent realization that affects and mental states are constantly changing and
ultimately transitory and unstable, though there is clearly a distinction between dis-
sociative process that occurs in the natural course of life, and pathological dissociation
rooted in traumatic experiences (for extended discussion, see Bromberg, 2011;
Schimmenti and Caretti, 2016). The recognition of change and fluidity in the nature
of self experience echoes current psychoanalytic understanding of the self. In self and
relational thinking, subjectivity is understood as a process of changing experiences rather
than a closed system; the self is viewed as a dynamic, fluid organism that is constantly
changing and adapting through relational interchange with others, and that is embedded
in one’s social and cultural milieu (Bromberg, 2006; Stolorow, 2013; Teicholz, 2016). In
Buddhism, the self is also seen as a fluid structure that is in a constant process of change
and transition, but that is essentially illusory as it is based on self-constructed identifica-
tions and conditioned mental states. Mindful meditation practice eventually leads to the
recognition of the emptiness of the self and the impermanence of human experience.
From a Buddhist perspective, one’s attachment to self-concepts is viewed as a significant
cause of human pain and suffering (Jennings, 2003; Epstein, 2007). However, Buddhist
thought also suggests, paradoxically, that concepts of self and identity are necessary in
order to function in everyday life (Goldstein, 2013). A famous Zen story illustrates this
conundrum: A seeker sees a monk climbing up a mountain with a heavy bag over his
shoulder. The seeker asks the monk what is enlightenment, and the monk puts the bag
down. The seeker then asks him “So, what now?” And the monk picks up the bag and
continues walking up the mountain.
Though self psychology and Buddhist thought outline differing conceptions of the
self, both emphasize empathy as a central factor in human relationships. Self psychology
Contemplative practice and embodied awareness 121

places the intersubjective bond of the analytic dyad within an empathic awareness that
deepens connection to self and others and facilitates change in habitual patterns of self/
other experience (Kohut, 1966; Teicholz, 2016). A primary treatment goal is to facilitate
self integration, complexity, and cohesiveness through the therapist’s attunement and
empathy (Teicholz, 2016, p. 327). While in self psychology, empathic awareness is
embedded in self/other matrix (Orange, 2011), in Buddhist practice it arises out of
meditative contemplation as one recognizes the inherent bond of interconnectedness
with all living beings (Kulka, 2012). In his early writings, Kohut described states of
transcendence that include creativity, empathy, acceptance of life’s impermanence,
humor, and wisdom, qualities that are quite similar to states described during the
practice of meditation (Kohut, 1966).
In summary, both self psychology and Buddhist thought emphasize sustained
inquiry into emergent experience, the recognition of the fluid nature of thoughts and
affects and the view of subjectivity as shifting and changing, although the psychoanalytic
endeavor is contextualized in a relational matrix rather than within personal contempla-
tion (Lichtenberg, Lachmann, and Fosshage, 2002; Orange, 2011; Brach, 2013). In
contrast to the psychoanalytic process, which focuses on the intersubjective domain
between patient and therapist through a rupture and repair cycle, enactments, mutual
affect regulation, and other modes of therapeutic action, a contemplative practice is
typically a solitary endeavor, providing a reflective vantage point within oneself; an
internal space within which to experience the transitory nature of thoughts, affect, and
bodily phenomena. This includes an inquiry into present experience as the practitioner
tracks subtle shifts in the sequence of sensory and affective patterns and gradually
becomes aware of mental constructions and self-narratives, based on conditioned pat-
terns of thought and feelings, which are often reified into misleading identifications and
compartmentalized self states (Smith, 2014).

Embodied Awareness, Developmental Trauma, and

Dissociation

Psychoanalysis has traditionally excluded the body as a primary focus of investigation,

though sensory and somatic processing have become an area of clinical attention in mind/
body therapies, specifically in regards to trauma and dissociation (Levine, 1997; van der
Kolk, 2002; Ogden, 2006). These somatically based models focus on working with the
sensory dimensions, utilizing the body to establish safety as well as to access dissociated
affects and self-states (or parts) that are often more accessible through somatic processing
(van der Kolk, 2014). Ogden suggests that a mindfulness-based sensorimotor approach
grounds an embodied awareness of oneself in a present moment relational engagement
between patient and therapist, a description that contextualizes a solitary contemplative
method of sensory observation within a relational matrix of self and other.
This focus on somatic and sensory states has been prevalent in the treatment of
trauma and dissociation. For example, Ogden integrates attachment research, neu-
roscience, and mindfulness practice in her sensorimotor approach (Ogden, 2006) and
Levine (1997) has emphasized the significance of body memory in dissociated traumatic
122 Shoshana Ringel

states. Both argue that the body, rather than the traumatic narrative, should be the
primary focus of investigation in the processing of trauma and dissociation. As well,
current research in neuroscience suggests that somatic experience holds the key to early
developmental trauma, when the capacity for cognitive processing and symbolization is
limited (van der Kolk, 2014). van der Kolk asserts that patients develop conditional
responses to trauma through fight, flight, and numbing and that during dissociative
episodes the brain’s frontal lobes, which process analytic, rational, and verbal functions,
are deactivated (2002, p. 384) and therefore the patient’s traumatic memories are not
readily available for narrative and cognitive integration. When dissociation occurs
between the symbolic (cognitive) and subsymbolic levels (somatic), individuals may
experience affective as well as bodily states that are not accessible to cognitive proces-
sing (Bucci, 1997). As well, early developmental trauma may not be available to verbal
memory and communication and so insight alone may not help integrate traumatic
memories although it can temporarily override them.
Schore (2011) emphasizes that it is the implicit, unconscious, and emotion-
processing mode of communication via right brain functions that is truly dominant in
human experience, rather than left brain language functions, and that it is the implicit,
nonverbal “psychobiological” communication processes in early child/parent interac-
tions, and between patient and analyst, which are what ultimately bring about deep
and abiding change. These right brain to right brain processes include facial, auditory,
tactile, and “emotionally charged attachment communications” (Schore, 2011, p. 79).
This author suggests, therefore, that verbal interactions and emphasis on language alone
do not reach the level of implicit communication between patient and analyst.
Along with neuroscience, current attachment research shows that traumatic dis-
sociation may occur in the context of early child/mother interactive contingencies
(Beebe and Lachmann, 2014). Beebe’s micro-moment video analysis of these facial
interactions suggests that the mother’s recognition of the child’s mental states is a
fundamental factor in the child’s experience of feeling known by another and in the
development of their capacity to know themselves. In a disorganized attachment pairing,
children internalize the mother’s own unresolved trauma, learning to survive by accom-
modating to her perceived needs and mental states at the cost of their own selfhood and
autonomy. The mother’s inconsistent and unpredictable behavior and her inability to
tolerate the child’s affective states contribute to the child’s difficulty in regulating their
own distress and can result in chronic states of hypervigilance and frantic anxiety, as
noted in the case this article describes (Perry, 2008; Schimmenti and Caretti, 2016). In
the absence of organized, coherent procedural processes of intimate relating, the infant
does not develop the capacity to know their mind or to be known by the other. These
early disrupted communications between infant and parent were found to predict later
dissociation (Lyons-Ruth, Bronfman, and Parsons, 1999; Slade, 2014). Beebe and
Lachmann (2014) assert that when the infant is impinged upon or ignored when
distressed, the infant’s affective and cognitive development is disturbed and processes
of coherence and internal integration do not take place. The child becomes susceptible
to dissociative strategies, learning to compartmentalize and hide their authentic sub-
jectivity and unacceptable affects and states of mind (Bromberg, 2006). This dissociative
Contemplative practice and embodied awareness 123

response disrupts the developmental process of coherence and integration between

physiological, psychological, and behavioral functions (Putnam, 1997; Schimmenti and
Caretti, 2016). The consequences of early non-recognition by the parent are therefore
quite significant and long lasting (Bromberg, 2011), as mutual recognition in the
intersubjective domain is fundamental to an individual’s capacity to repair relational
expectancies and to the development of a sense of self through mutual knowing
(Benjamin, 1995).
Kyle, the patient described in this article, presented with severe anxiety and
depression, dissociative states, and obsessive compulsive behaviors, in part related to
his attachment history. Kyle’s narrative suggests that he developed a disorganized
attachment pattern in which fear played a predominant role. As stated above, fear is
a primary affect in a disorganized attachment system between mother and child, and
emerges when the child realizes that he cannot rely on maternal recognition, attune-
ment, and responsiveness (Slade, 2014). Disorganized attachment is also characterized
by dissociative states and repetitive behaviors (Hesse et al., 2003), and may undermine
the child’s experience of appropriate boundaries between self and other, as well as the
sense of agency and self-assertion. In a disorganized child/parent system, the caregiver’s
dysregulated affects may be transmitted to the child and thereby threaten the child’s
sense of safety and security, so that the child may resort to controlling strategies to
ensure his survival.
By becoming his mother’s emotional caregiver, Kyle attempted to create a more
reliable, consistent environment and to ensure his physical and emotional well-being
(Lyons-Ruth et al., 2006). He became his mother’s stabilizing selfobject, providing her
with emotional intimacy, vitality, and soothing but sacrificing his own authentic subjectivity
in order to maintain the maternal bond (Brandchaft, Doctors, and Sorter, 2010). The lack of
physical and affective differentiation between Kyle and his mother contributed to dissocia-
tive states in which he felt unreal and insubstantial apart from her, unable to rely on or to
define his own physical and emotional subjectivity. As much as Kyle wished for an intimate
bond with others, he was assailed by a paralyzing fear of losing his identity and personal
boundaries and was ambivalent about his own gender identification and sexual preferences.
In a repetitive relational pattern, Kyle would form intense romantic relationships, become
frightened and overwhelmed and then distance himself and withdraw.

Clinical Illustration

Kyle was the youngest of three siblings and the closest to his mother. As his earliest
memories suggest, their relationship was emotionally intense and visceral. Like Kyle, his
mother suffered from pervasive anxiety and the two shared a deep bond based on mutual
fears and insecurities. Kyle grew up with the implicit message that without his mother he
could not survive and so any physical separation from her became painful and frightening.
His mother seemed to have undermined any attempt on Kyle’s part at separation and
autonomy and clearly relied on him for emotional intimacy and soothing. Kyle poignantly
recalled being held by his mother as an infant, experiencing safety and security, but also a
sense of suffocation and despair. Whenever he lost sight of his mother, or had to go to school
124 Shoshana Ringel

on his own as a young child, Kyle became frantically anxious and fearful. Though he was
now a full grown adult, Kyle and his mother continued to text and call each other several
times a day. As he matured, Kyle became aware that his mother needed him to shore up her
emotionally distant and unsatisfying marriage and looked to him for the intense intimacy
that his father was unable to provide.
Since early childhood, Kyle felt an overwhelming anxiety that typically manifested
in somatic symptoms including shaking, stammering, and crying uncontrollably, symp-
toms that caused him deep shame and embarrassment. As stated previously, Kyle also
experienced states of dissociation and depersonalization, when he would feel discon-
nected from his body and would lose the sense of where he was. This typically occurred
in situations of severe stress. Though Kyle tried a variety of treatments, a range of drug
regimens, and periodic hospitalization, nothing seemed to have a lasting impact. Because
of his debilitating anxiety, Kyle could not live his life to the fullest, develop lasting
romantic relationships, or even move away from his home town and his parents. While
most of his friends went on to pursue professional careers and marriage, Kyle, at age 40,
was still living alone a few minutes away from his parents. Though he craved travel and
adventure, Kyle would become paralyzed by fear and obsessive ruminations and would
be unable to follow through on his plans. During our sessions, he was frequently lost in
“thought storms,” harsh judgments, and self-doubts that frustrated and exhausted him,
and he hated himself for being “weak,” frightened, and vulnerable. We eventually
realized that only talking about his experience and trying to interpret it and develop
useful insights did not seem to help. We therefore decided to try a mindfulness-based
approach that might shift Kyle’s focus away from obsessive thought loops and debilitat-
ing anxiety, and thus allow us to process his paralyzing conflicts and aversive affects from
an embodied vantage point. We hoped that a more somatically based investigation
would help Kyle stabilize when he felt flooded by fear, anxiety, and self-doubts and that
such an approach would help him regulate his affective states.
Kyle had become involved in meditation practice in an effort to manage his fears
and obsessions and he went on several meditation retreats prior to starting the treat-
ment. While he valued the experience of solitary meditation practice during these
retreats, he found himself unable to tolerate the intensity of his emotions in the midst
of silence and solitude, and realized that he needed to work with a therapist who could
help him tolerate and regulate his intense affective states. For people who have a
traumatic history, these intensive retreats can trigger somatic states and affects that,
without a trained therapist, can become quite overwhelming and destabilizing, and this
seems to have happened to Kyle. Kyle knew that mindfulness meditation was a strong
interest of mine and so our decision to pursue a mindfulness-based treatment was
mutual. The clinical material described below took place following his month long
hospitalization due to a severe episode of anxiety and depression. While meditation is
usually solitary and contemplative in nature, we followed a collaborative meditative
process, which utilized mutual contemplation and a focus on a present moment aware-
ness of somatic and affective states (Brach, 2013) along with a relational focus on our
intersubjective communication. The sustained inquiry into somatic states allowed for a
more visceral and immediate experience of Kyle’s developmental history and its
Contemplative practice and embodied awareness 125

subsequent implications for his present difficulties. As I encouraged Kyle to follow his
somatic and affective experience, I also focused on my own subjective sensory response.
The following is a description of several sequential sessions, initially focused on tracking
Kyle’s moment to moment sensory and affective experience, and later elaborating on a
disruption that subsequently occurred between us.

Clinical Process

As usual, Kyle sat on the couch and carefully arranged his notebooks, pens, a box of
tissues, and two pillows, as if creating a protective shell around him. We started the session
with a few moments of silence, following our breath, letting our mind settle, and allowing
ourselves to be more present with one another. This seemed to help assuage some of Kyle’s
anxiety and alleviate the pressure he experienced to come prepared with an agenda (he
was in the habit of bringing in detailed notes and lists on slips of paper or inked on his
hand). As we sat in silence, I became aware of my breathing, the silence in the room, and
some sense of unease and uncertainty as to what was about to take place. I noticed that
Kyle seemed tentative and unsure, and I wondered whether he felt embarrassed as I
watched his familiar rituals, perhaps hesitant to reveal his pain and vulnerability.
After a few minutes, Kyle reported that he became aware of overwhelming fear and
anxiety associated with his desire to quit his job, which he found stultifying and
unbearable. Kyle had tried to change his life several times in the past, but had always
failed. We knew that this fear was present very early in his life and had accompanied
him for a long time. Continuing to attend to his sensory experience, Kyle reported a
frightening sense of the loss of physical boundaries as a memory emerged of being a
young child, feeling lost and frantically looking for his mother. By tracking the sequence
of sensory and affective states, Kyle saw that he had lived his life in a way that kept him
frozen and paralyzed. He described that whenever he imagined a state of solitude and
greater autonomy, he experienced an initial sense of excitement and exuberance. He felt
energized, vital, and free, and started to fantasize about going on imagined adventures
and living a life in which he might take physical and emotional risks, exploring parts of
the world he had only dreamed about. But after a while, he started to be overcome by
doubts and uncertainty and to experience terror, panic, and dissociation. Kyle noticed
that his body and his surroundings felt disconnected and unreal as he imagined leaving
his safe though confining life behind. I asked Kyle to imagine staying in his familiar life,
and continuing his romantic relationship, and he reported that he started to feel trapped
and suffocated, unsure of his identity, and that he experienced an intense desire to
escape. It became clear to us that both of these positions were untenable, either going on
his own to experience new adventures, or continuing in his familiar milieu. I asked Kyle
to describe what he was experiencing at that moment, and he responded that he started
to feel a sense of numbing and disorientation, as if enveloped by a “grey fog.” He
reported feeling disoriented and ungrounded, as if floating in space, anxious and having
a powerful urge to run away. I continued to encourage Kyle to focus on his sensations
and feelings, and Kyle became aware of anger at himself for being weak, fearful, and
dependent, and then became angry at his mother who, because of her insecurities,
126 Shoshana Ringel

encouraged him to remain dependent on her and thwarted his halting attempts at
autonomy and independence.
Kyle continued to notice the flow of thoughts and sensations, and reported a
memory fragment that had surfaced, of lying on his mother’s belly as a very young child.
He was aware of feeling comforted by a sense of warmth and security. His body felt
connected to hers, as if he and his mother were one, as if he had no existence apart from
her. In the midst of this soothing memory of apparent comfort and security, Kyle noticed
a sense of constriction in his throat, and suddenly had difficulty breathing. As I
encouraged him to continue his somatic tracking, Kyle realized how terrified he was
to leave his parents and live on his own. Though he felt smothered and diminished
around his mother, he felt unable to separate from the parental bond and rely on his
own resources (Brandchaft et al., 2011).
While Kyle recognized how pervasive and paralyzing his fear was, he observed at
that moment that his fear was only one in a sequence of other feelings, sensations, and
memories and so, as he realized that his fear was a transitory state, it no longer
overwhelmed him. This was an important insight into how his fear was keeping him
imprisoned and preventing him from becoming an agent in his own life. During this
session, and several subsequent sessions, I helped Kyle create a space for a sequence of
feelings and sensations associated with early memories and habitual patterns of living his
life, without getting lost in obsessive ruminations and negative self judgements.
Fear and paralysis became the subject during the following sessions, and while
initially an important and significant experiential insight, as Kyle continued to feel
imprisoned in his fear and paralysis, I started to notice my own frustration and impa-
tience. We had been over this ground so many times before, and I became aware that I
felt much more drawn to Kyle’s excitement and exuberance. Though I did not disclose
my sense of impatience to Kyle during a later session, my subjective feelings were
communicated implicitly, and I noticed that at some point during the session, Kyle
became silent and withdrawn. When I asked him what had happened, Kyle admitted
that he suddenly started to feel ashamed and embarrassed. He realized that he had
revealed to me his fear and vulnerability, a part of himself that he had tried to disguise
and hide from others and from me, and he was afraid that I was judging him as harshly
as he so often judged himself.
I became aware of a complex range of feelings and sensations. I experienced
empathy and felt protective of Kyle, and at the same time I also recognized a sense of
irritation and boredom. I much preferred Kyle’s moments of excitement and exuberance,
which energized the room and promised new experiences and adventure, rather than the
stultifying, paralyzing fear and anxiety that seemed to circle us without the possibility of
movement and change. I asked Kyle what he saw in me that had led to his observations.
Kyle admitted that at times he sensed that I was somewhat abrupt with him when he
became anxious. I wanted to know more about what Kyle had noticed, and he
responded that there was something in my expression that intensified his sense of
shame, and made it difficult for him to share with me his fear and ambivalence. I
admitted that at times I did get impatient, and that I also appreciated his insights. He
had helped me to become more aware of my own unconscious response though I wasn’t
Contemplative practice and embodied awareness 127

necessarily proud of it. I suggested that we both felt some impatience with his fear and
anxiety and perhaps needed to help each other allow this vulnerable part of him to
emerge with more patience and empathy, but also without being paralyzed by it. This
moment of rupture between us shows how implicit communication, the therapist’s self
disclosure and acknowledgement of her own vulnerability, and mutual affective holding
led to a transformative moment in the treatment, and allowed Kyle to transcend his
fears, so that a new experience could emerge for him. I also believe that Kyle’s new
experience of voicing his doubts in me, and receiving validation and acknowledgement,
encouraged him to trust his perceptions, and to shift from a habitual response of
dissociation and accommodation, to a more authentic self expression.
At the end of the session, Kyle reported an image that came to him of swimming in
the river and arriving at a waterfall, with his fearful and anxious child self being held by
his adult self as both jumped into the waterfall together and emerged unharmed on the
other side. As this image suggests, Kyle found a place of safety in the midst of powerful
currents and overwhelming emotions, allowing them to wash over him and transcending
his habitual fear, anxiety, and self-imposed limitations.
As we continued to process this session we discovered that Kyle’s anxiety played an
important function in protecting him from potential risks, and alerted him to consider
future consequences for risky and impulsive actions. We learned to hold his states of fear
and doubt so that greater freedom and flexibility could emerge, and eventually we found a
way to allow Kyle’s fear, along with his sense of adventure and excitement, to be held
between us, while not overwhelming either of us. Ultimately, we discovered that these two
self-states could co-exist so that Kyle could live a fuller, more expressive life. Subsequent
to this session, whenever Kyle expressed critical feelings towards himself, I would remind
him that we both needed to honor and hold his fear and vulnerability and be curious as to
what it could tell us. Kyle gradually became more aware of deeply embedded cognitive
patterns that exacerbated his anxieties, and was eventually able to make some significant
changes in his life. He moved away from his parents, found more fulfilling employment,
and is now fully engaged in trying to make his romantic relationship work.

Reflections on the Clinical Process and on My Own

Meditation Practice

I recognized that as much as Kyle feared losing his sense of self with others and having to
accommodate to their emotional demands, he was deeply ashamed of the intensity of his own
needs and vulnerabilities, and fearful of my potential judgements. I later reflected that my
feelings mirrored Kyle’s mother’s implicit shaming, and his contempt for his own vulnerability.
I had grown up in a culture (the Israeli Kibbutz) that encouraged independence and self-
reliance, where any expression of weakness or emotional vulnerability was treated with
disdain. It was an environment where the expression of fear, anxiety, and ambivalence were
discouraged, and there was a strong pull to mute and silence any intimation of vulnerability,
uncertainty, or regret. I had worked hard to allow myself to be aware of and accept my
subjective states of fear, shame, and confusion. Still, I realized that at times I wished that Kyle
would take action, overcome his paralyzing anxiety, and sustain deeper engagement with the
128 Shoshana Ringel

part of him that was adventurous and exuberant. In the process of my own self-examination, I
recognized my shame at having these feelings, and my embarrassment at having been caught. I
realized that both Kyle and I felt shame and frustration in our vulnerable states, which at times
overwhelmed and paralyzed us. I became more aware of my own self-doubts, wondering
whether I would be able to provide Kyle with the holding and safety he needed so that he
could transcend his fear and experience a deeper connection to himself and risk pursuing
greater personal freedom. My own reflective process was important in coming to understand
the nature of our rupture, to process it so that Kyle would feel seen and validated and so that
he could recognize and accept his own state of mind (Beebe and Lachmann, 2014).
I would like to conclude by describing an important experience that occurred
during my own meditation practice. I had started to practice mindfulness meditation
many years ago in order to find meaning and emotional healing. I was looking for a
spiritual home, which I did not find while growing up on a Kibbutz in Israel. I
experienced deep states of stillness, openness, and equanimity through this practice,
and have struggled for a long time to integrate my meditation practice with my psycho-
analytic training, though in reading more recent self and relational literature I found
many overlapping principles that I have tried to explicate in this article. Several of my
patients, much like Kyle, are now familiar with mindfulness meditation practice and are
open to integrating this approach in our psychoanalytic treatment process.
A particular experience resonates with Kyle’s transformative image of holding his baby
self while jumping into the waterfall. Like many others, throughout my life I experienced the
loss of family members and homeland and have lived with a pervasive feeling of rootlessness
and disconnection. I was aware that the loss and alienation I experienced were transmitted not
only through my personal history, but through several generations of Jewish ancestors who
experienced death and loss in pogroms and during the Holocaust. However, it was through an
experience during a meditation retreat that this knowledge became visceral and
transformative.
Kyle’s transformative image was of holding his child self while falling through a turbulent
waterfall, an experience of opening, allowing, and surrendering to forces within and outside
himself, while at the same time holding parts of himself that he previously disparaged and
disavowed. I encountered a different image during an intensive meditation retreat. As I was
walking one day feeling a deep sense of grief and loss, I had the sense of walking over my dead
ancestors’ bones, buried in the earth beneath my feet, and felt that they were all around me as
well as below me, and that I was no longer alone, that we all belonged to this earth. I then felt a
deep sense of peace, recognizing that my home was everywhere and that I was no longer a
stranger but rather deeply connected to myself and to others.
Although my realization occurred in relative solitude and Kyle’s through our
mutual sharing and engagement, we both experienced a transformational moment of
reconnection to parts of ourselves and our history, a state of expansion that transcended
ordinary self-experience and contributed to deep reorganization of our internal system. I
believe that this transformation was the result of our mindfulness practice through
cultivating attention to the flow of sensory experience from a stance of acceptance
and non-identification, as well as our implicit relational exchange and willingness to
repair intersubjective ruptures through the sharing of affect and vulnerability.
Contemplative practice and embodied awareness 129

Conclusion

In conclusion, this article offers an integrative perspective that incorporates mindfulness

meditation with the psychoanalytic treatment of severe anxiety and acute dissociative
states located in the patient’s early attachment experience. Self-psychology and rela-
tional perspectives share with contemplative practice the active inquiry into emergent
states that may ultimately lead to transformation. The psychoanalytic approach con-
tributes a unique perspective on the “enacted aspects of dissociated dimensions of
transference/countertransference field” (Bass, 2014, p. 670), and to mutual sharing
that was clearly significant in Kyle’s experience of self transformation. The mindfulness
meditation process, based in Buddhist psychology, adds an emphasis on embodied
awareness, non-identification, and the acceptance of emergent mental states. Both
share the view that the self is a fluid and dynamic system, and that self-awareness and
insight may deepen through a complex relational exchange, as well as through personal
contemplative practice and reflection (Bromberg, 2006; Smith, 2014). Buddhism and
psychoanalysis are complementary in examining the emergent experience between
patient and therapist and attending to subtle shifts in self and self/other processes,
through a shared inquiry and a collaborative engagement (Magid, 2000).
Awareness and observation of sensory phenomena may help facilitate preverbal
developmental experiences that contribute to attachment disorganization but are not yet
available to cognitive processing and language (Lyons-Ruth et al., 2006; Beebe et al.,
2012). Somatic and affective tracking of self and other through reflective listening and
contemplative awareness may allow patients to integrate sensory and affective fragmen-
tation, and to regulate affect shifts.
This article suggests that a psychoanalytic process of relational engagement, along
with a meditative focus on embodied and affective states, facilitated the patient’s
somatic grounding and capacity to hold and regulate conflicting affects within and
between patient and therapist. A mindfulness-based relational process helped access
dissociated memories embedded in early experience, and through close tracking the
patient was able to link current conflicts to preverbal experience and somatic memories
that previously were not accessible to conscious awareness and narrative coherence. By
attending to the fluid process of subjective experience through sensory shifts these
implicit memories could then be symbolized and articulated.

References

Bass, A. (2009), An independent theory of clinical technique viewed through a relational lens. Psychoanal.
Dial., 19:237–245.
Bass, A. (2014), Three pleas for measure of uncertainty, reverie and private contemplation in the chaotic,
interactive, nonlinear dynamic field of interpersonal/intersubjective/relational psychoanalysis. Psychoanal.
Dial., 24(6):663–675.
Beebe, B. & Lachmann, F. (2014), The Origins of Attachment: Infant Research and Adult Treatment.
New York: Routledge.
Beebe, B., Lachmann, F., Markese, S. & Bahrick, L. (2012), On the origins of disorganized attachment and
internal working models: Paper I. A dyadic systems approach. Psychoanal. Dial., 22(2):253–272.
130 Shoshana Ringel

Benjamin, (1995), Like Subjects Love Objects. New Haven, CT: Yale University Press.
Brach, T. (2013), True Refuge. New York: Bantam Books.
Brandchaft, B., Doctors, S. & Sorter D. (2010), Toward an Emancipatory Psychoanalysis: Brandschaft’s
Intersubjective Vision. New York: Routledge.
Bromberg, P. (2006), Standing in the Spaces. New York: Routledge.
Bromberg, P. (2011), Awakening the Dreamer. New York: Routledge.
Bucci, W. (1997), Psychoanalysis and Cognitive Science: A Multiple Code Theory. New York: Guilford Press.
Cooper, S. (2014), The things we carry: Finding/creating the object and the analyst’s self-reflective
participation. Psychoanal. Dial., 24(6):621–636.
Engler, J. (2002), Being somebody and being nobody: A reexamination of the understanding of self in psycho-
analysis and Buddhism. In: Psychoanalysis and Buddhism, ed. J. Safran. Boston: Wisdom Pubs., pp. 35–79.
Epstein, M. (1995), Thoughts Without a Thinker. New York: Basic Books.
Epstein, M. (2007), Psychotherapy Without the Self. New Haven, CT: Yale University Press.
Goldstein, J. (2013), Mindfulness: A Practice Guide to Awakening. Boulder, CO: Sounds True.
Hesse, E., Main, M., Abrams, K. & Rifkin, A. (2003), Unresolved states regarding loss or abuse can have
“second generation” effects: Disorganization, role inversion and frightening ideation in the offspring and
traumatized non-maltreating parents. In: Healing Trauma: Attachment, Mind Body and Brain, eds. M.
Solomon & D. Siegel. New York: Norton, pp. 57–106.
Jennings, P. (2003), Mixing Minds: The Power of Relationship in Psychoanalysis and Buddhism. Boston: Wisdom Pubs.
Kohut, H. (1966), Forms and transformations of narcissism. In: The Search for the Self. Vol. 1, ed. P.
Ornstein. New York: International Universities Press, pp. 427–460.
Kulka, R. (2012), Between emergence and dissolving: Contemporary reflections on greatness and ideals in
Kohut’s legacy. Internat. J. Psychoanal. Self Psychol., 7(2):264–283.
Levine, P. (1997), Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.
Lichtenberg, J., Lachmann, F. & Fosshage, J. (2002), A Spirit of Inquiry. Hillsdale, NJ: Analytic Press.
Lyons-Ruth, K., Bronfman, E. & Parsons, E. (1999), Chapter IV. Maternal frightened, frightening, or
atypical behavior and disorganized infant attachment patterns. Monogr Soc Res Child Dev., 64(3):67–96.
Lyons-Ruth, K., Dutra, L., Schuder, M. & Bianchi, I. (2006), From infant attachment disorganization to
adult dissociation: Relational adaptations or traumatic experiences? Psychiatric Clin. North Amer.,
29:63–86.
Magid, B. (2000), The couch and the cushion: Integrating zen and psychoanalysis. J. Am. Plann. Assoc., 28
(3), 513–528.
Ogden, P. (2006), Trauma and the Body. New York: Norton.
Orange, D. (2011), The Suffering Stranger. New York: Routledge.
Perry, B. D. (2008), Child maltreatment: A neurodevelopmental perspective on the role of trauma and
neglect in psychopathology. In: Textbook of Child and Adolescent Psychopathology, ed. T. P. Beauchaine &
S. P. Hinshaw. New York: Wiley, pp. 93–128.
Putnam, F. (1997), Dissociation in Children and Adolescents: A Developmental Perspective. New York: Guilford
Press.
Schimmenti, A. & Caretti, V. (2016), Linking the overwhelming with the unbearable: Developmental
trauma, dissociation, and the disconnected self. Psychoanal, Psychol., 33(1):106–128.
Schore, A. (2011), The right brain implicit self lies at the core of psychoanalysis. Psychoanal. Dial., 21
(1):75–100.
Slade, H. (2014), Imagining fear: Attachment, threat and psychic experience. Psychoanal. Dial., 24
(3):253–266.
Smith, R. (2014), Awakening. Boston: Shambhala.
Stern, D., Sander, L., Nahum, J., Harrison, A., Bruschweiler-Stern, N. & Tronick, E. (1998),
Noninterpretative mechanisms in psychoanalytic therapy. Internat. J. Psychoanal., 79:903–921.
Stolorow, R. (2013), Intersubjective theory: CA phenomenological-contextualist psychoanalytic
perspective. Psychoanal. Dial., 23:383–389.
Contemplative practice and embodied awareness 131

Teicholz, J. (2016), The end of comparative psychoanalysis? Blurring the boundaries between contemporary
theories. Internat. J. Psychoanal. Self Psychol., 11(4):325–339.
Van der Hart, O., Nijenhuis, E. & Steele, K. (2006), The Haunted Self: Structural Dissociation and the
Treatment of Chronic Traumatization. New York: Norton.
van der Kolk, B. A. (2002), Posttraumatic therapy in the age of neuroscience. Psychoanal. Dial., 12
(3):381–392.
van der Kolk, B. A. (2014), The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
New York: Penguin.

Shoshana Ringel, Ph.D.

1915 Greenberry Road
Baltimore, MD 21209
410-664-0359
[email protected]
Copyright of Psychoanalysis: Self & Context is the property of Taylor & Francis Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.