Monday, October 26, 2015

Case #160 - Missing father

Julie said her issue was deep pain.
She felt a bit nervous with me, so I invited her to ask me a question (rather than me putting the spotlight on her).
She asked me 'how do you deal with deep pain'. I share with her some ways I recently dealt with my deep pain.
Next she shared that she had a fear of abandonment, but she learned to take care of herself in that place, and not depend on anyone else.
I asked her experiences of being abandoned. She said she didn't have anything directly like that, but that her father had worked in another city, and was only able to come home for 1 month a year. So she missed him very much during her childhood.
In middle school she went with her brother to live with him. But her experience of going to school was that of being the outsider, coming to the city from the country, from the south to the north. She felt excluded.
I pointed out that the feeling she described is akin to a kind of abandonment, being left alone.
During this middle school time, she was staying with her father, but he had to work very hard, take care of her and her brother, and didn't have a lot of time or energy leftover for them. She felt lonely there, and wanted more affection from him. She learned to rely on herself.
I acknowledged her feelings, and shared my own experiences of being an outsider. Her eyes filled with tears. She talked about a feeling in her belly which held her back.
So I suggested an experiment - we would sit back to back, and she would lean against me.
She sobbed during this; she was able to lean against me, and finally she settle somewhat.
Then she asked to be held like a baby.
So I agreed for her to put her head in my lap, and I held her. She sobbed again. During the time she asked asked me, as her 'father', if I loved her. I spoke for her father - 'yes'. She asked me if I mattered to her. She asked me several things, wanting to confirm this. I explained 'as her father', that I had to go away to work, but missed her, and thought about her. I guessed that this was likely close to the truth.
The experience was extremely powerful for her. I told her to just let herself rest. She could take in the nourishment she had craved for so long.
In this place, where the experiment has such a powerful context, the experience is very real, and thus significantly healing. The result is a deeply embodied experience of the yearned-for connection, reassurance, and soothing of a pain she carried her whole life.
Sometimes, as therapist, we can give voice to others in a person's life, who they could never really know. Some may question speaking 'for' the father's reality; and its true, its an educated guess. However, being a father myself, I could place myself in the father's shoes, and perhaps understand something about him. In this way, including myself in the therapy, I can contribute. Whats important is that I am not doing this for my own benefit, out of my own unfinished business, but that this is focused on the clients need.
The same thing with agreeing to hold her. I am not in the business of evaluating the 'correctness' of the client's wishes. It seems within the bounds of therapy, appropriate to the case and the situation. If I can be part of a healing process, that is consistent with the client's ground, that feels right to me. I do not see the value of questioning the client's need - I find it better to take it at face value, experiment, and see what happens. If it fits, then good. If not, then we can explore what that is about. Part of the ethos here involves respecting the client as the best expert on themselves, an inherent part of the phenomenological stance.

Sunday, October 18, 2015

Case #159 - Getting unstuck

Linda raised her issues with her mother, who had come to stay with her recently. She said she didn't like being around her mother, who she found 'sticky'. Her mother would ask her for advice, then reject everything she said, and then later ask for advice again. Her mother would take a kind of child role and tone of voice with Linda, who couldn't stand this.
I sat for a while with this. It seemed a clear situation, and a difficult one. There were 'answers' - this was a case of a double bind, and there are various ways to deal with this in therapy. Its also clearly a case where the parent-child roles were being reversed, and the child needs to 'give back' the burdens the parent is putting on them.
But I didn't simply want to follow a theory here, give a glib answer, or provide a clever intervention.
I felt my own sense of 'stickiness' in the situation, and did not want to simply pull myself out of it with my knowledge, or my enthusiasm for helping Linda.
So I sat, for some time, letting the 'creative void' be there, waiting to see what emerged. After several minutes I remembered the 'Gestalt prayer' which Fritz Perls had been so fond of, even to the point he would get people to repeat it before a group session.
This goes:
You are you, and I am I
I am not in the world to live up to your expectations
and you are not in this world to live up to mine.
You are you, and I am I
If by chance we find each other, its beautiful.
If not, it can't be helped.

This is very much a statement of differentiation. It has fallen somewhat into disrepute in the Gestalt world now, as it is seen as too extreme an emphasis on the individual, without enough acknowledgement of interconnectedness. So I was a little reluctant to mention it.
However, what is important is the needs of the client, not the controversy of the Gestalt world. And in this circumstance, it seemed relevant.
So I introduced it to Linda.
As I spoke it, I asked what she felt. She said she felt stronger.
So I invited her to say it, repeating it after me.
She reported feeling more settled.
So I asked her to say it again.
She said that she felt good, but something was stuck in her throat - a hardness.
We explored this - it was related to a cultural introject to 'always be soft' in the way one expresses things.
The Gestalt mode of dealing with such 'shoulds' is the exercise I then gave to her: to make two sentences:
'I want to be soft'
'I don't want to be soft'
This brings in the element of choice.
She said she didn't want to have to always be soft.
So then we went back to the 'prayer', and I invited her to say it in a 'harder' way, imagining she was saying it to her mother.
She was able to do so, and felt stronger.
Linda wanted more.
I felt to stop there.
She wanted me to go through, explain to her what this meant, and how she could apply it.
I declined.
Sometimes such support is relevant.
But in this case, I simply said to her - the core issue is differentiation, and this gives you a sense of the spirit of it. But I am not going to spell it out further for you. I could feel myself otherwise moving into the 'sticky' position, giving her move 'advice' as she found herself doing with her mother.
Linda was not really satisfied, but I drew my limit.
This was important, as my own act of differentiation in the connection.
Differentiation is not something that can be put into a formula; its a shift in a way of being, a movement into a sense of oneself, without needing to be defined by others, yet not moving to isolation, but staying in contact.
Its an essential ingredient in maturing, and in family relationships of all types.
It can't really be 'taught', but only pointed to, and practiced. In this case, my own practice - in a non reactive way - could provide an example for her, and a felt experience, that would help her further in differentiating from her mother.
In that sense, its important not to be 'too' helpful to the client. We are here to assist them, but if we lean forwards too far in being helpful, thats not ultimately in their best interests.

Tuesday, October 13, 2015

Case #158 - All about needs

Dana had got very triggered by something that occurred in the group, had gone into her shame, and then said she felt like vomiting. So I encouraged her, and she vomited a little.
This is a positive step, to let out what has been swallowed. In Gestalt we are interested in what people 'introject', or swallow, in terms of beliefs and values from others. It is necessary to help them 'chew' these over, to be able to digest them, and find whats relevant for them. That leads to authenticity.
I asked her about her mother, and food. This is because when something has been swallowed, that is unhealthy, its also good to trace just how the person is in relation to food; and the source of this relationship is generally how their mother was with them around their needs (oral issues).
Dana said her mother was not in touch with her own needs, and that Dana also found it difficult being in touch with her needs.
She reported that she liked to eat rich food, but could only really stomach light food most of the time.
This indicated something about her need for nourishment, and her capacity to take it in. It provided an important pointer for the therapy process - and I needed to be careful about how much I 'fed her', even though her needs may be significant.
She talked about her orientation to other people's needs, and how her mother was also like this.
In such circumstances, there is an imbalance, and the 'sensitivity' to others needs is 'as if', because if we are not equally tuned into our own needs, we cannot really be there for others. In fact, what we do for others is an overcompensation, and in that sense, not really as generous as it seems.
This was a very big topic, requiring a lot of ongoing therapy.
To make a start, I asked her, 'so what do you need from me, right now?'
I knew this would be a difficult question for her, but I wanted to raise it to see what would come up. Its important to take large topics, and bring them into the 'here and now, I and thou', to make them workable, and to give me a direct experience of the issue we are talking about.
She reported being confused - I expected this.
I was patient though... directed her to her feelings, and waited.
In this type of situation, such a person needs a lot of support to recognise and ask for what they need.
She finally said she wanted my attention. That was good.
She said she wanted my steady attention, but that she would be allowed to come and go unrestricted. That was a very good step, and provided me with much important information, as this represents a fundamental need that children have - for the secure presence of the caregiver... with permission to come close to get reassurance, and then go off exploring, and then come back when they need.
Dana said she wanted to crawl. I asked if she would like me to do that with her. She did. This is because she was at a very young stage, and often young children want an adult there with them, joining and reflecting them, and playing with them.
So we crawled around for a while.
She was very happy. I pointed out that this was a fundamental need - for mirroring - to be recognised in one's feelings, and needs, and to be met in that place.
Then she asked me about my need. I was cautious, as in a way, this represented her pattern. But I wanted to go with it, as an experiment, and find a way to do something different with her around other's needs.
So I told her that I had a need for touch, physical affection.
She said that she didn't have that need so much.
This was excellent - I immediately said, 'yes, my need is different to yours, and thats ok'. This was excellent because it provided a chance to highlight differentiation - the capacity to be oneself, and yet stay connected in relationship.
I suggested that this kind of differentiation was also a fundamental need.
Mirroring requires me as caregiver to put my needs aside to be with the other.
Differentiation involves me recognising differences, and making that ok.
This set the tone for ongoing therapy, and provided a framework for her development in coming to terms with the topic of needs.
Finally, I said, 'I know you would like to keep going Dana, and I am going to stop now'
People in this situation often don't know when they are 'full', and require a clear, firm and non-reactive boundary to be set. This helps flag to them that some needs have been met, and they need to sit and digest, rather than keep going for more. This is also a kind of mirroring - acknowledging their fullness, so they can recognise it themselves.

Sunday, October 4, 2015

Case #157 - Pretending

Miranda's concern was about her tone of voice, which she felt was 'pretend'. She explained how she engaged at a level of social nicety, but that she felt a lack of authenticity in that place.
This got me interested in her field - the context for such a way of being.
She explained that her mother had been very controlling of her, but not her father. Her mother would instruct her exactly how to wash the dishes for instance, in great detail, correcting the slightest deviance from her protocol. Her mother had these kinds of specific expectations of her in every realm.
Now Miranda lived her life with as little structure as possible - at home, things were all over the place for instance. I pointed out that in fact she was not free of her mother, but was still in relationship to her - in reaction.
I pointed out that on the one hand her mother was controlling, and on the other, that could also be seen as support - clear instructions in how to behave. This clearly made it especially difficult for Miranda to go beyond her social persona, as it had been deeply embedded in there by her mothers careful and detailed instructions.
So, to bring this all into the 'here and now, I and thou', I invited Miranda into a Gestalt experiment with me. I suggested that she find some detail to criticise in me, and tell me about it. This is a relatively safe situation, because I am setting it up, inviting it, and reassured her that I have lots of steadiness and ground to hear her.
She told me 'you are too unstructured as a teacher'.
I acknowledged the truth of this - I like to work in a very unstructured way.
Embedded in this statement was a very rich ground for therapy - her reaction against structure, yet her desire for structure also implied by the criticism. But I simply noted that to myself, for another time.
What I did remark on was that as she was telling me, she was smiling, and was speaking in a soft tone of voice.
I acknowledged the embarrassment of confronting authority with a criticism. Its important not to push too hard in an experiment, to stretch too much beyond a client's familiarity. And when they do participate in an experiment to extend, its important to understand that there may be some shame associated with that.
I pointed out that here we were up against her mother's conditioning regarding being polite to one's elders.
So I invited her to 'put her mother on the pillow' and talk with her.
Miranda said 'I won't be controlled by you'. But again, with a  smile, and soft tone.
I picked this up, and remarked on it, especially as she had started the session with concerns about the pretence in her tone of voice. In Gestalt, we take the themes or 'figures' we are working with, and look for how they are manifesting in the present experience.
I offered her support to have a 'bitchier' tone of voice. It was hard for her. She closed her mouth in what I call a 'zip'. I pointed this out to her. She said she actually felt angry when talking to her mother.  So I invited her to show that in her voice.
She was able to do so a little, and say her piece without a smile.
This was a small step - she had not got to the point of raising her voice. But it was important to move at a pace which Miranda could integrate, rather than going for a dramatic movement.
There was much rich ground for therapy here, but such work needs to be done over a period of time. Gestalt privileges integration; otherwise, great insights, or great releases of energy, do not embed in the person's being.
Part of the value of therapy is in the new experiences and learning. Part is in the development of the ground of relationship, which comes through the client 'being known' by the therapist. So in cases such as this, I get to know and understand the client in important ways. This knowing then builds essential ground for subsequent sessions. Gestalt is very focused on providing a therapy that is not 'off the shelf', but one which is individualised and very much tailored to who the client is.

© Lifeworks 2012


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