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Case Study - Page 4

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As her feelings began to ebb, I commented, “You learned not to rely on anything or anyone, huh? Not even the back of the couch. How about we start by supporting your back, so it doesn’t have to hold you up all on its own?”

I was speaking somatically and metaphorically here. Could she risk taking in support after so many betrayals to her trust? This experience was designed to challenge the neural pathways that had led her to self-reliance, and to help her develop a new set of neuronal firings that would permit greater nourishment and support. Jane began to experiment with just leaning back and trusting the couch. While she explored the simple, metaphorical act of “leaning,” I encouraged her to slowly and mindfully notice her subtle internal reactions. As she did so, I could see her gradually relax her body, as she realized she could lean a little on the couch without losing herself.

“It’s important for you to be strong,” I said, “but it separates you from others. Now, it feels as if a softer part is calling to you, but you’re not sure it’s a good idea to follow it.”

She agreed. “I get trapped in my own hardness.” We’d taken the first few steps in the direction of her relearning the ability to engage in healthy, interdependent relationships.

Transformation and Integration

Several weeks later, I noticed that as Jane talked to me, she looked at me slightly out of the corners of her eyes. I was still looking for signs of the old patterns—compulsive self-reliance and the dismissal of human warmth—so I said, “Sometimes you look right at me, and sometimes you look from the side of your eyes. How about we explore the difference between the two looks?”

She agreed, and I asked her to turn her attention inward, noticing the thoughts, feelings, sensations, memories, and images that arose as she tried each way of looking. She reported that when she looked directly at me, she felt vulnerable, and when she looked at me somewhat sideways, she felt more protected, though lonely. I told her that she was entitled to look at me any way she wanted, and that she could decide which she wanted to do now; she could exercise her choice. She decided to look directly at me, and as she did, she smiled and then started to chuckle. She said, “I feel a bit scared, but this is really what I want.”

The next goal was to help her stabilize this resourceful experience. I asked her to take her time, to make room for this mirth bubbling up and the sense of connection, to notice how it lived in her body, and the words and impulses that came with it. Having clients immerse themselves in new experiences builds new neural pathways. Immersion in expansive experiences is at least as important as immersion in the experience of wounds and limitations.

During ensuing sessions, we returned many times to this constellation of issues. Each new pass helped Jane clarify the beliefs structuring her reality and the risks she could take to create new experiences and generate new models of the world. She practiced allowing herself to depend more on me without losing her self-reliance. She looked at me directly without losing her choice to withdraw when she wanted. Then she became increasingly able to transfer the vulnerability she showed in sessions to her relationship with her husband. She gained the ability to ask him for more time and closeness in a way that engaged him because of its genuineness and lack of the hostility that previously had accompanied her requests. He started to find her more interesting than the car engines that had been so absorbing.

At this point, she suggested it might be helpful to invite her husband to a session to help consolidate her gains in therapy. This is the integration stage, in which it’s important to help clients weave their newfound options and ways of behaving into the fabric of their daily social and professional lives. Frequently partners prefer homeostasis to changes in their relationship, and can undercut therapy. When Charles arrived, his eyes looked big and hypervigilant. Unsure of what to expect, he seemed more scared than oppositional to his wife’s new way of being. After I checked in with him conversationally about how he’d been experiencing the changes in Jane, she brought up the feeling that “she couldn’t lean on him.” Unsure whether she was referring to her inability to lean or his inability to support her, I suggested we try this out in mindfulness—to have her actually practice leaning physically on him—to see what the effect might be on each of them. It turned out that it was hard for her to do this, as it involved facing the demons of disappointment in all the people who’d failed her in the past. When she finally succeeded and let her head come to rest on Charles’s shoulder, he breathed a sigh of relief.

“Feels good, huh?” I said.

“Yeah, I finally feel useful to her, and less like she’s looking for trouble,” he said. I asked him to tell this to her directly, which challenged his tendency to withdraw. But, inspired by her smile, he was able to tell her about his discomfort. As it was beyond the work of an adjunctive session, I suggested that it might be helpful for him to continue with this theme in individual therapy with someone else. As Jane became better able to hold a new model of support in her life and integrate it into her relationships, it was time to start thinking about bringing therapy to a close.

She’d arrived in therapy determined to feel less isolated. We saw how her implicit belief in the unreliability of support, and her tendency to look tough and pretend that she had no needs, pushed others away. This observation guided the interventions over the next few months. Rather than being remote and barely accessible, Jane’s unconscious spoke of its implicit models of the world in many ways: in gestures, posture, her style of relating to me in the moment. Over time, we continued to explore the changes that eventually carried into her personal life.

At the heart of the process was Jane’s growing ability to experience an attunement in the therapeutic relationship that slowly allowed her to feel safe and held, something that hadn’t happened for her as a child. By learning to mindfully explore her organizing beliefs as they revealed themselves in the present, she accessed memories and resources that touched her deeply and allowed her to experiment with new ways of being, inside and outside of therapy.

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