August 31st, 2019 admin
A therapist asks, “After a client has named a feeling, when I inquire where they feel that in their body, they persistently deny any physical sensation. Where do I go with that?”
Susan’s response: I’m just working on a chapter for my upcoming book and right now I’m writing about the will to feel and connect, which is generated by caring about one’s internal experience. I’m imagining that significant others have not shown deep interest or caring in the internal experience of your client, who has developed isolation of affect. An approach that I’ve found to be beneficial to a number of people is to reassure them that they have an innate capacity to become aware of their internal experience and bodily sensations, which are occurring in every moment.
People who have disconnected from themselves to the degree your client presents don’t see an importance in noticing what they feel, usually related to shame, fear or guilt. It really takes desire and will to focus our attention inward. In meditation, we can choose to practice on focusing on anything we choose, like the breath or a candle flame. We’re probably not going to engage in such a practice without strong motivation. We have to see the vital benefits of such a practice. In therapy, our client is unlikely to practice an internal focus unless they see why it’s so important to the quality of their life and how such a focus can impact the symptoms that brought them into therapy. When we convey that we care and also believe in their capacity to show such caring and link this type of interest in their internal experience to the success of their therapy, I find repeatedly that the will becomes activated. I’m often amazed at all a person begins to recognize within themselves when the will comes online. The person’s awareness may begin with noticing sensations associated with anxiety or shame, and then we have the opportunity to work with those states.
Sometimes I’ll bring attention to visible or sensed bodily signals and invite the person to become aware of them and to share my interest in them. “It seemed that your voice changed or your arm stiffened. Does it seem that way to you?” I’ve often heard, “No, I didn’t notice that but now I do.” And we hope that our curiosity and caring will transfer to the person and we often need to clarify why this holds such significance related to what they want for themselves.
Often clients will need a specific type of assistance to discover why it so important for them to join you in your focused efforts to show interest in their internal experience. I’ve never met a person who didn’t have this capacity.
Posted in Therapist Concerns, Treatment Process | No Comments »
August 21st, 2019 admin
VIDEO DEMONSTRATIONS with SUSAN WARREN WARSHOW
IEDTA Conference, Boston
Sept. 26th-28th
REGISTER
LACPA Convention, Los Angeles
Oct 19th
IEDTA Conference
REGISTER
IEDTA CONFERENCE:
From the IEDTA website: The conference is divided into sessions, typically three hours long, most of which will focus on our theme of new frontiers in EDT. Each session will feature contributions from several presenters, and all clinical presentations will be accompanied by video of actual therapy sessions. Conference-goers have an unparalleled opportunity to sample a wide variety of stylistic variations in the practice of EDT. Because the conference includes patient video, it is open only to licensed professionals and students in full-time training to become licensed professionals.
We are very excited about the slate of presenters, which includes most of the leading figures in the Experiential Dynamic Therapy field, along with contributions from other colleagues from around the globe.
LACPA CONVENTION:
Connect. Collaborate. Get Inspired!
When: Saturday, October 19, 2019, 8:30 AM – 4:45 PM
Where: DoubleTree by Hilton Los Angeles Westside
Featured afternoon speaker:
Scott Miller, Ph.D.
Topic: Achieving Clinical Excellence: Three Steps to Superior Performance
Posted in Conference | No Comments »
April 22nd, 2019 admin
Visit The DEFT Institute YouTube Channel: WATCH NOW
View our series of videos from the DEFT training on topics including:
Therapeutic Transfer of Compassion for Self
Therapist Shame
Generating Hope in the Phase of Inquiry
Undoing Toxic Guilt
Working with Internal Saboteurs
And more!
Posted in Therapist Concerns | No Comments »
December 5th, 2018 admin
One of my photos was selected for Mirrors of The Mind 2018. Someone approached me about the caption beneath the photograph, and I thought I would share it here:
Therapy is about opening doors on each door is unique. Interior garden back into me. In my work, I hope to help others to discover the Freida territory that lies beyond the gates, walls and locks of the psyche. We often discover tragic neglect of the intended parts of the south. This saddens me and stirs my compassion. But I have learned I cannot rush in even though I yearn to relieve pain. I must stand respectfully at the entrance and take each step forward with the permission of the other. After all this is another is this private world. I do not attempt to open doors uninvited. There is something sacred about that for me. It is a privilege to be granted entry.
Doors have always intrigued me, especially when they have a history. They hold so much promise and mystery. What lies beyond them? My mind associates Ainsworth.s attachment styles to each door. When my therapeutic partner begins to share my interest, appreciation and compassion for all that lies within the self, it is as if the doors slide open on their own accord, the magic mechanism. Neither of us is pushing. The door itself has life and will.
Strolling in the late afternoon in San Miguel D’Allande and discovered this doorway with its infinite textures, patterns, and striking colors coming together with perfect synchronicity. Similarly made those in my care discover the beauty that lies within them and feel enough safety and freedom to swing open their doors to the delight of self and others.
Posted in Uncategorized | No Comments »
February 5th, 2018 admin
Susan welcomes your questions. The following questions were submitted by a member of the DEFT Institute webinar program. For more information on training, webinars and events with Susan visit DEFTinstitute.com
1. A therapist asked, “Sometimes, when a person expresses anger towards a significant other, it sounds more like accusation or pointing finger at the other (externalization) and it is sometimes hard to shift to authentic anger. I wonder in therapy how not to reinforce defensive anger and instead bring it back to authentic anger?”
That’s a really excellent question because often, when we feel in some way victimized, it is always valuable to explore how our vulnerabilities may have put us at risk or perpetuated damage to self. However, timing can be everything as well as other factors. I’m thinking of a client who was enraged with her husband for having an affair and leaving the marriage. This woman had a fragile and undeveloped sense of self. She had been victimized as a child and had no parental protection or reinforcement for her feelings. This is the early trauma that needs to be repaired by helping her to recognize and value all of what she feels.
Her husband never showed a willingness to work on their marriage, from her perspective. Once she could own and process what she felt towards him, (intense rage and complex feelings), she was then able to recognize, with guidance, her internalization of her feelings and compliance throughout her marriage. At that point she could see her part in the marital disaster (versus externalization). There was a reality that she had been a victim of his deceit and unwillingness to address their marital issues and also a reality that she had dismissed her concerns, fears and feelings for years.
If I’d started out with a focus on the defense of externalization, it could reinforce her shame. I also don’t think it would have been attuned to her enormous anxiety in the present moment, which was triggered by both shame and fear in exposing the powerful feelings that were activated within her and were related to early trauma. Once she could process some of her rage, her anxiety and shame lessened and a space was opened for further exploration.
Each case is so different, and if someone is projecting their will and externalizing their problem…“He made me marry him”… or “I had to take my boss’s abuse,” I would address these defenses first in a very compassionate, shame-sensitive way. (“So it felt like you had no power to choose? Somewhere along the line you learned to disconnect from your feelings, which would have given you more power to chart the course of your life”). But I would also then explore her feelings towards her husband or boss, whether he was in reality abusive or not. So in some cases, I would first address externalization first by raising awareness that she had more power and ability to express herself and make healthy choices inside her than she recognized, but then also open a path to explore her rage and complex feelings. The decision rests on what course is most likely to empower the individual in the moment.
2) A therapist asks, “When you said you normalize rage impulses in a context for the client (why and how any of us would feel it and the price for), can you give a concrete example of what you explicitly might say to normalize rage?”
“It’s so normal that you would feel this intense rage towards your husband for betraying you. Anyone would feel this way.” If we take the example of the client above, I might even say I would feel this way too if this happened to me and/or emphasize the magnitude of the injury (this man was not only having an affair but said he wanted out of their marriage for years and didn’t say anything.) I may also point out that rage is a protest. We are wired to protest when we are abandoned/injured in our important relationships.
3) A therapist asked, “How can I help a client who is not able to describe his body sensations in session. His anxiety is in his striated muscles (no collapsing or confusion), but he cannot name what he is sensing. I am not able to reach his feelings, and he feels incompetent not being able to give me an answer when I ask. Also, this client expresses fear of losing control if he goes into his body sensations.”
It seems like this question has 2 parts:
A) The client is having a shame response (“I’m incompetent/I can’t give you the answer you want”). You mention that you cannot reach his feelings. It seems he may be having the experience that you want something from him (projection of will). Remember we are not trying to reach the client’s feelings. The client usually develops a desire to reach his feelings b/c we help him to recognize that this will take him towards what he wants from therapy. What does he want from therapy? Is he clear about how focusing on his feelings and sensations will get him towards what he wants? Is he clear that you don’t want anything from him/he is not doing this for you/you don’t have any expectations/you don’t need to reach his feelings…? With him, picking up on what you said about a shame response, I would first be sure that he WANTS to learn to pay attention to his body. Does this make sense for him to work in this way?
If it’s something he wants to be able to do, accepting for now that the recommended approach can be healing for him, then we can say “Of course you are not familiar with paying attention to bodily signals. Most people are not. It takes a certain practice, which I am happy to help you with, if you want? (Space for response). If he can notice muscle tension, good! If he notices no sensations, then we’d begin to work with detachment. (Gosh, you’re describing such a horrific experience and you do not feel anything inside as you describe this. I wonder where your feelings have gone? Has it always been like this? So somehow you learned to disconnect from your emotions. How do you feel about this, as we look at how your emotions have been left behind?” “How do you imagine this disconnection from your feelings has affected your life?” Here we are working on transfer of compassion for self and mobilization of will. So this therapist is right about not going further towards feelings before defenses are lowered.
B) There is a fear that if he “goes to his body” he will loose control. Is there a reason he is concerned about losing control (is there a history of impulse control issues)? If not, then this is a thought he is having/this is a place his mind goes (and maybe for good reason, maybe his parents lost control). I would normalize this fear, and I might tell him that in my experience people are more likely to lose control when they don’t attend to their feelings than when they do. People who loose control say, “I don’t know what happened, I just saw red etc.” This is completely different than the mindful tracking of an emotional experience.
Posted in Shame, Therapist Concerns, Treatment Process | No Comments »
January 8th, 2018 admin
In the article Can Shame Be Useful? by SALLY L. SATEL and SCOTT O. LILIENFELD, the authors raised the question, “under what conditions does shame end up prodding people into correcting their course? ”
“An important influence appears to be whether people buy into the notion that a habit is under or out of their control. In a meta-analysis — a mathematical synthesis of previous studies — just published in The Journal of Personality and Social Psychology, the University of Connecticut psychologist Colin Leach and one of his doctoral students, Atilla Cidam, examined the links between shame and “constructive approach behaviors,” such as helping or cooperating with others, apologizing and making amends for one’s failures.
They found that study participants who were vulnerable to experiencing shame were less inclined to engage in corrective actions when they believed their mistakes were not fixable, such as when they had no opportunity to apologize to someone they’d offended. In contrast, participants were more inclined to engage in positive behaviors when they thought their errors could be repaired.”
I believe these findings can be extrapolated to one of the primary tenets in DEFT practice. This involves the types of interventions that sustain hope when facing those actions or defensive habits that have harmed others or have caused us to feel we have fallen short of our ideals. When we attempt to dismantle harmful defenses, we need to be simultaneously building the sense that something new can take its place. When we are working with an interplay of guilt and shame, the aforementioned meta-analysis validates that hope is essential to the change process. I find that hope is often built upon direct experiences of having an impact on others, and this may begin with impacting our therapist’s emotions and perspectives. And it is also built on the sense that we can build a new relationship to ourselves that is kinder, more compassionate and offers greater freedom.
Here are a few of the factors that come to mind that can generate hope during the therapeutic process:
1) A direct experience of one’s capacity to repair.
- We can consider that repair in our relationships to others begins with repair in relationship to ourselves.
- When we help our client to develop capacity to extend forgiveness and compassion towards one’s own shortcomings and failings, it is often only then that he can find the strength to admit them to others.
- Self condemnation precludes reparative action.
“Can we extend compassion to you because you were taught to withdraw from others, that this became automatic, and that you have not had alternatives at your disposal, as you are discovering them now.” “From this place of compassion for yourself and caring for your friend, would you want to express your remorse to your friend for having withdrawn from him?”
2) Therapeutic reminders of evidence of one’s capacity to impact self and others.
Therapists do well to refer frequently to instances when the the client has been kinder or more attuned in interactions with others. “I like how you said that.” “That was very generous of you.” Or “It’s great to see you extending more acceptance and tenderness to yourself.”
3) Knowledge of what constitutes repair, in cases of injury to another. Therapists can explain that this involves:
- Saying I’m sorry while feeling genuine remorse, a painful visceral sensation.
- Dropping all qualifiers
- Stating the injury as accurately and forthrightly as possible
- Leaving space for the other to express hurt and angry feelings without interruption.
- If the injured person is not accessible, making one’s best attempt to behave differently in future relationships. Therapists often need to help people to see the value in breaking cycles of traumatization. Even when someone we’ve injured had died or is unavailable, our efforts to change hurtful patterns are reparative in terms of the human family.
- Differentiating attempts at repair from the ultimate outcome of the attempt.
Therapists can help their clients to appreciate attempts at repair, regardless of success. True relationship repair requires an exchange of energies between two people and we can only be responsible for our personal role. Any attempt to be vulnerable and genuinely apologetic is to be recognized.
Posted in Uncategorized | No Comments »
November 21st, 2017 admin
Susan: You are so right about the importance of your client’s desire and will in this process. There are many avenues of response that might be helpful. Here are a few that come to mind. As I write this, I know some will think (as I once did), “Hey. I just want a definitive answer to how to proceed. You’re offering choices and perspectives but which is “right?” I’ve come to distrust absolutes in this work, a failure to know what we don’t know. Humility requires self-compassion. This allows us to more freely feel and intuit our way through every relationship and make use of the skills and treatment principles we find along our path that seem to fit the moment best.
Your client may not know what “looking at her shame” means. As a client, I’m not sure I would know and it might sound like there’s something wrong with me when I need to “look” at it. This choice of wording could evoke shame, even though that is not how you meant it. Subtleties of language, a turn of phrase or slight adjustment in tone can either reduce or increase shame.
I think there’s also a projection of will here. It becomes YOU who are interested in her shame rather than the fact that she brought it up. We don’t know what’s really bothering her about readily accepting her cheating husband. Perhaps she would be less defensive and more revealing with an open ended question like “I want to be sure I’m understanding your experience and what is bothering you here. Can you tell me more about the distress you feel?”
Another line of inquiry… “How do you imagine I’m reacting to your acceptance of your cheating husband?” I’m guessing she projects that you judge her like she judges herself. If she can come to realize this projection, it could be an opening to explore her feelings towards the judging “you” she perceives you to be. “I’m glad you see that this judging perspective is coming from within you and there are really no indicators that it is coming from me. And truthfully, I’m feeling compassion rather than judgment. If you want, I think it would be helpful to you for us to ask, “How are you feeling towards me as someone who judges you for accepting your cheating husband?”
If she again snaps back, “It seems like my showing an interest in what you bring to session is bringing up feelings in you. I’m curious why you may not want me or us to give attention to something that is causing you pain. You say you feel shame and shame is is a painful feeling.” (Very caring tone becomes important here to convey compassion not only for her painful feeling of shame but also for her quick dismissal of your caring interest). I wonder if we could bring some compassion to this obviously tormenting struggle inside of you? You have loved this man and nothing is more excruciating that pulling away from someone we’ve loved. Therefore, you want to hold on to this attachment. At the same time, there is this part of you that doesn’t want to see you hurt again and again by his betrayals. I wonder if we could create the space to hear these conflicting parts of you without judgment?”
When we reduce shame and self-judgment, a greater valuing of the self along with relationship safety develops. From this strengthened self-state, she may become more willing to explore how she feels towards that part of her husband who betrays her repeatedly.
Posted in Uncategorized | No Comments »
November 15th, 2017 admin
ASK SUSAN (we welcome your clinical questions)
I received a question posed by 2 trainees who were practicing DEFT skills in their buddy meetings. They inquired: “We were discussing a particular roadblock when the client relates a “hollow” or “empty” feeling inside due to the rise in anxiety/feelings. We recognized that this is a version of the defensive “wall” that comes up but we felt stuck in how to address it.”
Great question! This is an excellent example of a comment that can have many meanings depending on the individual client, the context in which it’s stated, and the tone that accompanies it. A sense of emptiness is not necessarily a “wall,” meant to block the therapist from moving closer, but rather this expression could reveal a sense of impoverishment. For example, one client described to me a gaping hole inside her and a sense she could float away. Her emptiness represented a state of fragility and disconnection from her own internal resources and also those that were offered by others, such as myself. She associated to a baby whose was left to cry without comfort and she wanted to be held without cease. She also knew I would fail to provide this and therefore she would withdraw or cover herself in shame.
We talked about how she felt an insatiable hunger today, akin to the infant’s yearnings, because she could not ingest and metabolize the relational nutrients that were available to her now, albeit imperfect. Were she to do so, her selfhood would grow stronger and begin to emerge and this exposure terrified her. So she dissociated from her feelings and perceptions and had a pervasive sense of emptiness. With her, we began to work on recognizing the relational safety that was possible between us if she would ingest my imperfect offerings and also begin to supply herself in the ways she so freely supplied others. We also talked about experiencing a relationship in which we could make space for her anger towards the Susan who could not give enough but could hold her anger with her help and without her having to withdraw. This new possibility and clarification (stay in relationship despite unmet needs, failures and activated rage) both frightened and excited her and gave her hope.
In another case, there is depression with a hollow feeling inside. This person does not dissociate but rather represses what he feels rather instantaneously and describes this as an empty state. We do not see anxiety nor sense a terror response or fragility but rather we perceive flatness and collapse. We focus our energies to help this person tap into his desire to feel alive and to see his depression as a force that deadens him, even as it attempts to protect him from relationship loss or attack. As his will to shed his depression increases, I offer an alternative. He could replace his depression with an active interest in what he feels, allowing his will to displace his darkness with light from within.
As this possibility looms, his anxiety rises and he begins to feel upper body activation. In this person, there is more selfhood to draw upon and more personality structure to provide scaffolding, if you will. I continually see people with no energy, fatigue, and exhaustion suddenly become alert, upright, and energized when they can see their flatness as a learned, protective defense, separate from their core self. This awareness along with a true caring for themselves and a reminder of what they hope to achieve in therapy can mobilize the will to act outside of constricting defenses, like a prisoner let out of jail. If the will comes online, we of course would focus on the activation in the upper body and encourage the client to identify the feeling that is trying to express itself. We should be prepared for rage in the transference or towards another figure.
Another possibility is someone who is convinced that either he or the therapist is hopeless and deficient. This sense of deficiency may be entirely unconscious and is often projected onto the therapist. This person may become defiant and argumentative, insisting that there is nothing more inside to tap into or may challenge our approach. This person defends his state of emptiness and incapacity to feel. This type of response is one I interpret as a wall because there is a determination to keep me out and there are barricades at every turn.
We spoke in training this past weekend about therapist anger that is activated when our best attempts to help are ineffective or outright rebuffed. Therapist anger is such a human response at a time like this, yet it is one we hope to transcend by reaching for our capacity for compassion, remembering the fear and loneliness that drives another to push away our caring efforts. It also means facing the pain of possible failure as we can go nowhere without a therapeutic partnership. So we may simply share this with our client… our desire to help and our sadness at being walled out and rendered impotent. Something inside this person insists on disbelieving in the potential in both of us, on seeing us as having less capacity than we have. We wish it were otherwise. It is a loss for us both. Yet it is a choice only he or she can make and we wish to be respectful of that fact. We may wonder aloud if she will take a leap of faith and risk engaging in a process that shows true interest and caring in what she feels, or does she continue to argue and intellectualize and insist she has no feelings? I would explore how it is for her if we were to go no further?
Posted in Therapist Concerns, Treatment Process | No Comments »
April 14th, 2017 admin
It’s my pleasure to respond to this great question from a fellow clinician:
“This is about paths. Some people believe that if a client is resistant, you should take a different path—meaning move to a different model. I know you believe in integration, but this is something different. If a client appears to be rejecting or pushing back on a focus on feelings and sharing what she is experiencing with the therapist, then maybe the therapist should just move to doing a different type of therapy and not stay on a path that would involve noticing and sharing feelings. As one person has said, ‘Clearly the path is creating the resistance.’ So why would a therapist remain on an emotion-focused path in these instances?”
This is a great question. When there is resistance to feeling feelings… and is there never NOT resistance?…should the emotion focused therapist abandon the approach? When there is a quality of insistence, which is a particular form of resistance, I tend to heed it and show flexibility. When insistence is operating and there is not an alliance to pursue an emotion focused path, I am not so attached to any approach to believe there is one path to healing. So we find our way together. When there is a sense of reconnection and greater trust, I will then introduce my suggested approach and share why I value a connection to feelings so highly. I may wonder “Why does exploring your feelings seem irrelevant? Why does such a vital part of yourself seem unimportant to attend to?” My responses are very tied to compassion and respect for self. Most often, people are touched by this. They may also be wiling to recognize that their pattern of functioning without emotional connection has not been yielding the desired results and they may be willing to try something new. When I can also identify and acknowledge feelings of shame and fear around attempting a new level of interpersonal exposure and show empathy and compassion for the struggle within them, very often doors open in a way that at times seems magical.
I’m reminded of the wisdom of holding a bird with an open hand. We never want to squeeze around a bird and deny it its freedom. Yet we may really want to feed the bird and if we go with this analogy, our food is an emotion focused approach. So, let’s think more about the complexity here. I remember a client telling me emphatically she wanted to problem solve together and NOT explore feelings. She was convinced they were not relevant to her at this particular time. “I’ve dealt with my feelings already.” I took a stance that I believed connecting to her feelings would open a window to the solutions she was seeking. She disagreed and dropped out. I never forgot the lesson she taught me. Today when a client says emphatically they want to problem solve, I am flexible and I may problem solve. When I can help create the experience that the client has impacted me and taught me something about how I can be more helpful, this itself has healing power, in my opinion. The client and I come together as two individuals seeking to find a way to dance together and gradually move in a direction that will serve the client. I agree with Scott Miller’s statement that we need to listen to what the client WANTS!!!
I’m also reminded of a horse story I sometimes tell. It was a big, black stallion that was recently in the wild and had been ridden very few times. We were in a group taking a ride in the mountains surrounding Santa Fe. Spectacular! The man who first mounted him rapidly disappeared into the distance and the trainer took off to rescue him. I probably very foolishly agreed to take that horse. The second I pulled back on the reins, he reared up on his hind legs and I was lucky not to be thrown. I clearly could not control him but maybe there was a way we could work together. So I released the reins and gently signaled the direction the group was heading. When I wanted to slow down, my hands communicated a certain flexibility and responsiveness. I would pull back gently and also release as he asserted his will. It was actually an interplay of 2 wills and rather amazingly, it worked and I had an unforgettable and beautiful ride. It was a first in my riding experience.
My relationships with humans have some similarities in terms of intuitive responding. I frequently notice ways in which therapists may impose their will. I’ve been among them and it either doesn’t turn out well or something is lost. Exerting control may be ever so subtle or it may appear as very engaging and even charming. But it is an imposition of will nevertheless. And it does not convey respect, in a very fundamental way, for the differences between 2 people and the right of people to choose… most especially in a therapeutic process. I encourage therapists to always use a light hand, to invite and not pull or push and to be ready to release when we notice we have our own agenda operating. This is not abandoning an approach but rather holding in mind the ultimate destination of human connection through differentiation and sense of self.
Posted in Therapist Concerns, Treatment Process | No Comments »
March 5th, 2017 admin
It was deeply satisfying to present again to the LACPA SIG chapter this month to such a responsive audience. We were looking at how shame shows up in a session. As I see it, a person who presents with depression, envy, grandiosity, aggressive anger and contempt is likely to have underlying shame that begs to be addressed. Recorded material helped us to get a clearer idea about DEFT interventions and role-plays helped us to practice them. When I invited a shame-based client to have a conversation about her difficulty making eye contact with me, a participant raised a great question about whether and when such directness is beneficial. I thought a discussion of it would benefit others.
When a client is having significant difficulty making eye contact, I typically find a way to talk about this guided by a heightened sense of shame sensitivity, even in a first session. There is a widespread perspective that it is best to wait a period of time, perhaps weeks or months, to develop sufficient connection with the client to address something as intimate as eye contact. Therapists have understandable concerns that such directness will lead to even greater shame. There is truth in the fact that anytime we draw attention to shame, especially the avoidance of eye contact, there will be a temporary increase in shame. Shame never wants to be seen and interpersonal exposure mobilizes shame. If it’s not handled helpfully, therapists have an understandable concern for potential malattunement. Therefore, I don’t advise therapists to draw attention to shame, especially the avoidance of eye contact, without having some skill development in shame work and emotional attunement.
Some of the elements of such shame work include: seeking permission to speak about non-verbal and body-based responses; differentiating compliance from a try alliance; putting the shame response into a normalizing context; tracking co-mingling anxiety; having the skills to work with projection of judgment; developing observing capacity so the shame response can be seen as separate from the core self; offering alternative paths to the shame state; creating enough safety in the relationship to support this degree of intimacy and deeper work.
I really empathize with the therapist who had reservations about stepping into this kind of shame work, and her fears were grounded in some realities. I myself felt the same for many years. However, I now have a different perspective having discovered that delicate shame work can be successful early in treatment, depending as much on HOW something is done as on WHAT is actually done. When certain elements are not present, any intervention can backfire including addressing the avoidance of eye contact, whether the intervention is made in the first session or the thirtieth. I’ll speak more about them in a moment.
So why would we forge ahead and deal more directly with avoidance of eye contact? The reality exists that when someone is afraid to look at us, this person does not feel safe with us and is threatened, either consciously or unconsciously. This is a state of distress that is usually accompanied by a deep sense of unworthiness and self-judgment that is being projected onto the therapist. There are different approaches that can, over time, help build a greater sense of comfort with the therapist and reduce shame, but when the forces that cause someone to look away from us are not addressed directly, the client remains unconscious of them and therefore largely at their mercy until such time as help is provided. When shame is dominant, it will close doors to emotional intimacy and stall the therapeutic process until it releases and becomes less of an obstacle.
I remember one of my teachers saying to me something like, “Why not interrupt suffering sooner rather than later?” This really stuck with me and has caused me to stretch myself in my work by trying out greater directness and openness with my clients. This doesn’t mean that I just jumped in and said what I’m thinking or observing without first reading a number of signals from my client that indicate an alliance is operating. These include subtle signs of reduced fear in the eyes or a drop in muscle tension as well as verbal affirmations that tell me I have a partner who wants to take this track. Moment-to-moment feedback that my client has explicitly chosen to walk the path of internal exploration with me, including bodily and emotional exploration, is so vital to a successful process.
Let me share a segment of a powerful first session with a woman I would consider to be a victim of spousal abuse. It was impactful because both of us acknowledged that something deeply moving had occurred, and it began a journey of change and highly productive work together. When she started the session, her speech was pressured to a very noticeable degree. She spoke almost breathlessly and rapidly, describing different facets of her recent separation from her husband. He drank too much and could become scary and also treated her very dismissively. He didn’t bother to invite her on weekends away and eventually became involved with a friend of hers, which was devastating to her. She sunk into depression. Her body was locked in pain in a very visceral way. Her tears were just traces of the mountain of grief and rage she had no idea she was containing at an unconscious level. She presented mostly like a tightly controlled, very pleasing young woman who at one time was a popular cheerleader.
I began to take particular notice of her difficulty with eye contact when she commented on her husband’s affair with her friend. I very gently began to inquire about this in the context of compassion for her discomfort. Tone is everything here. I also immediately asked her permission for us to have this conversation. When I do this, I am very careful to be sure my question is raised in an open-ended way, allowing space and acceptance for the client to decline. Any signal that such exploration is unwanted would stop me immediately.
However, as frequently occurs, she indicated that we could proceed. I should emphasize that this was not the first question or second or third that I asked. There was some time in which we had exchanges that indicated she saw me as being in attunement with her and also felt some confidence in my ability to help. Also, it was important that I did not tell her she had a difficulty meeting my eyes. This would definitely have been shaming. I posed this as an inquiry, inviting her collaboration as a co-observer. Did she notice what I noticed? I also put in in a context so as not to suggest she never makes eye contact. I mentioned that her tendency to look away from me seemed to happen as she was describing the breakdown of her marriage. Again I enlisted her help as a co-observer, “Does this seem true for you?”
She did in fact have a very good capacity to observe herself, and I complimented her for this ability. A big door opened as she told me how ashamed she was that her marriage had failed. She saw herself as a failure at her age and as a woman with little hope for the future. She blamed herself for having deficiencies that would cause her husband to stray. Her self-diminishment was heartbreaking.
Her reaction suggested she probably imagined I saw her in the same way she saw herself. So I asked her sense of how I was feeling and reacting to her disclosure? Not surprisingly, she confirmed that the projection was operating. She hadn’t been conscious of her tendency to project, but began to be curious about it. Rather than just tell her that I did not see her as she assumed I would, I suggested she could, if she wanted, take a look into my eyes and see what she actually saw. It was entirely up to her. She very tentatively began to move her eyes closer to mine, and there were several minutes that were among the most beautiful I have experienced in practice. I felt my whole body infuse with compassion that was soft, tender and embracing. It was a feeling that just swept over me. Within myself was an intention that she would see in my eyes pure acceptance and even love.
After a significant period of time, she suddenly broke into sobs. She later affirmed that she had seen the compassion in my eyes and it was a new, deeply felt experience for her. Working with shame so often goes beyond the verbal or intellectual dimension. It is a state of being that is transmittable and transferrable when it is genuine and authentic. It seemed like a transfusion of compassion for self. And of course this could not take place without sufficient willingness to receive. In this woman’s case, we also addressed in this session her extreme harshness towards herself. Not only was she reeling from the wound of betrayal but also from her own condemnation of herself, which justified her husband’s deceitful actions and pushed her rage out of awareness. We would discover how greatly she wanted to protect him and keep her attachment to him alive.
I attempted to make very clear that her ability to move forwards in her life, to find greater peace and satisfaction, would depend on her active intention to keep compassion for herself alive within her. Her avoidance of eye contact with me was the key signal, in this first session, to her enormous sense of unworthiness. If you’ve ever had the experience of a deeply satisfying massage, the practitioner probably had a way of moving her hands towards those points in the body that require attention and attuned pressure to release. The psyche is very similar. We can massage around the knots for long periods of time, but when we have permission to bring our touch to the points that are tightly held, the release can be exhilarating for both the therapist and client alike!
Posted in Uncategorized | No Comments »
