|Challenging Cases Gender Issues Future of Psychotherapy William Doherty Ethics Narcissistic Clients Couples Mindfulness Wendy Behary Trauma Symposium 2012 Mind/Body Attachment Theory Linda Bacon Anxiety The Future of Psychotherapy Clinical Excellence Community of Excellence Alan Sroufe Men in Therapy Etienne Wenger Brain Science David Schnarch CE Comments Couples Therapy Great Attachment Debate Mary Jo Barrett Clinical Mastery Diets Attachment|
|The Rise and Fall of PaxMedica - Page 8|
After saying this, she dissolved in tears and curled up in her chair, withdrawing from the world. I looked at my watch and thought about the friend I was planning to have lunch with. These attempts at self-distraction made me aware of my own agitation. To recover a sense of inner calm, I deliberately slowed down the process, asking Ilyana how she'd felt after this encounter with her boyfriend.
"How I felt when I was alone? It's . . . a longing . . . really deep longing . . . . I'm afraid. I remember feeling this even as a child, when my parents would fight and I'd worry that they were going to break up." I asked her if there was ever a time in her life when she didn't have this feeling, or it wasn't so intense. She said, "Yeah, when Ivan [her husband] was alive, things were fine then. But with what my son did and all that's happened to me—Ivan's death, losing the grandchildren and Dolores [her daughter-in-law]—it's the worst possible life for a person like me, who gets these awful feelings being by myself. I don't want this life any more. I don't want to be alive."
My mind and heart jumped with these last words, and I thought about a suicide attempt she'd made after the death of her husband. Could I help her come out of this tailspin or did she need to be hospitalized immediately? At this point in the hour, I recognized with some alarm, Ilyana was regulating my brain more than the other way around.
Regrouping, I thought about the second critical issue, after the brain, when working with dysregulated clients like Ilyana: attachment. In fact, her boyfriend was on the mark. Her insecurity and high levels of depression and anxiety had precipitated one of those self-fulfilling prophecies that beset the anxious and depressed: a narrowing of the one good relationship she had in her life. If I wanted to override my own anxiety and stay emotionally attuned to her, I needed to find a way to more fully engage with her in the moment. Rather than just thinking about the severity of Ilyana's problem. I needed instead to speak to her feelings without "catching" her pessimism and hopelessness. After all, the therapeutic relationship is based on the brain's capacity to understand, and to regulate, the emotional states of others. Our ability to acknowledge and mirror these states in others (through the signs of autonomic arousal that underlies another's unhappiness, stress, and anger) is sometimes all that makes human life bearable.
I told Ilyana that her feelings about being alone and her fear of ending up suffering alone were understandable. How could she not feel that way, given what had happened to her? "When you say that you don't want to live anymore, is it that you want your life to be over or is it that you want this feeling to end?" She shook her head and looked lost.
I said "Let me tell you what I was thinking earlier when you asked me how you could stop feeling so overwhelmed. All of us have these intense and painful feelings because our capacity to feel despair when terrible things happen is wired into the architecture of the brain. When you're feeling very sad or trapped and pessimistic, then you withdraw and the right side of your brain right behind your forehead becomes much more active. The right side produces feelings that are so huge you feel trapped inside them—they blot out everything else."
Just telling Ilyana what I understood about her suffering helped me feel more present, and, as I spoke, she seemed steadier and more focused; she looked at me directly, expectantly.
"Feelings work like a normal curve," I said. "They might begin with something small, like a sensation of discomfort or unease, and then get bigger until we become consciously aware of them as full-fledged emotion. What your boyfriend said to you was relatively small—part of a spat, really. If you hadn't been so overwhelmed at the time by other things, the remark might have annoyed you, but not ruined the trip. That's the way it's supposed to work—a feeling starts off small, builds up to some level of intensity, and then begins to subside. But with these huge feelings, your left side of the brain attacks the feelings like a white blood cell attacks a bacteria: it latches on to it and tries to control it. At such moments, it attacks your despair with thoughts like 'I've never been able to be alone!' 'What's the matter with me?' 'Why do I do this to myself?' 'The older I get the more I'm going to be alone.' 'I don't think I can stand it if I die like this!'"