Wednesday, April 29, 2015

Case #141 - Protective behaviours

Cheri hardly spoke. She appeared extremely shy, and mostly just watched what happened in the group. On the occasions she did say something, she was tentative, seemed nervous, and did not use many words.
She finally came forward to do some personal work.
She relayed how recently her cousin - Milly - had returned from overseas with her husband. When Milly walked with her, she was 'too close', and Cheri felt uncomfortable. While they were walking, Milly brushed Cheri's breast, something she was not ok with.
She then explained that since she was a child, her cousin had acted quite sexually towards and around her in a variety of ways. As an adult, Milly had showered her with gifts. The family had not understood Cheri's discomfort, nor her distancing from Milly who seemed 'so nice'.
I asked her feelings - disgust, and shame were primary.
Shame is an indication of the need for support, so I talked with Cheri about support - what I had to offer her in the present, and my availability to be present with her in revealing such a very personal matter.
Although such things are the content of psychotherapy, its important to explicitly acknowledge the support necessary, and available, in the present for the client.
A friend had suggested that Cheri 'just tell her to stop it'. This is the kind of simplistic advice one might expect from a friend; therapy offers a different route.
Firstly I gave Cheri validation. I acknowledged the validity of her need for support on this delicate issue, the value of her bringing it up with me; I told her that she was not a bad person (part of the experience that goes with shame), that she didnt do anything wrong, and that it was not ok to have her boundaries invaded by anyone.
This is a little the way one might talk to a child - carefully explaining certain basics. This was not done in a patronising way, but rather in a way which recognised that she had never received these messages, and needed some basic understandings to be put in place.
In this role, I do take a kind of parental, or helpful-adult role in relation to her child-self.
I introduced what are known as 'protective behaviours'. These can be taught to children, usually at school, from a very young age. They let children know that their bodies are their own, that they can speak up if someone uncomfortable happens, and they always have a right to say 'no' to any physical touch that they dont like.
So I explained all this to Cheri: she had never heard any of this as a child, and even as an adult, did not fully understand it. Its important to not assume people know that they have a right not to have their boundaries invaded!
I also sketched out a scenario for Cheri. I asked her to picture me as the adult, sitting both her and Milly down when they were children, and talking to them directly and openly about this matter - saying something like 'sexuality is ok, but its not ok to step over someone else's boundaries'.
This imaginary exercise gave Cheri the experience she never had - of being supported in a very vulnerable place, of having boundaries made clear, and of the topic being talked about in a natural and non-shaming way.
This can then provide a background experience she can draw on...and potentially empower her to say something as an adult.
We then shifted to adult mode, and I discussed with her how she might speak to her cousin directly about this matter now.

Friday, April 24, 2015

Case #140 - The circle of deep support

Damien said he was looking forward to the group, curious about what he would learn.
This is a passive position - it doesnt declare anything about himself.
So I asked him to imagine looking back on the group, and be specific about what he might have learned that would be interesting or helpful for him.
He said he would have liked to learn about dealing with rejection.
So he was set an exercise - to go around the group and name who was safe and who was unsafe. Then to pick 4 of the people who were unsafe, then to pick one of those.
Damien sat in from of him. He said he was expecting to be rejected. When asked to be specific about how that might happen, he couldnt - he reported feeling confused.
I took this as being a sign of dissociation - that is generally the case when someone reports confusion and cant focus on details. I asked how much in his body he felt - 10% he replied. This confirmed the level of his overwhelm, and made it clear that the therapeutic work had to proceed with a great deal of support.
So a small circle was created in the group, to increase the safety level for him. Each person made an attempt to understand how he was feeling. This helps take the focus off him, and provide a sense of being seen.
I was in the small circle, and I also spoke to him about my understanding. I said - 'I guess that you might be feeling in a kind of soup, of rejection, shame, and bruised feelings'.
He replied this was true.
I knew this because all the symptoms he showed were those of shame, and I know how difficult it can be for anyone when they are in the midst of such feelings - how lost you can get.
So next I invited each person in the small group - myself included, to share with Damien about an experience we had at some point in our lives of feeling shame.
This again took the spotlight off of him - very important in working with shame - and gave him a sense of the support that comes from feeling you are not alone.
I then invited the group to hold hands, including him. I asked how much in his body he felt - he reported 60%. This was a major change, and indicated the work had been effective.
I pointed out that he was no longer alone. We then did the same thing in the larger group - hold hands, and I asked him to really look people in the eyes. In this way, he was able to stay grounded, to really feel the connection, and draw strength and nourishment from it, rather than be scared of it.

Friday, April 17, 2015

Case #139 - Failure to protect

As I sat with Sally, I asked what she was feeling. She reported feeling anger, sadness and fear.
She talked about her dog, and how one time when she was out walking, a large mastiff attacked her dog and took a large bite of of her.
Sally was distraught, not only from the experience, but because she didnt feel that she could protect her dog.
This is a scary and upsetting incident, but there was also something about the way she said 'couldnt protect' that had a particular emphasis.
I wanted to know more about that aspect.
Sally then talked about an experience 20 years previously, where she had wanted to visit her family, and her husband had stopped her. She was trapped, and very unhappy.
She got ready to escape, with her son. But her husband caught her, and hit her. Her son was sobbing at the time. She had a similar feeling - she didnt do enough to protect her son.
This piece of unfinished business had stayed with her for all this time, being reawakened by the dog attack.
So I set up an experiment. I asked someone to play her ex-husband. I invited her to tell him exactly what she wanted to say at the time.
As she did so, there was a huge release of emotion that had been pent up for so long. I encouraged her to feel those feelings circulate in her blood - to flow to all parts of her body. This was important so it wasnt just about the external expression, or the release, but the full awareness in the present of all the feelings she had set aside.
After this, she felt profoundly enlivened, and the incident with the dog no longer had so much traumatic valence.

Friday, April 10, 2015

Case #138 - Angry eyes

Lilly lived with her grandmother from her mid childhood. She went overseas as an adult, and returned after 10 years to care for her parents. She reported feeling very angry at her parents, even feeling hate.
She reported a range of other issues - a child lost in childbirth, issues with her husband whom she was about to divorce. She had not told her parents about any of this, as she was afraid of their blame, especially her father.
I commented that this was a train full of big issues, and I would only deal with one today.
I let people know this so they have a realistic expectation of the therapy. In Gestalt we generally say, we just deal with one 'figure' at a time, that is, per session. If that is integrated, its more powerful than trying to solve everything at once. Its also a way of reminding myself that I dont have to do everything.
I brought her into the present, and asked what she wanted from me - she said a hug.
As we hugged, I could feel her tense still. I invited her to come into the present, and take it in. She relaxed.
I could see her issues with her father were deep seated, and complex. So I wanted to bring these also into the present. I invited her to imagine I was representing her father, and tell me/him that she was afraid of being blamed.
This facilitates what we term as 'good contact' in Gestalt - a fully owned statement is the start.
I then asked ask me/her father for someting.
Again she was afraid of blame. As I looked at her, I noticed her eyes - they were full of strong feeling. I asked her what she felt - she didnt know.
When someone is afraid of being 'blamed', often they have their own storehouse of blame, which they see in the other person.
I sat there for some time with her, patiently, just looking at each other.
She said 'I want to throw things, to smash things'.
Now she was getting in touch with her anger.
I said - you are showing me with your eyes how angry you are - and indeed, I could see that in her eyes.
I told her - I will make myself fully available to you, for you to really communicate with me about how angry you feel.
Lilly looked at me, very hard. I encouraged her to let the anger come fully into her eyes.
Then BANG - it was like she hit me. But she had not moved, or touched me. She let her full anger come out through her eyes. It went through my body like an electric shock.
I said 'I get it now'.
In that moment, I truly 'got' how angry she was - not just because she told me, or because I could see it, but because I allowed her anger to impact me, and she allowed her anger out.
This was a profound form of contact. It was strong and enlivening for both of us. It was profoundly satsifying for her - no longer in the victim role, and now fully able to own and be present with her anger; and to have me receive it, without reaction or collapse.
In Gestalt, we see good contact, in and of itself, as curative.

Friday, April 3, 2015

Case #137 - A terrifying wait at the train station

Evelyn's whole body was tense. She said she found it hard to sleep, since she was a child.
I wanted to know about the tension. I asked what happened to her when she was a child.
She told a story - she was 5 years old. Her mother left her at a train station, to wait, while she went shopping. She told Evelyn to stay there, until she came back. It was quite some time.
Evelyn said a similar thing happened one time with her father - he asked her to wait at the train station until he came back from an errand. But it was dark, and she was scared.
Clearly, these two incidents were highly traumatic, and the fear had remained in her body until adulthood, continuing to manifest in the present, as tension.
This is the 'creative adjustment' in Gestalt, the way of surviving from childhood, which becomes embedded in how we are in the world.
The context was crystal clear - so I wanted to work directly with that setting in the field, bringing it into the present, as we do in the Gestalt experiment, allowing something new to happen.
So I asked the group to wander around, representing people at the train station.
I asked Evelyn to select a woman to represent a female who felt like a safe person when she was little - an aunt. I asked who would have been a man who was a safe person when she was growing up - she said noone. Finally she said the closest person would have been her aunt's boyfriend
So the representative for the aunt  stood on one side, and I (representing the aunts boyfriend) stood on the other side of Evelyn.
Replicating the scene, I asked her how tense she felt - she reported 10/10.
I then held her tightly with one arm around her shoulders, and the aunt-representative did the same from the other side. I talked to Evelyn in the way she might have needed as a child - telling her that her parents were away, but that she was supported right now, and safe, and we would stay with her until they returned.
She shook, she cried, and I kept bringing her into the present experience of support, encouraging her to take in the new experience, to breathe it in, and ground through her feet, at the same time as holding her firmly, so she could also let go, and not have to hold herself together in way she was used to.
The experience was very intense for her. After some time, she started relaxing, becoming more steady and more able to 'stand on her own two feet'.
At the end, she reported her tension was 1/10 - a dramatic change.
This experience may or may not be permanently 'curative'. What is more important is that it introduced novelty - support, into a place where she has never experienced support. It allowed her to not only have a healing experience, but learn to take in support where she is used to holding herself together.

© Lifeworks 2012


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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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