Friday, February 20, 2015

Case #131 - A knife in the chest

Aimie spoke of the issue of security. She had fear, and sometimes anxiety about catastrophic things happening. I asked for an example. Her daughter was new to primary school. Aimie made sure that the teacher knew to show her daughter the playground, as she was not familiar with where things were. Aimie was quite anxious that her daughter would know where to go, and waited until the play time, when she saw another man, not the teacher, leading her daughter onto the playground. This brought up great fears in her. She approached the man, and found everything was ok. Nothing bad had happened. But there was a deep pain in her chest the whole day. I asked her about the feeling - she said it was like a knife scratching on her heart. In Gestalt style, I had asked about this in the present, and she showed me the place on her chest she felt this.
Clearly such intense emotions were connected to something deep. Nothing bad had happened in her adult life, to her, or her child. Her life was happy and settled.
Then she spoke of having been left with her grandmother between the ages of 1- 4. During that time, she only saw her mother a few times. Then she went to live with her parents again.
Again, there was the pain in her chest as she was talking about this. She had some some psychoanalysis, and so had gone into addressing this trauma. Yet, the feeling was still very real, palpable, and overwhelming. She understood about the topic. But the feelings were the issue.
So I asked her to show on my chest, the feelings in her chest.
This was because she was deeply caught in the feelings, they were locked inside her, and clearly had not been released.
So she 'cut' my chest with the 'knife' of her hand.
Now her feelings started to move. She shook, she trembled, she cried. She said she felt hate. I encouraged this.
Then she said - 'but I understand, my parents didn't mean badly'. This was the 'insight' she had got from her self reflection, and previous analytic work. But though it produced some measure of understanding, and perhaps a level of calming, it clearly did not address the visceral feelings that were present. So I encouraged her to feel the hate, and express it to me, as if I was the caregiver. This gave her permission, and allowed her to move it out, rather than keep it in. I legitimated her hate - the conclusion of a lot of deeply stored pain.
I tracked her feelings. Next she felt pain in her heart, then her stomach ached, and was shaky. Her face was shaky. I encouraged all these feelings. I gave her a lot of understanding - 'you were left, and even though your grandmother took good care of you, this was devastating for a 1 year old, and impossible to grasp or digest. Its natural that you have all sorts of feelings of fear, loss, anger'.
Then (with her permission), I put one hand on her stomach, and one on her back, opposite the stomach. I felt her shaky feelings, and palpated, in rhythm, emphasising them. She started to cry more fully, cry out. She had locked these feelings in for so long, she needed some help in being able to release them.
I invited her to hold onto me physically. As she did so, she said 'don't leave me'. 'I will be an obedient girl'. Clearly she had, as children do, blamed herself, and tried to internally bargain, hoping that by doing as she was told, her mother would return.
Again, I gave her understanding for this position. At the same time, I invited again the hate feelings  - the unexpressed opposite of the bargaining.
Again she took a 'compassion' position for her parents. I acknowledged the adult understanding she had, but again, invited her into the feelings, and to press my chest with the 'knife' . She did this, and was able to cry out, and speak her anger and hate.
Then she became dizzy. This was a sign she had released a lot of energy, and now needed to integrate it. There is no point continuing to release energy unless it is integrated into the body. She was unused to such a release. So I brought her back into the present. Her arms felt weak. Her back was a bit sore. I contextualised this by talking about her early efforts to 'reach out', finally giving up. Again a wave of emotion came over her. Again she got dizzy.
I walked with her around the room, getting her fully into her body, getting her to look around, come into the present.
She reported feeling very light and clear in her body, in ways she could not remember.

Friday, February 13, 2015

Case #130 - Twisted feelings transform into the vision

Isobel was depressed. She said her issue was a 'twisted feeling'.  
She fought often with her husband. In fact she said it was 'all the time'.  She was a housewife, and stayed mostly in the house. He would take their daughter out to places when he was off work, but Isobel would not accompany them.
She said her wardrobe consisted of clothes that were either black, or white. When she was doing anything, or wearing anything, she was not satisfied, and wanted the opposite. This presents some phenomenology that gives us clues as to the person's field, and how they are in that field. But we dont need to interpret, we can use this as information that the client will give us insights into.
Overall, this sounded like a very unpleasant life to me. I asked if she had any kind of vision of another life, less 'twisted'.
She immediately leapt out of her seat and got her phone. She showed me a picture she kept there - a bench, by a river and a mountain. That was her vision. I asked her to fill  out the vision for me in more detail. She pictured herself living there, alone. Painting drawing, reading. I asked what else. That was it. She pictured herself there, alone, for the rest of her life. That made her happy, thinking of that picture.
However, she did feel uncomfortable (twisted) because she did not even want her daughter there.
This was an extreme vision - total isolation, a life, completely on her own, for herself. This suggests one end of what we describe as a polarity in Gestalt. It also points to one end of the continuum of contact.
I asked how often had she been to a place like this. 'Never', she replied. Not even for half a day.
This surprised me. It was, indeed, a dream. She felt so caught in her current nightmare, she had made no steps at all towards something more nourishing.
I used my therapeutic authority and told her - you don't need therapy for now, you need to change your life. You need to go and be in that place.
I asked what got in the way - what made her hang onto her suffering lifestyle, while twisting herself to look at her vision. She was frank - so her husband would rescue her from her suffering.
I pointed out that after 10 years this hadn't happened, and so it probably wasn't likely to happen. He may not have the emotional intelligence to do so...or in fact, it just may  be that he is not clear  what she wanted from him, and what he could do about it.
So that left her with the existential responsibility to do something different, if she wanted an end to her suffering. Gestalt is all about becoming aware of choices.
I asked about her circumstances. Being at home she was responsible for her daughter, but on weekends her husband would often do things with her daughter.
I pointed out that she could go to her dream mountain place for those weekends. In doing so I was 'giving her permission'. This can be a useful application of therapeutic authority, when someone is stuck. If they don't take it up, it means there are other things in the way. But sometimes, this kind of support is all that is necessary to tip the scales, to help a person change direction.
Isobel became instantly very excited. She could see the realism of my proposition, it would directly meet her hearts desire, and by giving up on her husband rescuing her, this left her free to find her own happiness. She was full of energy. I talked with her more about the details.
I pointed out that if she was willing to find ways to make herself happier, this would benefit her daughter, and her husband as well. It started with her. In this way, therapy supports a healthy selfishness, as a base for healthy relationship.
Someone in the group immediately offered a mountain place he had available for significant parts of the year to her. That evening, spontaneously, her husband phoned and wanted her to go on a trip with her daughter and him. Now she had options. I helped guide her as to how she could explain to her husband her need to be alone. Sometimes its very supportive for people to be given words to be able to articulate their situation. The danger is 'putting words in their mouth', but done with attunement, and respect, it can allow them to hear a direct and clear way of expressing their needs, and acknowledging the other - part of a learning process therapy can offer.

Monday, February 2, 2015

Case #129 - Nothing wrong with you

Annabelle was concerned about some feedback she had got from others, over what people saw as her conservatism around relationship values. She wondered if in fact she was too rigid, and needed to listen to them, to loosen up a bit.
This indicates a willingness to engage in self reflection, and consider feedback. With some people, it might indicate a tendency to swallow other people's opinions - introject in Gestalt language.
I asked questions to ascertain who she was and about her context.
She was living a life that sounded happy and contented, in a nourishing and healthy marriage, and being productive yet without excess stress. The more I enquired the more it became evident to me that people's criticisms of her were their own agendas. She seemed contented with her values, they were working well for her, she did not impose them on anyone else, and she seemed to have a very good sense of boundaries - her own, and others.
I continued probing, trying to find where she may have contradictions we could examine, or perhaps a need or desire to loosen up, or change her values.
I could not find anything. She seemed to be a truly balanced person, living her life in a way which was both internally and externally healthy by any parameters I could apply.
Sometimes people come to therapy, or groups, not to heal trauma or transform neurosis, but simply to learn and grow. Gestalt is actually very much designed for this, and this was Perls' original vision - a way of living authentically, rather than just a professional type of therapy practice, to 'fix people up'.
After some time I stopped asking questions; I did not want to just keep looking for pathology; in Gestalt we take people as they bring themselves - this is the phenomenological method - not to look for hidden motivations. By staying with the person as they are, more gets revealed.
In this case, it seemed that Annabelle's presentation was not out of sync with who she was. I told her that she seemed to be living a wholesome and satisfying life, and I felt touched meeting her, and knowing her in this way. I felt my tears - they were tears of joy.
I told her that perhaps she had something to teach others - many people would like to find how to live like that. And there are many teachers and therapists who have all the 'knowledge', the models, the maps, and can deliver inspiring words, or coach people well. But its another matter to actually successfully live all those principles.
Annabelle was clearly a humble person, without aspirations to be a big name or to big note herself. I told her that made her ideal material as a teacher.
She now had tears - again, of joy. She had been seen by me, and we were both touched. This is what we call an I-thou moment. A place of profound meeting between two human beings. I did not need to occupy the teacher or therapist role in an explicit way. Instead, I used my authority to recognise her, to support her to recognise her own capacity, and to move in that direction.
I also told her, that was my agenda. Perhaps she did not need or want to step into such a role. I did express my hope she would do so, as I saw she had a lot to contribute.
She responded quietly, but positively. So I suggested she consider starting to formalise, in a way that felt just right for her, some kind of teaching role.
Gestalt is facilitative, and supportive in that it involves working with the clients reality. It also includes the therapists feelings, bias, hopes, wishes, and agendas - as long as those are made explicit, and are used in service of the client and their needs, and in enhancing the quality of contact in the therapeutic relationship.
So my response to her was a significant part of the therapy. She did not need facilitating, rather, to be seen in relationship. People were (and usually are) busy with their agendas. What we can offer as therapists is to recognise people; even 'difficult' qualities a person may have can be contactful if recognised in a non-pejorative way. It is also possible, after that, to bring in an agenda, as I did. But the key is to do so lightly, explicitly, and in a way that gives the other person a lot of space to be themselves.

© Lifeworks 2012


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