Expanding the Ordinary to Extraordinary: A Review of Eileen Russell’s Restoring Resilience

By Gil Tunnell

Restoring resilience:  Discovering your clients’ capacity for healing.  By Eileen Russell.  New York: W. W. Norton., 2015, 356 pp.

Eileen Russell’s new book Restoring Resilience is a major contribution to the psychotherapy literature. It is the best professional book I have read in a long time.  Rich in new, jargon-free theory and filled with clinical vignettes that illustrate working with different forms of resilience, the author begins with a comprehensive review of the literature on how clinicians, philosophers and poets have thought about resilience (later she cites relevant research on resilience, mostly on children). Russell is clear from the start that she is not talking about the everyday, ordinary notion of “resilience,” but rather a multi-faceted concept that manifests itself in different ways at each stage and state of the therapeutic process.

Russell believes resilience potential is hard wired yet needs to be nurtured and practiced.  First and foremost, she writes that resilience always operates “on behalf of the Self,” whether it exists in its more restrictive mode that results in defensive functioning (in the service of survival and protection of the nascent Self), or in its fully expansive mode such as in transformance, Fosha’s (2008) seminal concept of the individual’s hard-wired striving for healing, growth and expansion of Self.  Early in the book, Russell says that the “essence of resilience is the Self’s differentiation from that which is aversive to it” (p. 5).  This seems to be a simple sentence the meaning of which, frankly, I did not grasp immediately. Later I came to understand how and why Russell defines resilience this way: Her definition encompasses the complexity of resilience in all its facets.  Indeed, our therapeutic efforts might be described as attempts to help the patient minimize, mitigate and sometimes mute the parts aversive to the Self.

Although Russell’s ideas on resilience can be useful in any psychotherapy approach (from psychoanalysis to cognitive behavioral therapy), Russell applies it primarily to Accelerated Experiential Dynamic Psychotherapy (AEDP, Fosha, 2000).  She “slices and dices” the concept of resilience in a number of ways relevant to AEDP.  Taking a long view, she describes the arc of resilience as it appears in the stages of treatment when the patient is in different modes of functioning:  “self-at-worst” (resilience as “potential”), “self-in-transition” (resilience as “promise”), and “self-at best” (resilience as transformance/“flourishing”).  Similarly, Russell maps resilience onto each of the four intra-session AEDP states (defense, core affect, transformational affect, and core state).

More than demonstrating what resilience looks like in its various facets, Russell describes numerous clinical interventions that can be used to nurture it.  In my view, this is why the book is so important: The author goes beyond helping the reader identify resilience in all its forms, but provides explicit clinical interventions appropriate for cultivating each form.  For example, in early treatment, she writes that it is insufficient simply for the clinician to note the patient’s resilience privately or even share his thoughts on the patient’s resilience with the patient. Instead, Russell invites therapists to get curious about resilience, become more adept in spotting it, get the patient curious about it, and, together with the patient, mine it and bring it into the light.

Russell notes that resilience is implicitly embedded in Fosha’s concept of transformance (“the overarching motivational force operating in both development and therapy that strives toward maximal vitality, authenticity, and genuine contact,” Fosha, 2008, p. 292).  Russell goes to great lengths to explain that resilience is also present in its more buried form in the patient’s defensive functioning in real life and shows up in therapy in State One AEDP as resistance, the polar opposite of transformance.  Resilience in the resistance means that, although the patient is interacting with the therapist in “top of the triangle, self-at-worst” mode—defensive, oriented toward basic survival and protection, preserving the status quo and conserving energy that might be better put toward enhancing growth—the patient has nevertheless shown up asking for help (resilience potential) and is actually doing the best she can do, struggling in a compromised mode of “self-at-best-under-difficult-circumstances” (my phrase). Russell cites interventions designed to harness the patient’s resilience potential in State One (see below for examples).  Finally, in keeping with the idea that transformance strivings are always present even in the resistance, Russell seems to be saying that if the parts aversive to the Self can get out of the way, both resilience and transformance can come on board full throttle.  Of course, that is the work of therapy.

Many of us in AEDP make some positive statement of affirmation to a new patient at the end of a session, sometimes pointing out how well he coped in surviving difficult, often traumatic circumstances.  Russell goes beyond affirmation:  While acknowledging the wounded-ness that made defenses necessary, she helps the patient isolate and identify “the part” that doesn’t want to shut down (the resilience potential).  In early State One work, she is particularly empathic, doing what she calls “pressuring with empathy”—“the explicit use of the therapist’s emotional reaction, more specifically the explicit self-disclosure of her own feelings of compassion, warmth or appreciation, to help the patient feel at a deeper level” (p. 94, originally cited in Russell & Fosha (2008), p. 181).

In contrast, interventions around resilience in later treatment (when the patient is in States Three and Four, experiencing transformational affects and core state) are qualitatively different.  Here the patient is often feeling positive affects (joy, gratitude, mastery). Yet many patients have trouble “taking in” such positivity.  Russell suggests we linger and hang out there. To help healing truly “sink in” and deepen, therapists should metaprocess these feelings, e.g., “what’s it like to feel the joy,” and “to experience the joy with me.” In short, we should not view the positive feelings as a mere by-product of good treatment.

In traditional insight-oriented therapies, resistance is the primary avenue the therapist utilizes to help the patient gain insight into his defenses and thus develop his full potential.  These therapies confront and interpret patient’s defenses under the premise that once defenses are no longer needed and conflicts resolved, the patient will “somehow” thrive based on the insights achieved. (Russell reviews research that demonstrates this outcome—insight leading to growth—so often does not occur.)  In contrast, Russell and AEDP, while recognizing defenses, nonetheless try to bypass them and instead focus from the get-go on the patient’s resilience and transformance drive. Rather than strip away defenses, which, after all, are learned and acquired, we provide the patient a more “bottom up” experience, capitalizing and building upon the individual’s innate resilience and transformance drive.  It seems to me that building up “the good stuff” that’s already there might be easier and more efficient than trying to extinguish deeply ingrained, tenacious learnings that remain fiercely protective of the Self yet now stand in the way of healing, expansion and growth.  Easier or not, AEDP is almost always a more positive, and less fraught, experience for both patient and therapist.

In summary, it is difficult to capture in a short review all the insights this book offers (e.g., the distinction between resilience potential and resilience capacity, how to work with resilience when the patient is in “self-in-transition” mode when the therapist becomes a “transformational other”).  By the end of the book, Russell has demonstrated that resilience is anything but ordinary. She encourages us to discover and exploit it in all its forms.  Her masterful book Restoring Resilience provides a rich buffet of something for everyone: sophisticated theory, numerous moment-to-moment transcripts, and comprehensive scholarship.  Like her topic, Eileen Russell’s book is extraordinary.

References

Fosha, D. (2000).  The transforming power of affect: A model for accelerated change. New York: Basic Books.

Fosha, D. (2008).  Transformance, recognition of self by self, and effective action. In K. J. Schneider (Ed.), Existential-integrative psychotherapy: Guideposts to the core of practice (pp. 290-320).  New York: Routledge.

Russell, E., & Fosha, D. (2008).  Transformation affects and core state in AEDP: The emergence and consolidation of joy, hope, gratitude and confidence in the (solid goodness of the) self.  Journal of Psychotherapy Integration, 18, 167-190.

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