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Case Study - Page 8

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CASE COMMENTARY

By Wendy Behary

The appreciation for the mind-body relationship is thoughtfully articulated by Shai Lavie in this case study. He offers a clear strategy that’s accessible and easy to assemble within the framework of our theoretical allegiances. The emphasis on establishing safety and trust in the therapy relationship is an especially important element when working with early-attachment ruptures and trauma processing. Lavie discusses the value of an attuned “voice,” one that expresses empathy and a compassionate presence, allowing the client to go deeper into her personal story to discover early unmet needs at a felt level of experience.

Empirical support for attuned, contingent communication and a felt sense of connection to and with our clients is beautifully described in Daniel Siegel’s books The Developing Mind and Parenting from the Inside Out. Jeffrey Young, the founder of Schema Therapy, also strongly proposes that therapists become a “reparenting” model for the vulnerable side of the client, within the limitations of the therapy relationship, helping the healthy adult side to grow and nurture the “child.” Further, research has shown how patients with borderline personality disorder learn to heal extreme childhood wounds and develop healthy coping modes when the therapist takes the role of a needs-meeting, reparenting figure for the vulnerable or abandoned child side of the client, utilizing emotion-focused strategies, such as imagery and bodily awareness, to reach deep into core experiences.

Lavie’s case deftly chronicles the treatment journey from an identification of self-defeating beliefs linked to bodily sensations, to self-soothing strategies for regulating distress during triggering episodes, and the discovery of early-childhood emotions that become reactivated in conditions of perceived abandonment and deprivation. Despite harrowing times of despair when dating, Suzanne had a “devoted group of friends” and seemed to have some resourcefulness and the ability to be a quick study. However, this isn’t always the case for clients with abandonment and deprivation issues.

Many with borderline personality disorder are more severely impaired, avoidant, and isolated. They feel resentful when coached to soothe themselves, as they’ve experienced a lifetime of having no one but themselves to rely on. They desperately attempt to cope with pain and loneliness, only to perpetuate the same destructive outcomes. They long for someone else to lend a shoulder, or as one of my clients used to say, “Someone to help pull the wagon ... just once in a while.”

I’m not sure that these clients, after five months of “talk therapy,” are prepared to sustain emotional self-reliance in meeting their unmet needs. Even Suzanne, who appears a little sturdier, demonstrated a “worn thin” enthusiasm after a short while, according to Lavie. The effective strategy for resourcing her inner world was his use of imagery, which enabled her to construct a safe anchor to her grandmother, and the “dropping even deeper” into somatic awareness-imagery, which linked her “loss” experience (her nannies’ leaving her) to feelings that were replicated when waiting for a call back from a new date. The recognition and reinforcement of her “calm hands” in meeting her need for holding, affection, and security was nicely integrated into the imagery as well.

Lavie’s work elegantly demonstrates the most basic and powerful element in his success with Suzanne: filling the voids with steadily attuned presence and encouraging support, mentoring, and guidance—“getting” her and helping her to “get” little Suzanne. Careful and timely execution of the strategies Lavie proposes is obviously an important factor to consider during the assessment phase of therapy. Bringing attention to bodily sensations can assist clients (especially those in detached and overwhelmed states) in unlocking the door to their emotional world and achieving discernment, tolerance, and resilience as they confront the phantoms that still visit them.

Shai Lavie, M.A., works with adults, adolescents, and families in private practice in San Rafael. A Certified Hakomi Teacher on the faculty of the Hakomi Institute of California, he leads transformational groups with adults and teens that integrate Hakomi, Somatic Experiencing, group process, ritual, and Jungian dreamwork. Contact: shailavie@hotmail.com.

Wendy Behary, L.C.S.W., the founder and director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy, has been treating clients and training professionals for more than 20 years. She’s the author of Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed. Contact: wetb@aol.com

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