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.
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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?
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