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.
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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.
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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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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.
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January 2nd, 2017 admin
A therapist is concerned about being judgmental of a client’s abusive boyfriend.
Susan’s response: When you speak of being judgmental towards her abusive boyfriend, I can empathize with how hard it can be to walk the line between showing our caring and concern without inserting our own will, even subtly, especially when it comes to abuse. I’ve definitely grappled with that dilemma myself.
With someone like your client, there is usually an unconscious invitation to rescue or to take on the person’s rage (i.e. projective identification) so she doesn’t have to face her own conflict. This invitation can be very compelling when abuse is involved. It’s taken experiences like yours to cause me to make a real internal shift so I can step outside the projection. A question like “I see this is very painful for you. I wonder what you hope for when you tell me about this abuse?” helps her to clarify her own desires and vision for her life. If she expresses any desire to free herself, then there is a budding alliance to begin exploring her feelings towards him. We can then anticipate that anxiety and shame will follow because her sense of self has never truly developed. This emergence of these inhibitory affects will give her an opportunity to see what has stood in the way of her own healthy self-protective impulses and feelings. I’ve learned the hard way to be very careful about not preempting her feelings with my own, even though I would likely feel very much as you do. But I don’t want my own feelings to dwarf hers. Her signals to her own unconscious are so in need of strengthening that I don’t want to distract her with my own.
Your insightful comment about possibly conveying your own judgment about the boyfriend is probably true: “I can’t help but think she’ll feel pressure to have to give him up and she’s not ready to do that.” It seems like a good idea to bring this up directly and check it out with her. Like “I’m wondering how you imagine I’m reacting to what you’ve shared about your relationship?” You can always clarify that you of course desire that she be safe while at the same time having no need or requirement for her to do anything. In other words, your acceptance of her remains the same regardless of her choices and you are very respectful of her right to make her own decisions.
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May 4th, 2016 admin
Compassion for self, which extends tenderness in the face of one’s flaws and vulnerabilities, is a primary antidote to shame. Such compassion is a viscerally felt emotion, a nuanced form of love that has transformational power in treatment. Compassion is a light that overtakes the darkness of shame. The more the therapist can perceive and communicate caring for the suffering behind defenses, the greater the likelihood that compassion will be activated within both therapist and client. This healing process is an embodied art form, a relational dance of touching beauty.
Just today, I watched some video session material that I’m considering showing for my next training session. It showed work with a proud and kindly man who had been confronted by his wife for not being a “team player.” She’d experienced being dismissed by him when she’d asked him to do something for her during a stress-inducing holiday dinner. His anger was palpable as he ventilated about all he had done to help out, and we had definitely been working on his freedom to feel his anger and to assert himself. At the same time, there was truth in her comment as he was often detached and dismissive of the feelings and desires of others as well as his own.
Here we have an intuitive call, to focus on his anger towards his wife or his unconscious guilt and shame for having ignored her. There are some who would be absolutely clear that precise interventions were called for and would have resolved his issues. But I personally resist the algorithmic approach, finding that intuitive inclinations often take the process forward into marvelous new territory.
We’d done work previously on his anger and I knew we would again, but in this moment, I chose to focus on the unconscious guilt and shame that I sensed. He would vacillate between stating the reality that his wife had a point and then defending himself and pointing out her communication errors. It was extraordinarily difficult for him to focus on having hurt her and face his guilt over that simple fact.
The forces of unconscious shame and defense were powerful; repeatedly pulling us in the direction of what she had done wrong, and there was validity there. His expression of grievance was also quite subtle. But again, how difficult it was for him to admit he had made a relational mistake and to do something positive with that awareness! I saw this blockage as tremendously damaging to him and the relationship he wanted to build with his wife, so I repeatedly circled around, giving him opportunities to face his guilt with me without having to annihilate himself with shame. It really was a dance. A narcissistic injury and misalliance constantly loomed, and I found myself being tentative while also tenacious, doing a sort of side step.
My tenacity was driven by compassion for the harm done by his avoidance of healthy remorse and I wanted to make every communication convey my compassion in tone and body language, the non-verbal elements behind the message: “I see how you would be offended by her critical tone and I also hear that it is difficult for you to explore your feelings (i.e. shame and guilt) for having ignored her request. Yet I know this disturbs you because you care so much for her and your relationship and your feelings about having hurt her seem very important. If we ignore them, will we not be dismissing you as you experienced being dismissed by your wife and were also dismissed many times by your parents?”
Gradually he began to “get” the reality that shame was impeding him from exploring his guilt. He then revealed a significant secret for which he felt sizeable guilt, a breach of trust (not an affair) that could irreparably harm his marriage if his guilt was not faced. Fortunately, he chose to work on his guilt with me and initiated some truth-telling conversations with his wife. His expression of remorse proved to be one of the turning points in his floundering marriage.
Tip to therapists: if you feel pulled in a certain direction, based on your sense of what the client most needs in a moment, listen to that prompt. Perhaps share with the client why you feel pulled; or simply stick with your intuition and check out the client’s response to your endeavors, i.e. does the material go deeper? Or one might seek permission to continue a path of exploration. While we have certain guideposts that most of us rely upon and that we teach in our training, each relational moment is always unchartered territory. This is what can make our work such an amazing discovery and joy. I love learning what the moment has to teach.
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October 29th, 2015 admin
Therapists are often amazed when they begin to discover what it is to explore the full depth of core feelings in therapy, a process that is linked to positive outcome over and over again in clinical and neuroscientific research. Sometimes it looks like a patient is deeply experiencing emotion when they begin to weep or cry but underneath that may be a world of rage or shame. We need to be able to distinguish between core feelings and defense driven affects because if we encourage the latter, the client may become more depressed or we may activate other symptoms. Often we overlook or move too quickly past important affect signaling, and this can compromise the state of liberation and integration we are seeking.
These vignettes from one of Susan’s training sessions will help you to begin to differentiate defensive from core affects.
Susan began this lecture discussing projective anxiety. She explained that fear is a core emotion when it is based upon a real threat such as a true predator or natural disaster. However, humans are prone to generate anxiety by seeing themselves as incompetent and unimpressive, thereby assuming that others will automatically think less of them. Early experiences can cause us to anticipate that our feelings will appear stupid, excessive, overly needy, out of control and will potentially generate disgust, retaliation or abandonment. Too often the feared rejection or attack is actually being generated unconsciously within the self.
For example, the client may enter our office expecting criticism from us when, in fact, he may have an internal sense of unworthiness that he believes will be shared by the therapist. So, the client becomes anxious and/or ashamed or guilty about emotions believed to be unacceptable, disgusting or even evil. So, the threat of criticism, condemnation, abandonment or abuse in the consulting room is most often generated from traumatic memories that live in the body.
In this particular lecture, Susan teaches how we can deal with the defensive affects of projective anxiety and also weepiness. In the former case, Susan recommends a variety of possible collaborative explorations, including looking at what it is that the client fears. Once the client can identify the fear of rejection or criticism, Susan suggests the therapist can ask such questions as, “Do you experience anything like this coming from me? What do you notice that gives you the impression that I’m criticizing or rejecting you?” “What do you see as you look into my eyes?” “What is your actual experience?”
If the client says something like, “I see compassion,” the therapist can corroborate that this is true and it is good the client can recognize this. The therapist might then make a statement such as, ’Since you are able to see that there is no evidence that I am rejecting you, might we say that this is something coming from within you that you perceive to be coming from me instead and so your body signals danger? This type of fear of course makes it harder for you to open up to me and causes you to put up self protective barriers that can actually prevent me from helping you in all the ways I would like to offer you. Do you see what I mean?” If the client can understand this, then we see if the client would like to continue to observe and actively reduce this type of projective anxiety together. Just becoming aware of projective anxiety at its source, along with generating self compassion, often go a long way towards lessening it.
Susan now moves to the defensive affect that manifests as weepiness.
Susan: “You were asking about weepiness, right? And we do need to really differentiate the defensive affects from core feeling. And with core feelings, of course, we have the green light to explore these feelings to the fullest extent possible. However, we are not going to try to deepen weepiness associated with defense. So if someone is weeping we need to notice the context for the weepiness. If someone has just begun talking about something that we would assume made them very angry and then suddenly they have tears streaming down their face and they’re blotting their eye, then we can assume that weepiness is drowning out the anger. The tears are also understandable as anger is usually driven by hurt, and so there is surely sadness accruing as well. However, we want to try to access the most avoided feeling, which in this case is anger.
I might say, “I see your tears and there must be pain inside even though we may not fully understand its source. Yet you were talking about your husband talking down to you, and I’m wondering about your feelings towards him? Your tears may drown out other feelings you have, so might we take a moment to explore any other feelings you have?”
Or “Your tears may be a sign of anxiety about other feelings you’re having—are you aware of any anxiety in your body at this time?”
Also when weepiness is defensive, the therapist might feel annoyed or even angry because the tears are ambiguous and the therapists efforts to help seem to go nowhere. We can use our feelings of irritation to help us to recognize defensive weepiness so we can bring it to awareness in a constructive way. Not all therapies bring the client’s defense mechanisms and defensive affects to the client’s attention.
Would any of you want to venture an intervention here. How you might want to intervene?
Student: (this student is accustomed to not drawing explicit attention to defensive process): Now I just ignore it. When somebody’s weeping I just keep going cause I just ignore it. I don’t know if that’s appropriate or not.
Susan: You know, everybody has an opinion, everybody, so I’ll just share mine. My preference is to raise people’s awareness of their defenses and so that they can self-observe and I like it when my clients down the road will say, “Oh, I’m weeping again. I see that I was really just angry and then the tears came and I don’t really want to do this.”
And I also help people to see how it makes them small because it is a regressed state. So suddenly, you know, a powerful woman starts looking like she’s in a puddle and overwhelmed and can’t handle whatever the situation is. So sometimes I’ll point out how you’re making yourself so small here in the face of this really a powerful feeling of anger inside of you.
And I may also say, “I know there’s sadness. I know you’re hurt too. I don’t negate that there’s sadness.” But I might say to a person, “You don’t seem to have any trouble with sadness. You frequently seem to be able to get sad, but when you’re talking about somebody that clearly you have other feelings about, those feelings get abandoned. So what do you think? Do you see how this weepiness can be making you small, hurting you, pulling you away from other vital parts of you?”
BACK BY POPULAR DEMAND!
Save the date: 02/20/2016, 10:00 a.m. – 5:00 p.m
Susan Warren Warshow
will re-present her video from:
“Penetrating Defenses and Surmounting Shame”
This material has inspired comments such as:
- Best training I have ever attended!
- Susan was inspiring, genuinely humble, authentic and knowledgeable.
- This is my first exposure to DEFT, and I definitely want to learn more.
Susan will discuss the change factors in psychotherapy with a man who has ego fragility, fainting episodes (one begins to occur in session) and long term depression with disabling distancing defenses. Email us at admin@deftinstitute.com if you plan to attend. We will be choosing the location soon based on the response.
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July 12th, 2014 admin
UPCOMING EVENTS:
Penetrating Defenses to Awaken the Self with Susan Warshow and Jon Frederickson September 27th and 28th, Los Angeles
LACPA Continuing Education Series Working with Emotionally Defended Clients November 15th, Los Angeles
Milton Erickson Foundation Brief Therapy Conference Susan presents December 11, Orange County
DEVELOPING TRUST IN THE POWER OF SELF-REFLECTIVE PROCESS
I had a profound session this past week that once again demonstrated to me the power of building self-reflective capacity.Perhaps too often, we over emphasize intense emotional unlockings and under value the healing power of awareness of internal processes that harm the self, alongside the will to transcend those automatic, often unconscious, habits. This in no way is meant to diminish the immense value of depth emotion processing, but rather to consider the curative impact of pure awareness and will in relation to separating the self-enhancing from self harming aspects of the self.
My client came in severely regressed, weeping frequently, distrusting me, her husband and others, projecting her own relentless self attack, and fraught with anxiety. At times we focused intently on her devaluation of me and also of herself and her husband. She never wanted to acknowledge the progress we’d made together as she was highly suspect of it. Likewise, she didn’t want to acknowledge the caring of others towards her and was dismissive of anything good coming her way… or of anything good within herself.
It is always exceedingly gratifying to see the development of sense of self in a person in relatively short time. This female client became able to observe her projections and now challenges them, i.e. she has been able to see how she fuels her fears as a result of her projections that others disapprove of her or wish her harm… and she now actively intervenes when those projections occur and checks out reality instead. She is also intervening with her splitting defenses… seeing that neither of us is perfect and that she can make space for what is good and also what is limited in each of us. Therefore, she does not re-traumatize herself by robbing herself of an imperfect but still valuable relationship with me and most especially, with her husband. Essentially, she is becoming an acute observer of any self-harming parts of herself and applies her will to intervene.
It’s been a long time coming for me to trust in the power of this type of self- awareness. Therapists often feel like they have to move mountains or lift loads of bricks, but really we do something that is, in one sense, simple. We hold a light to what is revealed in a moment. We say, “Oh, so there is shame rising. Shall we look at this together?” (Differentiating adaptive shame from shame involving self attack or projection). Or “Shall we attend to this anxiety so it doesn’t continue to paralyze you?”
If our goal is to help others develop the most comprehensive awareness of their own processes, so that they may work with the moving parts within themselves to the greatest advantage, the therapist must have a (good enough) broad knowledge of the diverse phenomena that presents itself in a session…i.e. recognizing all of the defenses and all manifestations of shame, anxiety and guilt. Otherwise, how can we shine a light if we don’t know what we’re shining it on?
And then there is perhaps the most challenging part, which is our willingness to openly acknowledge reality with our clients… to share the truth of what we see in those we seek to help (assuming we have explicit permission to do so) and also to be aware of and guided by our own immediate experience (are we bored, anxious, experiencing an attack, shaming ourselves etc.).
But my central point in this post is that we seek to have FAITH that our work to heighten self-awareness (simply providing a caring mirror for the phenomena we witness, with fully informed consent!) and to stimulate the will to be actively kind and compassionate towards the self has enormous healing power… more than many of us can imagine. I overworked, overreached, and took on excessive responsibility. It is my hope that my own experience may help reduce the suffering incurred by other therapists. Probably the greatest challenge was to be able to step aside and trust that this healing force is at work when we shine the light with accurate attunement to what is occurring in the moment. When the client chooses to join us in this awareness, the results can be breathtaking.
REFLECTIONS ON 8th IEDTA CONFERENCE
I recently returned from the 8th International Experiential Dynamic Therapy Association’s biennial conference in DC, a dependably outstanding experience. It was a great privilege to be a presenter among master clinicians from around the world, many showing exceptionally powerful recorded sessions, including riveting work with a gang leader, a hard core drug addict, and an explosive, alienated and detached cardiologist. All were deeply moved by the remarkable levels of emotional intimacy that were achieved and the significant internal shifts that followed, validated by the client’s poignant words. I thank everyone who created this event, most notably Jon Frederickson and Kristin Osborn. I’m grateful for all the touching, meaningful encounters with other therapists who were so kind, inquisitive, openly sharing, and genuine in their acknowledgements. Unforgettable experience. For more info, go to IEDTA.net.
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April 2nd, 2014 admin
DVD Day with Susan is fast approaching on 4/26!! Join us as we devote a day to the study of rich, live case material, imagining ourselves in the room and considering DEFT approaches to the rapidly occurring therapeutic challenges presented by a variety of clients. Working with dreams and role playing emotions to gain access to the roots of trauma are some of the skills that will be demonstrated.
Register: http://deft.eventbrite.com
Therapist Devaluation: How to Turn Lemons into Lemonade
The client asked me to tell him what to do regarding his therapy, as he was at a crossroads in our work, and my impression was that he wanted me to make this decision for him. I steadfastly reoriented to what the client wanted for himself. His tendencies to be led by others even at his own expense caused me to not want to reenact the same thing. Also, I was not withholding something I knew but rather believed there was an exploratory process needed for both of us to arrive at more clarity together. For 2 sessions, his resistance was intermittently intractable. Ultimately, my failure to be omnipotent resulted in him saying, “I don’t feel held by you. I don’t feel heard by you.”
These statements were followed by a string of negatives about my flaws, and a mal-attunement that occurred months before was held up as evidence of my shortcomings as a therapist and as a person. I was charged with being someone who does not take responsibility and who doesn’t own her stuff. While I believe in self-examination on the part of the therapist and acknowledging counter-transference, I was also reacting to the tone of contempt that was occasionally acted out in our relationship. As I watched this trending towards devaluation and distancing, I found myself especially challenged.
When I tried to speak, he also complained that I was interrupting him. Whatever I said, it was not going to be seen as good enough… and no matter what I tried, and I tried all the interventions at my disposal, he was not going to let me in. I wanted to interrupt this toxic flow but struggled with how to do so in a way that would not shame the client and express empathy around an injury that had apparently occurred, and also be true to myself? I wanted to be optimally responsive to him and also responsive to the feelings that were swirling inside of me.
What made this especially confounding is that we had done some exceptionally profound work together, and it was recently that he had acknowledged several areas of significant improvements in his life alongside deep feelings of gratitude. Suddenly there was an invitation, as a result of projective identification, for me to feel “all bad.” While we can assume the “perpetrator” was activated by all the progress and a deepening relationship, there was still the reality of the state of our relationship to deal with. His contempt was threatening to override our successes in his mind and for some moments, in mine as well.
The client expressed distrust of my ability to help him and ended the session with, “I may be transitioning out soon.” Distancing against closeness and dependency had been primary themes of our work and I also saw rage and envy that I might have something the client was not able to provide for himself. This is very understandable given the nature of extreme emotional abandonment in the client’s history of trauma. In no way did I want to re-traumatize this person but I also didn’t want to abandon myself.
Interestingly, in the week to follow, the client opened the session as though his hostility towards me had never occurred. In the interim period, I had become acutely aware of my own desires to not expose myself to the toxicity of unbridled devaluation. While I confess that the thought crossed my mind for an instant to let sleeping dogs lie, I knew that would undermine the essence of what I teach in my training program regarding courage, and for the sake of my own sense of integrity, this wasn’t an option.
With the help of a dear colleague, I was able to connect even more with my own boundaries. After all, it was not only the client who had the right to choose regarding the therapy but I had the right as well. When we speak about the necessity of having a working alliance for therapy to be productive, it is equally important that not only the client’s but also the therapist’s will be engaged in the process as well. And if the trend of the prior couple of sessions were to continue unabated, my will would not endure.
At the same time, I had immense respect for this individual and deeply caring feelings for him. In fact our work together had been extremely moving. So a possible, impending abort would be a sad ending indeed to a most rewarding therapeutic relationship. So with anxiety as well as determination in my heart, I began with, “I realize I’m interrupting your train of thought, but I believe your comments about not trusting me and your last statement, “I may be transitioning out soon,” present a priority for us to address. Because obviously, if you do not trust me and you do not think I am a responsible person and you don’t believe I own my stuff to a sufficient degree, then why would you want to work with me as your therapist? At some point I also mentioned that from my perspective, it was not that I did not hear him but that there were times when we saw something differently and I wondered if there could be a place for both of us to exist and be different? And that as much as I wanted to be attuned to him, I had no doubt that there were times when I’d fall short. The question I wondered was whether the relationship could be felt to be good enough.
His cool and calculating response was rather jolting, about wishing to exploit my skills so he could get what he wanted from me and being willing to put my shortcomings aside. I immediately responded that my work is based on an attachment relationship and that I was experiencing a wall between us. I could not work in such a compartmentalized fashion. We needed to see what could be done about this wall, about the disdain and judgment that I was experiencing, because otherwise I couldn’t see a successful outcome. I found this devaluation to be destructive to me personally and to him as well. Perhaps another therapist could work according to his parameters, but this was not something that I was able to do. This was very impactful and painful for him to hear but yet it was the reality. He was having an experience of me as a separate person, the reality that I did indeed have human feelings and limitations.
What unfolded was a powerful breakthough of grief due to new insights about the cost of having been cruelly devalued by his parents for the ways in which he was different from them, and also their obliviousness to how he had been hurt by them. He saw how he had similarly hurt me, as well as a number of other important people in his life with his own contempt and judgments (he also used the word exploitation) and he felt remorse for this. He had been told by others that he had narcissistic traits and he brought this up with a new felt understanding of how this was operating within him. We were also able to discuss his splitting defenses, how all the good parts of what we’d experienced suddenly evaporated when the reality of imperfection reared it’s face. The “ good enough” option that I presented to him became another possibility for his consideration. A renewed alliance grew from this exchange on both our parts. In fact, as he softened and allowed more vulnerability, we were both able to reconnect with the affection and respect we have for one another. With another person, this could well have turned out differently. But this is the risk we take when we respond to the best of our ability and from the truest place within ourselves.
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March 5th, 2013 admin
It’s my pleasure to be sending free video segments and commentary from one of my training programs entitled “Identifying and Handling Defensive Affects” to all who subscribe to my mailing list. If you wish to subscribe now and receive this gift as well as notices of my special events and other resources, go to www.deftinstitute.com and fill out a simple form on the “Contact and Mailing List” page.
When Ventilation Dominates the Therapy Hour
Who has not experienced a session like the following, which was described to me by a therapist in training at the DEFT Institute:
“I just had a session that got away from me. She ventilated the ENTIRE time despite my efforts to interrupt repeatedly. After about 15-minutes I gave up and allowed her to do her thing….it was AWFUL! I AM consistently impressed with the difficulty of the task at hand that is essential for health and healing. Ugh!”
Yes, indeed, the task is difficult and here we have a client who is overriding her therapist’s interventions, which can be the result of multiple factors. Assessing these factors is the key to knowing what to do next to be most helpful. If the therapist’s countertransference is activated and the therapist begins to doubt or devalue himself, this will interfere with the therapist’s ability to stay present and to keep exploring the client’s will or choices with an open mind.
I don’t want to offer an overly simplistic “solution,” but will share a few suggestions that occur to me, keeping in mind this is not a substitute for supervision where we can track moment to moment phenomena. It appears that this is a highly resistant client who uses the defense of ventilation due to unconscious anxiety over intense underlying feelings (triangle of conflict). The therapist undoubtedly wishes to bring to her attention that this pattern of discharging, rather than fully experiencing her feelings, will prolong her suffering. The client could then be given a choice about whether she wants to attend to her underlying anxiety and reduce it so she can more freely access her feelings or continue this pattern of ventilation? But she is ignoring the therapist’s input. Timing is everything, and while these are perfectly appropriate interventions under certain circumstances, they may not be effective at other times.
Before addressing her ventilation and the fact that this will not help her, we need to ask whether the client has first declared what she hopes to gain from therapy and has she agreed to work with an intrapsychic perspective? Otherwise, there is no therapeutic alliance to explore what is going on within her internally and the therapist will risk a misalliance if she tries to address her ventilation or resistance to the therapist’s input. The client might be hoping the therapist will validate her view of the person she’s ventilating about, or perhaps she wants to assuage her guilt over something she did to this person, or she might be pursuing a fantasy that the therapist will help her find some key to changing this person. And how do we identify the client’s expectations so that she will understand whether they can be fulfilled realistically in therapy or not? If unrealistic expectations remain unconscious, she may well harbor resentments towards the therapist or the process itself.
We begin by asking about her goals for therapy. If she focuses on her frustrations with another person, we need to gently remind her that we are powerless to change anyone else and inquire into how she’d want to feel differently within herself as a result of therapy? If the ventilation continues, we’d want to reiterate that we’d love to help her with her sense of frustration but can only help her by taking a look at what happens inside her when this person behaves as he does. Would she want to do that? Hopefully, she will reveal something that will give the therapist an opportunity to help her see how her anxiety (or perhaps shame or guilt) is being ignored… and to see that these forces will keep her feelings out of awareness. When she bypasses her own internal experience by ventilating and focusing on the other person to the exclusion of herself, the price will indeed be steep.
If she still continues to ventilate and to ignore the therapist, I might say, in a caring tone, “You know, I’ve made a few comments that I think would help you, but I notice that you seem to talk over what I offer to you. It’s certainly ok with me if you prefer not to receive my input, but I am wondering how we will help you if this continues? What are your thoughts about this?”
Another possibility: “I see that you seem overwhelmed by your feelings towards so and so to the point that it is hard to focus on anything I’m saying or even to attend to your own internal experience. I wonder if you may be quite anxious? Have you been aware of this? Do you have problems with anxiety that you are aware of?” if so, I would inquire into all symptoms of anxiety and let her know that her anxiety comes up in the face of her feelings towards this person and that her anxiety will only get worse if we don’t attend to it rather than continuing to focus exclusively on him. I would then ask if she would want to get help for her anxiety in therapy? If so, I would reiterate that we’ll need to practice an internal focus rather than primarily focusing outside of herself.
If none of the above leads to anything productive, I would also leave open the possibility that this client may not really be motivated to do the work of therapy. She does have the right not to listen to her therapist. If that is the case, I would simply reflect this and work very hard on not blaming myself for a thwarted treatment. Any of us may need to remind ourselves that there are 2 people who make a successful therapy possible, not just the therapist!
Thanks to the therapist posing this quandary for giving us something to chew on that can be hard for any of us to digest.
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