Vignettes while on a break #1

A word about dissociative disorders, their subterranean compelled behaviors, states of unreality, ego-alien command voices, and alter personalities.

In one week, five men and women, unknown to each other, came to therapy with psychic rip currents from hell, material from an underworld of crushed and crazy-made childhood.  All five were pleasant personalities, good people being run, to varying degrees, by demons.  Not their demons.  In three cases, by their parent's demons, somatoemotionally raped into them.  One, a neighbor boy’s demons.  The last, unknown, as the several personalities were not even a twinkle in the child daydreamer’s eye but bloomed, fully active, during his workaday adult life.

I am not one of the exotic breed of specialists in traumatic dissociation, satanic abuse or multiple personality, and for some reason I find these hothouse jungle flowers only slightly interesting.  To me, symptoms are symptoms, they all come from injury – psychopath and nail-biter alike – but these purple-plumed poly-identity folk are reaching a bit beyond the pale.

“Let’s have a normal neurosis, OK?” I might say were my inner child in the captain’s seat, not me.

What I do know is the singularity of dissociation, and that it is a baseline state in countless lives which may seem, to self and all the world, completely earthbound.  Depression is dissociation – sending down and under one’s real feeling self.  Chronic anxiety is dissociation – fear replaces the spontaneous expression of feeling, thinking and action.  Those of us who have reason for pain – our childhood losses – but do not feel it, are by that fact “not all here,” no matter the clarity of our intellect or the competence of our lives.  This is dissociation.  And the split-off self, cramped, burning and frozen in the past inside us, remains primitive – like mayhem.  And mayhem is what may emerge later on.

As a little girl, the woman watched her mother pointing and talking to archangels on clouds for hours.  She would be beaten then told “it didn’t happen.”  A child can’t remain the rapt audience to her mother’s craziness or her own twisted reception.  She must “leave” herself.  Later on, like a car’s dimmer mirror that tilts a fraction of an inch to show a ghostly reflection, her reality would surprisingly flip away: Suddenly, everything was unreal.  And people would be on fire.

One of the men was a crazed killer, though he had never hurt an animal or person, and the reality was only in his ceaseless thoughts.  Another man, though he loved his wife and had all-good intentions, was aggressive and crazy-making: He needed to make her feel like a monstrous defect, to exorcise his father from his bed.

In Waking the Tiger*, Peter Levine describes a wild animal’s ability to prevent the post-trauma state.

“Nature has developed the immobility response for two good reasons.  One, it serves as a last-ditch survival strategy.  You might know it better as playing possum.  Take the young impala, for instance.  There is a possibility that the cheetah may decide to drag its ‘dead’ prey to a place safe from other predators; or to its lair, where the food can be shared later with its cubs.  During this time, the impala could awaken from its frozen state and make a hasty escape in an unguarded moment.  When it is out of danger, the animal will literally shake off the residual effects of the immobility response and gain full control of its body.  It will then return to its normal life as if nothing had happened” (p. 16).

“. . . .  The energy in our young impala’s nervous system as it flees from the pursuing cheetah is charged at seventy miles an hour.  The moment the cheetah takes its final lunge, the impala collapses.  From the outside, it looks motionless and appears to be dead, but inside, its nervous system is still supercharged at seventy miles an hour.  Though it has come to a dead stop, what is now taking place in the impala’s body is similar to what occurs in your car if you floor the accelerator and stomp on the brake simultaneously.  The difference between the inner racing of the nervous system (engine) and the outer immobility (brake) of the body creates a forceful turbulence inside the body similar to a tornado.”

“A threatened human (or impala) must discharge all the energy mobilized to negotiate that threat or it will become a victim of trauma.  . . . .”

“Animals in the wild instinctively discharge all their compressed energy and seldom develop adverse symptoms.  We humans are not as adept in this arena” (pp. 19-20).

What we absorb, what we swallow in childhood fells us, like the impala, in our tracks, yet we keep moving.  Brain and body hold our trauma which lives its atavistic, grimly repetitive life inside and outside.  Traumatic memories are those that aren’t “digested,” don’t assimilate into the narrative timeline.  Alter identities have two-dimensional scripts, unchanging.  Calof**, talking about the specialized nature of different personalities, cites a woman who contained an alter that ‘fed the baby’: That’s all it did.

Occasionally, “Murphy’s Law”-type psycho-observations rear their heads despite our hopes.  One is – Our parents and their ghosts damage us, but only we can deal with the mess.  Another is – All the knives and nightmares of our trauma, do we someday ‘discharge all the compressed energy’ and have healing mayhem, or do we continue to fuse, finesse it, keep it swallowed?

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* Peter A. Levine, Waking the Tiger – Healing Trauma, North Atlantic Books, 1997.

** David L. Calof, Multiple Personality and Dissociation -- Understanding Incest, Abuse, and MPD, Parkside Publishing, Illinois, 1993.

Left-handed Armenians

Within the next half-a-year I may be compelled to take a college course in chemical dependency.  This is because my wife and I are hoping to relocate to a western state, whose Counseling Board requires such a course for licensees – apparently even those who have been working for a long time and have treated many substance dependents in the course of a varied practice.  (In the ’90’s, my graduate counseling program included substance-related courses as electives not core, and I found the subject as boring as lint.)

Though I am not entirely averse to returning to college at age sixty-two, I am in “philosophical” disagreement with the requirement to complete a drug-specific course.  To me, this would be no different than having to take any of the following classes:

* Treatment of ambidextrous over-masturbators

* Psychotherapy of female chocolate abusers

            -- milk chocolate

            -- dark chocolate

* Group therapy of texting-while-driving adolescents

* Obsequious versus obnoxious female Domestic Violence victims

* Treating the symmetrical eyebrow-pulling obsessive-compulsive trichotillomanic

            -- simultaneous pulling

            -- sequential pulling

* Crisis intervention for latency-age intellectualizers

* The power- and fame-addicted man (or woman)

* Helping the “Adjuster” Adult Child of Alcoholics

My point is that people have pains and unmet needs that bring forth many – maybe an infinite number of – reactive and self-medicative behaviors, symptoms, which are the indicators of disorders, not the disorders themselves.  Is a cough a disease in itself, not a symptom of an irritation, obstruction, respiratory disturbance or worse?  Is a patient with AIDS well served by a physician who only treats the pain and disfigurement of lesions?  If you have the flu, would you go to a doctor who knows about runny but not congested noses, and who believes your problem is “runny nose disorder”?

Despite the fact that misinformed political correctness has created the “disease” of alcoholism, clinical evidence shows that addicted people are self-medicating people, and they are medicating away historical pain (which leads to contemporary suffering).  What is the pain?  Anxiety.  Depression.  Identity impairment.  Anxiety that blossomed in an insecure or abusive, suppressive, reversal-of-dependency home.  Depression that formed in a cold or angry home that had no empathy.  Identity failure, which grew from depression, which grew from the tamping down of the child’s emotional fire and compass.  Clients presenting, during early sessions, with symptoms such as food abuse or “excoriation disorder” (skin-picking, DSM 5) descend quickly enough to the deeper issues of cause – what is this tension, what is this emptiness that craves to be filled?

Because therapists work against pain in many of its forms, we do focus on the distress that symptoms, themselves, often lead to.  And symptom-management can have, in controlled environments and with very committed clients, deep effects.  An example is Masterson’s work with adolescent Borderlines in an inpatient setting:

“Today, in supervision, as I see the problems most therapists have in understanding and managing acting out, I wish that they could have had that experience in that unique crucible.  Only after we had become professionals at setting limits in order to survive did we learn that it had a far more important and profound psychodynamic effect.  We saw adolescents become depressed as they controlled their behavior – i.e., the first link between affect and defense.

“It was now clear to us that the acting out was a defense against the depression.”*

Once the adolescents’ depression was unmasked, absent the masking symptom of acting out, depth process could follow the taproot down to the “abandonment depression” – failure of the maternal bond in the first years of life – at the seat of patients’ personality disorder.

I have always been proud, though quietly, of the descriptor “generalist” counselor, because my meaning of it is someone who works beneath the smorgasbord of surface manifestations – the symptoms, the act-outs, the specialty disorders, the left-handed glue sniffers – to the why’s and to the source of pain.  If you come to me with a drinking problem, yes, I will try to help you stop drinking.  But by looking beneath it to your depression, your self-esteem, your father, your self, I’ll also help you not need to drink.

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* James F. Masterson, M.D. and Ralph Klein, M.D., editors, Psychotherapy of the Disorders of the Self, 1989, p. xiv.

Fantasy impromptu #1

When business is poor, clients’ scheduling is anemic, I will become very angry, bleak, nihilistic, and immature. Such an instant descent from my natural serenity, some idiots would call “bipolar.” (See?) I burn inside at the manager who directs the flow of Intakes, assuming a conspiracy to ditch me, before which I am completely impotent because she is so subtle about it. I seethe at clients with the cowardice and mendacious laziness to cancel their appointments. And most of all, I roil with fury at the other counselors whose doors are shut one hour after the other: Their clients keep trooping in like a carnival parade of middle-aged meds-benumbed sheep, of teenage girly gossip and angst. These counselors, in my mind, are shallow Dear Abby blinky-eyed fluffs who, in graduate school, misread the definition of “psychotherapy” and thought it meant having casual lite conversations about mundane or brand-name problems, and suggesting different, homey ways of looking at things. In other words, giving their clients sweets ‘n’ empathy.  Of course they keep coming back!

The other side of this bathetic coin is my flimsy, histrionic hurt-pussycat righteousness: My work is so deep, recondite and powerful, it sends most “real men” under the covers to hide, most women back to their girlfriends and Regency romance novels. They can’t handle the Journey to the Center of the Soul. And the fine ones who stay for therapy – the process, like lightning, so brilliantly and comprehensively scours their psychic insides that they are finished, elevated, in a matter of weeks. Gone, leaving unfairly deceptive gaps in my schedule.

The third side is the better world, where I am doing well, respect my competence and nod to my flaws, and grant the unique value of other clinicians’ work which I cannot match.

Some of my clients stay for years, even three or four years, a fair number for one-plus years, many exceed a few months or half a year, some last two weeks. I scare the occasional one away at intake, because I talk about “feeling is healing” and pain. What do people want? could be the question that undergirds, calms this tumult of unpredictability.

 

What do they want? Some want to change. Others – as nonsensical or paradoxical as this sounds – want to be exactly who they are but different. They want to feel different, magically and forever. And I know that the more palatable conversation of some of my fellow therapists, who do not seriously challenge a person’s childhood, or parents, or personality, can keep these magic-hoping clients coming back, month after month. I know this because I also see these people who have settled comfortably into highlights of the day talk, month after month. I don’t like it – I am not giving my best – but I sometimes tell myself they are deriving value from it.

With people wanting these different things – what do I want? If my original calling was to help deep, can I enjoy the client who runs home at the sight of himself in the mirror? The motivations of therapists is a subject in itself. In Claudia Black’s book, It Will Never Happen To Me! (adult children of alcoholics), she quotes “a very special friend”: “Those of us in the helping professions did not gravitate here accidentally. There must have been something wrong with us to be so preoccupied day-in and day-out with the pain of others” (p. 57, earlier 1981 edition). And Alice Miller, in The Drama of the Gifted Child, says –

“I think that our childhood fate can indeed enable us to practice psychotherapy, but only if we have been given the chance, through our own therapy, to live with the reality of our past and to give up the most flagrant of our illusions. This means tolerating the knowledge that, to avoid losing the ‘love’ of our parents, we were compelled to gratify their unconscious needs at the cost of our own emotional development” (p. 20). 

What do we all want, what do we all need? The world spins in a circle and rides a circle, the universe expands into itself, but people feel the command of a straight line of progress, an arc of a story, a search or journey of meaning. It’s all true but false, and psychotherapists are there to help people dance the best dance, for them.

Remember the “existential givens” described by Yalom:

“I have found that four givens are particularly relevant to psychotherapy: the inevitability of death for each of us and for those we love; the freedom to make our lives as we will; our ultimate aloneness; and, finally, the absence of any obvious meaning or sense to life” (p. xiii).*

Yalom believes these “grim” givens “contain the seeds of wisdom and redemption.” He is Matthew Arnold:

Ah, love, let us be true

To one another! for the world, which seems

To lie before us like a land of dreams,

So various, so beautiful, so new,

Hath really neither joy, nor love, nor light,

Nor certitude, nor peace, nor help for pain;

And we are here as on a darkling plain

Swept with confused alarms of struggle and flight,

Where ignorant armies clash by night.**

Better, I think, to be less ignorant, and to dance by night.

http://www.youtube.com/watch?v=uJfNkEth-9Y
 

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* Irvin Yalom, Love’s Executioner 

** Matthew Arnold, last verse of Dover Beach

The mother of interventions

Imagine how strange it feels to sit with an older teenager, and realize and discuss how the most important things may never get said between parent and child.  Everything that was supposed to happen to make him feel connected.  The nature of this hollow feeling, the real nature of love.  The child they never saw, how alone he felt, how invisible he was.  It is a very strange conversation, like an epitaph spoken even before living really begins.  And it would be terrible to have it, were I not about to bring the parents in and make them, so to speak, the wrench thrown in the works, to stop an inexorable passing.

In psychiatrist Peter Breggin’s book, Toxic Psychiatry, the author as therapist talks to the parents of Andy, a child labeled ADD.

“Right now, your son isn’t feeling loved by his dad, and he’s not feeling disciplined by his mom, and he’s getting very mixed messages about how to behave.  The one message he is getting is that his dad doesn’t love him and that he’s a problem for everyone.”  (p. 276)

By this powerful lecture, the family begins to change, becomes mutually respectful, ends fear, and it’s implied that the boy’s so-called ADD diminishes, maybe to the vanishing point.  Such a result would be harmonious with Janov’s statement that ‘Nothing calms a child more than being loved.’  But Andy is ten years old – a very good time to intervene and remove the blinders from parents’ eyes.  Can this be done after he has passed seventeen, may dread even recapping his past to these parents, touching the sea beneath him and disturbing everything within it?

What will happen is that one parent will attend solo.  The other who lives apart, the young man feels he is too delicate and inaccessible.

It could go like this:

“Your son is missing a relationship with his parents that would have made him feel positive and strong.  A long time ago, he tried to make the family happy, but it didn’t work, and he was left in a grief and loss state.  He is stuck in the past, and he knows it.  When you are stuck in the past, but have to move on, only part of you moves on, and that is depression.  His pleasant personality – you are seeing the cover of a person.  He knows it is his cover.  The smile is mostly unreal, though that may be hard for you to believe.  The big problem now is that most of his energy remains waiting in his childhood, so there is little to drive him over the barrier into adulthood.  Motivation must come from feeling, and his is still mourning.”

I know this mother is very businesslike, and it will take purposive drama to create and maintain an atmosphere that her business will not be comfortable in.  Under pressure, she will have to go deeper in herself.  What will be the goal?  To see her son drastically, to give him some essential nourishment he’s never had.  But mostly, no one can know what she might say or do that will help him find a center in himself.  No one knows what can be inspiration or redemption.  I just hope very much that it happens.

Parallel universes (this is the last article in the book, "I Forgive" and Other Delusions)

Therapists know that some individuals come to counseling as their balm during a storm, and vanish once the crisis moment has abated at some level.  This could happen after one hour’s meeting or four.  A man attended his first appointment for help against desperate anxiety and depression, alcoholism and relationship failure, then didn’t return.  A couple months later he reappeared, golden-faced and easygoing as could be, under court’s order to have “drug counseling”: He had gotten a DUI.  The deep issues had evaporated – weren’t even mentioned – by the interventions of a new marriage and a psychiatric drug.  More recently a young woman showed up several months after presenting, in three sessions, a turbid character of dysthymia, abandonment, pseudo-maturity, stillborn rage, and relationship yo-yoing and sabotage.  In this case I was pleased to see her again because of her endearing problem: She had shoplifted.

What I liked was that this long-toiling, prematurely stolid twenty-something who had once parented herself then carried her husband and captained their ship, had given in to an urge to finally have something in her hand that didn’t have to be mixed with thought and responsibility to earn it, something for free, a gift from the world.  She surely deserved this in all ways but the legal one.  The judge even seemed to understand that her act was poignant not callous, because he fully emasculated the charge and made her consequence that I could see her again.

This is one of those areas where two realities live together as parallel universes: the child-in-the-adult needing the free gifts of life: love, attention, food, a bicycle, a necklace, sports, overnight camp, a pet.  (Another dimensional parallel would be social versus real justice, where for example someone is jailed for rape, that you feel deserves death.)  This is not the world of healthy adults – the several who are probably out there – but of the rest of us, who traveled through their youth with critical things missed, arriving at adulthood less with “unfinished business” than with empty baggage.  Conceiving their lives this way leaves the therapist with a correspondingly scant bag of resources: We can’t really give them the gifts they need, as their baggage needs to be filled by the past.

So I saw her one-time shoplifting as a crime of passion, not the best solution, but maybe the only one.  The non-gifted child can't be deeply healed by any school of therapy.  My own approach probably contains a kind of magical thinking, where I hope that my addressing the immanent child, even seeing her inside the big person, can make her alive and restored in both parallel universes, past and present, at the same time.

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March 5, 2013

To:       Municipal Court

Re:      “Cathy J.”

From:  The Pessimistic Shrink

Cathy J. has asked me if I could support her appeal to have her Misdemeanor expunged, primarily to enable her to work in the health care field. Ms. J. has been my client in counseling / psychotherapy since August 2012. List of attended sessions:

. . . .

My assessment, based on these ten sessions, is that she is not at risk to re-offend (in a legal context) in any way, including shoplifting or any harm to person or property. Her offense was, in my view, a form of psychological stress-release based in lifelong unmet needs for nurture and support, childhood to recent. Cathy’s primary defense mechanism as someone who had to "grow up too fast" has been to become excessively responsible and hardworking – to in effect carry herself and others (including her ex-husband), denying herself and worrying continuously about money. I believe that her theft of earrings was a one-time “break” and symbolic of the gifts of love and goods that all children need, but which she had been denied. Client and I have worked on this and related issues, including her dysthymic depression and money insecurities. I’m confident that her openness to process and insight, and her desire to make something excellent of herself in a Nursing career, will inoculate her against any potential future legal transgressions.

Please feel invited to contact me (with client’s Release of Information) if you have questions or concerns.

Yours truly,

TPS

Space between the curve

I once counseled a seventeen-year-old who had, since around age eleven, been traveling the depressive curve.  That is not a term I intend to coin, but it has meaning in my understanding of depression.  Picture a vertical line rising from a ground.  This is the progression of one’s life when it is fueled, from childhood on, by the powers of Self: self as the central actor, feelings free to be owned and expressed, and therefore interests owned and followed.  Now picture a second vertical line, superimposed on the first at its base, but curving away from it more and more as it ascends, making a wayward ‘ V ’.  This is the deviate life path of the child lost to power, all unempathic power shutting down the feeling self to a greater or lesser degree.  Beyond the curve is where the young man was: Alone, empty – because loss of self over time equals “emptiness” – and feeling his distance from where he was meant to be: the true, real, ascending arrow.

Working with him, I learned more about depression than the books, the years, the clients, and introspection had taught me.  He was pleasant, nervously affable, effete but glib, enjoyed school singing, liked a girl (unrequited), did the teenage things.  He could not do his school work.  With the same inertial stationary force of a car empty of fuel, this boy could not motivate to prepare, begin, prosecute or complete any assignment.  He could not ignite the fuel of reason to, because there was nothing inside to feel.  He also lacked the fraudulent motives – fear, guilt, narcissism – that will push or pull many a lost self to do.

His parents were divorced, and when younger he lived with his mother.  Over the course of a year she was brutally abusive.  It was too much for him, but like the victims of Stockholm syndrome or those vicious parent-child relationships that fuse choking with embracing, ruthless power with safety, he felt a mutated, abject lifeline of hope. But then one day she apologized, and the hammer fell.  All of his pain and humanity, always needing help, the justice of loving containment, was now to be left behind because of an apology that meant nothing but: It is over.  From that moment on, the body continued, the meaning remained behind.

Depressions obviously have different shades, intensities, qualities, but likely a same bedrock.  I saw an analogy recently, where a woman’s and man’s different hallucinations were rooted in the ground of chronic dissociation.  As a girl, she could not remain emotionally present as her mother was crazy without insight.  As a boy, he walked home from an abusive house to a silent and condemning one, where fantasy replaced feeling.  Possibly the ground of all depression is emptiness, loss of essential meaning, of self, over time.  Maybe it takes only a small amount of time to grow a sense of this loss, which would feel irrevocable.  My “conscious repression” of disappointments in my youth would qualify as mini-depressions, accumulating and joining other losses over years to become a seamless dysthymia.  My client’s repeated failures to make his family one and happy would qualify, too, growing a bigger and bigger gap between the axes of his depressive curve, until the hammer fell.

For him I offered, over time, a variety of thoughts, the closeness of interest, and – as goes my paradigm – the possibility of regression, recapture, reparenting.  One intervention was a simple suggestion: Find shards of hope, “future anchors” within you.  People are complicated enough that within emptiness there can be stuff as bright as that.

Feeling-centered therapy

Many of the previous blog posts have mentioned, referred to or assumed my affinity for feeling-centered therapy. Or maybe the biggest emphasis has been on my disagreement with the rationale and practice of cognitive therapy. So here I’d like to say a little something about working with people feeling-wise, beneath their thoughts, their philosophies, their reason, even beneath their strength and motivating energies. I’ll be talking about my own insights and practice, not the historical ground I stand on, which features primal therapy and Freudian concepts of repression and unconscious motivation.

As I’ve said or implied before, I believe that people are dysfunctional not because of their bad thoughts, corrupt genes, wrong religion, bad behaviors or unbalanced chemistry, but because they have been hurt, most typically by other people. I’ll add that I believe this view would be universal if truth-seeking were an instinctive part of humanity’s blueprint. Then, people would not hide from the facts that they have been damaged by powerful, often dear and needed others in their most formative and vulnerable years, the damage has become entrenched not resolved through time, and the hurt is passed on to the next generations.

I believe that cognitive therapy approaches, while more respectable than the grand embarrassment of behaviorism, are little more than the codifying of the self-medicating defenses of denial, rationalization and intellectualization. James Gilligan, prison psychiatrist for over twenty-five years, has stated that the worst criminals are born of the worst childhoods.* Were a serial killer-rapist to claim, “My parents abused and abandoned me, but I’m a survivor not a victim!”, or “As Nietzsche said, ‘That which doesn’t kill me makes me stronger’!” or “Let’s not catastrophize, it could have been much worse,” or “I realize I don’t have to be perfect,” he’d not only be purveying absurd denial and intellectualization, but would also be successfully applying the method and tools of cognitive therapy: reasoning with a self-affirming tilt. In this extreme example, we can see the delusional nature and self-soothing impetus to specious though hollowly valid reasoning (were any of the gentleman’s statements wildly untrue?). But would this reasoning be any less empty if offered by a depressed, or anxious, or codependent parent who spends more time with his parents than with his wife and children, or who kowtows to her friends, or who is intolerant of his child’s silliness, or who can’t focus on her work, or who feels guilty for not being a good enough daughter? Thinking and reasoning are helpers that become deceivers in the wrong hands: clear lenses in a healthy individual, tinted lenses in a pain-bent one.

“Feeling-centered,” only a handle, is an inaccurate, two-dimensional term for a four-dimensional psychology. Our goal is to reach the core of holistic – cognitive-behavioral-somato-emotional – injury at its most direct access point: feeling as emotion and emotionalized body sensation (what Eugene Gendlin named the “felt sense”). Thus feeling process is ultimately identical to descending into one’s history, down to the points where injury first occurred. It is depth process, space and time process. When we find injurious pain, we have reached the source of all later dislocations of our true and life-directed energies, dislocations that manifest as errant behaviors, blind struggles for worth or vengeance, destructive philosophies, shut-down and frightened hearts.

One could say that any avenue which sets aside escapist thinking and reaches root psycho-biological truth is a part of feeling-centered regressive therapy. There are techniques, such as Empty Chair, that help a person remember (while conscious, not hypnotized); that disable defenses and center one in a single feeling-state then magnify that feeling to where it overflows pain and tension from the body-mind. Nathaniel Branden’s sentence completion and Death Bed Situation (see blog post Friday, October 4, 2013) can unearth completely forgotten but identity-forming emotions. Gendlin’s Focusing process identifies those subtle and amazingly complex body-based sub-emotion states that can only be described in poetical or action-type phrases. For example, at age seventeen I knew I'd be going off to college to major in philosophy. Had I Focused on the body-feeling of “philosophy,” or “I’m going to study philosophy,” I would have read terrible meaning-sensations of deadness, abandoning of my life, self-imprisonment in an ivory tower of useless ideas. Yet Focusing deeper, I would have reached feeling sensations of an abortive child, not able to be a college student, not able to be an adult. Vereshack’s technique of body congruence recognizes that we are defended by virtue of sitting upright in a chair: That posture reinforces the adult persona with its tendency to linear, “daytime” thinking. Better, if possible, to lie on a mat undefended, or to let body position conform to one’s feeling: fetal, contorted, hunched, enraged. His technique of sound congruence allowed a brilliant scientist to groan and growl, guttural and visceral, like someone in a horror movie being tortured – one with his past abuse pain, finally spoken and heard.

Besides technique there is atmosphere: what creates a “room of truth.” I confront euthymic (fake happy) laughter and the intellectual persona – help the child come out; dim the light to foster an introspective mood; encourage her to take her time finding a feeling where it doesn’t seem to exist but must. Psychoeducation about her unmet need for empathy – to be “seen” for who she is – can be very poignant and evocative of emotional memory. And there is momentum, where too often the client may lurch onto the dry land of conversational counseling, may need my own silence – no conversation – as encouragement to descend into her depths again.

In addition to all these factors, and more, is the underlying “ether” of the client’s acceptance of being somewhat undone in order to be remade. That’s quite a drastic notion, but really not bizarre when we consider the mess, or the wrong that people feel their life is. Nevertheless, I find that most people do not want the intense work necessary. That leads me to go where they want to go, but with occasional reminders that there is an ocean beneath their boat, and sharks and treasures in that ocean.

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* James Gilligan, M.D., Violence, 1996, Random House / Vintage Books.  “In the course of my work with the most violent men in maximum-security settings, not a day goes by that I do not hear reports – often confirmed by independent sources – of how these men were victimized during childhood.  Physical violence, neglect, abandonment, rejection, sexual exploitation and violation occurred on a scale so extreme, so bizarre, and so frequent that one cannot fail to see that the men who occupy the extreme end of the continuum of violent behavior in adulthood occupied an equally extreme end of the continuum of violent child abuse earlier in life” (p. 45).