Training for Psychotherapists

Speaking with Susan on Mini-Breakthroughs

I received some very good questions for us to ponder and welcome yours as well … I reproduce one here in its entirety and also refer to my article on “How Much [Emotional] Intensity is Good Enough?” See the publications page at www,warrenwarshow.com.

Question re. “How Much Emotional Intensity is Good Enough?:

“Often I have clients, as they move into portraiting a scenario, they move into imagining themselves, for example, shaking a loved one and yelling at them or somehow expressing anger/rage.  Then when I ask what’s next, they say that the loved one decides the client is right and the loved one is going to change / reform / apologize, etc. When they imagine the loved one reforming or apologizing or changing their ways, I double-check, asking if this is just fantasy or wishful thinking.  “No,” my client answers, “I really do imagine him/her changing / apologizing, etc….”  But IS this a fantasy defense?

The imagined reformation of the loved one or friend or boss etc.  pretty much stops the action.  In other words, we don’t move into a full portrait with the death, guilt, shame, regret, love, closure, etc….  I ask, and maybe there’s a little “guilt light” or “regret light” or words they want to say to  but no, they don’t feel guilty, remorseful, or anything….They feel:

  •  relieved, better, happy, hopeful and that’s pretty much the end of that
  •  SOMETIMES a couple minutes later they feel fearful that the loved one will revert – in which case I try to lead them into a futuristic scenario with mixed results.

Although I’m finding the EDT/ISTDP/DEFT treatment style helpful to my clients, I always want to maximize the efficacy.

Do you think the above is effective?  Is it necessary to go through the full portraiting every time to be effective?  I know I can’t FORCE the client to go into the full deal, but is what I’m doing helpful?   It SEEMS to be…but I wonder…

They ARE getting in touch with their feelings and they clearly feel relief, empowerment and pleasure at expressing them.  I haven’t usually noticed left-over guilt  (with a couple exceptions) or stuff.  Usually the external relationship improves.They ARE getting in touch with their feelings and they clearly feel relief, empowerment and pleasure at expressing them.  I haven’t usually noticed left-over guilt  (with a couple exceptions) or stuff. Usually the external relationship improves.  And we can always go back in a future session if more comes up. Or is just expressing their feelings in this way helpful?
So, I wonder:  
  • Do you think this sort of “half-portrait” is effective?  Is it always preferable to go through the full murder every time to be effective?  Or is just expressing their feelings in this way helpful?
  • I know I can’t FORCE the client to go into the full deal, but is what we are doing helpful enough?  I always want to “INVITE” them to express their feelings, not pressure them…

SUSAN’S RESPONSE:

I remember a therapist in training asking, “Do we have to do those damn murders?” She of course was asking whether healing treatment can take place if we don’t unearth the full range of complex feelings within our clients. The article I wrote and linked to above shares some perspective from Dr. Leigh McCullough’s research. From my personal experience, the more a client can uncover their full emotional truth as it resides within their body, the greater is the relief (e.g. freedom from anxiety and shame) and also the greater is the insight and integration related to feelings associated with early trauma. However, healing is relative and all gradations of healing have value.

When a client imagines in fantasy, after experiencing an angry impulse, that the loved one reforms or apologizes or changes their ways, I recommend exploring to see if the client is engaging in fantasy or wishful thinking in the service of defense.  If they say, “No, I can really imagine them changing….” I would ask if this feels true to the character of the person they have angry feelings towards and remind them that being absolutely honest with themselves is crucial to healing. So, I might say, “Would Dad truly respond this way to the impulse you just portrayed?” Frequently, the client will recognize they using the defense of avoidance.

Also, the body holds the true answer to your question. If the client “stops the action” while there are signs of residual anxiety and holding in the body, then they have not released the full impulse. It is important to check to see if they feel a full release of impulse from within the body. The primary point is to see what they are truly feeling in a given moment towards a certain figure regardless of how the other person might be responding in fantasy. The client might visualize Dad apologizing, which will probably induce guilt, but this doesn’t mean that all the rage has been released from within them. If there is more inside, then we need to address the toxic guilt over feeling.

It is terribly important that we seek the truth of the client’s feelings as they reside in his body. The truth may be that the client does not feel primitive murderous rage or it may be that she does. What is true? The body will tells us so long as the person is sufficiently freed of toxic shame, guilt and anxiety to explore their internal experience without censorship or restriction.

That being said, I caution those who train with me to refrain from portraiting primitive murderous impulses without a fairly good idea how they will handle intense complex feeling as it breaks through… we need to be prepared to deal with the guilt and the defenses that often follow upon this experience.

REFRAIN FROM ALL OR NOTHING THINKING

So, to your question, “Do you think this sort of “half-portrait” is effective?” For a patient who is detached from feeling and is therefore unable to name it, the very act of identifying a feeling is progress and worth appreciating. There is healing in the experience that the therapist is interested in what we feel and conveys the ability to hold and to value all that we feel. When the patient is able to name their anger and the therapist does not pull away, this begins to lessen fear and shame around emotion.

In the cases you described, your clients have been able to connect with the motoric impulses that accompany their feelings in addition to naming them. This is great as it provides yet a further level of emotional expression,  intimacy and self-awareness. Excellent.  Moving towards fuller portraiting with some clients may require additional skills, as I’ve suggested above, or in a particular client’s case, it may not be applicable as not everyone has pmr to process. I admire your commttment to “maximize efficacy.”

That being said, I would celebrate the fact that, as you said, “They ARE getting in touch with their feelings and they clearly feel relief, empowerment and pleasure at expressing them.  I haven’t usually noticed left-over guilt  (with a couple exceptions) or stuff.  Usually the external relationship improves.  And we can always go back in a future session if more comes up”.

When you ask, “Or is just expressing their feelings in this way helpful?” I believe you have some impressive evidence that it is, such as “Usually the external relationship improves.” Trust your client’s feedback above all else. Congratulations on your successes.


This entry was posted on Tuesday, October 16th, 2012 at 12:34 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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