Sunday, October 5, 2014

Case #114 - Brewing anger, releasing pain

Melanie was keen to work. However, before we jumped into her issue, I firstly shared something about where I was at in relation to her. This can be a component of the relational Gestalt approach - for the therapist to include their own experience and phenomenology, setting the ground in the therapeutic relationship.
I told her I enjoyed her warmth and sunniness, and at the same time; I felt a genuine desire to support her learning and awareness; and, I also experienced her stubbornness with taking in new information, and integrating that. I told her that I could recognise some of my own stubbornness to learning, as reflected in her way of being.
Sharing my own limitations and similarities helps reduce the shame that could be associated with such feedback and evaluations.
We then attended to her issue. She talked about her pain regarding a boss. She often thought about the situation, one of tension, stress and unhappiness for her, a situation that she felt a lot of pain about.
She outlined some of the details of the situation, as well as some of the previous context.
Then it became clear to me - that is, I got a clear figure myself. In Gestalt, we say that the figure is co-created. It emerges out of both client and therapist ground.
Underneath anger there is generally some kind of pain. Its often useful in psychotherapy to find the underlying pain, and this is the approach used in more subtle approaches such as Family Constellations. It can allow for a less attacking communication.
However, in Melanie's case, she never moved to anger. She always stayed at the pain stage. Anger is useful as it moves the pain forward, outward, and is a spontaneous way to mobilise appropriate action.
So in her case, she needed help in moving her pain into anger. Because she had not being doing that, the pain simply 'sat' there, with no change or resolution.
So I invited her to 'put the boss on the pillow' and speak to her directly. I encouraged her in this experiment to transform her pain into direct anger.
She was able to do this, though she found it difficult.
She felt better, but said 'I usually avoid conflict of this type'.
This was also a key, so I asked a field question - 'what has organised you to be conflict avoidant?'.
She explained about a previous work situation, where she had not been treated well; she had held back and contained herself in that situation, but then had finally exploded. She was warned off any such expressions in the future by her boss at the time.
So it became clear that she was working in a conflict avoidant environment. This gave a context - important in paying attention to the field.
I further explored her historical field; I asked about family context, and she described how as a child she had been the teacher's pet, and so had got a hard time from the other kids. So she learned to try to avoid such conflicts.
I acknowledged the impact of these contexts, and then brought her back to the present, and the possibility of expressing her anger. She said -' but if do, I will get into conflict, and then I will feel pain'.
This represented her 'creative adjustment', her way of processing experience. It can be hard for people to do something different, as the habitual way of responding can be deeply ingrained.
So I tried to give her support on two levels.
Firstly I challenged her belief - this was a cognitive intervention. I suggested that it was in fact the opposite way around - if she was willing to express her anger, she would not be holding onto the pain anymore.
Secondly, I provided the practical support of an experiment which involved helping her explore a skilful way of dealing with the expression of anger in the workplace.
Then came the phrase which I had come to recognise as her stubbornness - 'yes but'.
Fritz Perls would say - anything before the 'but' is a lie. In other words, the so-called 'yes' actually meant 'no' when followed by the 'but'.
Because I had a history of experience with Melanie, and had in fact brought up this very issue right at the start, I knew to decline to 'help' her further.
I said - 'ok, here it is, your pushing me away'.  She said - 'no you are the one who is not going to help me, its you pushing me away'. I said, 'you are pushing away my help - I will leave the work with you'.
Here we see a confusion at the 'contact boundary' - she is not in touch with her pushing away behaviour, so she thinks (quite often) that others are rejecting her, without recognising how she sets this up.
So I stopped. She was not happy at all, but I was not willing to get into a power struggle about her wanting help, but then refusing it when its offered. In the olden days in Gestalt this was called 'bear trapping'. Although this term is rarely used now, and could be used to disparage a client, it does describe a certain phenomena. The trick is to see the behaviour, refuse to pander to it, yet remain supportive and available for real connection.
Melanie brewed on this. Sometime later she started getting really angry. This was a positive step from my point of view.
She said 'I want to pinch you'. I let her show me how- she pinched my arms. I said 'I can feel how angry you are, and I can see in your face how angry you are'.
She wanted to keep pinching me. I said - I really get that you want to hurt me right now.
This was her sadistic side, the product of a lot of stored pain. Now there was a safe place for it to come out, there was a lot of history and a lot of force in it.
However, this is obviously not going to work in relationship. So I invited her to a therapeutic wrestle - meeting hands, pushing against each other.
I could then feel the fury in her arms. We did this for a while. She wanted more.
It was time to finish though. And so I stopped.
Again she was frustrated. What emerged underneath her smiling face, her friendly manner, and her containing the pain within herself... was a fury, and the way she manifested that was though control.
Declining to be controlled is a tricky thing in psychotherapy;  although it is necessary,  it can be easily used to blame or pathologies a client, which is not of benefit.
This is an example where 'frustrating' the client is a healthy intervention - not from an idea that its good to confront the client, but from the necessity in the moment of managing  the 'contact boundary'.  

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