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|Case Study - Page 3|
I organize my groups around the use of the body as a mechanism for knowing how we feel. I start each group by asking members to check in with their bodies to locate where they might be feeling tension, upset, numbness, or excitement. Each group member then reports what he's feeling. My thinking is based on the neurobiological finding that experiencing and processing emotion in empathic relationships actually builds and strengthens the neural connections necessary for emotional connection with others. Typically, sex addicts never got this "training," because they had caregivers who couldn't attune to infants' needs or provide the secure attachment required for their emotional, intellectual, and behavioral growth. Their families ignored, shamed, or punished feelings, and the fear this engendered paralyzed these childrens' capacities for self-reflection and relationships.
In our therapy together, Jim's verbal pace was slow, and I had to be patient with the spaces between his spoken thoughts. I attuned to his rhythms by slowing my conversations down and paying attention to my tone of voice and how close I sat to him. I also observed physical signs of Jim's anxiety and gently pointed them out as defenses against emotion. "Jim, have you noticed that when you begin to talk about something that has meaning to you, you look at the ground and your left leg starts to shake?" He hadn't noticed his bodily expressions until I pointed them out, which initially provoked a shame reaction, as if he had been "caught" doing something wrong.
Body sensations (dry mouth and throat, constricted chest or gut, constipation or diarrhea) or perceptual disturbances (ringing in the ears or tunnel vision) may also signal defenses that turn suppressed emotions into physical dysfunctions. At first, when I queried Jim about these manifestations of anxiety in group, he said he felt "numb" and worried that he was somehow "defective." I reassured him that, for now, he needed just to notice his "numbness" without judging or trying to change it. The simple act of noticing became a mindfulness practice in and of itself, and eventually a new habit for him. In time, without my prompting, Jim could feel and describe "tightness" in his throat "choking" his words. As he learned to identify his physical tension in the novel safety of the group, his emotions gradually began to bubble up.
Lending a Capacity to Relate
Throughout the first year of our relationship, Jim tended to respond to my interventions—however tactful and diplomatic I tried to be—with anger and hurt, saying things like, "Why are you picking on me?" or "You say you care about me, but you have to because I pay you." This would be followed by weeks of smoldering resentment mixed with panic because he just knew I'd never want to see him again. I often had to contain my own impatience as I reflected his feelings back to him: "I know you're scared right now and that it's hard for you to believe that I care for you," I'd say. "I think your mother's abuse of you probably has a lot to do with your reaction to me right now."
Because Jim had missed normal affective maturation, I had to "lend" him my own feelings at first, saying what I felt when he was unable to: "My chest feels tight as you're telling this story. It makes me really sad." Only then would he respond to my somatic countertransference with appropriate affect, such as tears. Over time, I could see that my eye contact, tone of voice, and body language (including how far away I sat) were creating resonant changes in his brain and body, and also modeling how someone senses and reflects emotions to create human connection.
Like all sex addicts in recovery, Jim had to come to terms with the lost years of his life. As he talked about the grief and loss of his teen years—having to fend for himself emotionally, take care of his younger brother, and figure out ways to get himself through school—his eyes welled up with tears. He looked up and saw the group sitting on the edge of their seats, many—including me—with tears in their eyes as we listened. This was the first time he felt that I really cared about him because he felt me feeling with him. As I noticed new, fleeting shifts in his facial expressions, I asked what he was experiencing, where in his body he felt it, if the feeling had a shape, color, or temperature, or if that body part wanted to move. Whenever he talked about ideas or said something like "I think I'm angry," I directed him back to his body sensations.
Eventually, he was able to talk out feelings without too much defensiveness and could even begin to acknowledge the role he played in creating unpleasant interpersonal scenarios, both with others and me. Unfortunately, for many months, these moments of "insight" didn't keep him from repeating the same old patterns.