Case #128 - Getting attention, paying attention

Jenny talked about wanting to be brave. She was a young woman, enthusiastic, interested in learning, and vocal.
I commented on the latter, saying she seemed to be good at getting attention…but it appeared to me that she didn't fully enjoy it the attention she got. She did attention grabbing things, but did not seem to fully notice, or take it in. She said that in fact she would like more attention. I joked about her future profession - perhaps being a performer could bring her the attention she wanted.
I asked her to look around the room - everyone was looking at her, she had their full attention. I asked her to take this in, to absorb what was available.
Often people are not fully in the moment and are focused on lack, so its helpful to bring them into the present, to be aware of the 'what is', including whats nourishing.
The next thing she mentioned was not wanting to hear the criticism of her parents. She was talking in a voice that sounded quite young to me - I asked what age she felt - 8 years old.
I connected her limits on taking in attention, to her limits in listening to criticism. She seemed unable to discriminate between negative and positive attention.
She then revealed she had certain symptoms - ringing in the ears - which sounded to me as if it was Tinitus she was describing.
She explained that she was running away from this ringing sound - distracting herself by various means. It certainly seemed like it was likely to be related to the 'not listening' she had been talking about.
She presented me with several other themes, e.g. - 'fear of money'…but I told her she was moving too fast for me.
This is important to interrupt a client, who may be skipping from one topic to another. In this case, it was her version of moving on quickly, rather than staying with what was happening. I told her that whilst she was good at getting my attention, I found myself losing interest soon after - she was not good at keeping the attention she was getting.
So I asked her to explore patience - slowing down, taking in deeply, being fully present. And from that place, to express herself with presence, rather than drama.
She said - 'the ringing in my ears is getting in the way of doing that. Why do I have to have it?'
I declined to answer the 'why' question, instead I moved into confrontative mode and said - 'get used to it. Its not going to go away'. This was using my therapeutic authority to stop her in her tracks. Sometimes such strategic interventions, used carefully and in context with the right timing can be helpful and effective for significant avoidances.
She had been avoiding dealing with the Tinitus, vaguely hoping it would go away, using it as an excuse to not listen, or to move on quickly. Although I believe that such conditions generally come out of a psychological and field configuration - fairly evident in this case with not wanting to listen to criticism - such things also become physically embedded, and not necessarily so easy to change. Sometimes what is necessary is acceptance, before something might change - or not.
In this way, Jenny calmed down, became more still, and was able to experiment with listening despite the Tinitus. This was also part of her growing up process - from the 8 year old, to her young woman self, an adult for whom the creative adjustment of avoidance and attention seeking was no longer necessary or helpful. And an adult who could accept that there were certain limits, and some things had to be lived with.
In many ways, therapy is a 'growing up' process, no mater what age the person it. It about supporting maturing, development, awareness, and capacity for quality contact. Sometimes this requires energising a person; sometimes it involves helping them to accept certain limitations, internal or external.

Case #127 - Guardian policemen

Linda brought a dream. She was driving a car, and the brakes were not working. Also, she was driving a truck and the same thing happened.
In Gestalt fashion, I  asked her to relay the dream in the present tense. Next I asked her to play the different parts - the car, which was broken down, the brakes, which were not protecting her, and herself, driving and being scared.
I invited her to talk to the brakes - she asked them why they were not working. In Gestalt we encourage changing why questions into statements. Her statement was then - 'I need you to work, to keep me secure'.
I then moved from the dream to her life, to find out where this was true. I asked if she felt secure in her current life - with her husband and parents. She replied she was. Yet there was hesitation. She said - 'on the outside, how it looks'.
I wanted to know what was happening on the inside. She paused, then burst into tears. She related a memory that had recently surfaced, that when she was a very young child - in her cot, a man had come into the room, and she said that therefore her mother had not protected her.
I asked if she could remember anything else, but she couldn't. However, the emotion was very strong, and she was clearly in profound pain.
I did not need to ascertain whether this was 'true', or get any more details. The fact is that she felt deep distress, and that security and protection were important issues for her.
I asked her to go back to the dream, but to continue it - to see what would happen if she kept dreaming. She talked about going for help, and then realised she had left her child in the broken down car, which made her very anxious. Then a police car came by, and she asked for directions.
This gave an important clue - an authority figure which was available to provide help.
I then suggested a change in the story of the dream - this was my first intervention. I gave her the idea of stopping and telling the police about the situation, instead of asking for directions, then they offered to bring her back to the car and her child. She rode in the police car, and they got out with her, to help her deal with the situation.
I asked what she felt with this story line I offered to her - she felt much better - both during my suggested change, and afterwards.
I suggested to her that some people have guardian angels - she had guardian policemen.
Then she pointed out that this didn't help with what had happened to her.
That is a trap people can fall into - wanting something that will entirely change their trauma. Gestalt works with trauma, but adding a new direction, rather than looking for a magic bullet.
I suggested that she could invoke these guardian policemen, whenever she felt insecure. She said 'but I don't have much faith'. This was an important indication that she was more attached to the 'problem' of the recalled event, than able to accept some nourishment and support in the present.
This may call for long term therapy, or at the least, an in-depth series of sessions. This however is not always the answer, and its not always available. What is available is support in new forms, and then it becomes a question of how much the client is willing to take that in.
So I proposed some homework - to create a small alter table at home - put  some things on it, like a Buddha or relevant sacred object on one side, and a little police car on the other. And then to daily give thanks to the guardian policemen.
These images  came out of the dream,  from her own ground. Its an odd idea - guardian poliemen, but provides a strong resource, needed to deal with the energy that draws her back to her pain and insecurity. This provides at least an operational intervention - it remains to be seen if its sufficient, or if more therapeutic work is needed.
This relates to 'trailing edge' and 'leading edge'. Trailing edge refers to the past, the trauma, the unfinished business. This needs to be attended to, but it can also pull us down, become endlessly fascinating, more so than the present.
Leading edge is the future, is the present moving into a new future. Its what draws us forward. Its also important in therapy. Good therapy finds the right mix of paying attention to both sides.

Case #126 - Moving into the time bomb

I spent some time trying to find what the issue was for Iona.
She said she was not in touch with her feelings. Friends said variously she was warm, or angry, or other descriptions, but she could not really identify with any of them.
I found this a little odd, as I experienced her as full of liveliness, energy and passion. She was animated when she spoke, she was interesting, and appeared engaged.
Of course, many people are out of touch with their feelings, but there was still something more I needed to understand. Then she told me she felt unhappy, a lot of the time. Again... there seemed to be something else going on, more than appeared on the surface.
I asked how long she had been unhappy - she said since her pregnancy, 9 years ago. She had conflicts with her mother in law, and her husband, and these had not really abated.
Certainly, external factors can contribute to someone's unhappiness. But this sounded more deep set. The fact that it came on during pregnancy, and lasted afterwards made me consider depression. She did not appear depressed. But she I enquired into a range of symptoms that tend to go with depression - lack of pleasure in life, lack of motivation, trouble with sleep - she said yes to all of it - it all added up.
Whilst diagnosis can be restrictive and limiting, it can also be helpful to name ongoing patterns, such as depression which indicate something more than passing unhappiness, and which require serious attention.
I explained this to her, and also pointed out that this was something that required ongoing support, and would only shift over time. Its important to give people realistic expectations of what therapy can achieve.
She said she worked hard to mange her very busy life - child, family, work. She felt exhausted most of the time.
It became clear to me that this was what could be called 'high functioning depression' - she is coping with her life, thus masking what she is feeling inside.
Her effort was to not sink into the blackness of her unhappiness. Yet, therapeutically, this is what needed to happen, in a supported way. Without going into the depression itself, she would continue in avoidance mode, and therefore be unable to access the feelings which were stuck.
So I invited her to notice her clothes. Her pants were black, and her top had some bright colour in it. I suggested this as a metaphor for her life - bright slashes of colour, but black and unhappy underneath. She agreed.
So I asked her to look at her pants, and for 2 minutes I would sit with her as she sunk into her blackness. She agreed.
This was important, to go into the depression, but do so with company and support.
Tears came to her eyes, which was good, as her feelings were starting to flow, and she was able to share them with me. But she reported feeling stuck in the throat.
So I asked her to lie down. I held her head with my hands, off of the ground, asking her to let me take the weight. This was a way to support her to feel her 'heaviness' and at the same time, feel held. As I slowly moved her head, it was very stiff. I was careful not to push, but just wait every time there was resistance.
I asked someone else to hold her feet, and pull gently, creating some more space in her body for the feelings.
I then sat besides her. Her feelings did start to come up, in waves, with little sobs. I invited her to let some voice be there, but that was as much as she could manage at that point. After some time, she reported her arm feeling numb.
This was an indication she had done enough.
Its important where someone's feelings have not been accessed, to go slowly, and allow time and space for integration. She had take a big step, and it was enough for now.
She reported feeling worried that she was a 'bomb, going to explode'. I pointed out that if she kept repressing her feelings, this could be true. But with opening up, and getting support, she could allow the 'bomb' of her feelings to release in a safer way.
Its important with major issues such as depression to not got too far, too fast. While Gestalt therapy processes and techniques can quickly take a person into 'their stuff', its essential to move at a pace they can integrate. This indicates long term work - at least 6 months of therapy, if not a year. While this may seem a significant amount to some, the alternative is the 'time bomb', impacts on health and/or functioning, or medication which brings its own problems.