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Monday, November 25, 2013

Case #38 - - The woman who failed


emma’s concern was failure. She failed at everything - had 5 accidents working for one company, made computing errors for another, on and on, she felt like a failure.

As she brought this concern up, I was wary. She told story after story, one merging into the next. She was weepy, collapsing, and I could see myself working with her for hours and still not getting anywhere. She also mentioned the problems she was having with her parents, after moving out, feeling very angry towards them, suspicious of her father and his motivations. She was clearly desperate for help, and that very desperation put me off. I found myself reacting, wanting to pull back.

So I knew I had to move straight into the heart of it, and include myself.  I said - lets deal with failure then; its happening right now - you are already failing with me - your style is having an impact on me. She nodded - she could sense that I had that reaction, and of course, this was her familiar experience.

The first step for someone locked into a self destructive way of being is to bring it completely into the present, rather than listening to stories ‘about’ it. And the best way to do that is to notice how it is panning out in the relationship.

I then asked her to play a little game with me. I wanted her to guess how I was reacting to her failure with me - after each two guesses I would tell her if she was on the mark or not.

She guessed that I was doing my best to be patient. I said no. She guessed that I was feeling compassionate towards her. I said no.

I told her - I feel irritated with you.

Then I asked her to guess just what that felt like for me. She guessed I was suppressing those feelings. I said, thats only a little true. She guessed that I was was feeling that in my belly and chest. 

I then told her that in fact I was feeling angry towards her, and that I felt that in my chest as a kind of internal pressure.

I asked her to do this experiment because I wanted to bring her out of her morass of self pity and locked-in failure-formula. I wanted her to see that it was a cocreated experience, and that she wasnt actually the only one suffering. It was also horrible for me. I also asked her to do this, as she was clearly paranoid (with father), and it was better to practice the ‘guessing game’ explicitly, and have a chance to be corrected, than being isolated in her projections.

Next I invited her to swap seats. I would be her, and visa versa. So, I was sad, dejected, feeling like a failure, and she was the angry one. 

She noted about herself in the role ‘I am just like my parents - lecturing, yelling, criticising, putting me down, pressuring me to perform’. 

That was useful because again, it pulled her out of her identified part of the polarity, giving her a larger experiential sense of what was going on.

I then gave her the metaphor of recruitment - its like she recruited me for the job of being angry with her, and did it so successfully that within a minute of listening to her I did indeed feel angry. I also pointed out that on some level I agreed to play the other side of this, and it was the sadistic part of me which acquiesced.

I explained this was two person game. She said - actually, when she was playing the angry one, it reminded her of the pressure that also came from her the grandparents in the same way.

So in fact, this was how her field operated. 

I gave her another metaphor: a script, and willing players. She reproduced the script in each area of her life. She agreed. This framed what was going on in field, rather than putting it in individual terms (her problem), and pointed to the compulsive and inexorably repetitive nature of her experience, and other around her, in this transactional process.

I then invited her to choose any famous play which she was familiar with, with characters in it that were similar to her personal field. She described one particular drama which had characters who exactly echoed the whole process we had just uncovered.

I then asked her for an example of another story - film or theatre, where there was a different script. Here I was looking wider, to other resources in the field, other ways of being. She picked Harry Potter, and when I asked her which character she wanted to be, she said Harry.

So then I asked her to look at me with a Harry Potter look. This was because the way she first set up the whole victim script was by using her eyes - she looked at me in a particular way.

She tried this experiment, and as we explored the nature of Harry Potter in the films - his inability to be killed, etc, she began to get a more solid sense of herself in his guise. 

She felt a shift in her identity, and on the other end, I experienced her differently.

To go through this process required me to be very present with her, and very honest all the way. I worked with the relationship, with a variety of experiments, the last of which was the ‘ground shifter’...but required everything that went before.

Sunday, November 24, 2013

Case #37 - The abusive spear, and the protective spear

I guessed Celia to be in her 30’s, but in fact she was 51, with a few kids. What was remarkable though was just how hard a life she had had, yet she appeared calm - and hence, her youthful appearance. These were things that I didnt have the space to explore, though I noted for any future work. Its always important to recognise immediate impressions, and even with familiar clients to ‘look with new eyes’ in order to note discrepancies or things of relevance therapeutically.

The issue she brought was fear of moving into the line of work she had been training for in the last 10 years. She wanted to be social worker, and now her children had left home, this was her stated goal.

Rather than try to work on her confidence or find out her fears, I wanted to find out about her context - the support in her environment for her to do so. She did have the professional support of a group of social workers, so that was no problem. 

However, her husband said he would divorce her if she went ahead in and moved into this line of professional work. This was a fairly strong reaction, but not entirely surprising given the patriarchal culture in which this session took place.

However, when I enquired further, she revealed she had been in a domestic violence relationship for decades. 

It struck me as odd that in the 10 years of study and therapy related to her social work aspirations, this had either not come up, or her teachers had somehow not felt responsible to see it was dealt with.

In therapy, its important to focus not only on feelings, but also on context, particularly if that context is currently abusive. This needs to be kept as a focus of therapy.

So I was unwilling to deal with other issues, unless the core of this - her understandable fear - was addressed. She said the violence had stopped only recently.

I told her my own feelings as I sat with her - open to her, feeling very connected with the seriousness of the issues, wanting to support her, but also very cautious and wanting to proceed in a way that was respectful.

I pointed out that fear was almost a ‘member of the family’. She agreed. I asked her to give an identity to fear - she said a figure with black clothes, large eyes, a smile and a spear. She described it as ‘eerie’.

I asked for more detail - what the clothes looked like. I want to really ground her in her connection with the fear. Then I invited her to participate in a Gestalt experiment: ‘be’ the fear - to show me how the fear stood, with its spear, and big eyes.

She did so - and I did it with her. Its often good to do such experiments with the client.

Then I asked her to sit again - I didnt want to spend too long on that. Describing, being it, was in itself a great deal.

She said she felt like I had given her a lot in this process, and she felt reluctant to take more - like she had to give something back to me. She explained she was schooled in ‘being there’ for men, and though she rebelled against it as a girl, it was part of her conditioning.

So I ‘went with’ this situation, and stopped. I said, ‘ok, then what would you like to give to me in some way; I am open to receiving’. We sat there in silence, and she then said she wanted to give me her appreciation for what I had done so far. 

After stating this,  she felt safe again with me, ready to proceed. Its very important to listen exactly to whats happening with the client, moment by moment, and be with them in those places, going with their rhythm.

I asked her where fear was now - she replied that it was inside her. She said its spear was poking into her brain hurting her.

I moved into a directly relational mode with her. I told her that I felt sad at the pain she was feeling, deeply sad. I wanted to ‘rescue’ her, to protect her, but didnt know how to do that.

She was very moved, and we sat there for some time in silent connection. This was a key shift - someone who cared, who could be with her, in a protective mode, yet not rushing into fix things.

This was an ‘I-thou’ moment, two human beings fully connecting. I was therapist and she client, but in that place, we were two people, sitting with each other, and the profound pain of the situation. I took her pain very seriously - not just a playful experiment, not just a figure of fear, but in fact, several decades worth of fear related to the violence. 

Sitting in this place, both our hearts opened. I was profoundly touched, and so was she. We both stated this. 

Then I said - well, I have a spear too, its a spear of protection. I invited her to ‘take me in’, along with my spear, into her heart.

She could do this easily, and had tears. She felt safe and cared for.

This was is referred to as a ‘self object’ - taking ‘me’ in, meant that she had an authority figure inside her who was FOR her, as her previous experience authority growing up was suppressive, and she was expected to be there FOR them men in her life.

Although not a huge amount ‘happened’ in the therapy, it had a very big impact. At the end I asked her about where her fear was in relation to moving into her profession. She said, she didnt feel intimidated anymore. I asked - even at the cost of divorce? She replied, yes.

Now, this is simply one piece of work in what needs to be ongoing therapy work to do with the relationship, and dealing with it after the long phase of violence. I would want to keep a careful eye on this, as its still possible that it could revert to violence, and as a professional, as well as a caring person, I want to make sure I am not in any way part of that cycle.

Saturday, November 16, 2013

Case #36 - The woman who didn't feel anything

Brenda spoke of not having a clear identity - she easily lost a sense of boundaries, and over identified with others.

She also spoke of being shy, not liking to be photographed or put under the spotlight.

These were indications of a need to proceed cautiously and sensitively, and aware of potential shame issues (exposure related).

I let her know that I was fine not to probe further than felt ok with her.

I pointed out we were in front of a group of people, and asked how that was. She said they were looking at her, but she didn't feel like she was being seen. I asked if thats because of their limited knowledge of her, or because she was hiding out. She said both.

This helped frame for me the relational dynamic. So I brought it back to her and I - I was looking at her, but was she also hiding out from me. She said yes, she did that with everyone.

This of course sets up a relational impasse - a part of her longs to be seen, but then another part doesnt allow that. This was a warning that I had to proceed carefully, or I would simply become frustrated and trapped myself in this dynamic.

So instead of probing, I told her the things which she had already revealed for me to see about her - the pieces of personal information she had shared. I also reported what I saw - for instance the colours of the clothes she was wearing.

This created some ground of what was between us, without asking her further questions, indicating that I was present with what she was sharing and what she was making available. In cases of shame its important to share something from oneself, rather than probe the other person too much.

Still, her eyes were glassy, and she reported that she was drifting off. This indicated that the contact was too much. So I asked her where she was drifting...she said into a place of countless worlds, past lives.

This indicated to me dissociation, and that safety issues were primary here.

I suggested that she could in fact drift off into a dreamy state, and I could do so too, and I could invite everyone in the group to go into a dreamy state, and we could all just sit together, in our dreamy places. 

This suggestion took up her momentum, and encouraged further movement in that direction. In Gestalt this is called the paradoxical theory of change - being with what is, and leaning into it.

She said ‘I dont feel anything’.

In other words, she was completely dissociated. In this place, only certain type of contact is available. 

I asked her what kind of support she needed, to feel safer. She said - I don't want to be seen.

So I told her I would look away from her, and at the same time,  I shared my sadness - that as I would not be looking at her at all, not be trying to see her, her hiding out would be fairly complete. I told her I felt warmth towards her, but couldnt find a way to reach her.

Brenda looked at me and said ‘I dont like to take in support’.

This was the revelation that gave me an indication of how to proceed.

I suggested an experiment - she hold up two hands - one hand pushing away, the other hand open to receiving support.

We did this and she was able to take in my support - I slowly reached my hand to her open hand and held it.

She then reported that there was a ‘force’ which told her not to feel. I asked someone to stand in front of us, representing that force. She couldnt/didnt want to identify who that represented, which was fine.

So I got her to make a statement to the force. She said ‘I will listen to you when its useful to me, and otherwise, and I will allow myself to feel support’.

This was a statement of differentiation and integration.

She could allow herself to feel, take in support, come into relationship, be seen in that place, and have a sense of choicefulness.

This work was slow, and required me to constantly respect her boundaries, not inquire into too much detail, even of what she was feeling...yet not give up either. Usually people react to someone who sets up these kind of privacy boundaries - either pulling back, or meeting in a disconnected way, or overwhelming the person with interest or even kindness. What is needed is a neutral presence, with enough warmth, but not too much, enough interest, but not too much -  this is called attunement, and is a core relational skill

Monday, November 4, 2013

Case #35 - Angry at the ex

Marion raised the issue of shared parenting arrangements with her ex husband. It became clear that this was not a substantive concern. What was more relevant was her discomfort and unfinished business with him.

Before going into the detail I said - my experience when I look at you is as if your eyes are piercing me. That has quite a strong impact on me. What I have in common with your ex husband is that I am a man, and I imagine that some of this energy you feel towards him may also be present here with me.

I asked her what her issue was, and she said, anger.

I asked her what she was angry about. She started to tell me a very long story about the circumstances...after some time I asked again: ok, so what exactly are you angry about. Again she started giving me more of the long story. 

I had to ask her several times until she was able to state clearly, directly and succinctly that she was angry because she felt betrayed by her ex-husband, as he had stopped supporting her financially in order to put money into the business he was running. She was also angry because he lied about this, to her, and to her parents (whom they lived with).

I said, yes, you look angry, I can see it in your eyes. What do you feel right now?

She started to tell me some things that were more about her evaluations, judgement and opinions, than about her feelings.

She did say, ‘I am biting back my feelings’

So I invited her to imagine that I was her ex husband, and ‘take a bite out of me’. She started explaining how she felt that she was also to blame in the situation.

So I focused her again, and asked her to tell me something directly, starting with the words ‘I am angry…..’

Finally, she started to express herself, directly, stating the things that she was angry about. 

I acknowledged her feelings, acknowledged how I could see and hear her anger...and then how I could see this shifted to tears - and so I could also see her pain.

I kept encouraging this direct expression, and she kept alternating between anger and tears. As she felt heard, she was more confident about expressing herself directly. There was a lot of silence as well, full of her feelings, and my simple acknowledgements.

In the end, she felt much lighter, and had released a great deal of the pain and anger which she had been carrying since the divorce. 

In order for this process to be successful, I had to be persistent, focusing her awareness, bringing her into her experience by participating in the experiment with her, and by cutting through the story telling, which was part of her way of avoiding feeling too deeply. I provided a relational container for the anger, and supported and encouraged her to express herself...it took some time before she felt safe enough to do so. I also didnt go along with her avoidances; asking her instead to really own her experience.

In response, I gave her acknowledgement, which is the thing she has been yearning for - to be seen and heard in this place. I was not her ex-husband, but the energy was strong enough between us for her to feel satisfied by expressing to me as a representative. My linking in the beginning of the fact I was also a man was enough to invite the strength of her feelings, and my receptivity was real enough for her to feel that this was not just ‘acting’.

What is notable is she did not yell, scream, hit pillows, or even raise her voice. Anger moves in relationship and through ownership, not necessarily through dramatic therapy techniques.

© Lifeworks 2012

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Who is this blog for?

These case examples are for therapists, students and those working in the helping professions. The purpose is to show how the Gestalt approach works in practice, linking theory with clinical challenges.

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Gestalt therapy demonstration sessions

Touching pain and anger: https://youtu.be/3r-lsBhfzqY (40m)

Permission to feel: https://youtu.be/2rSNpLBAqj0 (54m)

Marriage after 50: https://youtu.be/JRb1mhmtIVQ (1h 17m)

Serafina - Angel wings: https://youtu.be/iY_FeviFRGQ (45m)

Barb Wire Tattoo: https://youtu.be/WlA9Xfgv6NM (37m)

A natural empath; vibrating with joy: https://youtu.be/tZCHRUrjJ7Y (39m)

Dealing with a metal spider: https://youtu.be/3Z9905IhYBA (51m)

Interactive group: https://youtu.be/G0DVb81X2tY (1h 57m)