Pre-conference Interview with Stewart Aledort, MD, CGP, FAGPA

By Myrna L. Frank, PhD, CGP

MLF: What are we going to learn from you at the Spring MAGPS conference?

SA: I hope to teach the importance of the earliest periods of life.  These early preverbal experiences have a profound influence on the laying down of neuronal structures in the brain and in forming templates of intimacy and identity.  The baby has passionate, somatic responses to all these experiences.  If the attunement is bad, one can see excessive crying, stomach aches, skin irritations, and a general inability to be soothed. 
One sees a distressed dyad that intensifies the passionately held bad fits.  I will highlight the power of passionately held bad fits through the developmental stages of the group.

MLF: What makes your theory unique?

SA: There are two basic, parallel, and at times interconnecting neuronal tracks — the passionate good fit (PGF) and the passionate bad fit (PBF).  The PGF is where attunement is good enough.  This results in pleasure, optimism, curiosity, and learning.   In contrast, the PBF is evident in a sense of injury, hurt, depression and an absence of liveliness and curiosity.  These manifestations of the good and bad fits have an enormous influence on the character of the individual and the templates of intimacy in the dyad.  I call the PBF the “Omnipotent Child.”  This is the reservoir of the accumulated bad fits.

MLF:  Your title mentions shame and excitement.

SA: Yes – what I look at in my patients is the passion, the excitement, and the unconscious re-enactment that occurs in a person’s life and in the group.  The omnipotent child is bent on the unconscious re-enactment of the PBF to stabilize his identity, even though this identity doesn’t enable him to lead a full life.  Many think the re-enactment is driven by a need for mastery.  I believe the re-enactment is driven by the need to find words for the preverbal experiences and to stabilize that identity.  In my theory and technique, everyone who enters the group room is a newborn, looking to reenact his good and bad fits with therapist as the symbiotic mother.  As the group develops, the re-enactments are expressed toward each other.

An example of this re-enactment is the patient who keeps making the same bad choices so that he can feel like a failure.  Curiously, there is excitement in his search for the failed relationship.  Underneath most re-enactments there is shame, which is a powerful, early affect.  In my theory, there is excitement in the shameful experiences. There is enormous shame in yearnings, envy, failure, and self righteous indignation.  A woman in the group regularly destroys her man.  She finally is able to admit how excited and shameful she felt as she joked with the group.  The man who complains bitterly about his wife’s outrageous behavior becomes aware of how excited he is upon returning to his house and wonders what she will do to him next.  Character change and development cannot happen fully without working through the hidden excitement and shame.

MLF:  Can you describe how the shame and excitement play out in the group?

SA: The work of the group is to create an analytic culture in which its members can begin the work of character change.  In effect, this means that the group becomes a safe holding environment where bad fits can transform into good fits. The preverbal experiences become known and words are found to describe them.  Only in this way can the group member begin to have empathy for himself.  Only where there is empathy can we lay down the tracks for the fullness of the good fit.  This process is imbued with intense feelings and resistance to give up the bad fit.  The only antidote to the bad fit is to live in the good fit.

Members must mourn the omnipotent child in order to live in the excitement and satisfactions of the good fit.  Bob is an example of someone who relentlessly hangs onto his PBF.  We see his PBF as he attempts to seduce the reluctant Susan and bypasses Carol, who is eager to be seduced.  I point out to Bob that if he chooses Carol over Susan, he would feel the profound loss of his PBF, but he would allow himself to feel the excitement of trying on a new identity, the PGF.

MLF: In general the group therapist is far more exposed than the individual therapist.  You are an especially active and involved group therapist. I would think that this kind of exposure could be quite challenging even for the seasoned clinician, let alone the less experienced practitioner. Can you share your thoughts on this?

SA: There is no question that group work is really different from individual work.  It is much more difficult and one needs really good mentoring and training.  Group therapists need to attend conferences like this organization offers.   They need to be in a group, be a co-therapist, and really learn how to be “a receptacle.”  This is not an easy process, and it has taken me many years to get to this point.  In the early years I was much too reactive.  I’ve learned from group members who have not made it, and I’ve had to live with my shame.

MLF:  Do you ever explain the theory of the passionate bad fit to your patients or is it something that you allow to “happen” during treatment? Also, how can the less experienced therapist learn guidelines for this?

SA: Both occur.  Because of the way I run groups, I put myself in the center of the action as “the mother of symbiosis.”  This induces a regression in which they unconsciously relive the earliest bad and good fits.  I also explain what is happening. For example, I will interrupt two people talking, and say “You’re here for me and not for each other.”  In addition, I explain this process before people come into the group.  Of course, most people don’t hear this at that time!

MLF: So what language do you use when you do this psycho-ed piece? How do you explain to the unsophisticated patient what you do?

SA: In the evaluation I say the following: “I want you to work in my group because from what I have heard about your history, you have a series of bad fits in your life, such as a, b, and c, and I hear it in your relationships with x, y, and z. The wonderful thing is that in the group there will be a lot of the people in your life — your mother, your father, your sister, and so on.  I want us to look at what happens in the room, so we can see what happens in the good fit and in the bad fit.”   I think that group work of this nature is intense work.  I tell people that one weekly group session is like two individual sessions.  I let them know that group therapy is the best therapy deal that money can buy.