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Case Study - Page 4

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Self-State Awareness

Suzanne could now track her activation after a first date and resource herself so she didn’t alienate her potential partner. But how would we address the underlying vulnerability that triggered her intense anxiety in the first place?

The search for a way to change core developmental patterns could be described as the holy grail of psychotherapy. In The Mindful Brain, Daniel Siegel suggests that mindfulness has the capacity to build bridges between the limbic centers of the brain, which store emotional patterns from childhood, and the observing and contextualizing capacities of the prefrontal cortex. Here, Siegel is pointing us in the direction of the grail: the possibility of witnessing old emotional patterns without being compelled by them. But how do we actually apply mindfulness to achieve this integration?

Several weeks later, now a year into our therapy, Suzanne staggered into my office in tears. She dropped onto my couch in despair. “I’m in the middle of it now. This is how I get. I’m just waiting to hear from Harvey, the guy I told you about last time. I can barely keep myself from calling him.” She identified a pounding in her chest and a “terrible, warm, dead feeling” in her legs.

I asked, “Do you remember when I suggested to you, a few sessions ago, that we could drop even deeper into this experience, find out what it’s really about for you, and perhaps unwind the knot that keeps you bound in this pattern?” I’d planted the seed for this deeper level of work, knowing that only Suzanne could decide when she was ready. All the resourcing we had done so far had prepared her for this next step.

“Yeah,” she said sullenly, “I’m ready to try that.”

“OK, Suzanne, I’m going to invite you to tune in to your body, close your eyes if that helps, and become aware of the simple sensations of sitting on the couch, your feet on the floor, the air touching your skin. I know you’re feeling a lot of distress, the pounding in your chest, that ‘dead’ feeling in your legs. See if you can also be aware of something slightly pleasant, or even just neutral.”

“I guess my hands feel OK,” she said. “They’re just touching each other, kind of soft.”

“Great, let yourself just be with that OK feeling in your hands.” I saw the tension in her face start to ease.

To go deeper into the caverns of the psyche, we need anchors. The fact that she could locate this more tranquil feeling and respond somatically to it signaled to me that we could go forward.

“So now, let yourself feel the pounding in your chest, and the warm, dead feeling in your legs, knowing you can come back to your hands anytime you want to.”

“It’s like a throbbing in my chest,” she responded. “A deep, red color goes with it. It feels like a bottomless pit. It’s all I can do just to feel it, without freaking out.”

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