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Case Study - Page 3

“OK,” I said, “Let your attention go inside so you can notice whatever happens when I say these words. (Pause.) ‘Jane, your needs are important.’” I said this not to elicit agreement, but quite the opposite: I was looking for the parts that disagreed. Again, this was guided by the knowledge that people like Jane, who have a set of implicit rules of relationship, tend to protectively deny their needs. I wanted to bring this reaction into conscious awareness.

She opened her eyes for a moment, “Yeah, sure!” she mumbled sarcastically, more to herself than to me. Now, emerging in consciousness, we had the part of her that dictated toughness.

“Great!” I said. “Let’s invite that part to be here. It sounds like a street fighter.”

“Yeah,” she replied, “Needs are the same as disappointment.”

I asked Jane to turn her attention inside and let her own words echo—“Needs are the same as disappointment”—and notice what experience emerged. In this kind of mindful exploration, the therapist can track external signs of internal experience in the fine changes in the client’s face, emotional temperature, breathing, and voice quality. As both participants carefully attend to present experience in this manner, something deeper than rational conjecture can occur.

In this case, Jane said, “I feel really hot!” She looked down and noticed that her shoulders and the top of her chest were turning red. As with many clients who are beginning to explore unfamiliar territory, it was easier for her to recognize the physical sensation than the underlying emotion. I encouraged her to stay with the heat and the redness, and asked her to notice the mood that went with it. She said with surprised consternation, but also curiosity, “Oh, I’m ashamed . . . of my needs!”

There are, of course, contraindications to this procedure. Immersing a client in a trauma memory, for instance, risks his or her hyper- or hypoarousal—becoming flooded, immobilized, or even retraumatized. It’s important for the therapist to track the client carefully, remaining alert to signs of dissociation and disconnection, and to titrate the immersion in immediate experience to avoid overwhelming the client. Exploring experiences slowly, and noticing sensations and motor activity in particular, can yield more information and change in the long term than dramatic, “multiple-tissue-in-the garbage-can” sessions that release explosive feelings. Before, and alternating with, immersion in traumatic or negative memories, clients should be focused on the felt experience of their own resources—the places, people, things, and experiences that bring comfort, along with a sense of self-confidence and expansiveness.

Every experience we have, conscious or unconscious, is a mix of other, underlying experiences, many of which are unconscious, stored in the neural networks of implicit memory. Consciousness of one part of the neural network tends to evoke related parts. Jane’s sense of invulnerability was comprised of many associated cognitive, emotional, and somatic experiences, including tension in her muscles, a rigid posture, a belief that to show softness exposed her to danger, and a memory of being shamed for her vulnerability.

“Let’s make lots of room for shame,” I said. “We can hold it gently. Just let a little bit of it be here. Go ahead and stay with it, and let’s see where it takes you.”

I was intending to follow her lead, but the suggestion took us to what appeared to be a dead end. The feelings stopped and she sat up straight, wiping her eyes. As Jane started to explore the feeling of shame, something inside her obviously shut down. On a somatic level, her posture shifted—she sat up straight, no longer resting against the back of the couch.

Drawing on her immediate present experience for clues about where to go next, I said, “You’re sitting really straight, and it seems like your feelings just went away. Let yourself be with that uprightness. Feel all the muscles involved, and notice what they remember.” Eliciting a memory, in effect, from the feeling in her muscles, she remembered when her father taught her about the limits of trust: he told the 7-year-old Jane to jump from a kitchen counter into his arms, and then purposefully let her fall, without trying to catch her. “Never trust anyone,” he instructed her. She learned this lesson well.

To ensure that no one ever had the same kind of power over her again, she’d adopted a strategy, a relational model, requiring her to rely only on herself. Though superficially functional—she could protect herself from being hurt—this strategy sentenced her to the feeling of lonely disconnection that had brought her to therapy. In fact, this kind of strategy tends to recruit others to act in predictable ways that reinforce the underlying beliefs—Jane habitually dissuaded anybody from doing anything for her, which reinforced her distrust of others.

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