Further reflections from the 5th International Experiential Dynamic Therapy Association Conference (IEDTA) in Vancouver, B.C. this past July…

Patricia Coughlin, Ph.D., pointed out that Klaus Grawe, the eminent German psychologist who integrated neuroscience with psychotherapy, made therapists aware that we can’t focus on the problem alone but also on the healthy part of the patient; that we must speak to the healthy part while blocking defense at the same time.

Thought I’d share part of a session I had with a fragile, depressed patient with suicidal ideation and severely regressive defenses that I hope will illustrate this principle. The patient had described a bubbling energy in her stomach and then suddenly slumps and experiences a heavy feeling,

Th: So there’s this energy that wants to move up but there’s something blocking it. The heaviness holds it down (her depressive defenses).

Pt: I think sometime I shouldn’t show any emotion.

Th: Any anger. (Her narrative is highly suggestive of this emotion).

The pt. talks about how her family reinforced this repression of feeling and the therapist turns to the reality between the two of them.

Th. “Do you perceive any danger now, with me?”

The pt. recognizes there is no real danger, but she fears that the feelings inside her will be like soap bubbles endlessly rising from the mouth, coming and coming until they essentially drown her. Therapist comments that if we could make more room for her feelings, they would likely resolve themselves.

Th: “Do you want us to do that (make more room for her feelings)?”

Pt: Yes!

When the pt. emphatically responds affirmatively, the therapist feels moved by her. Smiling, she says, ”You’re a courageous lady.” The patient wonders why? “I think you have a wonderful spirit. There’s a very healthy spirit in you. Even when things are very difficult for you, you’ll say, ‘No, I want to go forward.” The patient recognizes this is true about her. Therapist goes on, “And I admire that.” Both patient and therapist share a sense of delight.

Th: “It takes courage. It isn’t easy.”

The patient has a moment of appreciation for herself and heightened hope, a primary curative factor in therapy.

Th. A part of you wants to release it (your anger), but another part wants to keep it inside.

Pt. But I know I don’t want that. So I’m kind of fighting inside, two of me.

Th. And then there’s the part that can observe with me this struggle inside. Would you say there is the part that wants to… keep you down…and then there’s the part that wants you to be freer.

The power to perceive these conflicting parts of herself activates a sense of hope and also her will. She then becomes aware of more bubbling up of feelings, with the ‘bubbles” getting bigger and rising up from her stomach but then getting stuck in her throat. The therapist views the “bubbles” as a mix of anxiety and also rage. This sign of the patient’s feelings moving up rather than being trapped in her stomach or under a weight of heaviness is viewed positively and is used to encourage the patient:

Th: But that’s progress!

With each step towards awareness of her strengths, this patient took another risk towards discovering and declaring herself. Eventually, she was able to access the full force of her rage as well as profoundly loving feelings towards her deceased father

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