January 28th, 2013 admin
I’ve been focusing madly on the official launching of the new DEFT Institute website… never dreamed how involved it would become. The only delay is due to time needed to finalize editing of some taped lectures of mine that are offered for purchase. For those who would like to preview the site, it is at www.deftinstitute.com.
Please check out my two upcoming events (June 9-14 in VA and Sept. 28, 29 in LA) with therapist/trainer/author Jon Frederickson, a collaboration that I always find extremely exciting. Perhaps this is because Jon’s mind is a beacon to our field and I always experience the joy of discovery and new insights when I speak with him, appreciating his passion and brilliance in teaching psychotherapy. Participants at these events are in for a great treat! Jon is with the Washington School of Psychiatry in D.C.
Client vs. Patient
I’d like to share some comments I made on the IEDTA listserve in response to a most lively discussion on whether we should refer to those we treat as “clients” or “patients.” I then began to reflect on a larger subject… the impact of the words we select in our comunications. By the way, I don’t use any term other than “you” when speaking directly to the person in my office, but people seeking therapy will see how we refer to them when they visit our websites, hear us lecture or read our books. And how do these terms affect their feelings about seeking therapy? How do they affect their view of themselves and the fact that they’re suffering?
Generally speaking, I have always been an aspiring wordsmith and I chew on words constantly in session to see if my words have an empowering or disempowering effect. Of course, I always want to choose the former. Having intensely observed thousands of responses to my interventions over the decades and frequently inquired into the impact of my language (“How do you feel as I say these words?”), I conclude without a doubt that my choice of words has significant impact on the therapeutic alliance. Some words and phrases enhance the relationship and are more empowering and others do the opposite even though the differences in meaning does not seem significant. If I say, “You are destroying yourself” vs. “So you have this system that operates inside you, that once tried to protect you, and now it harms you,” the client may feel less shame. As we know, use of “you messages” creates greater defense.
Also, it’s so easy for therapists to become vague in their language too. If you ask, “How do you feel this anger?” it is not as clear as “How do you feel this anger in your body? What physical sensations do you become aware of as you remember your husband….” The vague language can cause confusion in the client and thus greater shame.
I have learned that MFT’s moved away from using “patient” and substituted “client” possibly in the 90’s. This mattered to me because, when reaching out to colleagues, I want to “speak their language.” Yet my commentaries on many of the tapes I present are heavily sprinkled with references to the term “patient.” I’d never reflected much about this before receiving this feedback. I’ve discovered from the listserve discussion that there are strong preferences related to these terms among professionals. One person believed this represents a struggle based on feelings, preferences, and values between professionals, having no impact on the person seeking treatment. I would argue that words do in fact carry meaning and they get inside our bodies for good or ill. I see evidence that the medical model of mental health has in fact created much shame. How many times have I heard a client say, “I am sick.” “There’s something wrong with me.” “I must be crazy.” I’ve often responded, “There’s nothing inherently wrong with you. You just haven’t discovered this truth yet. Or tapped into your capacity for health.”
Some agree with Carl Rogers. From his website:”Rogers was deliberate in his use of the term client rather than patient. He believed that the term patient implied that the individual was sick and seeking a cure from a therapist. By using the term client instead, Rogers emphasized the importance of the individual in seeking assistance, controlling their destiny and overcoming their difficulties. Self-direction plays a vital part of client-centered therapy.” The word egalitarian also comes to mind.
My approach to therapy is very aligned with the teaching of Dr Paul Pearsall, one of the founders of positive psychology, which represents new research into optimum human functioning and emphasizes that which is healthy within us. He was selected by the Oxford Biographical Society as one of the 1000 most influential scientists of the 20th Century. He said, “For me… life is made difficult so it can be made more authentic, real and intensely meaningful. We suffer because we breathe, and asking why we must suffer is like asking why we must breathe. There is no life without it.” Indeed, we are all sufferers in this world and we rotate chairs continually between being on the receiving and the giving end of healing.
Since “patient” comes from the Latin word meaning “one who suffers,” then we could say we are all patients. How does the label feel? I think there’s a better term for all of us who “suffer.” In a word association test, if I heard patient, I’d think “sick.”
From Jonathan Mahrer, Ph.D., founder of Blue Mountain Counseling: “I use the word “client”, not “patient.” The word “patient” can imply a medical model in which the doctor works on and heals the patient, and the patient more passively receives the treatment. Psychotherapy is different.” And “The medical patient terminology can also imply that
you are sick, and can create a (to our minds) false dichotomy between sick and well, those who need help versus those who do not.” One author said, “A patient is the object of medical care, a client is the subject of medical services. In language as in life, an object is passive, a subject is active.”
As if we don’t have enough to keep track of in a session, now we must consider the impact of our language! Nevertheless, I believe it is well worth the effort.
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October 16th, 2012 admin
Scroll down to read about the “contagion of shame” (Morrison, Herman). Check out new Gallery photos! Hope to get new training videos posted soon.
WEBINAR on Compassionate Interventions
to Dissolve Defenses
You and your friends are happily invited to attend two of my upcoming events this week and next. It’s my great pleasure to be presenting a Webinar again through the ISTDP Institute with my brilliant colleague, Jon Frederickson, on October 19, 2012,12-3 pm EST. You can register at www.istdpinstitute.com.
I plan to illustrate my own therapeutic style through role plays dealing with specific defenses with Jon Frederickson aimed at dissolving defenses in cooperation with the client. I hope to demonstrate the conveyance of compassion through carefully selected language, vocal tone, facial expression and other aspects of neurobiological attunement. There are other factors too, like how we promote a sense of equality, build upon client strengths and create a felt partnership through healing attachment and authentic, egalitarian relationship between client and therapist.
“Going Slow to Accelerate Later” at LACPA
Also, please join me for my presentation on mindfulness, “Going Slow to Accelerate Later,” as it applies to Dynamic Emotion-Focused Therapy (DEFT) at an LA County Psychological Association event. Follow the link to register.
| Oct. 22, 2012 |
09:00 AM – 10:30 AM |
|
LACPA Conference Room
17277 Ventura Blvd., #202
Encino, CA 91316 |
This will include recorded session material and a slide presentation with a brief overview on Dynamic Emotion-Focused Therapy (DEFT).
I’m loving the expansion of the DEFT/EDT community here in L.A., and feel extremely fortunate to have such great therapists participating! May everyone enjoy the fabulous photos added to the Gallery page, contributed by DEFT participants, as thoroughly as I have, as they capture our joy in learning and in supporting each other on this journey. I also thank each participant for your feedback on the program, which just keeps inspiring me to make the DEFT training better and better.
Please visit
www.warrenwarshow.com to learn about my current, ongoing three-tier training program, “Accessing and Integrating Deep Affect,” held one Saturday per month for 10 month blocks, at the Skirball Cultural Center in L.A. Therapists who feel a strong pull to do this training and have a serious interest… but need to check it out first… have the option to “sample the training” at any point for up to 2 consecutive months before deciding to commit to the program.
“CONTAGION OF SHAME” IN THE CONSULTING ROOM AND IN TRAINING
In our September and October training, we dove into the riveting topic of shame as it affects both clients and their therapists… and also myself (perfectionism perhaps?) as I’ve tackled the daunting task of sharing DEFT/EDT with high-aspiration therapists! Curiously, I’ve had some serious shame attacks myself while taking on this most central subject affecting our work. I endure my own performance anxiety/shame issues for one reason only … this work begs to be shared!
It also strikes me that my own shame experiences may actually be helping me to be even more empathic and attuned to the experience of therapists in training who doubt their competence. Seasoned therapists also have self-doubt and I believe that appropriate humility has advantages for all of us.
One of the topics we covered was “adaptive aspects of shame.” Epstein & Falconier: “[Shame] can motivate people to make positive change.” There is truth in the statement that the more you know, the more you know what you don’t know… which is an invaluable motivator. Therapists tell me it would be helpful for me to show session material that reveals my own struggles and I plan to do so in future trainings.
That being said, we can all celebrate those times when we really make a difference in people’s lives and we have reason to feel deeply gratified to be informed by such great thinkers and scientists as Sigmund Freud, MD, Habib Davanloo, MD, and many others.
It was my awareness of the shame experience in my clients that drove me over the past 10 years to painstakingly craft defense interventions to reflect the most sensitive language, to communicate equality with the client by sometimes revealing myself and eschewing the role of expert, and to convey the compassion that I truly feel around the pain of shame.
I also feel strongly that we are better when we avoid language that is directive or overbearing, “You need to..,” “You must…” “We will…” and remember to ask permission and to honor client choice. This does not have to be cumbersome to the process, as therapists tend to think, and it goes a long way towards building self regard, sense of self and reducing compliance. I know of clients who gained symptom reduction in treatment but retained the same degree of co-dependency/compliance and I think our therapeutic stance can have an impact on this. Generally speaking, “You Messages” provoke shame… “You’re doing it again…,” “You’ve forgotten…,” even perhaps “You treat yourself like you’re nothing.” As i write, I ask myself, could it be preferable to say, “After all those years of being treated like you don’t count, it’s no wonder you have learned to treat yourself as though this is true. Do you see what I mean?” “How is it for you inside to see this so clearly with me?” and “It’s so great you want to turn this around!” Of course, tone of voice and facial expressions are HUGE in their impact on how our communications are received. Do we lean forward or do we appear disengaged? How about an occasional comforting smile or look of compassion?
It was my pleasure to write an article entitled “Slaying the Serpent of Shame” and it contains transcript material on the treatment of a chronically depressed, anxious patient. It appeared in Volume 11, Number 3 December 2007, Page 6, “Ad Hoc Bulletin,” an international journal of the Dutch Association for Short-Term Dynamic Psychotherapy (the VKDP). It can be accessed through the Southern California Society for ISTDP.
So many of our clients feel shame acutely, as they enter our offices with their “shameful” problems. When we focus on internal process, such as anxiety and depression, it inevitably and simultaneously evokes shame as well as relief. I’ve always included toxic forms of shame and guilt in addition to anxiety on the triangle of conflict, as conceptualized by Davanloo and Malan, and have seen shame as a significant factor to be assessed in ego fragility. I agree with Herman that we must learn to “titrate shame” just as we use a graded approach with anxiety. I believe the importance of shame is under-addressed and was so pleased to discover the book, “Shame in the Therapy Hour” by Dearing and Tangney, which I heavily referenced in our recent studies. The authors said that they themselves had little exposure to shame work during their training and supervision experiences on opposite coasts.
Participants in our DEFT program expressed enthusiasm for this topic and all of us felt that something powerful occurred as we supported each other to deal with our own internal shame experiences. We discovered that as we do this, our own performance anxiety is reduced and we are therefore more able to be mindfully present for our clients.
The supervised live role plays were poignant, as our therapists-in-training portrayed client and therapist grappling with the often fragile, intensely vulnerable state of shame, sometimes leading to dissociation and high anxiety. After all, what can be more fear-enducing than the chance of becoming an outcast, stranded and alone. It is especially difficult to stay connected to a positive sense of self that can be separate from an excruciatingly painful state of shame-related unworthiness.Yet the effective therapist seeks ways to speak to the client’s observing capacity that has the power to intervene and save the self from drowning in shame. Shame inflicts not only great pain on the one experiencing it but also on others, as it so often it leads to hostile devaluation, withdrawal and separation.
SENSITIVITY TO SHAME ON LISTSERVE AND TRAINING PROGRAMS
It’s become something of a mission with me to support a therapeutic community that helps each other to refrain from shaming either ourselves or each other. Toxic shame is poisonous to any person or group. Recently, I felt personally challenged to find ways to address communications that I found to be shaming and devaluing on a list serve without engaging in the shaming of others or myself. How do we request that something be changed or corrected without sounding critical? It’s tough. And there’s always the punitive superego, doing its projection thing, that may misinterpret… not to mention the great difficulty communicating feelings electronically. I also want to say here, for the record, that I plead guilty to erring in choice (and quantity) of words at times and that I am by no means above anyone else in needing to work in this area. I didn’t entirely succeed at my endeavors but some very good things did evolve for me personally as a result of taking the risks of exposure, such as some deepening relationships and also learning a lot from the experience.
Brene Brown, Ph.D., had fascinating findings about the links between showing vulnerability and connection to others. Certainly when we communicate in a public forum about a controversial subject, there is indeed vulnerability. And also benefits!
Stadter tells us, “Therapists are vulnerable to shaming and being shamed by clients.” I would add that we are vulnerable to shaming ourselves and each other professionally as well. I have always encouraged my therapists in training to use the listserve as a resource. I may not always be available to answer their questions and others on the listserve can add valuable perspectives. It also takes considerable repetition of certain principles before they really sink into our minds. But some who posted questions about their cases were told to “speak to their supervisor.” It struck me that these are sophisticated people who don’t need to be told they can call their supervisor and who have made an inquiry on the list serve to explore additional ways of understanding their clients. Practically speaking, many therapists don’t have the funds for both training and a lot of supervision. So, it concerned me that these individuals might interpret that reaching out to the list serve was somehow inappropriate and that such information should only be obtained through supervision. Seems to me that a good use for a list serve is to share our expertise with one another and to also normalize our self doubts by sharing our vulnerabilities with each other. There were other areas that also aroused my concern even more and I hope that the lengthy discussion will bear some fruit along the way.
Gilbert tells us “Shame may be a major reason that important material is not disclosed during supervision.” Indeed, this is a clarion call to all of us who teach and supervise to heighten our sensitivity to shame inducing language and tone and to bring shame into the light of awareness for our therapists in training and for ourselves. Interesting, I’m finding myself using the phrase “therapists in training” rather than “trainees” as “trainee” creates an impression to me that doesn’t reflect the advanced knowledge and experience that many “trainees” have. Also, I advocate that teachers of the work promote a sense of equality and collegiality with the therapists we teach, showing a willingness to share our own limitations and stumbles, and also appreciating the way that our colleagues in training often teach us too.
And finally, I agree with the following statement:
“Therapists need to do their own shame resilience work. We need to do the work before we do the work.” Brown et al.
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May 3rd, 2012 admin
Webinar and Special Events:
My webinar sponsored by the ISTDP Institute on “Interrupting Defenses as a Form of Compassion” is coming up on 5/11/12. Go to istdpinstitute.com to register. There will be live role plays to demonstrate how we can work effectively with a wide variety of defenses.
Also, I’m offering a one day special event to be held on both 6/9 in LA and 6/16 in Glendale on “Penetrating Defenses to Awaken the Self.” Go to www.warrenwarshow.com to register! This event includes recorded session material showing a style of dissolving defenses that conveys and evokes compassion for self in our clients/patients.
SHAME AND GUILT
We’ve had a passionate exchange of ideas and conflicting perspectives within our professional community on how to conceptualize and deal with shame and guilt with our patients. Are they affects? Do they inhibit, hence are they “inhibitory affects,” or are they defenses to be treated as we treat all defenses?
As I share my perspective, I put forth one caveat, I do hold all my theories lightly, as suggested by Nemeroff!
As I see this, shame, the toxic form of guilt and anxiety are emotions that lead to defenses that do inhibit the process of reparation and healing. I explain shame and guilt to my patients as painful feelings (like anxiety) that then lead to various distancing, repressive or self attacking defenses. “You feel anxious over an underlying painful feeling, then you put a wall up of detachment to avoid both anxiety and underlying feeling.” “Your friend says he was hurt by your action. You feel guilt, which is a very painful feeling, then you withdraw, deny and project (“She’s overly sensitive” or “He’s hyper-critical”) which allows you to avoid the painful feeling of guilt arising from the caring and love that you actually feel… and also to avoid reparation, which would be healing.” Or, “You feel guilt over your rage and then you detach and shut down to avoid both the guilt and the rage.”
I just spent an entire session in which the patient was flooded with guilt because she’d injured a close friend. Her friend was hurt because my patient had cancelled a special celebration that her friend had planned for her (albeit with her friend’s compliant permission). My patient avoided her painful feeling of guilt (due to love) by projecting (“She was critical of me”; “She was overly sensitive”) and repressing the pain of guilt. The session involved delicate work but it led to some new awareness that took her back to how she defended as a child against being unfairly blamed and had been transferring her mother onto other people. She also saw how she mercilessly attacked herself. She was also able to reconnect with her love for her friend and saw the value of a simple apology. As she allowed the feeling of guilt to be experienced, she noticed a rise in anxiety over the sense of vulnerability over letting in how important she was to her friend… and how important her friend was to her. She realized that she had been afraid to similarly expose her own hurt feelings over past events when her friend had also treated her dismissively. This also opened a door to recognize her defenses of numbing, denial and minimization, which she did not want to carry forward.
Jon Frederickson said in his
blog, which I highly recommend: “When we experience our guilt, it makes us anxious. So we use defenses.” (We use defenses to avoid the painful feeling of guilt due to a sense of having wronged or hurt a loved one). I think it’s painful because there is caring feeling beneath it. Of course, healthy guilt is fully conscious and does not lead to defense but rather to reparation of the wrongdoing. Jon also said that ,”as a result of guilty feelings, the patient “narcissistically withdraws into self-punishment.” (a painful feeling leading to a defense).
Expanding on the triangle of conflict as used by Davanloo to guide our understanding of the patient’s psychodynamic process and also our interventions, I can now see having the anxiety corner of the triangle include all emotions that are defensive in nature and that arise to inhibit or shut down the experience of additional painful feeling and that also inhibit a healing or reparative process. This categorization would include the feelings of anxiety, shame, toxic forms of guilt, defensive rage ignited by projection (“She devalues me therefore I hate her”) and defensive weepiness (avoiding rage and complex feeling). These defensive affects would be distinguished from the tactical, repressive and regressive defenses, even though together they function as a system that separates us from self and other.
I’d like to recommend a wonderful book called Shame in the Therapy Hour, edited by Ronda Dearing and June Tangney. Some great excerpts below, which I believe provide further validation for understanding shame as an “inhibitory affect” that would reasonably fall on the anxiety pole and can also be understood as defensive in nature. Shame is referenced multiple times as an emotion with an inhibitory function (Schore – “sudden brake on excited arousal states”) and also an “emotion” that “inhibits speech and thought,” an experience of “shock and flooding,” and “likened to fear.” The accompanying self-attacking cognitions support the initial inhibiting shame response arising from being scorned and needing to appease. This hard wired response is of course self-perpetuated, like anxiety, without an attentive ego. The comparisons to guilt do not include unconscious guilt over rage, but only healthy guilt and remorse.
Judith Herman stated the following while referencing various researchers:”Shame can be likened to fear in many respects. Like fear, it is a fast-tracked physiological response that can overwhelm higher cortical functions. Like fear, it is also a social signal with characteristic facial and postural signs that can be recognized across cultures. The gaze aversion, bowed head and heightened behaviors of shame are similar to appeasement displays of social animals. It may serve a similar social function among human beings from an evolutionary point of view; shame may serve an adaptive function as a primary mechanism for regulating the individual’s relation both to primary attachment figures and to the social group. Like fear, shame is a biologically hard wired experience.” “Schore proposed that shame is mediated by the parasympathetic nervous system and serves as a sudden brake on excited arousal states.” “The subjective experience of shame is of an initial shock and flooding with painful emotion.” “Shame is a relatively wordless state in which speech and thought are inhibited. It is also an acutely self-conscious state. The person feels small, ridiculous and exposed. There is a wish to hide characteristically expressed by covering the face with the hand. The person wishes to ‘sink through the floor’ or crawl in a hole and die. Shame is always implicitly a relational experience.
From other articles in this book: “Because shame tends to arise in conjunction with cognitive appraisals of the self, it falls into the category of self-conscious emotion. This type of cognitive processing requires a certain level of developmental maturity, which explains why the propensity to experience shame is developed over time during early childhood rather than present from birth.” Shame is a “Powerful, ubiquitous emotion.”
Whereas shame is focused on the global self, guilt is focused on a specific action the person has committed. (Again, this doesn’t take into account the guilt that occurs over feelings like rage and love towards the same person). Shame is an acutely self-conscious state in which the self is divided between imaging the contemptuous viewpoint of hating the other and feeling the impact of the other’s scorn. By contrast, in guilt the self is unified. Feelings of guilt an seem to originate in the self. In shame the self is passive. Shame may be evoked by a sense of failure or disappointment or being the object of ridicule, rejection or rebuke. By contrast, in guilt the self is active; guilt is evoked by one’s own transgression. Shame is an acutley painful and disorganizing emotion. Guilt may be experienced without intense affect. Shame engenders a desire to hide, escape or lash out at the person in whose eyes one feels ashamed. By contrast, guilt engenders a desire to undo the offense, to make amends. Finally, shame is discharged in retored eye contact and shared, good humored laughter, whereas guilt is discharged in an act of reparation.” Lewis 1987
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December 6th, 2011 admin
I am most thrilled to announce a new, expanded skill-building training entitled “Intensifying and Integrating Deep Affect,” beginning February 11, 2012. Participants will have the option to pursue three levels of certification over the course of three years. Check out the link to my website. My commitment is to help colleagues to significantly elevate their work and to create a nurturing atmosphere so necessary for this to occur. Now, on to my topic…
OK, I admit it and I apologize to those who have been faithfully reading my blog… I dropped the ball right after I saw the movie, “Buck,” a take-your-breath away documentary about Buck Brannaman, a 3rd generation horse whisperer. He’s a rare breed himself… an open, vulnerable, wise cowboy who has transcended the most horrific trauma at the hands of his violently abusive father and was rescued by foster parents who are true angels. He determined not to perpetuate the agony of his childhood upon other living beings.
I was so fired up to write a post about how Buck could get a horse to enjoy a dance with him through the power of gentle, always kind-yet-confident, non-verbal cues… the two of them gliding sideways across a majestic terrain or a horse following him with no halter and matching Buck’s pace exactly…because I saw something that could be applicable to those of us who aspire to be people whisperers. I saw metaphors that we can remember, as attuned therapists, as we practice interrupting defenses and coaxing our patients into whole new ways of relating to us and to others.
But then I thought, this subject is not scientific and horses have nothing to do with people, and if I write about this, it will look like I’ve wandered off the range! So instead I kept thinking about it off and on and essentially stymied myself and stopped writing. So now I’m going to get these observations out of my system and hope you’ll bear with me, because you know I have you in mind.
From the time I was a kid, horses could transfix me, and a most painful childhood experience was dreaming that I’d been given a horse and then waking up to discover it wasn’t true! I was always fascinated by the way a horse looked at me… not a direct gaze…but rather a peripheral glance. Yet I learned from Buck just how much these creatures are actually taking in, how much they read about the man or woman approaching them, and first and foremost they want to be safe and they also want to please.
And then I talked to my sister, Linda, about it because she raises championship Arabian horses surrounded on all sides by the gorgeous Shenandoah Mountains, not another house in sight. She and her husband watch the pregnant mares round the clock on closed-circuit TV and know when to race out to the barn they built and mid-wife that breathtaking baby into the world. She’s studied with Clinton Anderson, one in the line of great horse whisperers, because she loves her magnificent creatures with the chiseled, aristocratic faces almost as much as her 8 grandchildren, and that’s a mighty amount.
She sent me the following about Monty Roberts, who wrote the book, Horse Sense for People, and gives demonstrations in sold-out arenas all over the world. “Corporate executives, educators, psychologists and experts who work with victims and violent victimizers, autistic children or in the field of substance abuse, study Monty Roberts’ methods to learn how they might apply these same trust-based communication and training principles to their own work. In Monty’s experience with over 250 major companies, he has seen the same dynamics at work, time and time again. …From horses he has learned guidelines for “improving the quality of our communication with one another; for learning to ‘read’ each other effectively; and for creating positive, fear-free learning environments.” Horse Sense for People has at its core an inspiring belief in the power of gentleness, positive actions, and trust as the basis of success.”
OK, so what did I see in the film “Buck” that applies to STDP? Buck would walk into a ring with a new horse he’d never met before, and the horse would exhibit an endless variety of rude misbehaviors, essentially to “create distance” from him. As he explained, no one ever taught these horses how to be a member of their herd. So, as my sister explained to me, you walk sideways up to a horse, which can be translated to…remember to use a graded approach when people are anxious. Don’t just walk up and keep asking, “How do you feel” without reading the body signals and adjusting your approach according to the level of safety that’s been created.
When Buck saw misbehaviors (defenses), he’d gently flap the flank of the horse with some kind of soft rags on a stick to gently irritate the horse enough so he wouldn’t like it but would also recognize that no harm was meant. My sister added that consistency in applying this “pressure” was all-important until the new behavior was learned. To be effective, the intervention needed to be very clear, leaving no room for doubt or confusion. Of course, unlike with horses, we intervene with our patients only with their permission and understanding. So, when we draw attention to the defenses and compassionately point out that they carry a cost, this is irritating to the part of the patient that has relied on these self-protective habits.
Therapists so often back away at this point because who wants to be an irritant? Yet, just like a “good enough horse whisperer” or a “good enough parent” or a “good enough therapist,” we don’t stand idly by while our patients are hurting themselves. And our patients sense that we mean no harm and are expressing our caring engagement. We are also providing clear teaching about the specific defenses being employed and do not ignore self-destructive mechanisms one minute while emphasizing them at another time. Are they important or not? Of course, our patients are adults, so they have the right to hurt themselves with pathological defenses. But it is our responsibility to be sure they are aware of the consequences of their choice.
Linda told me, “It’s ALL body language.” She said, “Your body needs to be RELAXED (people whisperers, listen up…we FIRST must attend to our own anxieties which are so often fueled by our own toxic self-criticisms)! She said: “Your eyes and face need to be soft.” I absolutely cannot second this point enough!! And there must be instant praise when the horse is trying, like when he backs up a foot when you’ve asked him to. My sister said cutely, “You should have a “happy tone” to let a horse know he has done something pleasingly because they so want to please! Linda demonstrated this to me with a lilting voice that was charming. As Buck said, “You love on ‘em.’” So to “create a sense of mastery,” one of the top 4 or 5 positive therapy outcome factors, we need to signal our patients with a warm smile or word of praise and appreciation when they courageously risk a new level of self-disclosure or intimacy.
Linda made another interesting point: horses do not learn from pressure but rather learn from “release from pressure.” She told me that when you are trying to get a horse to move his forequarters, you tap in rhythm with a stick, and when the horse moves, you stop tapping and rub affectionately. How fascinating! So, can we say that it is the positive reinforcement and encouragement when a patient drops a defense that actually creates the learning experience? Perhaps something like, “You really allowed me to feel close to you when you dropped that wall of detachment and let me see your tears.” Another point Linda made: “The release of the pressure must be perfectly timed or the horse becomes confused by the signals.” She said, “The signal must be “clear, decisive and positive.” Ah yes, timing really is everything!
I’ll end on a most encouraging note. Horses don’t forget what they’ve learned! So as our patients have new attachment experiences with us, as neuroscience tells us, brain structure is actually altered over time and our patients will not forget how to relate in the new ways they’ve experienced with us!
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